Psychiatry - Research Publications

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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.
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    International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci
    Nievergelt, CM ; Maihofer, AX ; Klengel, T ; Atkinson, EG ; Chen, C-Y ; Choi, KW ; Coleman, JR ; Dalvie, S ; Duncan, LE ; Gelernter, J ; Levey, DF ; Logue, MW ; Polimanti, R ; Provost, AC ; Ratanatharathorn, A ; Stein, MB ; Torres, K ; Aiello, AE ; Almli, LM ; Amstadter, AB ; Andersen, SB ; Andreassen, OA ; Arbisi, PA ; Ashley-Koch, AE ; Austin, SB ; Avdibegovic, E ; Babic, D ; Baekvad-Hansen, M ; Baker, DG ; Beckham, JC ; Bierut, LJ ; Bisson, J ; Boks, MP ; Bolger, EA ; Brglum, AD ; Bradley, B ; Brashear, M ; Breen, G ; Bryant, RA ; Bustamante, AC ; Bybjerg-Grauholm, J ; Calabrese, JR ; Caldas-de-Almeida, JM ; Dale, AM ; Daly, MJ ; Daskalakis, NP ; Deckert, J ; Delahanty, DL ; Dennis, MF ; Disner, SG ; Domschke, K ; Dzubur-Kulenovic, A ; Erbes, CR ; Evans, A ; Farrer, LA ; Feeny, NC ; Flory, JD ; Forbes, D ; Franz, CE ; Galea, S ; Garrett, ME ; Gelaye, B ; Geuze, E ; Gillespie, C ; Uka, AG ; Gordon, SD ; Guffanti, G ; Hammamieh, R ; Harnal, S ; Hauser, MA ; Heath, AC ; Hemmings, SMJ ; Hougaard, DM ; Jakovljevic, M ; Jett, M ; Johnson, EO ; Jones, I ; Jovanovic, T ; Qin, X-J ; Junglen, AG ; Karstoft, K-I ; Kaufman, ML ; Kessler, RC ; Khan, A ; Kimbrel, NA ; King, AP ; Koen, N ; Kranzler, HR ; Kremen, WS ; Lawford, BR ; Lebois, LAM ; Lewis, CE ; Linnstaedt, SD ; Lori, A ; Lugonja, B ; Luykx, JJ ; Lyons, MJ ; Maples-Keller, J ; Marmar, C ; Martin, AR ; Martin, NG ; Maurer, D ; Mavissakalian, MR ; McFarlane, A ; McGlinchey, RE ; McLaughlin, KA ; McLean, SA ; McLeay, S ; Mehta, D ; Milberg, WP ; Miller, MW ; Morey, RA ; Morris, CP ; Mors, O ; Mortensen, PB ; Neale, BM ; 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 ; Ripke, S ; Risbrough, VB ; Roberts, AL ; Rothbaum, AO ; Rothbaum, BO ; Roy-Byrne, P ; Ruggiero, K ; 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 ; Sumner, JA ; 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 ; Wolff, JD ; Yehuda, R ; Young, RM ; Young, KA ; Zhao, H ; Zoellner, LA ; Liberzon, I ; Ressler, KJ ; Haas, M ; Koenen, KC (NATURE PORTFOLIO, 2019-10-08)
    The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5-20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson's disease gene involved in dopamine regulation, PARK2, is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations.
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    Onset of common mental disorders and suicidal behavior following women's first exposure to gender based violence: a retrospective, population-based study
    Rees, S ; Steel, Z ; Creamer, M ; Teesson, M ; Bryant, R ; McFarlane, AC ; Mills, KL ; Slade, T ; Carragher, N ; O'Donnell, M ; Forbes, D ; Silove, D (BMC, 2014-11-18)
    BACKGROUND: Women exposed to gender-based violence (GBV) experience a high rate of common mental disorders and suicidal behaviour ("mental disturbance"). Little is known however about the timing of onset of mental disturbance following first exposure to GBV amongst women with no prior mental disorder. METHODS: The analysis was undertaken on the Australian National Mental Health and Wellbeing Survey dataset (N = 8841). We assessed lifetime prevalence and first onset of common mental disorder and suicidal behaviour (mental disturbance) and exposure to GBV and its first occurrence based on the Composite International Diagnostic Interview Version 3 (WMH-CIDI 3.0). We used the Kaplan-Meier method to derive cumulative incident curves for first onset mental disturbance. The two derived subgroups were women who experienced GBV without prior mental disturbance; and women never exposed to GBV stratified to match the former group on age and socio-economic status. RESULTS: For women with no prior mental disorder, the cumulative incidence curves showed a high incidence of all mental disturbances following first GBV, compared to women without exposure to GBV (all log rank tests <0.0001). Nearly two fifths (37%) of any lifetime mental disturbance had onset in the year following first GBV in women exposed to abuse. For these women, over half (57%) of cases of lifetime PTSD had onset in the same time interval. For GBV exposed women, half of all cases of mental disturbance (54%) and two thirds of cases of PTSD (66.9%) had onset in the five years following first abuse. In contrast, there was a low prevalence of onset of mental disturbance in the comparable imputed time to event period for women never exposed to GBV (for any mental disturbance, 1% in the first year, 12% in five years; for PTSD 3% in the first year, 7% in five years). CONCLUSIONS: Amongst women without prior mental disturbance, common mental disorders and suicidal behaviour have a high rate of onset in the one and five year intervals following exposure to GBV. There is a particularly high incidence of PTSD in the first year following GBV.
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    The effect of group involvement on post-disaster mental health: A longitudinal multilevel analysis
    Gallagher, HC ; Block, K ; Gibbs, L ; Forbes, D ; Lusher, D ; Molyneaux, R ; Richardson, J ; Pattison, P ; MacDougall, C ; Bryant, RA (PERGAMON-ELSEVIER SCIENCE LTD, 2019-01)
    Involvement in voluntary associations is a key form of social capital and plays an especially important role following disaster as a venue for coordination and decision-making for the wider community. Yet, relatively little attention has been paid to how group involvement affects mental health, at either the individual or community level. The aim of this study was to assess the impact of involvement in voluntary associations on mental health among residents of bushfire-affected communities. A longitudinal sample of 642 individuals affected by the 2009 Victorian bushfires in south-eastern Australia were surveyed in 2012 and 2014 (3- and 5-years post-disaster). A further subsample (n = 552) of residents residing continuously within 22 bushfire-affected communities were examined for community-level effects using multilevel regression methods. After adjusting for demographics, disaster exposure, and network variables, group involvement at time 1 bore a curvilinear relationship with PTSD at both time points: moderate involvement was most beneficial, with no participation, or high amounts, yielding poorer outcomes. High amounts of group involvement was likewise linked to a greater risk of major depression. Furthermore, communities with higher median levels of group involvement reported lower levels of PTSD symptoms and major depression two years later. With respect to group involvement, more is not always better. For individuals, moderation - if possible - is key. Meanwhile, community-level health benefits come when most people participate to some extent, suggesting that the distribution of involvement across the community is important.
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    Delayed Disaster Impacts on Academic Performance of Primary School Children
    Gibbs, L ; Nursey, J ; Cook, J ; Ireton, G ; Alkemade, N ; Roberts, M ; Gallagher, HC ; Bryant, R ; Block, K ; Molyneaux, R ; Forbes, D (WILEY, 2019-07)
    Social disruption caused by natural disasters often interrupts educational opportunities for children. However, little is known about children's learning in the following years. This study examined change in academic scores for children variably exposed to a major bushfire in Australia. Comparisons were made between children attending high, medium, and low disaster-affected primary schools 2-4 years after the disaster (n = 24,642; 9-12 years). The results showed that in reading and numeracy expected gains from Year 3 to Year 5 scores were reduced in schools with higher levels of bushfire impact. The findings highlight the extended period of academic impact and identify important opportunities for intervention in the education system to enable children to achieve their academic potential.
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    Identifying distinctive psychological symptom profiles among a nationally representative sample of refugees resettled in Australia
    Nickerson, A ; Hadzi-Pavlovic, D ; Edwards, B ; O'Donnell, M ; Creamer, M ; Felmingham, KL ; Forbes, D ; McFarlane, AC ; Silove, D ; Steel, Z ; van Hoof, M ; Bryant, RA (SAGE PUBLICATIONS LTD, 2019-09)
    OBJECTIVE: The number of refugees worldwide is unprecedented in recent history. Little is known, however, about profiles of psychological symptoms following persecution and displacement. METHODS: This study reports on a latent class analysis that identified profiles of posttraumatic stress disorder (PTSD), depression and anxiety symptoms in a nationally representative sample of 1625 refugees in Australia. The association between specific symptom profiles, exposure to potentially traumatic events and post-migration stressors, and overall health and help-seeking was examined. RESULTS: Latent class analysis yielded an optimal five-class solution. These classes comprised the Pervasive Symptom class (19.2%), the High PTSD Symptom class (17.1%), the High Depression/Anxiety Symptom class (16.4%), the Moderate PTSD Symptom class (16.2%) and the Low Symptom class (31.1%). Participants in the symptomatic classes were more likely to be female, older and report greater post-migration stressors than those in the Low Symptom class. In addition, individuals in classes characterized by PTSD symptoms had been exposed to more types of potentially traumatic events. Membership in symptomatic classes was associated with poorer overall heath and greater help-seeking. CONCLUSION: Qualitatively distinct symptom profiles were observed in a nationally representative sample of refugees. In addition to a group of people who reported high symptoms across psychological disorders and may warrant clinical intervention, we identified two subclinical classes who may be missed by existing diagnostic classification systems. Post-migration stressors play an important role in influencing refugee symptom profiles over and above exposure to potentially traumatic events. Clinicians should consider specific symptom profiles and contextual factors when planning interventions with refugees.
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    Association of Economic Status and Educational Attainment With Posttraumatic Stress Disorder A Mendelian Randomization Study
    Polimanti, R ; Ratanatharathorn, A ; Maihofer, AX ; Choi, KW ; Stein, MB ; Morey, RA ; Logue, MW ; Nievergelt, CM ; Stein, DJ ; Koenen, KC ; Gelernter, J ; Klengel, T ; Atkinson, EG ; Chen, C-Y ; Coleman, JRI ; Dalvie, S ; Duncan, LE ; Provost, AC ; Torres, K ; Aiello, AE ; Almli, LM ; Amstadter, AB ; Andersen, SB ; Andreassen, OA ; Arbisi, PA ; Ashley-Koch, AE ; Austin, SB ; Avdibegovic, E ; Babic, D ; Baekvad-Hansen, M ; Baker, DG ; Beckham, JC ; Bierut, LJ ; Bisson, JI ; Boks, MP ; Bolger, EA ; Borglum, AD ; Bradley, B ; Brashear, M ; Breen, G ; Bryant, RA ; Bustamante, AC ; Bybjerg-Grauholm, J ; Calabrese, JR ; Caldas-de-Almeida, JM ; Dale, AM ; Daly, MJ ; Daskalakis, NP ; Deckert, J ; Delahanty, DL ; Dennis, MF ; Disner, SG ; Domschke, K ; Dzubur-Kulenovic, A ; Erbes, CR ; Evans, A ; Farrer, LA ; Feeny, NC ; Flory, JD ; Forbes, D ; Franz, CE ; Galea, S ; Garrett, ME ; Gelaye, B ; Gelernter, J ; Geuze, E ; Gillespie, C ; Uka, AG ; Gordon, SD ; Guffanti, G ; Hammamieh, R ; Harnal, S ; Hauser, MA ; Heath, AC ; Hemmings, SMJ ; Hougaard, DM ; Jakovljevic, M ; Jett, M ; Johnson, EO ; Jones, I ; Jovanovic, T ; Qin, X-J ; Junglen, AG ; Karstoft, K-I ; Kaufman, ML ; Kessler, RC ; Khan, A ; Kimbrel, NA ; King, AP ; Koen, N ; Kranzler, HR ; Kremen, WS ; Lawford, BR ; Lebois, LAM ; Lewis, CE ; Linnstaedt, SD ; Lori, A ; Lugonja, B ; Luykx, JJ ; Lyons, MJ ; Maples-Keller, J ; Marmar, C ; Martin, AR ; Martin, NG ; Maurer, D ; Mavissakalian, MR ; McFarlane, A ; McGlinchey, RE ; McLaughlin, KA ; McLean, SA ; McLeay, S ; Mehta, D ; Milberg, WP ; Miller, MW ; Morris, CP ; Mors, O ; Mortensen, PB ; Neale, BM ; 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 ; Ripke, S ; Risbrough, VB ; Roberts, AL ; Rothbaum, AO ; Rothbaum, BO ; Roy-Byrne, P ; Ruggiero, K ; Rung, A ; Rutten, BPF ; Saccone, NL ; Sanchez, SE ; Schijven, D ; Seedat, S ; Seligowski, AV ; Seng, JS ; Sheerin, CM ; Silove, D ; Smith, AK ; Smoller, JW ; Solovieff, N ; Sponheim, SR ; Stein, DJ ; Sumner, JA ; 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 ; Wolff, JD ; Yehuda, R ; Young, KA ; Young, RM ; Zhao, H ; Zoellner, LA ; Liberzon, I ; Ressler, KJ ; Haas, M ; Koenen, KC (AMER MEDICAL ASSOC, 2019-05)
    IMPORTANCE: There is a well-established negative association of educational attainment (EA) and other traits related to cognitive ability with posttraumatic stress disorder (PTSD), but the underlying mechanisms are poorly understood. OBJECTIVES: To investigate the association of PTSD with traits related to EA. DESIGN, SETTING, AND PARTICIPANTS: Genetic correlation, polygenic risk scoring, and mendelian randomization (MR) were conducted including 23 185 individuals with PTSD and 151 309 control participants from the Psychiatric Genomics Consortium for PTSD and up to 1 131 881 individuals assessed for EA and related traits from UK Biobank, 23andMe, and the Social Science Genetic Association Consortium. Data were analyzed from July 3 through November 19, 2018. MAIN OUTCOMES AND MEASURES: Genetic correlation obtained from linkage disequilibrium score regression, phenotypic variance explained by polygenic risk scores, and association estimates from MR. RESULTS: Summary association data from multiple genome-wide association studies were available for a total of 1 180 352 participants (634 391 [53.7%] women). Posttraumatic stress disorder showed negative genetic correlations with EA (rg = -0.26; SE = 0.05; P = 4.60 × 10-8). Mendelian randomization analysis, conducting considering a random-effects inverse-variance weighted method, indicated that EA has a negative association with PTSD (β = -0.23; 95% CI, -0.07 to -0.39; P = .004). Investigating potential mediators of the EA-PTSD association, propensity for trauma exposure and risk-taking behaviors were observed as risk factors for PTSD independent of EA (trauma exposure: β = 0.37; 95% CI, 0.19 to 0.52; P = 2.57 × 10-5; risk-taking: β = 0.76; 95% CI, 0.38 to 1.13; P = 1.13 × 10-4), while income may mediate the association of EA with PSTD (MR income: β = -0.18; 95% CI, -0.29 to -0.07; P = .001; MR EA: β = -0.23; 95% CI, -0.39 to -0.07; P = .004; multivariable MR income: β = -0.32; 95% CI, -0.57 to 0.07; P = .02; multivariable MR EA: β = -0.04; 95% CI, -0.29 to 0.21; SE, 0.13; P = .79). CONCLUSIONS AND RELEVANCE: Large-scale genomic data sets add further evidence to the negative association of EA with PTSD, also supporting the role of economic status as a mediator in the association observed.
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    Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward
    Forbes, D ; Pedlar, D ; Adler, AB ; Bennett, C ; Bryant, R ; Busuttil, W ; Cooper, J ; Creamer, MC ; Fear, NT ; Greenberg, N ; Heber, A ; Hinton, M ; Hopwood, M ; Jetly, R ; Lawrence-Wood, E ; McFarlane, A ; Metcalf, O ; O'Donnell, M ; Phelps, A ; Richardson, JD ; Sadler, N ; Schnurr, PP ; Sharp, M-L ; Thompson, JM ; Ursano, RJ ; Van Hooff, M ; Wade, D ; Wessely, S (TAYLOR & FRANCIS LTD, 2019-01-02)
    Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health.
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    A population study of prolonged grief in refugees
    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 (Cambridge University Press, 2019)
    AIMS: Despite the frequency that refugees suffer bereavement, there is a dearth of research into the prevalence and predictors of problematic grief reactions in refugees. To address this gap, this study reports a nationally representative population-based study of refugees to determine the prevalence of probable prolonged grief disorder (PGD) and its associated problems. METHODS: This study recruited participants from the Building a New Life in Australia (BNLA) prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015-2016, and comprised 1767 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, probable PGD, post-traumatic stress disorder (PTSD) and mental illness. Children were administered the Strengths and Difficulties Questionnaire. RESULTS: In this cohort, 38.1% of refugees reported bereavement, of whom 15.8% reported probable PGD; this represents 6.0% of the entire cohort. Probable PGD was associated with a greater likelihood of mental illness, probable PTSD, severe mental illness, currently unemployed and reported disability. Children of refugees with probable PGD reported more psychological difficulties than those whose parents did not have probable PGD. Probable PGD was also associated with the history of imprisonment, torture and separation from family. Only 56.3% of refugees with probable PGD had received psychological assistance. CONCLUSIONS: Bereavement and probable PGD appear highly prevalent in refugees, and PGD seems to be associated with disability in the refugees and psychological problems in their children. The low rate of access to mental health assistance for these refugees highlights that there is a need to address this issue in refugee populations.
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    Adjustment of refugee children and adolescents in Australia: outcomes from wave three of the Building a New Life in Australia study
    Lau, W ; Silove, D ; Edwards, B ; Forbes, D ; Bryant, R ; McFarlane, A ; Hadzi-Pavlovic, D ; Steel, Z ; Nickerson, A ; Van Hooff, M ; Felmingham, K ; Cowlishaw, S ; Alkemade, N ; Kartal, D ; O'Donnell, M (BMC, 2018-09-04)
    BACKGROUND: High-income countries like Australia play a vital role in resettling refugees from around the world, half of whom are children and adolescents. Informed by an ecological framework, this study examined the post-migration adjustment of refugee children and adolescents 2-3 years after arrival to Australia. We aimed to estimate the overall rate of adjustment among young refugees and explore associations with adjustment and factors across individual, family, school, and community domains, using a large and broadly representative sample. METHODS: Data were drawn from Wave 3 of the Building a New Life in Australia (BNLA) study, a nationally representative, longitudinal study of settlement among humanitarian migrants in Australia. Caregivers of refugee children aged 5-17 (N = 694 children and adolescents) were interviewed about their children's physical health and activity, school absenteeism and achievement, family structure and parenting style, and community and neighbourhood environment. Parent and child forms of the Strengths and Difficulties Questionnaire (SDQ) were completed by caregivers and older children to assess social and emotional adjustment. RESULTS: Sound adjustment according to the SDQ was observed regularly among young refugees, with 76-94% (across gender and age) falling within normative ranges. Comparison with community data for young people showed that young refugees had comparable or higher adjustment levels than generally seen in the community. However, young refugees as a group did report greater peer difficulties. Bivariate and multivariate linear regression analyses showed that better reported physical health and school achievement were associated with higher adjustment. Furthermore, higher school absenteeism and endorsement of a hostile parenting style were associated with lower adjustment. CONCLUSIONS: This is the first study to report on child psychosocial outcomes from the large, representative longitudinal BNLA study. Our findings indicate sound adjustment for the majority of young refugees resettled in Australia. Further research should examine the nature of associations between variables identified in this study. Overall, treating mental health problems early remains a priority in resettlement. Initiatives to enhance parental capability, physical health, school achievement and participation could assist to improve settlement outcomes for young refugees.