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Although emotion dysregulation has been robustly associated with posttraumatic stress disorder (PTSD), there is relatively little understanding of this process in refugees. Specifically, longitudinal methodology has not been used to examine the relationship between emotion dysregulation and PTSD among refugees. In this study, we investigated the temporal relationship between emotion dysregulation, postmigration stressors, and PTSD clusters (reexperiencing, avoidance, negative alterations in mood and cognition [NAMC], and hyperarousal) from the fifth edition of the Diagnostic and Statistical Manual of Mental Disordersamong a community sample of refugees (N= 1,081) over a 2-year period. Random intercept cross-lagged panel analysis found that emotion dysregulation was antecedent to within-persons increases in reexperiencing and NAMC symptoms over time and bidirectionally associated with hyperarousal and postmigration stressors. In addition, postmigration stressors were antecedent to within-persons increases in reexperiencing, avoidance, and NAMC and bidirectionally associated with hyperarousal symptoms. Findings provide novel evidence in support of postmigration stressors and emotion dysregulation as mechanisms maintaining PTSD and highlight the potential utility of tailoring interventions to address these factors.

A recent study conducted in Australia revealed the severe impact of offshore and onshore detention on the mental health of people seeking asylum. The study found high rates of post-traumatic stress disorder (PTSD), depression, and suicidal thoughts among individuals who had been previously detained, particularly those who experienced offshore detention. The findings highlight the significant psychological burden of detention, urging other countries to reconsider similar policies and explore evidence-based alternatives to offshore detention. [Extracted from the article]

Objective: To understand the impact of family separation on refugees living in Australia. Method: Thirteen participants with a refugee background and experiencing separation from family participated in a semi‐structured qualitative interview. Interviews were coded and a thematic analysis was conducted using NVivo software. Results: Identified themes were organised under four domains. Domain 1 focused on the personal impact of family separation. Themes were the effects on mental health and functioning, driven by incessant worrying about the safety of family and the absence of key attachment figures, the specific effects of having missing family, alterations to self‐identity and family dynamics. Domain 2 focused on themes relating to actions taken to find missing family, connect or reunite with separated family. Domain 3 highlighted the coping strategies, support mechanisms and protective factors used by participants. Domain 4 identified core beliefs about the importance of family unity, focusing on security, settlement and a happy future. Conclusions: Family separation has an enduring effect on the wellbeing of refugees, with key pathways being ongoing fear and insecurity, disrupted social attachments and identity shifts in relation to the future self. Implications for public health: Refugees separated from or missing family struggle with ongoing stress and adjustment issues.

Moral-injury cognitions (beliefs regarding moral violations) represent a potential mechanism that may underlie the association between potentially morally injurious events (PMIEs) and psychological symptoms in refugees. We implemented a novel experimental paradigm (i.e., the simulation of a PMIE using mental imagery) to investigate the impact of moral-injury cognitions on psychological outcomes in 71 Arabic-speaking refugees. A latent class analysis of preexisting moral-injury beliefs yielded three classes characterized by (a) high moral-injury beliefs about violations by others (49.3%), (b) high moral-injury beliefs about violations by others and by oneself (25.5%), and (c) low moral-injury beliefs (25.5%). Investigation of group differences revealed that the moral-injury classes reported greater negative emotional responses following the simulated PMIE. Furthermore, the association between moral-injury classes and psychological outcomes was moderated by situation-specific blame appraisals of the simulated PMIE. These findings have important implications for psychological interventions for refugees.

Torture trauma is characterized by intentional uncontrollable acts, but the long-term effects of torture exposure on cognitive control brain mechanisms are unknown.

Regulatory selection flexibility—the ability to flexibly choose emotion regulation strategies that are appropriate to dynamic contextual demands—has been theorized as a critical component of adaptive emotional functioning. Despite this, little research has investigated whether individual differences in regulatory selection flexibility influence real-time emotional experiences. The current study aimed to test the effectiveness of regulatory selection flexibility in reducing negative affect while exposed to emotion-eliciting stimuli. Using a behavioral regulatory selection task, participants viewed negative images that differed in emotional intensity and selected between engagement cognitive change (reappraisal) or attentional disengagement (distraction) strategies to manage their emotional responses. Negative affect was rated immediately before and after the regulatory period, to index emotional experience. Greater regulatory selection flexibility was associated with greater reductions in negative affect. Our findings offer preliminary evidence for the immediate psychological benefit of regulatory selection flexibility and highlight some promising avenues for future research.

Disturbed grief, operationalized as persistent complex bereavement disorder (PCBD), correlates with yet differs from posttraumatic stress disorder (PTSD) and depression symptoms. However, knowledge about temporal associations among these symptoms is limited. We aimed to enhance our understanding of the etiology of loss-related distress by examining temporal associations among PCBD, PTSD, and depression symptom levels. Dutch people (N= 172) who lost significant other(s) in a plane disaster completed questionnaires for PCBD, PTSD, and depression 11, 22, 31, and 42 months after the disaster. Cross-lagged analyses revealed that changes in PCBD symptom levels have a greater impact on changes in symptom levels of PTSD and depression than vice versa. Our findings contradict the notion that PTSD and depression symptoms should be addressed before grief in treatment. Pending replication of our findings in clinical samples, we tentatively conclude that screening and treatment of grief symptoms has potential value in preventing long-lasting distress.

Refugees are exposed to multiple traumatic events and postmigration stressors, elevating risk for posttraumatic stress disorder (PTSD), but there is limited research into how these factors affect emotional neural systems. Here, resettled refugees in Australia (N= 85) completed a functional magnetic resonance imaging scan while viewing fear and neutral faces. We examined the influence of PTSD symptoms, cumulative trauma, and recent postmigration stress on neural reactivity and regional coupling within the refugee sample. Cumulative trauma and postmigration stress but not PTSD symptoms correlated with fear-related brain activity and connectivity. Trauma exposure correlated with stronger activity but overall decreased connectivity in the bilateral posterior insula/rolandic operculum, postcentral gyrus, ventral anterior cingulate cortex, and posterior cingulate gyrus. Postmigration stress correlated with fusiform gyrus hyperactivity and increased connectivity in face-processing networks. Findings highlight the impact of past trauma and recent postmigration stress on fear-related neural responses within refugees over and above PTSD symptoms.

Objectives: Current regional conflicts are creating a surge in forced migration, and heightened visa restrictions are increasingly being applied. The current study aimed to examine the relationship between visa insecurity and psychological outcomes within a large clinical sample of refugees and people seeking asylum in Australia. Methods: The sample comprised 781 clients (53.9% male, 16–93 years) attending a clinic for trauma survivors. Country of birth was most frequently identified as Afghanistan (18.1%), Iraq (15.3%) and Iran (15.1%). The Hopkins Symptom Checklist was administered at admission. Results: Latent class analyses identified four groups varying in severity of symptoms, namely very high (16.1%), high (38.1%), moderate (31.5%), and low (14.3%). People with insecure visa status were at least five times more likely to report high (OR = 5.86, p< 0.001) or very high (OR = 5.27, p< 0.01) depression and anxiety symptoms than those with permanent residency. Women were almost twice as likely to report high (OR = 1.96 p< 0.01) or very high (OR = 1.96, p< 0.05) symptoms. Conclusions: The findings suggest that temporary visas play a significant role in psychological distress and that timely immigration processing has important implications for health outcomes.

ABSTRACTBackground:Research has largely focused on the psychological consequences of refugee trauma exposure, but refugees living with visa insecurity face an uncertain future that also adversely affects psychological functioning and self-determination.Objective:This study aimed to examine how refugee visa insecurity affects the functional brain.Method:We measured resting state brain activity via fMRI in 47 refugees with insecure visas (i.e. temporary visa status) and 52 refugees with secure visas (i.e. permanent visa status) residing in Australia, matched on key demographic, trauma exposure and psychopathology. Data analysis comprised independent components analysis to identify active networks and dynamic functional causal modelling tested visa security group differences in network connectivity.Results:We found that visa insecurity specifically affected sub-systems within the default mode network (DMN) – an intrinsic network subserving self-referential processes and mental simulations about the future. The insecure visa group showed less spectral power in the low frequency band in the anterior ventromedial DMN, and reduced activity in the posterior frontal DMN, compared to the secure visa group. Using functional dynamic causal modelling, we observed positive coupling between the anterior and posterior midline DMN hubs in the secure visa group, while the insecure visa group displayed negative coupling that correlated with self-reported fear of future deportation.Conclusions:Living with visa-related uncertainty appears to undermine synchrony between anterior-posterior midline components of the DMN responsible for governing the construction of the self and making mental representations of the future. This could represent a neural signature of refugee visa insecurity, which is marked by a perception of living in limbo and a truncated sense of the future.

Moral injury is not inevitable following exposure to a potentially morally injurious event (PMIE). Since moral injury is associated with poor mental health outcomes, it is clinically important to understand when moral injury develops following PMIE exposure and when it does not. The current study explores associations between both PMIE exposure and moral injury with a range of mental health and functioning outcomes to explore possible differences in comorbidities between those who do, and those who do not go on to develop moral injury following PMIE exposure.

While cognitive reappraisal represents a promising emotion regulation strategy to assist refugees with posttraumatic stress disorder (PTSD) in managing responses to trauma reminders, there has been no experimental research investigating its efficacy in reducing intrusions and negative affect in this group. In this study, 76 refugees and asylum-seekers with varying levels of PTSD received instructions in cognitive reappraisal or emotional suppression before viewing emotional images depicting trauma-related scenes. Findings indicated that cognitive reappraisal led to fewer subsequent image-related intrusions in refugees high in PTSD symptoms. Trait suppression moderated the efficacy of cognitive reappraisal such that participants high in PTSD who had low levels of trait suppression reported significantly lower levels of negative affect when using cognitive reappraisal compared to emotional suppression. These findings highlight the potential utility of cognitive reappraisal when assisting individuals with PTSD to manage responses trauma reminders and for informing the treatment of the psychological effects of the refugee experience.

AbstractAimsRefugees 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.MethodsParticipants 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.ResultsLatent 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.ConclusionsThese 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.

ABSTRACTBackground:The most used questionnaires for PTSD screening in adults were developed in English. Although many of these questionnaires were translated into other languages, the procedures used to translate them and to evaluate their reliability and validity have not been consistently documented. This comprehensive scoping review aimed to compile the currently available translated and evaluated questionnaires used for PTSD screening, and highlight important gaps in the literature.Objective:This review aimed to map the availability of translated and evaluated screening questionnaires for posttraumatic stress disorder (PTSD) for adults.Methods:All peer-reviewed studies in which a PTSD screening questionnaire for adults was translated, and which reported at least one result of a qualitative and /or quantitative evaluation procedure were included. The literature was searched using Embase, MEDLINE, and APA PsycInfo, citation searches and contributions from study team members. There were no restrictions regarding the target languages of the translations. Data on the translation procedure, the qualitative evaluation, the quantitative evaluation (dimensionality of the questionnaire, reliability, and performance), and open access were extracted.Results:A total of 866 studies were screened, of which 126 were included. Collectively, 128 translations of 12 different questionnaires were found. Out of these, 105 (83.3%) studies used a forward and backward translation procedure, 120 (95.2%) assessed the reliability of the translated questionnaire, 60 (47.6%) the dimensionality, 49 (38.9%) the performance, and 42 (33.3%) used qualitative evaluation procedures. Thirty-four questionnaires (27.0%) were either freely available or accessible on request.Conclusions:The analyses conducted and the description of the methods and results varied substantially, making a quality assessment impractical. Translations into languages spoken in middle- or low-income countries were underrepresented. In addition, only a small proportion of all translated questionnaires were available. Given the need for freely accessible translations, an online repository was developed.HIGHLIGHTSWe mapped the availability of translated PTSD screening questionnaires.The quality of the translation and validation processes is very heterogenous.We created a repository for translated, validated PTSD screening questionnaires.

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.

The pervasive negative impact of human rights violations (HRVs) on psychological functioning has been well documented. There is limited research, however, investigating the mechanisms that mediate the link between exposure to HRVs and various mental and behavioral health outcomes. We propose three theory‐ and evidence‐based pathways by which HRVs may lead to psychosocial impairment, namely, disruptions in interpersonal processes, decreased perceptions of control, and the denigration of individual and group identity. We also underscore how the post‐HRVenvironment moderates each of these pathways, and we describe the implications of the proposed model for clinical practice.

The pernicious individual and societal effects of exposure to violence highlight the importance of understanding factors related to trauma perpetration. Little research has investigated the phenomenon of accidental perpetration of serious injury and death, or considered the relationship between perpetration and trauma exposure.

ABSTRACTBackground: The prevalence of mental disorders among asylum seekers and refugees is elevated compared to the general population. The importance of post-migration living difficulties (PMLDs), stressors faced after displacement, has recently been recognized due to research demonstrating their moderating role of on mental health outcomes. Traditionally, PMLDs were investigated as count variables or latent variables, disregarding plausible interrelationships among them.Objectives: To use network analysis to investigate the associations among PMLDs.Methods: Based on a cross-sectional measurement of seventeen PMLDs in a clinical sample of traumatized asylum seekers and refugees (N = 151), a partial correlation network was estimated, and its characteristics assessed.Results: The network consisted of 71 of the 120 possible edges. The strongest edge was found between ‘Communication difficulties’ and ‘Discrimination’. ‘Loneliness, boredom, or isolation’ had highest predictability.Conclusion: Our finding of an association between communication difficulties and discrimination has been documented before and is of importance given the known negative impact of discrimination on mental and physical health outcomes. The high predictability of isolation is indicative of multiple associations with other PMLDs and highlights its importance among the investigated population. Our results are limited by the cross-sectional nature of our study and the relatively modest sample size.

ABSTRACTBackground: Refugees may be especially vulnerable to the adverse effects of COVID-19. Therefore it is critical that refugee communities are supported to access COVID-19 vaccines and for public health responses to address vaccine hesitancy.Objective: To investigate the key demographic factors, barriers and attitudes associated with vaccine hesitancy in a community sample of refugees.Method: Participants in the Refugee Adjustment Study, a cohort of refugees living in Australia, were invited to complete a survey about their COVID-19 vaccine intentions, barriers to access and attitudes relating to the vaccine.Results: Of the 516 participants, 88% were unvaccinated and 28.1% were classed as vaccine hesitant. Key predictors of vaccine hesitancy were younger age, information and trust barriers, lower logistical barriers, and attitudes relating to low control and risk posed by COVID-19.Conclusions: Findings suggest that public health strategies need to address trust, control and risk perception attitudes to increase COVID-19 vaccine uptake in resettled refugee communities.

ABSTRACTBackground: Refugees may be particularly vulnerable to the adverse effects of the COVID-19 pandemic on mental health due to their traumatic pasts and the challenges of the postmigration environment.Objective: To evaluate the prevalence of COVID-19 related stressors and their relationship to key mental health and functioning outcomes in a resettled refugee sample.Method: N= 656 refugees and asylum seekers living in Australia completed a survey in June 2020 to index their mental health (posttraumatic stress disorder (PTSD), depression, health anxiety and disability) and COVID-19 experiences. The relationship between COVID-19 stressors and mental health was examined using a series of hierarchical linear regression models while controlling for other key demographic factors.Results: Refugees’ most prevalent stressors related to worries of being infected by COVID-19 or the risk COVID-19 posed to others, which predicted health anxiety and PTSD. Social-related difficulties predicted depression and disability symptoms. Accessing and trusting information from authorities were the least prevalent stressors and were not significantly associated with mental health outcomes; neither was accessing basic supplies and financial support. Fears relating to the future such as concerns about visa application processes predicted health anxiety and disability. Crucially, the strongest predictor of all mental health outcomes was COVID-19 serving as a reminder of difficult past events.Conclusions: Refugees may be uniquely affected by COVID-19 because the pandemic serves as a reminder of their past conflict and persecution trauma. It is critical that mental health strategies accommodate the specific needs of refugees during the COVID-19 pandemic.

ABSTRACTThis letter provides an update on the activities of “The Global Collaboration on Traumatic Stress” (GC-TS) as first described by Schnyder et al. in 2017. It presents in further detail the projects of the first theme, in particular the development of and initial data on the Global Psychotrauma Screen (GPS), a brief instrument designed to screen for the wide range of potential outcomes of trauma. English language data and ongoing studies in several languages provide a first indication that the GPS is a feasible, reliable and valid tool, a tool that may be very useful in the current pandemic of the coronavirus disease 2019 (COVID-19). Further multi-language and cross-cultural validation is needed.Since the start of the GC-TS, new themes have been introduced to focus on in the coming years: a) Forcibly displaced persons, b) Global prevalence of stress and trauma related disorders, c) Socio-emotional development across cultures, and d) Collaborating to make traumatic stress research data “FAIR”. The most recent theme added is that of Global crises, currently focusing on COVID-19-related projects.

ABSTRACTBackground: Emotion regulation difficulties are common among individuals from refugee backgrounds. Little is known, however, about whether there are specific patterns relating to the types of emotion regulation strategies commonly employed by refugees, nor how this relates to psychopathology. Moreover, wider literature on emotion regulation has primarily focused on examining specific emotion regulation strategies in isolation, rather than patternsof emotion regulation across multiple strategies.Objective: The current study was the first to identify individual differences in patterns of habitual emotion regulation among refugees, and explore their unique associations with trauma exposure and PTSD symptoms.Method: Levels of trait reappraisal and suppression were measured among 93 refugees, using the Emotion Regulation Questionnaire and the White Bear Suppression Inventory. A latent class analysis was conducted to identify distinct classes of participants based on differing levels of habitual engagement in reappraisal and suppression. The association between class membership and key variables indexing refugee experiences (e.g. trauma exposure) and psychopathology (e.g. PTSD symptoms and emotion dysregulation) were also examined.Results: Latent class analysis revealed three distinct profiles of habitual emotion regulation: a high regulators class (55.7%; high trait reappraisal/high trait suppression), an adaptive regulators class (23.6%; high trait reappraisal/moderate trait suppression), and a maladaptive regulators class (20.6%; low trait reappraisal/high trait suppression). Each class evidenced unique relations with trauma exposure and psychopathology. Compared to adaptive regulators, maladaptive regulators had more PTSD symptoms, experienced greater emotion dysregulation, and were more likely to be female, while high regulators had experienced more types of traumatic events.Conclusions: This study identified distinct patterns of emotion regulation among refugees. Our findings demonstrate the importance of measuring multiple strategies to uncover patterns of emotion regulation and better understand the links between emotion regulation and psychopathology, which has important implications for the development of effective treatment with traumatized refugees.

ABSTRACTBackground: Refugees often exhibit reactions to traumatic events that may be conceptualized as moral injury (i.e. the impact of events that violate important moral values). There have been two types of moral injury appraisals found in refugees: transgressions by others and transgressions by oneself.Objective: To examine whether these types of moral injury appraisals co-occur or whether one form is usually predominant. Additionally, to investigate what types of events (trauma, living difficulties) and outcomes (PTSD, depression, anger, suicidality) were associated with each moral injury appraisal profile.Method: Participants included 221 refugees and asylum seekers residing in Australia. Data was collected online, and via pen and paper. A latent profile analysis was used to identify profiles of moral injury appraisals.Results: Results indicated a three-profile solution: Moral Injury-Other (MI-O; 37.8%), Moral Injury Other + Self (MI-OS; 35.2%), and no moral injury (No-MI; 26.9%). MI-O and MI-OS were predicted by both trauma experience and living difficulties. MI-O and MI-OS were also associated with greater psychopathology across all outcome variables compared to No-MI. MI-OS was also associated with greater anger and depression, compared to the MI-O profile. Conclusions: The association between the moral injury appraisal profiles and traumatic events, living difficulties and psychopathology, will have important clinical implications.

ABSTRACTBackground: The vast majority of the world’s refugees and people seeking asylum live in a state of sustained displacement. Little is known, however, about the mental health impact of prolonged insecurity.Objective: This study aimed to investigate the association between insecure visa status and mental health, suicidality, disability and social engagement in a sample of refugees and asylum-seekers living in AustraliaMethod: Participants were 1,085 refugees with secure (i.e. permanent residency or Australian citizenship, n= 826, 76.1%) and insecure (i.e. asylum-seeker claim, bridging visa, temporary visa, n= 259, 23.9%) visa status who had arrived in Australia since January 2011, and were from Arabic, Farsi, Tamil or English-speaking backgrounds. Participants completed an online survey assessing pre- and post-migration experiences, mental health, disability and social engagement.Results: Results indicated that, after controlling for background factors, refugees with insecure visas had significantly greater PTSD symptoms, depression symptoms, thoughts of being better off dead and suicidal intent compared to those with secure visas. There were no group differences in disability. Refugees with insecure visas received support from significantly more groups in the Australian community than those with secure visas. Further, refugees with insecure visa status who had low group membership showed greater depression symptoms and suicidal intent than those with secure visa status who had low group membership.Conclusion: Findings highlight the negative mental health consequences of living in a state of protracted uncertainty for refugees and people seeking asylum, and the key role of social engagement in influencing mental health amongst insecure visa holders. Results also underscore the importance of designing and implementing policies and services that facilitate improved mental health for those with visa insecurity.

ABSTRACTBackground: Network analysis is an emerging methodology for investigating psychopathological symptoms. Given the unprecedented number of refugees and the increased prevalence of mental disorders such as posttraumatic stress disorder (PTSD) in this population, new methodologies that help us better to understand psychopathology in refugees are crucial.Objective: The objective of this study was to explore the network structure and centrality indices of DSM-5 PTSD symptoms in a cross-sectional clinical sample of 151 severely traumatized refugees with and without a formal PTSD diagnosis.Method: The R-packages qgraphand bootnetwere used to estimate the structure of a PTSD symptom network and its centrality indices. In addition, robustness and significance analyses for the edges weights and the order of centrality were performed.Results: Three pairs of symptoms showed significantly stronger connections than at least half of the other connections: hypervigilance and exaggerated startle response, intrusion and difficulties falling asleep, and irritability or outbursts of anger and self-destructive or reckless behaviour. Emotional cue reactivity had the highest centrality and trauma-related amnesia the lowest.Conclusion: Although only 51.0% of participants fulfilled criteria for a probable PTSD diagnosis, emotional cue reactivity showed the highest centrality, emphasizing the importance of emotional trauma reminders in severely traumatized refugees attending an outpatient clinic. However, due to the small sample size, the results should be interpreted with care.

BackgroundRefugees have been shown to present high prevalence rates of trauma-related mental disorders. Despite their psychological impairment, they are expected to meet high functional requirements in terms of social integration into, and financial independence from, the host society.MethodsThis cross-sectional study examined the relationship of mental health problems, post-migration living difficulties (PMLD), and social integration in a sample of 104 refugees seeking treatment for severe posttraumatic stress and comorbid symptoms in two outpatient clinics in Switzerland.ResultsDespite an average time of residence in Switzerland of over 10 years, participants showed poor integration and a high number of PMLD. Integration difficulties were closely associated with psychological symptoms, but not with socio-demographic parameters such as education or visa status.ConclusionsPsychological impairment in treatment-seeking traumatized refugees is associated with poor integration. To foster social integration, it is crucial to better understand and address the specific needs of this highly vulnerable population.

BackgroundThe construct of complex posttraumatic stress disorder (CPTSD) has attracted much research attention in previous years, however it has not been systematically evaluated in individuals exposed to persecution and displacement. Given that CPTSD has been proposed as a diagnostic category in the ICD-11, it is important that it be examined in refugee groups.ObjectiveIn the current study, we proposed to test, for the first time, the factor structure of CPTSD proposed for the ICD-11 in a sample of resettled treatment-seeking refugees.MethodThe study sample consisted of 134 traumatized refugees from a variety of countries of origin, with approximately 93% of the sample having been exposed to torture. We used confirmatory factor analysis to examine the factor structure of CPTSD in this sample and examined the sensitivity, specificity, positive predictive power and negative predictive power of individual items in relation to the CPTSD diagnosis.ResultsFindings revealed that a two-factor higher-order model of CPTSD comprising PTSD and Difficulties in Self-Organization (χ2(47)=57.322, p=0.144, RMSEA=0.041, CFI=0.981, TLI=0.974) evidenced superior fit compared to a one-factor higher-order model of CPTSD (χ2(48)=65.745, p=0.045, RMSEA=0.053, CFI=0.968, TLI=0.956). Overall, items evidenced strong sensitivity and negative predictive power, moderate positive predictive power, and poor specificity.ConclusionsFindings provide preliminary evidence for the validity of the CPTSD construct with highly traumatized treatment-seeking refugees.Highlights of the articleComplex PTSD (CPTSD), proposed as a sibling diagnosis to posttraumatic stress disorder (PTSD) in ICD-11, has not been previously evaluated with treatment-seeking refugees.This study compared higher-order one and two-factor models of CPTSD using confirmatory factor analysis in a sample of traumatized refugees.Findings indicated that a higher-order two-factor model comprising PTSD and Disturbances in Self-Organization best fit the data.These findings provide preliminary evidence that the CPTSD construct is relevant to individuals exposed to persecution and displacement.