Suchergebnisse

The relatively frequent occurrence of rapid onset and very brief, but often florid, psychotic states, with periodic recurrence, alongside relatively low rates of PTSD and chronic psychosis, were unexpected findings from the 2004 East Timor Mental Health Study, conducted in the context of the country's recently won independence and in the wake of the atrocities endured in the protracted fight for sovereignty. Further unanticipated was the frequent association of recurrence with the time of the new moon (fulan lotuk) and other times or places of sacred (lulik) or associated cultural significance. The perceived violation of culturally sacrosanct lulikobligations often also appeared to foreshadow the initial onset of such patterns of distress. Significant episodes of trauma and loss appeared a hidden feature of affected individuals histories, which we argue have become symbolically entwined with local cultural understandings of ritual obligation, sacredness, and taboo.-ansi-language:EN-GB;mso-fareast-language: EN-US;mso-bidi-language:AR-SA;mso-bidi-font-style:italic'> This volume develops a dynamic but contextualized multi-level formulation of psychosis and psychotic-symptoms, able to incorporate a range of factors from the biological, through the sociocultural, to the political. The work is truly interdisciplinary drawing on both the quantitative and qualitative findings of our own study but further supported through local ethnography and broader anthropological enquiry into the outcomes of psychosis in non-Western settings; psychoanalysis and psychoanalytic anthropology; evidence and theory exploring links between trauma, dissociation and psychosis; and novel culturally-adaptable psychosocial focused interventions for psychosis. We situate both evidence and theorising in wider epistemological and political context, including in relation to the movement for Global Mental Health. Culturally patterned presentations of brief remitting-relapsing psychosis are ultimately conceived as the trade-off between competing fragmentary and synthetic forces: the former in part secondary to the lasting and deleterious effects of overwhelming loss, trauma and adversity; the latter emboldened by cultural meaning and social response in the context of broad ecological pressures demanding survival and resilience. Dr. James Rodgeris a Consultant Child and Adolescent Psychiatrist in the United Kingdom National Health Service and an Honorary Associate Research Fellow at the University of Exeter. He holds an additional degree in Medical Anthropology and has undertaken postgraduate training in Systemic Practice. His principle clinical and research interest is the developmental, social and cultural aspects of psychotic phenomena and related implications for intervention. He undertook the key fieldwork forming the basis of this work in 2004, in the context of an 18-month mental health research program in Timor-Leste. In addition Dr Rodger has provided expert evidence relating to transcultural trauma-related psychiatric presentations for both asylum and criminal cases. Previous publications relate to the wider epidemiological research findings and implications from Timor-Leste, to critical-relational challenges to psychiatric practice, and to the anthropology of altered mental states. ZacharySteel is a clinical psychologist who holds the St John of God Professorial Chair of Trauma and Mental Health,School of Psychiatry, University of New South Wales and Richmond Hospital, New South Wales, Australia. Dr Steel has developed a program of mental health research across culturally diverse communities and settings with a particular focus on traumatic stress, forced displacement, conflict and culturally specific symptoms of mental disorder and distress. Within the Asia-Pacific region he is involved in collaborative mental health research programs in Vietnam, Aceh-Indonesia, and Timor-Leste as well as with asylum seeker and refugee communities in Australia and amongst Aboriginal communities in Far West New South Wales. His research with asylum seeker populations in Australia has helped to develop an evidence base on the adverse mental health consequences of harsh asylum policies including the use of immigration detention and temporary protection visas.

Previous research has demonstrated the importance of intercultural willingness to interact; however, these investigations have yet to be applied to a health context or to compare an ethnic minority with a majority sample. Consequently, the current study sought to better understand engagement with health services by investigating both attitudes towards seeking psychological help and intercultural willingness to interact within an ethnic minority South East Asian population, relative to an Anglo Australian sample. As predicted, negative attitudes towards seeking psychological help were higher in the South East Asian sample, with this relationship persisting across generations, despite significant differences in acculturation. In contrast, intercultural willingness to interact was not associated with ethnicity status but was associated with higher anxiety, uncertainty, ethnocentrism and help-seeking, consistent with current empirical and theoretical literature. The current study also sought to examine factors associated with help-seeking attitudes and found that ethnocentrism was a significant predictor, when accounting for previous health experience.

The final decades of the twentieth century were accompanied by an upsurge in the number of persons fleeing persecution and regional wars. To stem the flow of asylum seekers, several countries in the west introduced policies of deterrence, including detention. Although many countries detain asylum seekers, Australia has been unique in establishing a policy of mandatory, indefinite detention. The impact of prolonged detention on the mental health of asylum seekers drew commentary from mental health professionals soon after the policy was introduced, but administrators and politicians disputed the assertion that detention was a factor in causing or exacerbating mental disorder. This overview examines the impact of mandatory, indefinite detention on the mental health of asylum seekers by drawing on evidence gathered during Commissions of Inquiry, from observations of health and mental health professionals who have worked in detention centres, and from the small body of systematic research undertaken among immigration detainees. The data from all sources converge in demonstrating that prolonged detention has adverse mental health and psychosocial impacts on adults, families and children. Recent studies suggest that the mental health effects may be prolonged, extending well beyond the point of release into the community. The Australian experience offers general lessons to health professionals worldwide about the importance of remaining vigilant in protecting the rights of vulnerable groups, and more specifically, to ensure that the traumas that cause mental suffering in refugees are not compounded as a consequence of immigration policy decisions in recipient countries. Documentation and research can be vital in achieving policy change in these settings.

This article describes the development and validation of the Phan Vietnamese Psychiatric Scale (PVPS). The PVPS was derived from Vietnamese idioms and cultural understandings of psychiatric and emotional distress identified from the Vietnamese literature and using ethnographic methods. The PVPS consists of a 26-item depression subscale, a 13-item anxiety subscale and a 14-item somatization subscale. Estimates of internal consistency for the three subscales ranged from .87 to .95, with 4-day interval test–retest reliability ranging from .81 to .89. Confirmatory factor analysis supported the subscale structure, with the depression subscale comprising two components 'general mood disturbance' and 'psychovegetative symptoms.' Multitrait–multimeasure analysis supported the construct validity of the scale. The PVPS demonstrated good criterion validity against case assignments by psychiatrists, naturalist healers, and structured diagnostic measures. The PVPS was rated as superior in clinical sensitivity and acceptability in comparison to other related measures.

Abstract
Purpose
Intimate partner violence (IPV) is known to increase the risk of suicidal thoughts and behaviors. Despite the urgent need to increase women's safety and wellbeing, trajectories to suicide are not well understood and few studies have tested potentially important mediators, such as post-traumatic stress disorder (PTSD), that could help to improve risk stratification and clinical responses.

Methods
This study used baseline data from a prospective cohort study (2019–2020) to examine differential effects of psychological, physical, sexual, and multiple IPV on suicidal ideation and suicide attempt and test whether pathways are mediated by PTSD. Simple random sampling – online/in-person in Australian emergency departments (EDs) – was used to survey consenting women with a recent suicide-related ED presentation. Structural equation modelling was used to test the pathways between recent and lifetime IPV, PTSD, and suicidal ideation and attempt.

Results
Of the 1,715 women (M = 30.24, SD = 11.91 years) who participated, 1,012 (59%) reported lifetime IPV exposure, with 608 (35%) reporting recent victimization (< 18 months). Presence of PTSD wholly mediated the effects of psychological, physical, and sexual IPV on ideation (p < .05). Multiple IPV was unique in its direct effects on ideation and attempt and these pathways were most consistent for recent IPV, compared with lifetime exposure (p < .05).

Conclusions
Pathway analysis identified two high-risk patient-populations: Women with recent multiple IPV and those with a diagnosis of PTSD following lifetime IPV exposure. Findings can be used to improve risk prediction and clinical intervention for patients living with mortality risk from partner- and self-directed violence.

The Mandaeans are a small religious community originating from Iraq and Iran who are facing the possibility of cultural extinction within the next few generations. This study aimed to examine the relationships between life experiences, psychopathology and fear of cultural extinction in Mandaean refugees. A survey was conducted of 315 adult Iraqi Mandaean refugees living in Australia. Past traumatic experiences and current resettlement difficulties were assessed. Mental health outcomes were also examined, including measures of posttraumatic stress disorder (PTSD) and depression. Fear of cultural extinction was measured by items developed in consultation with the Mandaean community. A path analysis was employed to investigate the relationship between trauma, living difficulties, PTSD, depression, and fear of cultural extinction. Results indicated that trauma and living difficulties impacted indirectly on fear of cultural extinction, while PTSD (and not depression) directly predicted levels of anxiety about the Mandaean culture ceasing to exist. The current findings indicate that past trauma and symptoms of posttraumatic stress contribute to fear of cultural extinction. Exposure to human rights violations enacted on the basis of religion has significant mental health consequences that extend beyond PTSD. The relationship between perception of threat, PTSD, and fear of cultural extinction is considered in the context of cognitive models of traumatic stress. Government immigration policy must prioritize the reunification of small, endangered groups to sustain cultural traditions. Treatment interventions implemented with cultural groups facing extinction should take into consideration anxiety about loss of culture.

Abstract
Pre-employment screening to assess for psychological vulnerability is common in trauma-exposed occupations such as policing. However, the ability of such screening to predict those at increased risk of subsequent mental health problems has been questioned. The present study sought to investigate the ability of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) to predict absenteeism related to psychological injury in police officers. Pre-employment screening data from 1,399 sworn police officers was linked to organizational records. A total of 150 police officers who had taken at least 2 weeks' sick leave with work-related mental health concerns were matched to 150 healthy controls. Conditional logistic regression was used to examine any association between MMPI-2 scales and psychological injury-related absenteeism. We found no evidence that elevations in the pre-employment MMPI-2 scores of police recruits were associated with an increased chance of future absenteeism as a result of psychological injury (P &gt; 0.05). In addition, there was no evidence of an increased likelihood of psychological injury-related absenteeism among those with a higher number of positive pre-employment risk factors (P = 0.09). While the MMPI-2 may be able to predict different outcomes among police officers, it is important to note that based on these results, the MMPI-2, if used at pre-employment, is not able to predict later psychological injury-related absenteeism.