Dimensional Structure and Cultural Invariance of DSM V Post-traumatic Stress Disorder Among Iraqi and Syrian Displaced People

Ibrahim H, Catani C, Ismail AA, Neuner F. Dimensional Structure and Cultural Invariance of DSM V Post-traumatic Stress Disorder Among Iraqi and Syrian Displaced People. Frontiers in Psychology. 2019;10: 1505.While the factor structure of post-traumatic stress disorder (PTSD) symptoms has been investigated among various traumatized populations in Western and high-income countries, knowledge regarding the validity of factor structure of PTSD among culturally diverse populations in low-and-middle-income countries is limited. The current study examined the factor structure and cultural invariance of PTSD in 521 Iraqi and 993 Syrian war-affected displaced people who were living in the Kurdistan Region of Iraq. Results from confirmatory factor analyses demonstrated that alternative factor models for PTSD, including a new model derived from this population (anhedonia and affect model) resulted in a better fit than the current DSM V models. Taken together, the results showed that a good fit, as well as the measurement invariance of PTSD factors, could be obtained by applying the anhedonia and hybrid model. This study provides further support for the anhedonia and hybrid model of PTSD and fills an important gap in knowledge about the validity of PTSD symptom clusters among Arab and Kurdish populations

The validity of Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) as screening instrument with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq

Ibrahim H, Ertl V, Catani C, Ismail AA, Neuner F. The validity of Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) as screening instrument with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq. BMC Psychiatry. 2018;18(1): 259.Background The Posttraumatic Stress Disorder Checklist (PCL) is a valid and reliable self-report measure for the assessment of Posttraumatic Stress Disorder (PTSD). Recently the PCL was updated according to the DSM-5 criteria for PTSD. So far only a few studies have examined the psychometric properties of the PCL-5, and all of these are restricted to populations living in industrialized countries. The aim of this study was to determine the psychometric properties and diagnostic utility of the PCL-5 as a screening instrument for war-affected displaced Kurdish and Arab populations. The specific goal was to determine a contextually valid cut-off score for a probable diagnosis of PTSD. Methods The PCL-5 was translated into Arabic and two Kurdish dialects. Trained interviewers administered these translations as assisted self-reports to 206 adults living in camps for displaced people in Iraq, together with depression and war-exposure instruments. Two weeks later, 98 randomly chosen subjects were reassessed by expert clinical psychologists. In the absence of a gold-standard instrument with proven validity in this context, the expert interviewers applied the PCL-5 items in the form of a clinical interview and used a DSM-5-algorithm to determine a diagnosis of PTSD. Receiver operator characteristics (ROC) were performed to determine a valid cutoff-score. Results The internal consistency of the PCL-5 was high (alpha = .85) and the instrument showed an adequate convergent validity. Using the cut-off score of 23, the PCL-5 achieved the optimal balance of sensitivity and specificity (area under the curve = .82, p < .001; sensitivity = .82, specificity = .70). Conclusions Given that the comparison of the two assessments included both a re-test interval and validation by different interviewers, our results indicate that the PCL-5 can be recommended as an assessment and screening instrument for Kurdish and Arab populations

Post-traumatic stress disorder and depression among Syrian refugees residing in the Kurdistan region of Iraq

Mahmood HN, Ibrahim H, Gößmann K, Ismail AA, Neuner F. Post-traumatic stress disorder and depression among Syrian refugees residing in the Kurdistan region of Iraq. Conflict and Health. 2019;13(1): 51.Background Since the Syrian civil war began in March 2011, more than half of the Syrian population was forced to escape from their homes, and more than 5 million of them fled their country. The aim of the present study is to estimate the psychological consequences of this conflict among the refugee population who fled to Iraq. Method In 2017, a team of locally trained psychologists and social workers interviewed 494 married couples (988 individuals) who were Syrian Kurdish refugees in the Kurdistan Region of Iraq. Validated Kurdish Kurmanji and Arabic versions of post-traumatic stress disorder (PTSD) Checklist for DSM-5 and depression section of Hopkins Symptom Checklist-25 were used for assessing PTSD and depression symptoms. Results Almost all of the participants (98.5%) had experienced at least one traumatic event and 86.3% of them experienced three or more traumatic event types. The prevalence of probable PTSD was about 60%. Gender, length of time in the camp, area in which participants were grown up, and the number of traumatic event types were significant predictors for the presence of PTSD symptoms. Approximately the same rate of participants (59.4%) experienced probable depression, which was associated with gender, age, time spent in the camp, and the number of traumatic event types. Conclusion PTSD and depression are prevalent among refugees exposed to traumatic events, and various variables play important roles. The pattern of risk factors in this population is consistent with findings from war-affected populations in other regions and should be considered for intervention within this population and more broadly

Impact of Marble Powder on the Geotechnical Behavior of Expansive Soil

In geotechnical engineering, the process of changing the characteristics of weak or undesirable soils using waste materials has gained importance. Waste materials frequently involve waste and by-product minerals, such as marble powder, which were unethically obtained in Iraq and had harmful environmental repercussions. The aim of this study is to determine how marble powder affects the geotechnical features, including consistency limits, density, shear strength parameters and swelling characteristics of clayey soils in Erbil city. Different percentages of marble powder (6%, 12%, 18%, 24%, 30%, and 36%) were used to treat the expansive soil. The outcomes indicated that marble powder could enhance the geotechnical properties. It is advised to add 18% percentage of marble powder to improve the soil as an optimized amount

Analyzing different types of advertising and its influence on customer choice

Marketers spend money on a variety of media platforms in order to influence consumer purchasing choice. Every advertisement on every media platform has a unique composition that engages the customers in a different way depending on the platform. The purpose of this research is to determine five types of advertisement and its influence on consumer purchasing choice at selected retailer stores in Erbil. It is a quantitative approach that is used to analyze data that has been obtained by the researcher. The Manager has circulated the survey to consumers of retailer stores and has gathered responses from those customers. When conducting the current study, the researcher employed a questionnaire in order to gather information. In the first segment, demographic questions were asked, beginning with the customer\u27s gender and marital status and progressing to other inquiries. The second section had questions about the company\u27s products and services. The second part of questionnaire was regarding five types of advertisement as independent factors and consumer purchasing choice at selected retailer stores in Erbil. When it comes to the sampling process, it will be a random sampling method, which means that almost all consumers at retailer stores in Erbil will have equal odds of being picked for the findings revealed that all five advertisements will have positive and significant influence on consumer purchasing choice at selected retailer stores, however, it was found that online advertising is the most effective and efficient among all five advertisements to bring consumer attentions while making decision in selecting certain brand or a product at their daily, weekly and monthly shopping at retailer stores in Erbil. The study recommended that management of firms in retail stores should consider it a requirement to adequately market their products, since doing so will provide them a competitive advantage over their competitor

Network structure of DSM-5 PTSD symptoms: Results from cross-national survey among Iraqi and Syrian displaced people.

Ibrahim H, Neuner F. Network structure of DSM-5 PTSD symptoms: Results from cross-national survey among Iraqi and Syrian displaced people. Asian journal of psychiatry. Accepted;54: 102307

The Impact of Interpersonal and Organized Violence on Psychopathology of Yazidi Women

Gößmann K, Ibrahim H, Neuner F. The Impact of Interpersonal and Organized Violence on Psychopathology of Yazidi Women. In: EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY. Vol 10. Abingdon: Taylor &amp; Francis Ltd; 2019

Sharing for relief: associations of trauma-focused interviews and well-being among war-affected displaced populations in the Middle East

Ibrahim H, Gößmann K, Neuner F. Sharing for relief: associations of trauma-focused interviews and well-being among war-affected displaced populations in the Middle East. Ethics and Behavior . 2022.Nonmaleficence is a key ethical value of research among vulnerable populations. Trauma-focused research typically includes detailed interviews about traumatic life events and post-traumatic symptoms. This raises concerns about causing distress and harm for the affected individuals. We aimed to determine the immediate effects of trauma-focused interviews on participants' wellbeing. We developed the brief Distress and Harm Scale (DH7) for the assessment of current symptoms of distress and urge to harm oneself or others. Using data from 332 Iraqi and Syrian children and both of their parents (N = 996), we assessed these symptoms before and after participating in trauma-focused interviews. Results showed that the mean levels of self-reported distress and harm impulses were significantly decreased among adults and children rather than increased immediately after the interviews. Once measures to safeguard cases at risk are carefully implemented in research, the potential benefits of participating in trauma-focused interviews outweigh the risk for individuals. Potential implications of the results for ethical review boards evaluating trauma-focused studies are discussed

Association of War-Related and Gender-Based Violence With Mental Health States of Yazidi Women.

Gößmann K, Ibrahim H, Neuner F. Association of War-Related and Gender-Based Violence With Mental Health States of Yazidi Women. JAMA network open. 2020;3(9): e2013418.Importance: Yazidi women in northern Iraq have experienced severe human rights violations through attacks by the so-called Islamic State group, with severe consequences for their health. However, no studies to date have investigated how war-related and gender-based violence, including partner violence, are associated with mental health disorders in this population.; Objective: To evaluate the associations between Yazidi women's experiences of violence (ie, war violence, partner violence, enslavement) and their mental health.; Design, Setting, and Participants: This cross-sectional study of 326 women was conducted in camps for displaced persons in the Kurdistan region of Iraq between January and July 2017. Participants were married women from the Yazidi population in northern Iraq who were affected by Islamic State attacks. Participants were selected via household-randomized sampling. Data analysis was conducted from December 2018 to September 2019.; Exposures: Experiences of enslavement, war-related events, and intimate partner violence were measured with event checklists.; Main Outcomes and Measures: Posttraumatic stress disorder (PTSD) and depression levels were measured using culturally validated instruments.; Results: A total of 326 women (mean [SD] age, 34.3 [12.9] years) participated in the study. Almost all participants reported the experience of at least 1 war-related violent event (325 [99.7%]), 54 (16.6%) reported a history of abduction and sexual slavery, and 215 (66.0%) reported the experience of at least 1 type of intimate partner violence in the past year. There were no significant differences between women who did and did not experience abduction regarding exposure to intimate partner violence. Rates of PTSD and depression symptoms were high among the whole sample, and women who experienced abduction reported significantly higher levels of psychopathology than those who did not (mean [SD] PTSD score: 61.48 [12.38] vs 47.61 [14.42]; t324=-6.91; P<.001; mean [SD] depression score: 3.07 [0.68] vs 2.43 [0.68]; t324=-6.78; P<.001). Multivariate hierarchical regressions revealed that psychopathology was associated with exposure to war-related events (PTSD: beta=0.29; P<.001; depression: beta=0.27; P<.001) as well as with exposure to gender-based violence in Islamic State captivity (PTSD: beta=0.19; P=.001; depression: beta=0.28, P<.001) and in their marriage (PTSD: beta=0.13; P=.008; depression: beta=0.18; P<.001).; Conclusions and Relevance: In this study, interviewed Yazidi women often experienced intimate partner violence as well as war-related and gender-based violence under Islamic State attacks and enslavement, experiences that were associated with mental health impairment. The findings underline the importance of also addressing gender-based violence within health care approaches for war-affected populations

The posttraumatic stress interview for children (KID-PIN): development and validation of a semi-structured interview of PTSD symptoms among displaced children in the Middle East

Ibrahim H, Catani C, Neuner F. The posttraumatic stress interview for children (KID-PIN): development and validation of a semi-structured interview of PTSD symptoms among displaced children in the Middle East. PeerJ . 2021;9: e12403.Background: In populations affected by mass disaster such as armed conflict and displacement, children are at risk of developing mental ill-health, in particular post-traumatic stress disorder (PTSD). Valid and reliable screening instruments are needed to assess the severity of PTSD symptoms among children and to identify individuals in need of treatment. Method: In the context of an ongoing war in the Middle East, we developed the KID-PIN as a semi-structured interview for PTSD symptoms that can be administered by trained paraprofessionals. To achieve a culturally and contextually appropriate instrument, the development was based on open-ended interviews with affected children and involved both local and international experts. Using the KID-PIN and instruments for constructs associated with PTSD, 332 Iraqi and Syrian displaced children were interviewed. A subset of the sample (n = 86) participated in validation interviews based on experts applying the Clinician-Administered PTSD Scale for DSM-5-Child/Adolescent Version (CAPS-CA-5). Results: The KID-PIN demonstrated excellent internal consistency (Cronbach's alpha = 0.94) with good convergent validity. Confirmatory factor analyses of the KID-PIN showed an acceptable fit with the DSM-5 and other common models; the best fit was reached with the Hybrid model. Receiver operating characteristic analyses indicated that the cut-off score of 28 or higher on the KID-PIN is the optimum cut-off for a probable PTSD diagnosis. Conclusion: The utility of the newly developed KID-PIN as a screening instrument for PTSD in children is supported by the measure's high internal consistency and good convergent and structural validity, as well as its diagnostic accuracy