Psychiatry - Research Publications
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ItemNo Preview AvailableStressors and Supports in Postdisaster Recovery: Experiences After the Black Saturday Bushfires(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2021-07-03)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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ItemSecure attachment primes reduce fear consolidation(WILEY, 2021-10)BACKGROUND: Recent studies have found that attachment security primes can inhibit fear acquisition. This current study aimed to examine whether a brief imaginal prime of one's attachment figure could impact on fear consolidation. METHODS: A total of 75 participants underwent fear conditioning on Day 1 and fear recall was tested on Day 2. Immediately following conditioning, half the participants were instructed to imagine an attachment figure while the other half imagined a nonattachment positive situation. Fear-potentiated startle and subjective expectancy of shock ratings were used as the measures of fear learning across trials. RESULTS: The attachment group showed significantly lower levels of fear recall on Day 2 at both physiological and subjective levels. Furthermore, this effect was moderated by attachment anxiety, such that it was greatest for individuals who were securely attached. CONCLUSIONS: These findings suggest that attachment relationships are protective during the consolidation of fear memories, and may have implications for how social attachments may impact how anxiety disorders can develop.
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ItemInvestigating neural circuits of emotion regulation to distinguish euthymic patients with bipolar disorder and major depressive disorder.(Wiley, 2021-05)BACKGROUND: Up to 40% of patients with bipolar disorder (BD) are initially diagnosed as having major depressive disorder (MDD), and emotional lability is a key aspect of both sets of mood disorders. However, it remains unknown whether differences in the regulation of emotions through cognitive reappraisal may serve to distinguish BD and MDD. Therefore, we examined this question in euthymic BD and MDD patients. METHODS: Thirty-eight euthymic BD, 33 euthymic MDD and 37 healthy control (HC) participants, matched for age, gender and depression severity, engaged in an emotion regulation (ER) cognitive reappraisal task during an fMRI scan were examined. Participants either reappraised (Think condition) or passively watched negative (Watch condition) or neutral (Neutral condition) pictures and rated their affect. Activation and connectivity analyses were used to examine group differences in reappraisal (Think vs Watch) and reactivity (Watch vs Neutral) conditions in ER-specific neural circuits. RESULTS: Irrespective of group, participants rated most negatively the images during the Watch condition relative to Think and Neutral conditions, and more negatively to Think relative to Neutral. Notably, BD participants exhibited reduced subgenual anterior cingulate activation (sgACC) relative to MDD during reappraisal, but exhibited greater sgACC activation relative to MDD during reactivity, whereas MDD participants elicited greater activation in right amygdala relative to BD during reactivity. We found no group differences in task-related connectivity. CONCLUSIONS: Euthymic BD and MDD patients engage differential brain regions to process and regulate emotional information. These differences could serve to distinguish the clinical groups and provide novel insights into the underlying pathophysiology of BD.
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ItemNo Preview AvailableA critical review of mechanisms of adaptation to trauma: Implications for early interventions for posttraumatic stress disorder.(Elsevier BV, 2021-04)Although many attempts have been made to limit development of posttraumatic stress disorder (PTSD) by early intervention after trauma exposure, these attempts have achieved only modest success. This review critiques the biological and cognitive strategies used for early intervention and outlines the extent to which they have prevented PTSD. The major predictors of PTSD are reviewed, with an emphasis on potential mechanisms that may underpin the transition from acute stress reaction to development of PTSD. This review highlights that there is a wide range of biological and cognitive factors that have been shown to predict PTSD. Despite this, the major attempts at early intervention have focused on strategies that attempt to augment extinction processes or alter appraisals in the acute period. The documented predictors of PTSD indicate that a broader range of potential strategies could be explored to limit PTSD. The evidence that people follow different trajectories of stress response following trauma and there is a wide array of acute predictors of PTSD indicates that a flexible and tailored approach needs to be investigated to evaluate more effective early intervention strategies.
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ItemMental health screening amongst police officers: factors associated with under-reporting of symptoms.(Springer Science and Business Media LLC, 2021-03-08)BACKGROUND: Mental health screening in the workplace aims to identify employees who are becoming symptomatic, in order to provide timely support and evidence-based interventions to those affected. Given the stigma associated with mental illness, accurate disclosure of mental health symptoms cannot be assumed. The present study sought to investigate factors associated with the accurate reporting of mental health symptoms amongst police officers. METHODS: A total of 90 serving police officers completed identical mental health screening surveys, one administered by the employer and the other anonymously by an independent organisation. Responses were then linked to compare differences in the number and severity of mental health symptoms reported on each questionnaire. RESULTS: Comparisons of matched self-report scores indicated that employees under-reported symptoms of mental health disorders when completing screening administered by their employer, with only 76.3% of symptoms declared. Under-reporting occurred regardless of gender and symptom type. Less senior staff (p = 0.05) and those with the most severe post-traumatic stress disorder and common mental disorder symptoms (p = 0.008) were significantly more likely to under-report symptoms. CONCLUSIONS: Employer-administered mental health screening is not able to accurately capture all mental health symptoms amongst first responders. The fact that the severity of symptoms predicted the level of under-reporting means that simple changes to cut-off values cannot correct this problem.
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ItemNovel insights into irritability: the relationship between subjective experience, age and mood(CAMBRIDGE UNIV PRESS, 2021-10-28)BACKGROUND: The relationship between irritability as a subjective experience and the behavioural indicators typically used to measure the construct are not known. Its links to mood, and contextual relationships, vary with age and are yet to be thoroughly examined. AIMS: First, to interrogate the relationship between the subjective experience of irritability and mood, and that with its behavioural indicators. Second, to determine how these relationships vary with age and over time. METHOD: This study examined data from a previous clinical trial of adolescents and young adults (N = 82) with bipolar disorder, who received a psychological intervention over 18 months. Participants completed a battery of questionnaires, which included assessments of irritability. Analyses of covariance were conducted to examine the interaction between mood symptoms, subjective measures of irritability, behavioural measures of irritability and age over time. RESULTS: Subjective irritability scores differed significantly over time when controlling for manic, but not depressive, symptom scores. Further, subjective irritability significantly differed when controlling for behavioural measures of irritability (temper outbursts and argumentativeness). There were significant interactions between scores of depressive symptoms, temper outbursts and subjective irritability with age, wherein younger participants showed no correlation between depressive symptoms and temper outbursts. In addition, younger participants showed lower correlations between subjective irritability and both depressive and temper outburst scores, than older participants. CONCLUSIONS: Subjective irritability is linked to mood morbidity and behavioural outbursts, and these relationships are contingent on age. Our novel findings suggest that subjective irritability should be assessed in greater detail in patients with mood disorders.
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ItemAn exploratory study of embitterment in traumatized refugees.(Springer Science and Business Media LLC, 2021-06-10)BACKGROUND: Refugees and asylum seekers are frequently exposed to violence, human rights violations and unstable living conditions before, during, and after their displacement. Elevated prevalence rates of psychiatric disorders in forcibly displaced persons are well documented. However, less is known about other problems related to common refugee experiences, such as embitterment, moral injury, and diminished self-efficacy, and how they are related to trauma exposure and post-migration living difficulties. METHODS: A cross-sectional sample of 71 refugees and asylum seekers in treatment were examined regarding exposure to potentially traumatic events, post-migration living difficulties, moral injury appraisals, self-efficacy, and embitterment. RESULTS: Elevated levels of embitterment were reported by 68% of participants. The regression analysis revealed that greater moral injury appraisals and low levels of self-efficacy were significantly associated with higher levels of embitterment. CONCLUSION: The results provide first insights into embitterment and associated factors in refugee populations. Furthermore, they highlight the significance of moral transgressions and low levels of self-efficacy emerging from displacement and traumatic experiences for the development of mental health problems in a clinical sample of refugees. The findings have implications for future research, policy development and clinical practice.
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ItemEffect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial.(Springer Science and Business Media LLC, 2021-01-19)BACKGROUND: In many low resource settings, the provision of government mental health care services is limited to specialized psychiatry units in urban hospital care facilities, where the most common treatment for common mental disorders (CMDs) is pharmacotherapy, occasionally with adjunct nonspecific psychological support. We aimed to evaluate the effectiveness of adding a low intensity, psychological intervention, Problem Management Plus (PM+) for CMDs into routine care in a specialized mental health care facility in Pakistan. METHODS: A two arm, single-blind individual randomized controlled trial (RCT) was carried out with adults (N = 192), referred for psychological support by psychiatrists. The study participants were randomized (1:1) to PM + plus Treatment as Usual (TAU) (n = 96) or TAU only (n = 96). The primary outcomes were symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS) and functional impairment as measured by WHO Disability Assessment Schedule (WHODAS 2.0) at 20 weeks after baseline. RESULTS: The analysis was done on intention-to-treat principle. The linear mixed model analysis showed that at 20 weeks after baseline, there was a significant reduction in symptoms of anxiety and depression (mean [SD], 16.23 [8.81] vs 19.79 [7.77]; AMD, - 3.10; 95% CI, - 0.26 to - 5.76); p = 0.03 and improvement in functioning (mean [SD], 22.94 [9.37] vs 27.37 [8.36]; AMD, - 4.35; 95% CI, - 1.45 to - 7.24); p = 0.004 in PM + plus TAU versus TAU arm. The follow-up rate was 67% at primary end-point. CONCLUSIONS: Specialized care facilities in LMICs may consider adding brief, evidence-based psychological treatments for CMDs to their routine care. Trial Registration Australian New Zealand Clinical Trials Registry, ACTRN12616000381482. Registered March 23, 2016. Retrospectively registered, https://www.anzctr.org.au/Default.aspx/ ACTRN12616000381482.
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ItemA longitudinal study of mental health before and during the COVID-19 pandemic in Syrian refugees(TAYLOR & FRANCIS LTD, 2021-01-01)BACKGROUND: The COVID-19 pandemic has resulted in increased anxiety and depression around the world. Refugees may be particularly vulnerable to the mental health effects of the pandemic because of their higher rates of mental health disorders, trauma histories, and daily stressors. OBJECTIVES: This study used data from a controlled trial of a brief behavioural intervention for psychological distress in Syrian refugees living in Azraq Camp in Jordan to examine the psychological effects of the pandemic on refugee mental health. METHOD: A total of 410 participants were randomized to either the intervention or control arms of the trial and were assessed at baseline and 3-month follow-up. Half the sample (199; 48.5%) completed their 3-month follow-up assessment after the pandemic restrictions began in Jordan and 211 (51.5%) completed the assessment prior to the pandemic. Refugees were independently assessed for symptoms of PTSD, anxiety, and depression at baseline and follow-up, and pandemic-related worries were assessed at follow-up for those who completed their assessment during the pandemic. RESULTS: The most commonly reported worries were economic difficulties (82.4%), shortage of essential supplies (71.3%), and infecting others (59.7%) or themselves (51.9%). Refugees who were assessed during the pandemic had less severe PTSD symptoms than those assessed prior to the pandemic. Significant predictors of pandemic-related worries were lower levels of depression prior to the pandemic and greater anxiety during the pandemic. CONCLUSION: These findings highlight the specific needs of refugees during the pandemic and suggest that pre-existing mental health issues may not necessarily be the key risk factors for who will experience major mental health issues or worries during the pandemic.