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Intimate Partner Violence (IPV) is a risk factor for depressive disorders and other harms to women and their pregnancy. There is a need for longitudinal evidence to assist with understanding the subgroups of women including those from refugee background affected by IPV. We recruited women at their prenatal visit from three antenatal clinics in Australia (January 2015–March 2016). A total of 1335 women, 650 (48.7%) born in Australia and 685 (51.3%) from refugee backgrounds, completed baseline assessment; then, Time 2 follow-up was at 6 months and Time 3 follow-up was at 24 months post birth. The WHO Intimate Partner Violence (IPV) measure was used. Latent class growth analysis grouped individuals based on trajectories of IPV across three time points. A three-step process identified characteristics associated with respective latent class membership. Similar three-class solutions were observed across both cohorts, composed of Limited IPV (64% and 48% Australian-born and refugee background, respectively); Changing IPV (31%; 46%)—various combinations of IPV categories across time; Combined IPV (4%; 6%)—IPV at all time points, all transitioning to the combined physical and psychological abuse category at Time 3. Older age, fewer children, being in a couple, having a better partner, family and friend relationships, fewer partner trauma events, and fewer living difficulties emerged as protective factors for the changing and combined categories, with a distinct pattern for the refugee cohort. The findings assist with understanding and defining of the highest risk group for targeting interventions to prevent IPV, and the unique protective factors across the two IPV-affected classes for women born in Australia and those who arrived as refugees. [ABSTRACT FROM AUTHOR]

Despite the well-established benefits of antenatal education (ANE) and breastfeeding for mothers, there is a paucity of evidence about the uptake of ANE and breastfeeding amongst women from refugee backgrounds or its associations with sociodemographic factors. The current study is a cross-sectional survey at two time points examining the prevalence of ANE attendance, breastfeeding, and intimate partner violence (IPV) amongst 583 women refugees resettled in Australia and a control group of 528 Australian-born women. Multi-logistic regression was used to explore bivariate associations between ANE attendance, breastfeeding, IPV, and sociodemographic characteristics (parity, maternal employment, and education). Refugee-background women compared to Australian-born women have lower ANE utilization (20.4% vs. 24.1%), higher rates of breastfeeding on hospital discharge (89.3% vs. 81.7%), and more IPV reports (43.4% vs. 25.9%). Factors such as nulliparity, higher level of education, and employment predict higher rates of ANE and breastfeeding adoption. In contrast, IPV is a risk factor for ANE underutilization. Further, of the women from refugee backgrounds who accessed ANE services, 70% attended clinics designed for women from non-English-speaking backgrounds. These findings support the need to ensure effective screening and interventions for IPV during antenatal care and to better understand the role of culture as a protective or risk factor for breastfeeding initiation. [ABSTRACT FROM AUTHOR]

Background: The aim was to compare, for the first time in a large systematic study, women born in conflict-affected countries who immigrated to Australia with women born in Australia for attitudes towards gender roles and men's use of IPV and the actual prevalence of IPV. The study also examined if any associations remained across the two timepoints of pregnancy and postpartum. Methods: Women were interviewed during their first visit to one of three Australian public hospital antenatal clinics and re-interviewed at home six months after giving birth. A total of 1111 women completed both interviews, 583 were born in conflict-affected countries and 528 born in Australia. Associations between attitudes towards gender roles and men's use of IPV, socio-demographic characteristics and reported actual experiences of IPV were examined using bivariate and multiple logistic regression analyses. Results: Attitudes toward inequitable gender roles including those that condone men's use of IPV, and prevalence of IPV, were significantly higher (p<0.001) among women born in conflict-affected countries compared to Australia-born women. Women born in conflict-affected countries with the strongest held attitudes towards gender roles and men's use of IPV had an adjusted odds ratio (aOR) of 3.18 for IPV at baseline (95% CI 1.85–5.47) and an aOR of 1.83 for IPV at follow-up (95% CI 1.11–3.01). Women born in Australia with the strongest held attitudes towards gender roles and IPV had an aOR of 7.12 for IPV at baseline (95% CI 2.12–23.92) and an aOR of 10.59 for IPV at follow-up (95% CI 2.21–50.75). Conclusions: Our results underscore the need for IPV prevention strategies sensitively targeted to communities from conflict-affected countries, and for awareness among clinicians of gender role attitudes that may condone men's use of IPV, and the associated risk of IPV. The study supports the need for culturally informed national strategies to promote gender equality and to challenge practices and attitudes that condone men's violence in spousal relationships. [ABSTRACT FROM AUTHOR]

Background: Schools play a key role in supporting the well-being and resettlement of refugee children, and parental engagement with the school may be a critical factor in the process. Many resettlement countries have policies in place to support refugee parents' engagement with their children's school. However, the impact of these programs lacks systematic evaluation. This study first aimed to validate self-report measures of parental school engagement developed specifically for the refugee context, and second, to identify parent characteristics associated with school engagement, so as to help tailor support to families most in need.Methods and Findings: The report utilises 2016 baseline data of a cohort study of 233 Arabic-speaking parents (77% response rate) of 10- to 12-year-old schoolchildren from refugee backgrounds across 5 schools in Sydney, Australia. Most participants were born in Iraq (81%) or Syria (11%), and only 25% spoke English well to very well. Participants' mean age was 40 years old, and 83% were female. Confirmatory factor analyses were run on provisional item sets identified from a literature review and separate qualitative study. The findings informed the development of 4 self-report tools assessing parent engagement with the school and school community, school belonging, and quality of the relationship with the schools' bilingual cultural broker. Cronbach alpha and Pearson correlations with an established Teacher-Home Communication subscale demonstrated adequate reliability (α = 0.67 to 0.80) and construct and convergent validity of the measures (p < 0.01), respectively. Parent characteristics were entered into respective least absolute shrinkage and selection operator (LASSO) regression analyses. The degree of parents' psychological distress (as measured by the Kessler10 self-report instrument) and postmigration living difficulties (PLMDs) were each associated with lower school engagement and belonging, whereas less time lived in Australia, lower education levels, and an unemployed status were associated with higher ratings in relationship quality with the schools' cultural broker. Study limitations include the cross-sectional design and the modest amount of variance (8% to 22%) accounted for by the regression models.Conclusions: The study offers preliminary refugee-specific measures of parental school engagement. It is expected they will provide a resource for evaluating efforts to support the integration of refugee families into schools. The findings support the need for initiatives that identify and support parents with school-attending children from refugee backgrounds who are experiencing psychological distress or resettlement stressors. At the school level, the findings suggest that cultural brokers may be effective in targeting newly arrived families. [ABSTRACT FROM AUTHOR]

Approximately 1 in 10 of the current 26 million people who are refugees reside in high-income countries. They have commonly experienced trauma related to violence, insecurity, persecution and shortage of food and medicine. Our research suggests that COVID-19 and its health and social sequalae may be triggering past traumatic reactions, exacerbating mental health problems and undermining functioning. The purpose of this article is to promptly communicate these anecdotal findings to general health practitioners to ensure informed and sensitive health care delivery to this vulnerable population. [ABSTRACT FROM AUTHOR]

The article discusses the study on the mental health and human rights trauma of West Papuan refugees who resettled in Australia by Susan Rees and colleagues. It mentions that the methods used include the mixed-methods data analysis, Harvard Trauma Questionnaire (HTQ), and statistical analysis. Results show that West Papuan refugees in Australia have a broad range of premigration potentially traumatic events (PTEs) including post-traumatic stress disorder (PTSD) and human rights violations.

Abstract: There has been an increasing interest in the role of gross injustices in generating pathological states of anger. The goal of this study amongst 41 West Papuan refugees conducted in Australia between 2007 and 2010 was to explore the phenomenology of Sakit Hati, a condition in which there appeared to be a close link between human rights violations and anger. West Papuan refugee participants made repeated reference to the condition of Sakit Hati in the early phase of the study so that the remainder of the study focused specifically on this construct. The qualitative approach involved an iterative process including focus groups, in-depth interviews, and semi-structured confirmatory interviews. The research revealed that Sakit Hati included elements of chronic brooding, resentment and anger attributed to experiences of injustice, a state that created vulnerability to episodes of explosive rage and aggression in response to reminders of persecution. Sakit Hati was distinguished from a depression-loss constellation, Susah Hati, although the two reactions overlapped. Sakit Hati led to substantial personal suffering and interpersonal difficulties. The intractable political conditions in West Papua made it difficult to achieve a durable resolution for the condition. Sakit Hati provides a cross-cultural illustration of the nexus between injustice and chronic anger, demonstrating how this dynamic interaction can be perpetuated by ongoing social and political forces. Greater attention may be warranted by psychiatric classification systems to the recognition of anger as an affective state that may be provoked and maintained by experiences of injustice. [Copyright &y& Elsevier]

Families in remote mining towns constitute a specific sociological group living under unique geographical and sociocultural circumstances. Isolation from friends and relatives and limited resources and opportunities for family members of mine workers are some of the distinct disadvantages of these towns. Decades ago it was observed that a large number of women in new and remote mining towns suffered from neurotic problems. In contemporary times there is a deficit of knowledge about the mental health of women in remote mining towns. However, there are certain indicators of significant mental distress among women living in these particular environments. Deriving from a review of literature, this paper explores various mining work-related issues and sociocultural settings and processes within remote mining towns that could possibly exert coercive pressures on the psychological health of female partners of mine workers and their relationship well-being. The paper suggests that work schedules and preponderance of men in mining jobs help promote a patriarchal culture within the community and the family; thereby marginalising women to a secondary status. Limited opportunities and resources within the community isolate women to domestic lives; while atypical work rosters associated with mining employment could negatively impact on the relationship well-being of couples. The paper recommends that an inquiry into psychiatric well-being among women of remote mining communities needs to consider the sociocultural structure and processes within these communities, and the structural nature of the mining job that could be responsible for role strain-induced stress and mental health problems among these women. [ABSTRACT FROM AUTHOR]

The article offers information on bushfires, COVID-19 pandemic, and the need for an Australian Task Force on gender, mental health and disaster. Topics include the prevalence of domestic violence associated with the Australian disasters; and that gender inequality impacts women's safety during times of social unrest, and in intimate relationships.

After up to 10 years of living as asylum seekers in Australia it appears that most of 1650 East Timorese will be granted permanent residency. The present study describes research into the wellbeing of East Timorese women asylum seekers that found severe risks to social and emotional wellbeing associated with prolonged asylum seeker status. The research findings highlighted a need for measures to protect the wellbeing of asylum seekers during the assessment stage of applications for protection visas. The author refers to the research findings to encourage debate around the need for asylum seekers generally to have access to resettlement services as a policy strategy to provide necessary psychological and material support. Arguing that neglect of basic assistance during the assessment phase of protection applications potentially breaches the UN Declaration, the author illustrates individual, community and global benefits of providing adequate support and avenues for personal development to asylum seekers. [ABSTRACT FROM AUTHOR]

There is mounting evidence of systematic abuses, including torture, rape and extrajudicial killings directed against independence activists as well as the civilian population in Indonesian occupied West Papua. Refugees from West Papua have sought safety in neighbouring Australia, experiencing hazardous journeys during their flight. We report early observations from a mental health study among West Papuan refugees living in North Queensland, Australia. The project includes qualitative methods aimed at gathering histories of trauma and human rights violations as well as standard mental health assessments and indices of acculturation and resettlement stresses. We consider the emerging data from the vantage point of the Adaptation and Development After Persecution and Trauma model that identifies five psychosocial domains that require repair following exposure to gross human rights violations and refugee trauma. The model emphasizes the inter-relatedness of key challenges, the compounding of adversity, and the bivalent effects of complex experiences, with both positive and negative elements shaping the adaptive trajectory of displaced persons. Refugee groups have their own approaches to conceptualizing the complexity of their problems, with the term dua sakit representing the expression used by West Papuans to identify the multiple challenges they face. The study highlights the importance of assessing each refugee group within its unique social and cultural context, taking into account such diverse factors as geographical location, employment, and ongoing conflict in the homeland in designing appropriate interventions. [ABSTRACT FROM AUTHOR]

Objective: To summarise findings from interdisciplinary research into the experiences of East Timorese women asylum seekers residing in the Australian community, and specifically to highlight the effects of prolonged asylum seeker status on wellbeing. ‘Wellbeing’ was defined as a holistic state that includes psychological, physical, spiritual, social and cultural welfare and contentment. Methods: A qualitative multimethod data collection tool comprised semistructured interviewing of East Timorese women asylum seekers, questionnaires to professional workers assisting East Timorese asylum seekers at the community level, and an analysis of secondary source material. Results: Insecurity of tenure and living with the fear of forced removal from Australia was found to have significantly affected and dangerously compromised the wellbeing of the asylum seekers. The findings further revealed a flaw in current social policy with respect to the length of time asylum seekers could reside in the community without adequate supports, services and avenues for social inclusion. Conclusions: The research illustrated the necessity for faster processing of claims for asylum seeker status, recognition of the effects of torture and trauma on asylum seekers in policy, and consequently immediate access for asylum seekers to essential and gender specific supports and services. The research provides evidence to support the East Timorese asylum seekers’ claim to permanent status in Australia on humanitarian grounds. [ABSTRACT FROM AUTHOR]

Introduction: There are few empirically supported social and emotional well-being programmes for First Nations adolescents, and we found none targeting those living in Aboriginal communities in remote areas of Australia. The dearth of social and emotional well-being programmes is concerning given that adolescents in remote Australia are at much greater risk of mental disorder and suicide. Our pragmatic community-based research intervention 'Enabling Dads and Improving First Nations Adolescent Mental Health' is designed by and for First Nations people living in remote communities to promote and support the parenting role and examine the interconnection between men's parenting knowledge and adolescent mental health. The aim is to improve adolescent mental health by strengthening the participating father's empowerment, parenting confidence and engagement in the parenting role. The words Aboriginal, First Nation and Indigenous are applied interchangeably, as appropriate, throughout the article., Methods and Analysis: The intervention is currently being conducted in five remote First Nations communities in Far North Queensland, Australia. The project is funded by the Medical Research Future (MRFF UNSW RG200484), and staff recruitment and training began in early December 2020. The aim is to recruit 100 men and dyad adolescents, that is, in each of the five community sites, we will recruit 20 men and adolescent dyads at baseline. To date, we have complete data collection in one community, and fieldwork will begin in the final community in September 2023.The intervention involves a pragmatic randomised controlled trial, using a novel and culturally designed and manualised parenting programme with men (Strong Fathers, SF). The comparison group is receiving a culturally congruent and familiar yarning/relaxation (YR) condition. The SF component focuses on reinforcing knowledge related to parenting adolescents, promoting father's empowerment, and increasing their confidence and engagement with the adolescent. The second component systematically measures and examines differences in adolescent social and emotional well-being before and after their father's involvement in either the SF or YR. The adolescent is blind to the father's group allocation. The outcome measures for the men include parenting knowledge, attitudes and beliefs; a First Nations measure for empowerment; the Harvard Trauma Questionnaire (Indigenous) used to assess post-traumatic stress disorder symptoms; and alcohol use. The adolescent mental health outcomes are measured by a culturally congruent social and emotional well-being measure., Ethics and Dissemination: Ethics approval was granted from the Aboriginal Health and Medical Research Council of Australia: Human Research Ethics Committee (1711/20). Results will be verbally shared at community meetings and conferences, and reports will be produced for community stakeholder use. Data will be available for community-controlled health services and stakeholders. Findings will also be published in peer-reviewed journals, and summaries will be provided to the funders of the study as well as male participants and adolescents., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The Women Aware with Their Children study was created because prospective data are required to accurately guide prevention programmes for intimate partner violence (IPV) and to improve the mental health and resettlement trajectories of women from refugee backgrounds in Australia., Participants: 1335 women (685 consecutively enrolled from refugee backgrounds and 650 randomly selected Australian-born) recruited during pregnancy from three public antenatal clinics in Sydney and Melbourne, Australia. The mean age was 29.7 years among women from refugee backgrounds and 29.0 years among women born in the host nation. Main measures include IPV, mood, panic, post-traumatic stress disorder, disability and living difficulties., Findings to Date: Prevalence of IPV at all three time points is significantly higher for refugee-background women. The trend data showed that reported IPV rates among Australian-born women increased from 25.8% at time 1 to 30.1% at time 3, while for refugee-background women this rate declined from 44.4% at time 1 to 42.6% at time 3. Prevalence of major depressive disorder (MDD) at all three time points is higher for refugee-background women. MDD among Australian-born women significantly declined from 14.5% at time 1 to 9.9% at time 3, while for refugee-background women it fluctuated from 25.1% at time 1 to 17.3% at time 2 and to 19.1% at time 3., Future Plans: We are currently examining trajectories of IPV and mental disorder across four time points. Time 4 occurred during the COVID-19 pandemic, enabling a unique opportunity to examine the impacts of the pandemic over time. Time 5 started in August 2021 and time 6 will begin approximately 12 months later. The children at time 5 are in the early school years, providing the capacity to examine behaviour, development and well-being of the index child., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Sexual abuse is a strong predictor of future psychiatric problems. A more nuanced qualitative understanding of mental health outcomes, in the context of interpersonal responses from family members towards survivors after sexual abuse, may help to better inform prevention and interventions., Design: A mixed-methods approach included a qualitative timeline method to map and identify contextual factors and mediating emotional responses associated with mental disorder following sexual abuse., Setting: Participants were adult survivors of sexual abuse, seeking support from the Sexual Assault Counselling Service, Sydney Local Health District, Australia., Participants: Thirty women 18 years and older with current or past mental disorder or symptoms were interviewed between August 2015 and May 2016., Outcome Measures: A qualitative timeline interview and the Mini-International Neuropsychiatric Interview (MINI, 5.5.0) were applied., Results: The MINI prevalence of current post-traumatic stress disorder was 96.6% (n=28) and of major depressive disorder was 82.8% (n=24). More than half (53%) reported suicidal ideation at some time in their lives. Women exposed to childhood sexual abuse reported being ignored, not believed, or threatened with retribution on disclosing the abuse to others, usually adult family members, at or close to the time of the violation(s). Participants described experiences of self-blame, betrayal, and psychosocial vulnerability as being the responses that connected negative disclosure experiences with mental disorder. Participant accounts suggest that these reactions created the foundations for both immediate and long-term adverse psychological outcomes., Conclusion: A more in-depth understanding of the type and emotional impact of negative responses to disclosure by parents and other family members, and the barriers to adequate support, validation and trust, may inform strategies to avert much of the longer-term emotional difficulties and risks that survivors encounter following childhood abuse experiences. These issues should receive closer attention in research, policy, and practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Importance: Pregnancy may increase the risk of depression among women who self-identify as refugees and have resettled in high-income countries. To our knowledge, no large systematic studies among women with refugee backgrounds in the antenatal period have been conducted., Objectives: To compare the prevalence of major depressive disorder (MDD), trauma exposure, and other psychosocial risk factors among women who identify as refugees, women from the same conflict-affected countries, and women from the host nation and to test whether self-identification as a refugee indicates greater likelihood of prevalence and risk., Design, Setting, and Participants: This cross-sectional study was undertaken in 3 public antenatal clinics in Sydney and Melbourne, Australia, between January 2015 and December 2016. Overall, 1335 women (685 consecutively enrolled from conflict-affected backgrounds and 650 randomly selected from the host nation) participated. Data analysis was undertaken between June and September 2018., Exposures: One-hour interviews covering mental health, intimate partner violence, and other social measures., Main Outcome and Measures: World Health Organization measure for intimate partner violence and the Mini-International Neuropsychiatric Interview from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) for MDD. To make a diagnosis, 1 of 2 items relating to being consistently depressed for 2 weeks and 3 further symptoms that cause personal distress or psychosocial dysfunction were endorsed., Results: Overall, 1335 women (84.8% overall response rate), comprising 685 (51.3%) from conflict-affected countries (women self-identifying as refugees: 289 [42.2%]) and 650 (48.7%) from the host nation, participated. The mean (SD) age was 29.7 (5.4) years among women from conflict-affected backgrounds and 29.0 (5.5) years among women born in the host nation. Conflict-affected countries included Iraq (260 [38.0%]), Lebanon (125 [18.2%]), Sri Lanka (71 [10.4%]), and Sudan (66 [9.6%]). Women who identified as refugees reported higher exposure to 2 to 3 (67 [23.2%]) and 4 or more (19 [6.6%]) general traumatic events compared with women from the host nation (103 [15.8%] and 21 [3.2%], respectively). Women who identified as refugees also reported higher exposure to 1 (147 [50.9%]) and 2 or more (97 [33.6%]) refugee-related traumatic events compared with women from the host nation (86 [13.2%] and 20 [3.1%], respectively). Women who identified as refugees reported higher rates of psychological intimate partner violence than women born in the host nation (124 [42.9%] vs 133 [20.5%]; P < .001). Women who identified as refugees were less likely to identify 5 or more supportive family or friends compared with women born in the host nation (36 [12.5%] vs 297 [45.7%]; P < .001). A greater proportion of women who identified as refugees reported experiencing 3 or more financial stressors compared with women born in the host nation (65 [22.5%] vs 41 [6.3%]; P < .001). Women who identified as refugees had the highest prevalence of MDD (94 [32.5%]), followed by women from other conflict-affected backgrounds (78 [19.7%]), and women born in the host nation (94 [14.5%])., Conclusion and Relevance: Women identifying as refugees reported a higher prevalence of MDD and all the indicators of adversity related to that disorder. Even after risk factors were accounted for, refugee status was associated with risk of MDD. Assessing whether women attending an antenatal clinic self-identify as refugees may offer an important indicator of risk of MDD and a range of associated psychosocial adversities.

Traditional Australian Aboriginal and Torres Strait Islander societies value men's role as parents; however, the importance of promoting fatherhood as a key social determinant of men's well-being has not been fully appreciated in Western medicine. To strengthen the Aboriginal and Torres Strait Islander male parenting role, it is vital to examine current barriers and opportunities. The first author (a male Aboriginal health project officer) conducted yarning sessions in three remote Australian communities, two being Aboriginal, the other having a high Aboriginal population. An expert sample of 25 Aboriginal and 6 non-Aboriginal stakeholders, including maternal and child health workers and men's group facilitators, considered barriers and opportunities to improve men's parenting knowledge and role, with an aim to inform services and practices intended to support men's parenting. A specific aim was to shape an existing men's group program known as Strong Fathers, Strong Families. A thematic analysis of data from the project identified barriers and opportunities to support men's role as parents. Challenges included the transition from traditional to contemporary parenting practices and low level of cultural and male gender sensitivity in maternal and child health services. Services need to better understand and focus on men's psychological empowerment and to address shame and lack of confidence around parenting. Poor literacy and numeracy are viewed as contributing to disempowerment. Communities need to champion Aboriginal and Torres Strait Islander male father role models. Biases and barriers should be addressed to improve service delivery and better enable men to become empowered and confident fathers.

Documentation is limited in relation to the mental health of the people of West Papua, a territory that has been exposed to decades-long political persecution. We examined associations of traumatic events (TEs) and current stressors with mental disorder and functioning, amongst 230 West Papuan refugees residing in six settlements in Port Morseby, Papua New Guinea (PNG). We used culturally adapted modules to assess exposure to TEs and mental disorders. Current stressors and functioning were assessed using modifications of measures developed by the World Health Organization (WHO). 129 of 230 respondents (56%) reported exposure to at least one traumatic event (TE), including: political upheaval (36.5%), witnessing or hearing about family members tortured and murdered (33.9%), and not being able to access medical care for family members (33%). One fifth of respondents (47, 20.4%) experienced exposure to high levels of TEs (16 to 23). 211 (91.7%) endorsed at least one or more ongoing stressors, including: exposure to illicit substance use in the community (91.7%), problems with safety and the protection of women (89.6%), no access to legal rights and citizenship (88.3%), and lack of adequate shelter and facilities (85.2%). A quarter (26.9%) met criteria for one or more current mental disorder, and 69.1% reported functional impairment ranging from mild to extreme. Mental disorder was associated with being male (adjusted odds ratio=2.00; 95% CI=1.01-3.97), and exposure to the highest category of ongoing stressors (AOR=2.89; 95% CI=1.08-7.72). The TE count showed a dose-response pattern in its relationship with functional impairment, the greatest risk (AOR=11.47; 95% CI=2.11-62.37) being for those experiencing the highest level of TE exposure (16-23 events). West Papuans living in settlements in Port Moresby reported a range of TEs, ongoing stressors and associated mental disorders characteristic of populations exposed to mass conflict and persecution, prolonged displacement, and ongoing conditions of extreme hardship.

Objective: Interpersonal trauma and violence is currently considered a global public health emergency. However, studies have not differentiated between intimate interpersonal trauma and nonintimate interpersonal trauma in their impact on posttraumatic stress disorder (PTSD) symptomatology. This cross-sectional study based on epidemiologic data examined the differential likelihoods of endorsing PTSD symptoms following 3 categories of trauma: noninterpersonal (eg, accidents, natural disasters), nonintimate interpersonal (physical assaults perpetrated by nonintimates), and intimate interpersonal (physical assaults perpetrated by intimates or caregivers and sexual assaults)., Method: DSM-IV PTSD symptom data drawn from a weighted subsample (N = 1,012) of people reporting "most severe" reactions following one of the above types of trauma in the 2007 Australian National Survey of Mental Health and Well-Being (NSMHWB) were analyzed using binary logistic regression., Results: Participants reporting intimate interpersonal compared with noninterpersonal trauma were significantly (P < .001) more likely to endorse core symptoms (intrusive reexperiencing, avoidance of reminders, hypervigilance, and startle response) of PTSD. The intimate interpersonal trauma group members were significantly more likely than the nonintimate interpersonal trauma group members to endorse distress at reminders (odds ratio [OR] = 3.2; P < .001; 99.7% CI, 1.3-7.9), avoiding thinking about the event (OR = 3.2; P < .001; 99.7% CI, 1.3-7.7), detachment from others (OR = 3.2; P < .001; 99.7% CI, 1.2-8.9), and restricted affect (OR = 4.1; P < .001; 99.7% CI, 1.5-11.3). Participants reporting nonintimate interpersonal and noninterpersonal traumas did not significantly differ except in endorsement of behavioral avoidance (OR = 2.8; P < .001; 99.7% CI, 1.2-6.6), hypervigilance (OR = 2.5; P = .002; 99.7% CI, 1.0-6.3), and exaggerated startle response (OR = 3.5; P < .001; 99.7% CI, 1.7-7.4)., Conclusions: Survivors of intimate trauma appear to experience particularly severe intrusive memories and reminders of past trauma and suppression of emotional responsivity. The unique impact of interpersonal trauma, however, intimate or otherwise, compared with noninterpersonal trauma, is the experience of an environment as unsafe and unpredictable, due to the potential of human threat. Such findings have significant implications for the assessment of and interventions for survivors of interpersonal violence., (© Copyright 2013 Physicians Postgraduate Press, Inc.)

Context: Intimate partner physical violence, rape, sexual assault, and stalking are pervasive and co-occurring forms of gender-based violence (GBV). An association between these forms of abuse and lifetime mental disorder and psychosocial disability among women needs to be examined., Objectives: To assess the association of GBV and mental disorder, its severity and comorbidity, and psychosocial functioning among women., Design, Setting, and Participants: A cross-sectional study based on the Australian National Mental Health and Well-being Survey in 2007, of 4451 women (65% response rate) aged 16 to 85 years., Main Outcome Measures: The Composite International Diagnostic Interview version 3.0 of the World Health Organization's World Mental Health Survey Initiative was used to assess lifetime prevalence of any mental disorder, anxiety, mood disorder, substance use disorder, and posttraumatic stress disorder (PTSD). Also included were indices of lifetime trauma exposure, including GBV, sociodemographic characteristics, economic status, family history of mental disorder, social supports, general mental and physical functioning, quality of life, and overall disability., Results: A total of 1218 women (27.4%) reported experiencing at least 1 type of GBV. For women exposed to 3 or 4 types of GBV (n = 139), the rates of mental disorders were 77.3% (odds ratio [OR], 10.06; 95% confidence interval [CI], 5.85-17.30) for anxiety disorders, 52.5% (OR, 3.59; 95% CI, 2.31-5.60) for mood disorder, 47.1% (OR, 5.61; 95% CI, 3.46-9.10) for substance use disorder, 56.2% (OR, 15.90; 95% CI, 8.32-30.20) for PTSD, 89.4% (OR, 11.00; 95% CI, 5.46-22.17) for any mental disorder, and 34.7% (OR, 14.80; 95% CI, 6.89-31.60) for suicide attempts. Gender-based violence was associated with more severe current mental disorder (OR, 4.60; 95% CI, 2.93-7.22), higher rates of 3 or more lifetime disorders (OR, 7.79; 95% CI, 6.10-9.95), physical disability (OR, 4.00; 95% CI, 1.82-8.82), mental disability (OR, 7.14; 95% CI, 2.87-17.75), impaired quality of life (OR, 2.96; 95% CI, 1.60-5.47), an increase in disability days (OR, 3.14; 95% CI, 2.43-4.05), and overall disability (OR, 2.73; 95% CI, 1.99-3.75)., Conclusion: Among a nationally representative sample of Australian women, GBV was significantly associated with mental health disorder, dysfunction, and disability.

Background: Adult separation anxiety disorder (ASAD) has been identified recently, but there is a paucity of data about its prevalence and associated characteristics amongst anxiety patients. This study assessed the prevalence and risk factor profile associated with ASAD in an anxiety clinic., Methods: Clinical psychologists assigned 520 consecutive patients to DSM-IV adult anxiety subcategories using the SCID. We also measured demographic factors and reports of early separation anxiety (the Separation Anxiety Symptom Inventory and a retrospective diagnosis of childhood separation anxiety disorder). Other self-report measures included the Adult Separation Anxiety Symptom Questionnaire (ASA-27), the Depression, Anxiety, Stress Scales (DASS-21), personality traits measured by the NEO PI-R and the Work and Social Adjustment Scale. These measures were included in three models examining for overall differences and then by gender: Model 1 compared the conventional SCID anxiety subtypes (excluding PTSD and OCD because of insufficient numbers); Model 2 divided the sample into those with and without ASAD; Model 3 compared those with ASAD with the individual anxiety subtypes in the residual group., Results: Patients with ASAD had elevated early separation anxiety scores but this association was unique in females only. Except for social phobia in relation to some comparisons, those with ASAD recorded more severe symptoms of depression, anxiety and stress, higher neuroticism scores, and greater levels of disability., Conclusions: Patients with ASAD attending an anxiety clinic are highly symptomatic and disabled. The findings have implications for the classification, clinical identification and treatment of adult anxiety disorders.