Psychiatry - Research Publications

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    Attention-control training as an early intervention for veterans leaving the military: A pilot randomized controlled trial
    Metcalf, O ; O'Donnell, ML ; Forbes, D ; Bar-Haim, Y ; Hodson, S ; Bryant, RA ; McFarlane, AC ; Morton, D ; Poerio, L ; Naim, R ; Varker, T (WILEY, 2022-08)
    Transitioning out of the military can be a time of change and challenge. Research indicates that altered threat monitoring in military populations may contribute to the development of psychopathology in veterans, and interventions that adjust threat monitoring in personnel leaving the military may be beneficial. Australian Defence Force personnel (N = 59) transitioning from the military were randomized to receive four weekly sessions of either attention-control training or a placebo attention training. The primary outcome was symptoms of posttraumatic stress disorder (PTSD), as measured using the PTSD Checklist for DSM-5 (PCL-5) at posttreatment. Following training, participants who received attention-control training reported significantly lower levels of PTSD symptoms, Hedges' g = 0.86, 95% CI [0.37, 1.36], p = .004, and significantly improved work and social functioning, Hedges' g = 0.93, 95% CI [0.46, 1.39], p = .001, relative to those in the placebo condition. Moreover, no participants who received attention-control training worsened with regard to PTSD symptoms, whereas 23.8% of those who received the placebo attention training experienced an increase in PTSD symptoms. The preliminary findings from this pilot study add to a small body of evidence supporting attention-control training as a viable indicated early intervention approach for PTSD that is worthy of further research.
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    The mental health of Farsi-Dari speaking asylum- seeking children and parents facing insecure residency in Australia
    Rostami, R ; Wells, R ; Solaimani, J ; Berle, D ; Hadzi-Pavlovic, D ; Silove, D ; Nickerson, A ; O'Donnell, M ; Bryant, R ; McFarlane, A ; Steel, Z (ELSEVIER, 2022-10)
    BACKGROUND: This research examined the mental health of a cohort of asylum-seeking children, adolescents and their primary caregiver affected by insecure residency while living in the community, compared to refugees and immigrants. METHODS: The project investigated the prevalence of psychosocial problems among Iranian and Afghani asylum seeker, refugee and immigrant children and adolescents, and their caregivers who arrived in Australia from 2010. In total, n=196 children and adolescents aged 5-18 years, and their primary caregiver were asked about family visa status, country of origin, level of education, parent symptoms of posttraumatic stress disorder (Harvard Trauma Questionnaire) and child wellbeing (Strengths and Difficulties Questionnaire). An additional n=362 Farsi and Dari speaking children, recruited through the Building a New Life in Australia (BNLA) study, a national comparison sample of families with permanent refugee visas, were included. FINDINGS: Asylum seeker children and adolescents displayed significantly more psychosocial problems compared to those with full refugee protection and immigrant background within the current sample and when benchmarked against a national sample of Farsi-Dari speaking refugee children. Higher parental posttraumatic stress disorder symptoms was associated with poorer child and adolescent psychosocial functioning. This effect was more marked in families with insecure residency. INTERPRETATION: Insecure visa status is associated with higher rates of children's mental health problems and a stronger association with parental PTSD symptoms compared to children with secure residency. This raises important questions about Australia's restrictive immigration policies. FUNDING: This project was supported by an Australian Rotary Health Research Fund / Mental Health of Young Australians Research Grant and by the Australian Research Council (DP160104378).
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    Impact of displacement context on psychological distress in refugees resettled in Australia: a longitudinal population-based study
    Nickerson, A ; Kashyap, S ; Keegan, D ; Edwards, B ; Forrest, W ; Bryant, RA ; O'Donnell, M ; Felmingham, K ; McFarlane, AC ; Tol, WA ; Lenferink, L ; Hoffman, J ; Liddell, BJ (CAMBRIDGE UNIV PRESS, 2022-07-12)
    AIMS: Refugees typically spend years in a state of protracted displacement prior to permanent resettlement. Little is known about how various prior displacement contexts influence long-term mental health in resettled refugees. In this study, we aimed to determine whether having lived in refugee camps v. community settings prior to resettlement impacted the course of refugees' psychological distress over the 4 years following arrival in Australia. METHODS: Participants were 1887 refugees who had taken part in the Building a New Life in Australia study, which comprised of five annual face-to-face or telephone surveys from the year of first arrival in Australia. RESULTS: Latent growth curve modelling revealed that refugees who had lived in camps showed greater initial psychological distress (as indexed by the K6) and faster decreases in psychological distress in the 4 years after resettling in Australia, compared to those who had lived in community settings. Investigation of refugee camp characteristics revealed that poorer access to services in camps was associated with greater initial distress after resettlement, and greater ability to meet one's basic needs in camps was associated with faster decreases in psychological distress over time. CONCLUSIONS: These findings highlight the importance of the displacement context in influencing the course of post-resettlement mental health. Increasing available services and meeting basic needs in the displacement environment may promote better mental health outcomes in resettled refugees.
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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 ; Belanger, 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 ; Van Hooff, M ; Wessely, S ; Forbes, D ; Pedlar, D (PERGAMON-ELSEVIER SCIENCE LTD, 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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    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, 2021-08)
    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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    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, 2021-09)
    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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    Genomic influences on self-reported childhood maltreatment
    Dalvie, S ; Maihofer, AX ; Coleman, JR ; Bradley, B ; Breen, G ; Brick, LA ; Chen, C-Y ; Choi, KW ; Duncan, LE ; Guffanti, G ; Haas, M ; Harnal, S ; Liberzon, I ; Nugent, NR ; Provost, AC ; Ressler, KJ ; Torres, K ; Amstadter, AB ; Austin, SB ; Baker, DG ; Bolger, EA ; Bryant, RA ; Calabrese, JR ; Delahanty, DL ; Farrer, LA ; Feeny, NC ; Fiore, JD ; Forbes, D ; Galea, S ; Gautam, A ; Gelernter, J ; Hammamieh, R ; Jett, M ; Junglen, AG ; Kaufman, ML ; Kessler, RC ; Khan, A ; Kranzler, HR ; Lebois, LAM ; Marmar, C ; Mavissakalian, MR ; McFarlane, A ; O'Donnell, M ; Orcutt, HK ; Pietrzak, RH ; Risbrough, VB ; Roberts, AL ; Rothbaum, AO ; Roy-Byrne, P ; Ruggiero, K ; Seligowski, A ; Sheerin, CM ; Silove, D ; Smoller, JW ; Stein, MB ; Teicher, MH ; Ursano, RJ ; Van Hooff, M ; Winternitz, S ; Wolff, JD ; Yehuda, R ; Zhao, H ; Zoellner, LA ; Stein, DJ ; Koenen, KC ; Nievergelt, CM (SPRINGERNATURE, 2020-01-27)
    Childhood maltreatment is highly prevalent and serves as a risk factor for mental and physical disorders. Self-reported childhood maltreatment appears heritable, but the specific genetic influences on this phenotype are largely unknown. The aims of this study were to (1) identify genetic variation associated with self-reported childhood maltreatment, (2) estimate SNP-based heritability (h2snp), (3) assess predictive value of polygenic risk scores (PRS) for childhood maltreatment, and (4) quantify genetic overlap of childhood maltreatment with mental and physical health-related phenotypes, and condition the top hits from our analyses when such overlap is present. Genome-wide association analysis for childhood maltreatment was undertaken, using a discovery sample from the UK Biobank (UKBB) (n = 124,000) and a replication sample from the Psychiatric Genomics Consortium-posttraumatic stress disorder group (PGC-PTSD) (n = 26,290). h2snp for childhood maltreatment and genetic correlations with mental/physical health traits were calculated using linkage disequilibrium score regression. PRS was calculated using PRSice and mtCOJO was used to perform conditional analysis. Two genome-wide significant loci associated with childhood maltreatment (rs142346759, p = 4.35 × 10-8, FOXP1; rs10262462, p = 3.24 × 10-8, FOXP2) were identified in the discovery dataset but were not replicated in PGC-PTSD. h2snp for childhood maltreatment was ~6% and the PRS derived from the UKBB was significantly predictive of childhood maltreatment in PGC-PTSD (r2 = 0.0025; p = 1.8 × 10-15). The most significant genetic correlation of childhood maltreatment was with depressive symptoms (rg = 0.70, p = 4.65 × 10-40), although we show evidence that our top hits may be specific to childhood maltreatment. This is the first large-scale genetic study to identify specific variants associated with self-reported childhood maltreatment. Speculatively, FOXP genes might influence externalizing traits and so be relevant to childhood maltreatment. Alternatively, these variants may be associated with a greater likelihood of reporting maltreatment. A clearer understanding of the genetic relationships of childhood maltreatment, including particular abuse subtypes, with a range of phenotypes, may ultimately be useful in in developing targeted treatment and prevention strategies.
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    An Open Label Pilot Study of a Brief Psychosocial Intervention for Disaster and Trauma Survivors
    O'Donnell, ML ; Lau, W ; Fredrickson, J ; Gibson, K ; Bryant, RA ; Bisson, J ; Burke, S ; Busuttil, W ; Coghlan, A ; Creamer, M ; Gray, D ; Greenberg, N ; McDermott, B ; McFarlane, AC ; Monson, CM ; Phelps, A ; Ruzek, JI ; Schnurr, PP ; Ugsang, J ; Watson, P ; Whitton, S ; Williams, R ; Cowlishaw, S ; Forbes, D (FRONTIERS MEDIA SA, 2020-06-26)
    BACKGROUND: In the aftermath of disaster, a large proportion of people will develop psychosocial difficulties that impair recovery, but for which presentations do not meet threshold criteria for disorder. Although these adjustment problems can cause high distress and impairment, and often have a trajectory towards mental health disorder, few evidence-based interventions are available to facilitate recovery. OBJECTIVE: This paper describes the development and pilot testing of an internationally developed, brief, and scalable psychosocial intervention that targets distress and poor adjustment following disaster and trauma. METHOD: The Skills fOr Life Adjustment and Resilience (SOLAR) program was developed by an international collaboration of trauma and disaster mental health experts through an iterative expert consensus process. The resulting five session, skills-based intervention, deliverable by community-based or frontline health or disaster workers with little or no formal mental health training (known as coaches), was piloted with 15 Australian bushfire survivors using a pre-post with follow up, mixed-methods design study. RESULTS: Findings from this pilot demonstrated that the SOLAR program was safe and feasible for non-mental health frontline workers (coaches) to deliver locally after two days of training. Participants' attendance rates and feedback about the program indicated that the program was acceptable. Pre-post quantitative analysis demonstrated reductions in psychological distress, posttraumatic stress symptoms, and impairment. CONCLUSIONS: This study provides preliminary evidence that the delivery of the SOLAR program after disaster by trained, frontline workers with little or no mental health experience is feasible, acceptable, safe, and beneficial in reducing psychological symptoms and impairment among disaster survivors. Randomized controlled trials of the SOLAR program are required to advance evidence of its efficacy.