War can harm intimacy: consequences for refugees who escaped Syria.

BackgroundSyrians seeking refuge have been exposed to atrocities and trauma beyond comprehension. This study examines how personal, interpersonal, displacement and war-related factors have impacted married refugees' intimate lives.MethodsData included 158 married Syrian refugee individuals who live in the host communities of Jordan. Refugees reported on their personal, interpersonal, current-displacement and past-war related experiences. Traumatic impacts were assessed using the Harvard Trauma Questionnaire (HTQ), K6 screening scale for serious mental illness (SMI), The War Events Questionnaire (WEQ), and Personal Assessment of Intimacy in Relationships (PAIR). Stepwise multiple regressions were used to determine the factors associated with refugees' intimacy-total score and its six dimensions.ResultsMost refugees (94.2%) experienced war events, and 34% screened positive on the PTSD-HTQ scale. Overall intimacy scores were low, scoring M (±standard deviation) = 2.4 (±1.1) of a possible five on average. Intimacy scores were lower for refugees who screened positive on the PTSD-HTQ (M = 1.95 ± 65) compared to the ones screening negative, respectively (M = 2.23 ± 66). Furthermore, the higher the PTSD symptoms reported, the lower the couples' intimacy. PTSD and forced marriage were the strongest factors to predict decreased total-intimacy scores (β = -0.23, P = 0.002; β = -0.32, P < 0.001), and decreased scores on four dimensions of intimacy (emotional, sexual, intellectual and recreational). Whereas gender was the second strongest factor associated with decreased total-intimacy scores (β = -0.29, P < 0.001), and decreased scores on three dimensions of intimacy (emotional, social and anger), meaning that women reported suffering more than men from deteriorated intimacy in their marital relationships. Other displacement and war-related factors associated with intimacy were: decreased sexual intimacy associated with having been raped; increased intellectual intimacy associated with escaped from Syria with one's spouse; decreased recreational intimacy associated with the number of family members lived with; decreased sexual, emotional and total-intimacy scores associated with number of children; and years of education as a seemingly personal protective factor associated with increased intellectual and recreational intimacy.ConclusionsAddressing Syrian refugees' intimacy issues in interventions is essential, as well as raising the awareness of stakeholders and community leaders to the negative impacts of PTSD, forced marriage, rape, and displacement difficulties endured by the already challenged and distressed married refugees

Trauma during humanitarian work: the effects on intimacy, wellbeing and PTSD-symptoms.

Background: Organizations assisting refugees are over burdened with the Syrian humanitarian catastrophe and encounter diverse difficulties facing the consequences of this massive displacement. Aid-workers experience the horrors of war through their efforts to alleviate suffering of Syrian refugees. Objective: This study of Syrian refugee aid-workers in Jordan examined work-stressors identified as secondary traumatic stress (STS), number of refugees assisted, worker feelings towards the organization, and their associations to PTSD-symptoms, wellbeing and intimacy. It also examined whether self-differentiation, physical health, and physical pain were associated with these variables. Method: Syrian refugee aid-workers (N = 317) in Jordans NGOs were surveyed. Univariate statistics and structural equation modeling (SEM) were utilized to test study hypotheses. Results: Increased STS was associated with lower self-differentiation, decreased physical health and increased physical pain, as well as elevated PTSD-symptoms and decreased intimacy. Decreased connection to the NGO was associated with lower self-differentiation, decreased physical health, increased physical pain, and with decreased intimacy and wellbeing. Lower self-differentiation was associated with increased PTSD-symptoms, decreased wellbeing and intimacy. Elevated physical pain was associated with increased PTSD-symptoms, and decreased wellbeing. Diverse mediation effects of physical health, physical pain and self-differentiation were found among the studys variables. Conclusions: Aid-workers who assist refugees were at risk of physical and mental sequelae as well as suffering from degraded self-differentiation, intimacy and wellbeing. Organizations need to develop prevention policies and tailor interventions to better support their aid-workers while operating in such stressful fieldwork

The Utility of Outpatient Commitment: I. A Need for Treatment and a Least Restrictive Alternative to Psychiatric Hospitalization.

ObjectivesThis study examined whether psychiatric patients assigned to community treatment orders (CTOs), outpatient commitment in Victoria, Australia, have a greater need for treatment to protect their health and safety than patients not assigned to CTOs. It also considered whether such treatment is provided in a least restrictive manner-that is, in a way that contributes to reduced use of psychiatric hospitalization.MethodsThe sample included 11,424 patients first placed on a CTO between 2000 and 2010, and 16,161 patients not placed on a CTO. Need for treatment was independently assessed with the Health of the Nation Outcome Scales (HoNOS) at hospital admission and at discharge. Ordinary least-squares and Poisson regressions were used to assess savings in hospital days attributable to CTO placement.ResultsHoNOS ratings indicated that at admission and discharge, the CTO cohort's need for treatment exceeded that of the non-CTO cohort, particularly in areas indicating potential dangerous behavior. When analyses adjusted for the propensity to be selected into the CTO cohort and other factors, the mean duration of an inpatient episode was 4.6 days shorter for the CTO cohort than for the non-CTO cohort, and a reduction of 10.4 days per inpatient episode was attributable to each CTO placement.ConclusionsCTO placement may have helped patients with a greater need for treatment to experience shorter hospital stays. Whether the CTO directly enabled the fulfillment of unsought but required treatment needs that protected patient health and safety is a question that needs to be addressed in future research

Fear of adverse mental health treatment experiences: Initial psychometric properties of a brief self-report measure.

Many are apprehensive about mental health care, which potentially affects engagement in recovery processes as well as health outcomes. This article introduces a tool to assess fear of adverse mental health treatment experiences from the client's perspective. In a sample of 656 adults receiving mental health services at community agencies, this study is an initial exploration into the validity of a scale assessing fears associated with commonly experienced coercive or disorganized interventions. Factor analyses supported the construct validity of the 10-item Fear of Adverse Treatment Experiences Scale. It significantly discriminates based upon service characteristics, gender, history of victimization, and past experiences with coercive or disorganized interventions, with higher levels of fear reported by users of traditional mental health services, former inpatients who had their voluntary admission status changed, males, people with history of childhood abuse, and people with certain forms of criminal justice involvement. (PsycINFO Database Recor

A Tale of Two Cities: The Exploration of the Trieste Public Psychiatry Model in San Francisco

According to the World Health Organization (WHO), the “Trieste model” of public psychiatry is one of the most progressive in the world. It was in Trieste, Italy, in the 1970s that the radical psychiatrist, Franco Basaglia, implemented his vision of anti-institutional, democratic psychiatry. The Trieste model put the suffering person—not his or her disorders—at the center of the health care system. The model, revolutionary in its time, began with the “negation” and “destruction” of the traditional mental asylum (‘manicomio’). A novel community mental health system replaced the mental institution. To achieve this, the Trieste model promoted the social inclusion and full citizenship of users of mental health services. Trieste has been a collaborating center of the WHO for four decades with a goal of disseminating its practices across the world. This paper illustrates a recent attempt to determine whether the Trieste model could be translated to the city of San Francisco, California. This process revealed a number of obstacles to such a translation. Our hope is that a review of Basaglia’s ideas, along with a discussion of the obstacles to their implementation, will facilitate efforts to foster the social integration of persons with mental disorders across the world