Psychiatry - Research Publications

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    Stressors and Supports in Postdisaster Recovery: Experiences After the Black Saturday Bushfires
    Harms, L ; Gibbs, L ; Ireton, G ; MacDougall, C ; Brady, K ; Kosta, L ; Block, K ; Baker, E ; Gallagher, HC ; Kellett, C ; Forbes, D ; Bryant, R (ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2021-03-03)
    Many studies show that long-term poor mental health outcomes for disaster-affected people are predicted by postdisaster stressors. Despite this finding, existing recovery frameworks vary in how these stressors are conceptualised. This paper examines community members’ subjective perceptions of what they found problematic and useful in their recoveries after the Australian 2009 Black Saturday bushfires, and considers them in the light of these frameworks. We report the findings from responses to semi-structured survey questions as part of the Beyond Bushfires study, 3–4 years after these bushfires (n =811). Participants identified the biggest problems as managing rebuilding processes and managing their own mental health, memories of the Black Saturday fires, and their concerns for family members. The four most useful supports were family, friends, rebuilding resources, and their community. We found a complex interplay of the same factors operating as both stressors and supports, particularly in relation to family levels of coping. IMPLICATIONS Disaster recovery efforts require the simultaneous management of physical rebuilding and human processes. Families, friends, and neighbours are underestimated resources in postdisaster recovery. Given the complex interplay of the same factors operating as both stressors and supports, interventions are needed that maximise the positive dimensions of these factors. To manage this complexity, multiple frameworks are needed to guide disaster recovery.
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    Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective.
    Fikretoglu, D ; Sharp, M-L ; Adler, AB ; Bélanger, S ; Benassi, H ; Bennett, C ; Bryant, R ; Busuttil, W ; Cramm, H ; Fear, N ; Greenberg, N ; Heber, A ; Hosseiny, F ; Hoge, CW ; Jetly, R ; McFarlane, A ; Morganstein, J ; Murphy, D ; O'Donnell, M ; Phelps, A ; Richardson, DJ ; Sadler, N ; Schnurr, PP ; Smith, P ; Ursano, R ; Hooff, MV ; Wessely, S ; Forbes, D ; Pedlar, D (Elsevier BV, 2022-02)
    Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the past six years to update and broaden the discussion on pathways to mental healthcare in military populations. We find that at a broad population level, there is improvement in several indicators of mental health care access, with greater gains in initial engagement, time to first treatment contact, and subjective satisfaction with care, and smaller gains in objective indicators of adequacy of care. Among individual-level barriers to care-seeking, there is progress in improving recognition of need for care and reducing stigma concerns. Among organizational-level barriers, there are advances in availability of services and cultural acceptance of care-seeking. Other barriers, such as concerns around confidentiality, career impact, and deployability persist, however, and may account for some remaining unmet need. To address these barriers, new initiatives that are more evidence-based, theoretically-driven, and culturally-sensitive, are therefore needed, and must be rigorously evaluated to ensure they bring about additional improvements in pathways to care.
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    Dropout from guideline-recommended psychological treatments for posttraumatic stress disorder: A systematic review and meta-analysis
    Varker, T ; Jones, KA ; Arjmand, HA ; Hinton, M ; Hiles, SA ; Freijah, I ; Forbes, D ; Kartal, D ; Phelps, A ; Bryant, RA ; McFarlane, A ; Hopwood, M ; O'Donnell, M (Elsevier BV, 2021-04-01)
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    Enhancing Discovery of Genetic Variants for Posttraumatic Stress Disorder Through Integration of Quantitative Phenotypes and Trauma Exposure Information
    Maihofer, AX ; Choi, KW ; Coleman, JR ; Daskalakis, NP ; Denckla, CA ; Ketema, E ; Morey, RA ; Polimanti, R ; Ratanatharathorn, A ; Torres, K ; Wingo, AP ; Zai, CC ; Aiello, AE ; Almli, LM ; Amstadter, AB ; Andersen, SB ; Andreassen, OA ; Arbisi, PA ; Ashley-Koch, AE ; Austin, SB ; Avdibegovic, E ; Borglum, AD ; Babic, D ; Baekvad-Hansen, M ; Baker, DG ; Beckham, JC ; Bierut, LJ ; Bisson, J ; Boks, MP ; Bolger, EA ; Bradley, B ; Brashear, M ; Breen, G ; Bryant, RA ; Bustamante, AC ; Bybjerg-Grauholm, J ; Calabrese, JR ; Caldas-de-Almeida, JM ; Chen, C-Y ; Dale, AM ; Dalvie, S ; Deckert, J ; Delahanty, DL ; Dennis, MF ; Disner, SG ; Domschke, K ; Duncan, LE ; Kulenovic, AD ; Erbes, CR ; Evans, A ; Farrer, LA ; Feeny, NC ; Flory, JD ; Forbes, D ; Franz, CE ; Galea, S ; Garrett, ME ; Gautam, A ; Gelaye, B ; Gelernter, J ; Geuze, E ; Gillespie, CF ; Goci, A ; Gordon, SD ; Guffanti, G ; Hammamieh, R ; Hauser, MA ; Heath, AC ; Hemmings, SMJ ; Hougaard, DM ; Jakovljevic, M ; Jett, M ; Johnson, EO ; Jones, I ; Jovanovic, T ; Qin, X-J ; Karstoft, K-I ; Kaufman, ML ; Kessler, RC ; Khan, A ; Kimbrel, NA ; King, AP ; Koen, N ; Kranzler, HR ; Kremen, WS ; Lawford, BR ; Lebois, LAM ; Lewis, C ; Liberzon, I ; Linnstaedt, SD ; Logue, MW ; Lori, A ; Lugonja, B ; Luykx, JJ ; Lyons, MJ ; Maples-Keller, JL ; Marmar, C ; Martin, NG ; Maurer, D ; Mavissakalian, MR ; McFarlane, A ; McGlinchey, RE ; McLaughlin, KA ; McLean, SA ; Mehta, D ; Mellor, R ; Michopoulos, V ; Milberg, W ; Miller, MW ; Morris, CP ; Mors, O ; Mortensen, PB ; Nelson, EC ; Nordentoft, M ; Norman, SB ; O'Donnell, M ; Orcutt, HK ; Panizzon, MS ; Peters, ES ; Peterson, AL ; Peverill, M ; Pietrzak, RH ; Polusny, MA ; Rice, JP ; Risbrough, VB ; Roberts, AL ; Rothbaum, AO ; Rothbaum, BO ; Roy-Byrne, P ; Ruggiero, KJ ; Rung, A ; Rutten, BPF ; Saccone, NL ; Sanchez, SE ; Schijven, D ; Seedat, S ; Seligowski, A ; Seng, JS ; Sheerin, CM ; Silove, D ; Smith, AK ; Smoller, JW ; Sponheim, SR ; Stein, DJ ; Stevens, JS ; Teicher, MH ; Thompson, WK ; Trapido, E ; Uddin, M ; Ursano, RJ ; van den Heuvel, LL ; Van Hooff, M ; Vermetten, E ; Vinkers, CH ; Voisey, J ; Wang, Y ; Wang, Z ; Werge, T ; Williams, MA ; Williamson, DE ; Winternitz, S ; Wolf, C ; Wolf, EJ ; Yehuda, R ; Young, KA ; Young, RM ; Zhao, H ; Zoellner, LA ; Haas, M ; Lasseter, H ; Provost, AC ; Salem, RM ; Sebat, J ; Shaffer, RA ; Wu, T ; Ripke, S ; Daly, MJ ; Ressler, KJ ; Koenen, KC ; Stein, MB ; Nievergelt, CM (ELSEVIER SCIENCE INC, 2022-04-01)
    BACKGROUND: Posttraumatic stress disorder (PTSD) is heritable and a potential consequence of exposure to traumatic stress. Evidence suggests that a quantitative approach to PTSD phenotype measurement and incorporation of lifetime trauma exposure (LTE) information could enhance the discovery power of PTSD genome-wide association studies (GWASs). METHODS: A GWAS on PTSD symptoms was performed in 51 cohorts followed by a fixed-effects meta-analysis (N = 182,199 European ancestry participants). A GWAS of LTE burden was performed in the UK Biobank cohort (N = 132,988). Genetic correlations were evaluated with linkage disequilibrium score regression. Multivariate analysis was performed using Multi-Trait Analysis of GWAS. Functional mapping and annotation of leading loci was performed with FUMA. Replication was evaluated using the Million Veteran Program GWAS of PTSD total symptoms. RESULTS: GWASs of PTSD symptoms and LTE burden identified 5 and 6 independent genome-wide significant loci, respectively. There was a 72% genetic correlation between PTSD and LTE. PTSD and LTE showed largely similar patterns of genetic correlation with other traits, albeit with some distinctions. Adjusting PTSD for LTE reduced PTSD heritability by 31%. Multivariate analysis of PTSD and LTE increased the effective sample size of the PTSD GWAS by 20% and identified 4 additional loci. Four of these 9 PTSD loci were independently replicated in the Million Veteran Program. CONCLUSIONS: Through using a quantitative trait measure of PTSD, we identified novel risk loci not previously identified using prior case-control analyses. PTSD and LTE have a high genetic overlap that can be leveraged to increase discovery power through multivariate methods.
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    Mental health across the early years in the military
    Dell, L ; Casetta, C ; Benassi, H ; Cowlishaw, S ; Agathos, J ; O'Donnell, M ; Crane, M ; Lewis, V ; Pacella, B ; Terhaag, S ; Morton, D ; McFarlane, A ; Bryant, R ; Forbes, D (CAMBRIDGE UNIV PRESS, 2022-02-24)
    BACKGROUND: The mental health impact of the initial years of military service is an under-researched area. This study is the first to explore mental health trajectories and associated predictors in military members across the first 3-4 years of their career to provide evidence to inform early interventions. METHODS: This prospective cohort study surveyed Australian Defence personnel (n = 5329) at four time-points across their early military career. Core outcomes were psychological distress (K10+) and posttraumatic stress symptoms [four-item PTSD Checklist (PCL-4)] with intra-individual, organizational and event-related trajectory predictors. Latent class growth analyses (LCGAs) identified subgroups within the sample that followed similar longitudinal trajectories for these outcomes, while conditional LCGAs examined the variables that influenced patterns of mental health. RESULTS: Three clear trajectories emerged for psychological distress: resilient (84.0%), worsening (9.6%) and recovery (6.5%). Four trajectories emerged for post-traumatic stress, including resilient (82.5%), recovery (9.6%), worsening (5.8%) and chronic subthreshold (2.3%) trajectories. Across both outcomes, prior trauma exposure alongside modifiable factors, such as maladaptive coping styles, and increased anger and sleep difficulties were associated with the worsening and chronic subthreshold trajectories, whilst members in the resilient trajectories were more likely to be male, report increased social support from family/friends and Australian Defence Force (ADF) sources, and use adaptive coping styles. CONCLUSIONS: The emergence of symptoms of mental health problems occurs early in the military lifecycle for a significant proportion of individuals. Modifiable factors associated with wellbeing identified in this study are ideal targets for intervention, and should be embedded and consolidated throughout the military career.
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    Defining post-traumatic stress disorder recovery in veterans: Benchmarking symptom change against functioning indicators
    Hinton, M ; O'Donnell, M ; Cowlishaw, S ; Kartal, D ; Metcalf, O ; Varker, T ; McFarlane, AC ; Hopwood, M ; Bryant, RA ; Forbes, D ; Howard, A ; Lau, W ; Cooper, J ; Phelps, AJ (WILEY, 2020-12-28)
    Improved metrics of Post-traumatic stress disorder (PTSD) treatment response that extend beyond a focus on symptom reduction to incorporate meaningful, patient-centred indicators of functioning are needed in veteran populations. The aim of this study was to extend previous research by investigating whether indicators of functioning can successfully distinguish against symptom response categories derived from the Post-Traumatic Stress Disorder Checklist (PCL-5) pre- and post- PTSD treatment. Participants were 472 veterans receiving hospital-based treatment for PTSD. In addition to the PCL-5, measures included quality of life, social relationships, physical health and psychological distress. Four mutually exclusive, progressive response categories were used to define treatment response including: No Response, Response, Response and Below Threshold, and Remission. PTSD symptom reductions were associated with corresponding improvements in broader indicators of functioning. However, it was only when the magnitude of symptom reduction placed the individual in the 'Response and Below Threshold' category that improvement on functioning measures achieved levels indicative of a good end state. Traditional metrics of treatment 'response' in PTSD treatment do not necessarily indicate recovery on important functioning indicators. Only when an individual both responds to treatment and drops below threshold for probable disorder are they likely to report having meaningful levels of functioning.
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    Anger Dimensions and Mental Health Following a Disaster: Distribution and Implications After a Major Bushfire
    Cowlishaw, S ; Metcalf, O ; Varker, T ; Stone, C ; Molyneaux, R ; Gibbs, L ; Block, K ; Harms, L ; MacDougall, C ; Gallagher, CH ; Bryant, R ; Lawrence-Wood, E ; Kellett, C ; O'Donnell, M ; Forbes, D (WILEY, 2020-11-02)
    Anger is an important dimension of affect and a prominent feature of posttraumatic mental health, but it is commonly overlooked in postdisaster settings. We aimed to examine the distribution and implications of significant anger problems in the aftermath of a natural disaster, via analyses of Beyond Bushfires survey data from 736 residents of rural communities 5 years after the 2009 Black Saturday bushfires in Victoria, Australia. Assessments included the five-item Dimensions of Anger Reaction (DAR-5) scale along with measures of PTSD, depression, and significant mental illness, and indicators of life satisfaction, suicidality, hostile aggressive behavior, and violence exposure. The results indicated that approximately 10% of respondents from areas highly affected by the bushfires scored above the provisional cutoff criteria for significant anger problems on the DAR-5, which was a more than 3-fold increase, OR = 3.26, relative to respondents from areas of low-to-moderate bushfire impact. The rates were higher among women, younger participants, and those who were unemployed, and co-occurred commonly, although not exclusively, with other postdisaster mental health problems. Anger problems were also associated with lower life satisfaction, β = -.31, an 8-fold increase in suicidal ideation, OR = 8.68, and a nearly 13-fold increase in hostile aggressive behavior, OR = 12.98. There were associations with anger problems and violence exposure, which were reduced when controlling for covariates, including probable PTSD. The findings provide evidence indicating that anger is a significant issue for postdisaster mental health and should be considered routinely alongside other posttraumatic mental health issues.
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    Prolonged grief in refugees, parenting behaviour and children's mental health
    Bryant, RA ; Edwards, B ; Creamer, M ; O'Donnell, M ; Forbes, D ; Felmingham, KL ; Silove, D ; Steel, Z ; McFarlane, AC ; Van Hooff, M ; Nickerson, A ; Hadzi-Pavlovic, D (SAGE PUBLICATIONS LTD, 2020-10-30)
    BACKGROUND: Many refugees experience bereavement, and as a result they suffer elevated rates of prolonged grief disorder. Evidence also indicates that elevated rates of psychological disturbance in refugee children can be associated with parental mental health. This study examined the extent to which prolonged grief disorder in refugees is associated with their parenting behaviour and in turn with their children's mental health. METHODS: This study recruited participants from the Building a New Life in Australia prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015-2016 and comprised 1799 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, harsh and warm parenting, probable prolonged grief disorder and posttraumatic stress disorder. Children were administered the Strengths and Difficulties Questionnaire. The current analyses on bereaved refugees comprise 110 caregivers and 178 children. RESULTS: In this cohort, 37% of bereaved refugees reported probable prolonged grief disorder. Path analysis indicated that caregivers' grief was directly associated with children's emotional difficulties. Caregiver warmth was associated with reduced emotional problems in children of refugees with minimal grief but associated with more emotional problems in caregivers with more severe grief. More harsh parenting was associated with children's conduct problems, and this was more evident in those with less severe grief. CONCLUSION: Severity of prolonged grief disorder is directly linked to refugee children's mental health. The association between parenting style, grief severity and children's mental health highlights that managing grief reactions in refugees can benefit both refugees and their children.
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    The dynamic course of psychological outcomes following the Victorian Black Saturday bushfires
    Bryant, RA ; Gibbs, L ; Colin Gallagher, H ; Pattison, P ; Lusher, D ; MacDougall, C ; Harms, L ; Block, K ; Ireton, G ; Richardson, J ; Forbes, D ; Molyneaux, R ; O'Donnell, M (SAGE PUBLICATIONS LTD, 2020-11-11)
    OBJECTIVES: To profile the long-term mental health outcomes of those affected by the 2009 Black Saturday bushfires and to document the course of mental health since the disaster. METHOD: The longitudinal Beyond Bushfires study included 1017 respondents (Wave 1; 3-4 years after the fires), 736 (76.1%) at Wave 2 (5 years after the fires) and 525 (51.6%) at Wave 3 (10 years after the fires). The survey indexed fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive disorder, alcohol use, severe distress and receipt of health services for mental health problems. RESULTS: Relative to their status 3-4 years after the fires, there were reduced rates of fire-related posttraumatic stress disorder (6.2% vs 12.2%), general posttraumatic stress disorder (14.9% vs 18.7%) and severe distress (4.4% vs 7.5%) at 10 years. There were comparable rates between Wave 1 and Wave 3 for depression (10.9% vs 8.3%) and alcohol abuse (21.8% vs 18.5%). Of people in high-affected regions, 22.1% had posttraumatic stress disorder, depression or severe distress at Wave 3. One-third to one-half of participants who reported probable posttraumatic stress disorder or depression at any assessment did not display the disorder at the next assessment. Worsening of mental health at Wave 3 was associated with the extent of property loss, exposure to recent traumatic events or recent stressful life events. Only 24.6% of those with a probable disorder had sought professional help for this in the previous 6 months. CONCLUSION: Approximately one-fifth of people from high-affected areas have a probable psychological disorder a decade after the fires. Mental health appears to fluctuate for those who are not consistently resilient, apparently as a result of ongoing stressors. The observation that most people with probable disorder are not receiving care highlights the need for further planning about managing long-term mental health needs of disaster-affected communities.
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    The contribution of gender-based violence and network trauma to gender differences in Post-Traumatic Stress Disorder
    Silove, D ; Baker, JR ; Mohsin, M ; Teesson, M ; Creamer, M ; O'Donnell, M ; Forbes, D ; Carragher, N ; Slade, T ; Mills, K ; Bryant, R ; McFarlane, A ; Steel, Z ; Felmingham, K ; Rees, S ; Homberg, J (PUBLIC LIBRARY SCIENCE, 2017-02-16)
    BACKGROUND: Posttraumatic stress disorder (PTSD) occurs twice as commonly amongst women as men. Two common domains of trauma, network trauma and gender based violence (GBV), may contribute to this gender difference in PTSD rates. We examined data from a nationally representative sample of the Australian population to clarify the characteristics of these two trauma domains in their contributions to PTSD rates in men and women. METHODS: We drew on data from the 2007 Australian National Survey of Mental Health and Well-being to assess gender differences across a comprehensive range of trauma domains, including (1) prevalence of lifetime exposure; (2) identification of an index trauma or DSM-IV Criterion A event; and (3) the likelihood of developing full DSM-IV PTSD symptoms once an index trauma was identified. RESULTS: Men reported more traumatic events (TEs) overall but women reported twice the prevalence of lifetime PTSD (women, 13.4%; men, 6.3%). Women reported a threefold higher level of exposure to GBV and were seven times more likely to nominate GBV as the index trauma as compared to men. Women were twice more likely than men to identify a network trauma as the index trauma and more likely to meet full PTSD symptoms in relation to that event (women, 20.6%; men, 14.6%). CONCLUSION: Women are more likely to identify GBV and network trauma as an index trauma. Women's far greater exposure to GBV contributes to their higher prevalence of PTSD. Women are markedly more likely to develop PTSD when network trauma is identified as the index trauma. Preventing exposure to GBV and providing timely interventions for acute psychological reactions following network trauma may assist in reducing PTSD rates amongst women.