Eff ects of recurrent violence on post-traumatic stress disorder and severe distress in confl ict-aff ected Timor-Leste:a 6-year longitudinal study

Background Little is known about the eff ect of recurrent episodes of communal violence on mental health in countries recovering from mass confl ict. We report results of a 6-year longitudinal study in post-confl ict Timor-Leste assessing changes in mental health after a period of communal violence. Methods We assessed 1022 adults (600 from a rural village, 422 from an urban district) exposed to mass confl ict during the Indonesian occupation after independence in 2004, and again in 2010–11, following a period of internal confl ict. We took a census of all adults living at the two sites. The survey included measures of post-traumatic stress disorder, severe distress, traumatic events, poverty, ongoing confl ict, and injustice. Findings 1247 (80%) of 1554 invited adults participated in the baseline survey. 1038 (89% of those eligible) were followed up. The analysis included 1022 people who had suffi cient data at baseline and follow-up. The prevalence of post-traumatic stress disorder increased from 23 of 1022 (2∙3%) in 2004, to 171 of 1022 (16∙7%) in 2010. The prevalence of severe distress also increased, from 57 of 1022 (5∙6%) in 2004, to 162 of 1022 (15∙9%) in 2010. Both these outcomes were associated with disability at follow-up. Having post-traumatic stress at follow-up was associated with being a woman (odds ratio [OR] 1·63, 95% CI 1∙14–2∙32), experience of human rights trauma (OR 1∙25, 95% CI 1∙07–1∙47), or exposure to murder (OR 1∙71, 95% CI 1∙38–2∙10) during the Indonesian occupation (1975–99), human rights trauma during the period of internal violence in 2006–07 (OR 1∙46, 95% CI 1∙04–2∙03), and ongoing family or community confl ict (OR 1∙80, 95% CI 1∙15–2∙80) or preoccupations with injustice for two or three historical periods (OR 4∙06, 2∙63–6∙28). Severe distress at follow-up was associated with health stress (OR 1∙47, 1∙14–1∙90), exposure to murder (OR 1∙57, 1∙27–1∙95), and natural disaster (OR 1∙65, 1∙03–2∙64) during the Indonesian occupation, confl ict-related trauma during the internal violence (OR 1∙33, 1∙02–1∙74), and ongoing poverty (OR 1∙53, 1∙36–1∙72) or preoccupations with injustice for two or three historical periods (OR 2∙09, 1∙25–3∙50). Interpretation Recurrent violence resulted in a major increase in post-traumatic stress disorder and severe distress in a community previously exposed to mass confl ict. Poverty, ongoing community tensions, and persisting feelings of injustice contributed to mental disorders. The fi ndings underscore the importance of preventing recurrent violence, alleviating poverty, and addressing injustices in countries emerging from confl ict

Heart rate variability and the relationship between trauma exposure age, and psychopathology in a post-conflict setting

BACKGROUND: Cumulative exposure to potentially traumatic events (PTEs) increases risk for mental distress in conflict-affected settings, but the psychophysiological mechanisms that mediate this dose-response relationship are unknown. We investigated diminished heart rate variability (HRV) - an index of vagus nerve function and a robust predictor of emotion regulation capacity - as a vulnerability marker that potentially mediates the association between PTE exposure, age and symptoms of posttraumatic stress disorder (PTSD), psychological distress and aggressive behavior, in a community sample from Timor-Leste - a post-conflict country with a history of mass violence. METHOD: Resting state heart rate data was recorded from 45 cases of PTSD, depression and intermittent explosive disorder (IED); and 29 non-case controls. RESULTS: Resting HRV was significantly reduced in the combined case group compared with non-cases (p = .021; Cohen's d = 0.5). A significant mediation effect was also observed, whereby a sequence of increased age, reduced HRV and elevated PTSD symptoms mediated the association between PTE exposure and distress (B = .06, SE = .05, 95% CI = [.00-.217]) and aggression (B = .02, SE = .02, 95% CI = [.0003-.069])). CONCLUSION: The findings demonstrate an association between diminished resting HRV and psychopathology. Moreover, age-related HRV reductions emerged as a potential psychophysiological mechanism that underlies enhanced vulnerability to distress and aggression following cumulative PTE exposure

The factor structures and correlates of PTSD in post-conflict Timor-Leste: an analysis of the Harvard Trauma Questionnaire

Abstract Background Post-traumatic stress disorder (PTSD) is the most widely assessed form of mental distress in cross-cultural studies conducted amongst populations exposed to mass conflict and displacement. Nevertheless, there have been longstanding concerns about the universality of PTSD as a diagnostic category when applied across cultures. One approach to examining this question is to assess whether the same factor structure can be identified in culturally diverse populations as has been described in populations of western societies. We examine this issue based on an analysis of the Harvard Trauma Questionnaire (HTQ) completed by a large community sample in conflict-affected Timor-Leste. Method Culturally adapted measures were applied to assess exposure to conflict-related traumatic events (TEs), ongoing adversities, symptoms of PTSD and psychological distress, and functional impairment amongst a large population sample (n = 2964, response rate: 82.4%) in post-conflict Timor-Leste. Results Confirmatory factor analyses of the ICD-10, ICD-11, DSM-IV, four-factor Emotional Numbing and five-factor Dysphoric-Arousal PTSD structures, found considerable support for all these models. Based on these classifications, concurrent validity was indicated by logistic regression analyses which showed that being a woman, trauma exposure, ongoing adversity, severe distress, and functional impairment were all associated with PTSD. Conclusions Although symptom prevalence estimates varied widely based on different classifications, our study found a general agreement in PTSD assignments across contemporary diagnostic systems in a large conflict-affected population in Timor-Leste. Further studies are needed, however, to establish the construct and concurrent validity of PTSD in other cultures

Trends in Data Centre Energy Consumption under the European Code of Conduct for Data Centre Energy Efficiency

Climate change is recognised as one of the key challenges humankind is facing. The Information and Communication Technology (ICT) sector including data centres generates up to 2% of the global CO2 emissions, a number on par to the aviation sector contribution, and data centres are estimated to have the fastest growing carbon footprint from across the whole ICT sector, mainly due to technological advances such as the cloud computing and the rapid growth of the use of Internet services. There are no recent estimations of the total energy consumption of the European data centre and of their energy efficiency. The aim of this paper is to evaluate, analyse and present the current trends in energy consumption and efficiency in data centres in the European Union using the data submitted by companies participating in the European Code of Conduct for Data Centre Energy Efficiency programme, a voluntary initiative created in 2008 in response to the increasing energy consumption in data centres and the need to reduce the related environmental, economic and energy supply security impacts. The analysis shows that the average Power Usage Effectiveness (PUE) of the facilities participating in the programme is declining year after year. This confirms that voluntary approaches could be effective in addressing climate and energy issue

Heart rate variability and the relationship between trauma exposure age, and psychopathology in a post-conflict setting

2016). Heart rate variability and the relationship between trauma exposure age, and psychopathology in a post-conflict setting. BMC Psychiatry, 16(1) http://dx.doi.org/10.1186/s12888-016-0850-5 _____________________________________________________________ This article is brought to you by Swansea University. Any person downloading material is agreeing to abide by the terms of the repository licence. Authors are personally responsible for adhering to publisher restrictions or conditions. When uploading content they are required to comply with their publisher agreement and the SHERPA RoMEO database to judge whether or not it is copyright safe to add this version of the paper to this repository. http://www.swansea.ac.uk/iss/researchsupport/cronfa-support/ R E S E A R C H A R T I C L E Open Access Heart rate variability and the relationship between trauma exposure age, and psychopathology in a post-conflict setting Abstract Background: Cumulative exposure to potentially traumatic events (PTEs) increases risk for mental distress in conflict-affected settings, but the psychophysiological mechanisms that mediate this dose-response relationship are unknown. We investigated diminished heart rate variability (HRV) -an index of vagus nerve function and a robust predictor of emotion regulation capacity -as a vulnerability marker that potentially mediates the association between PTE exposure, age and symptoms of posttraumatic stress disorder (PTSD), psychological distress and aggressive behavior, in a community sample from Timor-Leste -a post-conflict country with a history of mass violence. Method: Resting state heart rate data was recorded from 45 cases of PTSD, depression and intermittent explosive disorder (IED); and 29 non-case controls

Effects of recurrent violence on post-traumatic stress disorder and severe distress in conflict-affected Timor-Leste: a 6-year longitudinal study

Background: Little is known about the effect of recurrent episodes of communal violence on mental health in countries recovering from mass conflict. We report results of a 6-year longitudinal study in post-conflict Timor-Leste assessing changes in mental health after a period of communal violence. Methods: We assessed 1022 adults (600 from a rural village, 422 from an urban district) exposed to mass conflict during the Indonesian occupation after independence in 2004, and again in 2010–11, following a period of internal conflict. We took a census of all adults living at the two sites. The survey included measures of post-traumatic stress disorder, severe distress, traumatic events, poverty, ongoing conflict, and injustice. Findings: 1247 (80%) of 1554 invited adults participated in the baseline survey. 1038 (89% of those eligible) were followed up. The analysis included 1022 people who had sufficient data at baseline and follow-up. The prevalence of post-traumatic stress disorder increased from 23 of 1022 (2·3%) in 2004, to 171 of 1022 (16·7%) in 2010. The prevalence of severe distress also increased, from 57 of 1022 (5·6%) in 2004, to 162 of 1022 (15·9%) in 2010. Both these outcomes were associated with disability at follow-up. Having post-traumatic stress at follow-up was associated with being a woman (odds ratio [OR] 1·63, 95% CI 1·14–2·32), experience of human rights trauma (OR 1·25, 95% CI 1·07–1·47), or exposure to murder (OR 1·71, 95% CI 1·38–2·10) during the Indonesian occupation (1975–99), human rights trauma during the period of internal violence in 2006–07 (OR 1·46, 95% CI 1·04–2·03), and ongoing family or community conflict (OR 1·80, 95% CI 1·15–2·80) or preoccupations with injustice for two or three historical periods (OR 4·06, 2·63–6·28). Severe distress at follow-up was associated with health stress (OR 1·47, 1·14–1·90), exposure to murder (OR 1·57, 1·27–1·95), and natural disaster (OR 1·65, 1·03–2·64) during the Indonesian occupation, conflict-related trauma during the internal violence (OR 1·33, 1·02–1·74), and ongoing poverty (OR 1·53, 1·36–1·72) or preoccupations with injustice for two or three historical periods (OR 2·09, 1·25–3·50). Interpretation: Recurrent violence resulted in a major increase in post-traumatic stress disorder and severe distress in a community previously exposed to mass conflict. Poverty, ongoing community tensions, and persisting feelings of injustice contributed to mental disorders. The findings underscore the importance of preventing recurrent violence, alleviating poverty, and addressing injustices in countries emerging from conflict. Funding: Australian National Health and Medical Research Council

Associations of socio-demographic factors, trauma, conflict, poverty and injustice with Intermittent Explosive Disorder amongst Timorese women.

1<p>Odds Ratios adjusted for presence of PTSD, psychological distress and all other variables in the model.</p>2<p>3 historical periods: Indonesian occupation; Independence period.</p><p>Model c-statistic (Area Under the Curve)  = 0.799.</p

Practical suggestions women provided to ameliorate or prevent anger.

<p>Practical suggestions women provided to ameliorate or prevent anger.</p

Intermittent explosive disorder amongst women in conflict affected Timor-Leste: associations with human rights trauma, ongoing violence, poverty, and injustice

Women in conflict-affected countries are at risk of mental disorders such as posttraumatic stress disorder and depression. No studies have investigated the association between experiences of abuse and injustice and explosive anger amongst women in these settings, and the impact of anger on women's health, family relationships and ability to participate in development.\ud \ud A mixed methods study including an epidemiological survey (n = 1513, 92.6% response) and qualitative interviews (n = 77) was conducted in Timor-Leste. The indices measured included Intermittent Explosive Disorder, posttraumatic stress disorder; severe distress; days out of role (the number of days that the person was unable to undertake normal activities); gender-specific trauma; conflict/violence; poverty; and preoccupations with injustice.\ud \ud Women with Intermittent Explosive Disorder (n = 184, 12.2%) were more disabled than those without the disorder (for >5 days out of role, 40.8% versus 31.5%, X²₍₂₎ = 12.93 p = 0.0016). Multivariable associations with Intermittent Explosive Disorder, controlling for the presence of PTSD, psychological distress and other predictors in the model, included the sense of being sick (OR 1.73; 95% CI 1.08–2.77); victimization as a result of helping the resistance movement (OR 2.33, 95% CI 1.48–3.68); war-related trauma specific to being a woman (OR 1.95, 95%, CI 1.09–3.50); ongoing family violence and community conflict (OR 1.88, 95% CI 1.27–2.77); extreme poverty (OR 1.23, 95%, CI 1.08–1.39); and distressing preoccupations with injustice (relating to 2/3 historical periods, OR 2.10, 95% CI 1.35–3.28). In the qualitative study, women elaborated on the determinants of anger and its impact on their health, family and community functioning, child-rearing, and capacity to engage in development. Women reflected on the strategies that might help them overcome their anger.\ud \ud Intermittent Explosive Disorder is prevalent and disabling amongst women in conflict-affected Timor-Leste, impacting on their health, child-rearing and ability to participate fully in socio-economic development