Showing papers in "Journal of Nervous and Mental Disease in 2002"

Reliability and validity of the Japanese-language version of the impact of event scale-revised (IES-R-J): four studies of different traumatic events.

Abstract: The authors developed the Japanese-language version of the Impact of Event Scale-Revised (IES-R-J) and investigated its reliability and validity in four different groups: workers with lifetime mixed traumatic events, survivors of an arsenic poisoning case, survivors of the Hanshin-Awaji earthquake, and survivors of the Tokyo Metro sarin attack. Evidence includes retest reliability and internal consistency of the IES-R-J. Posttraumatic stress disorder (PTSD) and partial PTSD cases indicated significantly higher scores than non-PTSD cases. The IES-R-J can be a useful self-rating diagnostic instrument particularly for survivors with PTSD symptoms as a clinical concern (PTSD + partial PTSD) by using a 24/25 cutoff in total score. In analysis of scale structure, the majority of intrusion and hyperarousal items were subsumed under the same cluster, whereas avoidance items made up a separate cluster. Female patients indicated higher scores than male patients. A negative weak correlation between age and the score was found only among female earthquake survivors. The IES-R-J can be used as a validated instrument in future international comparative research.

Young adults with attention deficit hyperactivity disorder: subtype differences in comorbidity, educational, and clinical history.

Abstract: The present study sought to examine subtype differences in comorbidity and in antisocial, educational, and treatment histories among young adults (ages 17-27) with attention deficit hyperactivity disorder (ADHD). Comparisons were made between ADHD Combined Type (ADHD-C; N = 60) and Predominantly Inattentive Type (ADHD-I; N = 36) relative to each other and to a community control group of 64 adults. Both ADHD groups had significantly less education, were less likely to have graduated from college, and were more likely to have received special educational placement in high school. Both groups also presented with a greater likelihood of dysthymia, alcohol dependence/abuse, cannabis dependence/abuse, and learning disorders, as well as greater psychological distress on all scales of the SCL-90-R than the control group. Both ADHD groups were more likely to have received psychiatric medication and other mental health services than control adults. In comparison with ADHD-I, adults with ADHD-C differed in only a few respects. The C-type adults were more likely to have oppositional defiant disorder, to experience interpersonal hostility and paranoia, to have attempted suicide, and to have been arrested than the ADHD-I adults. These results are generally consistent with previous studies of ADHD in children, extend these findings to adults with ADHD, and suggest that the greater impulsivity associated with the ADHD-C subtype may predispose toward greater antisocial behavior and its consequences than does ADHD-I type in adults.

Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients.

Abstract: This study has two purposes. The first purpose is to describe the severity of sexual abuse reported by a well-defined sample of borderline inpatients. The second purpose is to determine the relationship between the severity of reported childhood sexual abuse, other forms of childhood abuse, and childhood neglect and the severity of borderline symptoms and psychosocial impairment. Two semistructured interviews of demonstrated reliability were used to assess the severity of adverse childhood experiences reported by 290 borderline inpatients. It was found that more than 50% of sexually abused borderline patients reported being abused both in childhood and in adolescence, on at least a weekly basis, for a minimum of 1 year, by a parent or other person well known to the patient, and by two or more perpetrators. More than 50% also reported that their abuse involved at least one form of penetration and the use of force or violence. Using multiple regression modeling and controlling for age, gender, and race, it was found that the severity of reported childhood sexual abuse was significantly related to the severity of symptoms in all four core sectors of borderline psychopathology (affect, cognition, impulsivity, and disturbed interpersonal relationships), the overall severity of borderline personality disorder, and the overall severity of psychosocial impairment. It was also found that the severity of childhood neglect was significantly related to five of the 10 factors studied, including the overall severity of borderline personality disorder, and that the severity of other forms of childhood abuse was significantly related to two of these factors, including the severity of psychosocial impairment. Taken together, the results of this study suggest that the majority of sexually abused borderline inpatients may have been severely abused. They also suggest that the severity of childhood sexual abuse, other forms of childhood abuse, and childhood neglect may all play a role in the symptomatic severity and psychosocial impairment characteristic of borderline personality disorder.

Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study.

Abstract: The association between trauma and personality disorders (PDs), while receiving much attention and debate, has not been comprehensively examined for multiple types of trauma and PDs. The authors examined data from a multisite study of four PD groups: schizotypal, borderline (BPD), avoidant, and obsessive-compulsive, and a major depression comparison group. Rates of traumatic exposure to specific types of trauma, age of first trauma onset, and rates of posttraumatic stress disorder are compared. Results indicate that BPD participants reported the highest rate of traumatic exposure (particularly to sexual traumas, including childhood sexual abuse), the highest rate of posttraumatic stress disorder, and youngest age of first traumatic event. Those with the more severe PDs (schizotypal, BPD) reported more types of traumatic exposure and higher rates of being physically attacked (childhood and adult) when compared to other groups. These results suggest a specific relationship between BPD and sexual trauma (childhood and adult) that does not exist among other PDs. In addition, they support an association between severity of PD and severity of traumatic exposure, as indicated by earlier trauma onset, trauma of an assaultive and personal nature, and more types of traumatic events.

Childhood asthma, chronic illness, and psychiatric disorders.

Abstract: Asthma is a serious and vexing problem for many children and their families. Asthma, like most syndromes, has many symptoms and potential causes and effects. Studies have shown that pediatric asthma is associated with psychiatric disorders, but the specificity and temporality of these relations is not well known. This study examined the associations between any and specific psychiatric disorders and both childhood asthma and other childhood chronic illnesses. The study used the Methods for the Epidemiology of Child and Adolescent Mental Disorders data, a four-site, community-based study of 1,285 pairs of youths and caretakers. Psychiatric disorders were assessed using the Diagnostic Interview Schedule for Children (DISC 2.3). Methods for the Epidemiology of Child and Adolescent Mental Disorders was also used to assess individual characteristics, parental reports of asthma, and other chronic illnesses. Asthma and 'other' chronic illnesses were associated with different psychiatric disorders. In particular, having a history of asthma was associated with having an anxiety disorder, after adjustment for potential confounding, but was not associated with having an affective disorder. Having a chronic illness other than asthma or cancer was associated with having any affective disorder and dysthymia but not anxiety disorder. These results call for more mechanistic research that explores the specific relations between childhood anxiety disorder and asthma and between affective disorder and other pediatric chronic illnesses.

Suicidal Ideation and Suicide Attempts in Treatment-Seeking Pathological Gamblers

Abstract: This study assessed rates and correlates of suicidal ideation and suicide attempts in individuals seeking treatment for pathological gambling. At intake to gambling treatment programs, 342 pathological gamblers completed the Addiction Severity Index and the South Oaks Gambling Screen. Participants were categorized into three groups: no suicidal ideation (N = 175, 51%), suicidal ideation alone (N = 109, 32%), and suicide attempters (N = 58, 17%). After controlling for gender, age, treatment site, and substance abuse treatment histories, differences among the groups emerged in terms of severity of psychiatric, social/family, and gambling problems. Compared with nonsuicidal gamblers, those with suicidal ideation suffered from more psychiatric symptoms, were less satisfied with their living situations, and experienced more days of conflict in the month before entering gambling treatment. Compared with pathological gamblers with no history of suicidal ideation, those with suicidal ideation spent more money gambling in the month before entering treatment, reported greater cravings for gambling, and had higher South Oaks Gambling Screen scores. These data confirm other reports of high rates of suicidality in pathological gamblers and may suggest the need for more intensive and focused treatments in pathological gamblers with suicidality.

Need for closure and jumping-to-conclusions in delusion-prone individuals.

Abstract: Members of the general population were screened for delusion-proneness using the Peters et al. Delusions Inventory (PDI). Two groups were formed from the participants who scored in the upper and lower quartiles of the PDI and compared on a probability judgment task and on the Need for Closure scale (NFC). The study investigated whether the "jump-to-conclusions" (JTC) reasoning bias, characteristic of deluded participants, could be found in delusion-prone individuals. NFC was investigated as a motivational factor that may correlate with this reasoning bias. Evidence for the existence of the data-gathering, but not the probability judgment, part of the JTC reasoning bias was found in the delusion-prone individuals. This group also scored significantly higher on the NFC scale. As the data-gathering reasoning bias was found in delusion-prone individuals this suggests that it may be involved in the formation, rather than merely the maintenance, of delusional beliefs.

Cognitive-behavioral coping skills and psychoeducation therapies for adolescent substance abuse

Abstract: The objective of this study was to compare the efficacy of cognitive behavioral therapy (CBT) versus psychoeducational therapy (PET) for adolescent substance abusers. Eighty-eight consecutively referred predominantly dually diagnosed adolescents were randomized to one of two eight-week, outpatient group psychotherapy conditions. Drug urinalysis and the Teen-Addiction Severity Index (T-ASI) were used as outcome measurements. Treatment completion rate was 86%, follow-up location rate was 95%, and rates of posttreatment at 3- and 9-month follow-up evaluation were 80% and 65%, respectively. Comorbid conduct disorder was significantly associated with treatment noncompletion and reduced follow-up rate. CBT subjects exhibited significantly lower rates of positive urinalysis than did PET subjects for older youth and male subjects at 3-month follow-up evaluation. Most T-ASI subscales indicated sound improvement from baseline to 3- and 9-month follow-up evaluation across conditions. Reduction in substance use was achieved regardless of treatment conditions. Replication of these findings, continued exploration of potential matching effects of conduct disorder, age, and gender to singular or integrative treatment modalities, and exploration of aftercare programs for the maintenance or enhancement of treatment gains are warranted.

Depression and health-related quality of life.

Abstract: Chronic medical conditions drastically affect the lives of those afflicted, leading to pain, disability, and disruption. Comorbid depression can exacerbate the effects of medical illness and may be an independent source of suffering and disability. Data from the Epidemiological Follow-Up Study (NHEFS) of the first National Health and Nutrition Examination Survey (NHANES I) are used to examine the manner in which depression and comorbid medical conditions interact to affect health-related quality of life (HRQOL). The findings suggest a) that the effects of depression are comparable with those of arthritis, diabetes, and hypertension; and b) that depression and chronic medical illnesses interact to amplify the effects of the medical illness. The data also support the merit of adopting a multidimensional approach to HRQOL rather than treating it unidimensionally.

A twin registry study of familial and individual risk factors for trauma exposure and posttraumatic stress disorder.

Abstract: This study examines the association of individual and familial risk factors with exposure to trauma and posttraumatic stress disorder (PTSD) in male twins (N = 6744) from the Vietnam Era Twin Registry. Independent reports of familial psychopathology from co-twins were used to avoid the potential biases of the family history method. Risk for exposure to traumatic events was increased by service in Southeast Asia, preexisting conduct disorder, preexisting substance dependence, and a family history of mood disorders whose effects appear to be partly genetic. Preexisting mood disorders in the individual were associated with decreased odds of traumatic exposure. Risk of developing PTSD following exposure was increased by an earlier age at first trauma, exposure to multiple traumas, paternal depression, less than high school education at entry into the military, service in Southeast Asia, and preexisting conduct disorder, panic disorder or generalized anxiety disorder, and major depression. Results suggest the association of familial psychopathology and PTSD may be mediated by increased risk of traumatic exposure and by preexisting psychopathology.

Affect regulation in women with borderline personality disorder traits.

Abstract: Affect dysregulation is considered a defining feature of borderline personality disorder (BPD). In spite of this, there is a dearth of empirical research that examines affect regulation among persons with BPD. The present study examined the relationship between specific dimensions of affect regulation and borderline traits in a sample of 39 patients. Participants were administered the Personality Diagnostic Questionnaire-Revised to assess the degree of borderline traits and the Affect Intensity Measure and Affect Control Scale to assess dimensions of affect regulation, selected based on the biosocial theory of BPD. Results from hierarchical regression analyses indicated that level of affect intensity and affect control were significantly associated with number of BPD traits, even after controlling for level of depression. Findings for affect control remained significant even after controlling for affect intensity. These results, consistent with biosocial theory of BPD, suggest that persons with BPD experience emotions more intensely and have greater difficulty in controlling their affective responses.

The experience of providing care to relatives with chronic mental illness.

Abstract: Research on family caregivers of mentally ill relatives has historically focused on negative aspects of caregiving, often described as caregiver burden. The authors document caregivers' perspectives on both the negative and positive aspects of caregiving. A qualitative approach was used. Data collection involved 20 in-depth, audiotaped, semistructured interviews focusing on caregivers' positive and negative personal experiences with caregiving to a relative with mental illness. Caregivers reported common negative impacts but also beneficial effects, such as feelings of gratification, love, and pride. Main themes included stigma, systems issues, life lessons learned, and love and caring for the ill relative. This study counterbalances the predominantly negative consequences previously reported and adds to the emerging literature on positive aspects of caregiving. Mental health professionals need to help caregiving families make choices to improve their challenging situations and identify the rewards of caregiving, and to advocate for increased systemic supports to ease caregiver burden.

Prevalence of depression in rural Rwanda based on symptom and functional criteria.

Abstract: The authors' objective was to estimate the prevalence of major depressive disorder among Rwandans 5 years after the 1994 genocidal civil war. They interviewed a community-based random sample of adults in a rural part of Rwanda using the Hopkins Symptom Checklist and a locally developed functional impairment instrument. The authors estimated current rates of major depression using an algorithm based on the DSM-IV symptom criteria (A), distress/functional impairment criteria (C), and bereavement exclusionary criteria (E). They also examined the degree to which depressive symptoms compromise social and occupational functioning. Three hundred sixty-eight adults were interviewed, of whom 15.5% met Criteria A, C, and E for current major depression. Depressive symptoms were strongly associated with functional impairment in most major roles for men and women. The authors conclude that a significant part of this population has seriously disabling depression. Work on appropriate, feasible, safe, and effective mental health interventions should be a priority for this population.

Design and reporting modifications in industry-sponsored comparative psychopharmacology trials.

Abstract: This review of recently published pharmaceutical industry-sponsored comparative psychotropic drug trials aims to classify apparent design and reporting modifications that favor the sponsor's product. The modifications have been grouped into 13 discrete categories, and representative examples of each are presented. Strong circumstantial evidence suggests that marketing goals led to these adjustments. The consequences of marketing influences on comparative psychopharmacology trials are discussed in terms of conflicts of interest, the integrity of the scientific literature, and costs to consumers, as well as their impact on physician practice.

Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors.

Abstract: Using American Academy of Sleep Medicine research criteria, sleep-disordered breathing (SDB) was assessed in a pilot study of 187 sexual assault survivors with posttraumatic stress symptoms. Nightmares, sleep quality, distress, and quality of life were also assessed along with historical accounts of prior treatments for sleep complaints. Presumptive SDB diagnoses were established for 168 patients. Twenty-one of 168 underwent sleep testing, and all met objective SDB diagnostic criteria. There were no clinically meaningful differences in age, body-mass index, sleep quality, distress, or quality of life measures between 21 confirmed SDB cases and 147 suspected cases not tested. Compared with 19 women without SDB, 168 women with diagnosed or suspected SDB reported significantly worse nightmares, sleep quality, anxiety, depression, posttraumatic stress, and impaired quality of life. Despite suffering from sleep problems for an average of 20 years, which had not responded to repeated use of psychotropic medications or psychotherapy, few of these women had been referred to sleep specialists. SDB appears widespread among sexual assault survivors seeking help for nightmares. Research is needed to clarify the associations among SDB, distress, and physical and mental health impairment in trauma patients.

Heritability of social anxiety-related concerns and personality characteristics: a twin study

Abstract: Negative evaluation fears figure prominently in the cognitive psychology of patients with social phobia. In this study, we examine the heritability of negative evaluation fears by using a twin sample. The authors also examine the relationships between negative evaluation fears and personality dimensions relevant to social phobia. Scores on the brief version of the Fear of Negative Evaluation Scale (BFNE) were examined in a sample of 437 (245 monozygotic and 192 dizygotic) twin pairs. Biometrical model fitting was conducted by using standard statistical methods. Genetic and environmental correlations with personality dimensions (from the Dimensional Assessment of Personality Pathology-Basic Questionnaire) were also calculated. Broad heritability estimate of the BFNE was 48%. Additive genetic effects and unique environmental effects emerged as the primary influences on negative evaluation fears. Genetic correlations between BFNE scores and the submissiveness, anxiousness, and social avoidance facets of the Dimensional Assessment of Personality Pathology-Basic Questionnaire were high (r(g) =.78 to.80). A cognitive dimension central to the phenomenology (and, perhaps, cause) of social phobia, the fear of being negatively evaluated, is moderately heritable. Moreover, the same genes that influence negative evaluation fears appear to influence a cluster of anxiety-related personality characteristics. Implications and limitations of these findings are discussed.

Relationship between tobacco smoking and positive and negative symptoms in schizophrenia.

Abstract: In an attempt to understand the reasons behind the high prevalence of tobacco smoking in patients with schizophrenia, the study examined whether specific symptoms of schizophrenia were associated with smoking. Standardized assessments of nicotine dependence (Fagerstrom Test for Nicotine Dependence) and psychopathology (Positive and Negative Syndrome Scale) were performed on 87 inpatients with schizophrenia. Nearly 76% of patients were nicotine dependent. Significant positive correlations were found between Fagerstrom scores and the total negative symptom score and scores on the negative symptom subscales of blunted affect, social withdrawal, difficulty in abstract thinking, and stereotyped thinking. Fagerstrom scores were also significantly associated with impairment in attention, orientation, thinking, and impulse control. Positive symptoms were not significantly associated with smoking. A combination of negative symptoms, duration of illness, and alcohol use optimally predicted smoking in the sample. Neurobiological mechanisms could possibly underlie some of our findings and require further investigation.

History of childhood abuse in panic disorder, social phobia, and generalized anxiety disorder.

Abstract: The authors examined the prevalence of self-reported childhood physical or sexual abuse in a sample of adult patients presenting for treatment of panic disorder, social phobia, or generalized anxiety disorder. Regardless of the presence of comorbid anxiety disorders or comorbid depression, patients

Impulse control disorders and depression.

Abstract: This study assessed the frequency of impulse control disorders (ICDs) and their association with bulimia, compulsive buying, and suicide attempts in a population of depressed inpatients. We investigated ICDs using the Minnesota Impulsive Disorders Interview. Patients answered the Zuckerman Sensation-Seeking Scale and the Barratt Impulsivity Rating Scale. Among the 31 depressed patients who met criteria for ICD (ICD+ group), we found 18 cases of intermittent explosive disorder, three cases of pathological gambling, four cases of kleptomania, three cases of pyromania, and three cases of trichotillomania. Patients with co-occurring ICDs were significantly younger (mean age = 37.7 versus 42.8 years). Patients with kleptomania had a higher number of previous depressive episodes (5.7 versus 1.3), and patients with pyromania had a higher number of previous depressions (3.3 versus 1.3, p =.01). Bipolar disorders were more frequent in the ICD+ group than in the ICD- group (19% versus 1.3%, p =.002), whereas antisocial personality was not (3% versus 1%, p = ns). Bulimia (42% versus 10.5%, p =.005) and compulsive buying (51% versus 22%, p =.006) were significantly more frequent in the ICD+ group. Patients from the ICD+ group had higher scores of motor impulsivity assessed with the Barratt Impulsivity rating scale (p =.01).

Is there a differential impact of fatigue and physical disability on quality of life in multiple sclerosis

Abstract: To investigate the quantitative impact of fatigue on health-related quality of life (HRQoL) in multiple sclerosis (MS) and to determine whether fatigue was related to HRQoL independently from bodily disability, data on HRQoL were ascertained for 87 patients with definite MS by using the SF-36. HRQoL scores and subscores were related to the basic MS disability score (EDSS) and further MS parameters, and to fatigue, which was assessed by using different fatigue scales. Factors related to predominantly physical but not mental HRQoL aspects were identified as related to EDSS, duration of disease, and age. Different fatigue scores did impact significantly on both physical and especially mental HRQoL. The influence of fatigue on physical HRQoL was independent from EDSS. Fatigue experience reduces HRQoL markedly and independently from EDSS. Therefore, fatigue assessment provides additional information to disability-derived scales such as the EDSS with relevant implications for therapeutic decisions.

Health functioning impairments associated with posttraumatic stress disorder, anxiety disorders, and depression.

Abstract: Although anxiety disorders have been associated with impairments in self-reported health functioning, the relative effect of various anxiety disorders has not been studied. We compared health functioning of patients with a principal diagnosis of posttraumatic stress disorder (PTSD), panic disorder (PD), generalized anxiety disorder (GAD), and major depressive disorder (MDD). Patients with PTSD and MDD were equally impaired on overall mental health functioning, and both were significantly worse than patients with PD and GAD. PTSD was associated with significantly worse physical health functioning relative to PD, GAD, and MDD. Hierarchical regression showed that the association of PTSD with physical health functioning was unique and was not caused by the effects of age, depression, or comorbid anxiety disorders. Both PTSD and comorbid anxiety accounted for unique variance in mental functioning. These results highlight the association of PTSD with impaired physical and mental functioning and suggest that effective treatment of PTSD may affect overall health.

Insight and work performance in schizophrenia.

Abstract: Research has linked impaired insight in schizophrenia to poorer medication compliance and poorer treatment outcome. The current study attempts to replicate previous findings that impaired insight is related to deficits in work function. To examine this question, 121 participants with schizophrenia or schizoaffective disorder enrolled in vocational rehabilitation were classified as having unimpaired (N = 65), or impaired (N = 56) insight. Next, participants were assigned a work placement and their work performance assessed on the third, fifth, and seventh weeks of work by using the Work Behavior Inventory. Among the 85 participants who completed these weeks of work, a multivariate analysis of variance and subsequent analysis of variance showed participants with impaired insight had significantly poorer ratings of work quality, work habits, cooperativeness, and personal presentation. When measures of global intelligence and executive function were entered as covariates in individual analysis of covariance, groups differed on measures of cooperativeness and personal presentation. Implications for rehabilitation are discussed.

Preventing poststroke depression: a 12-week double-blind randomized treatment trial and 21-month follow-up.

Abstract: This study examined the effect of antidepressants in preventing depression after stroke. Nondepressed poststroke patients (N = 48) were randomly assigned to receive nortriptyline, fluoxetine, or placebo for 3 months by using double-blind methodology and were followed-up for 21 months by using a naturalistic design. During the treatment period, one minor depression developed in the nortriptyline group (n = 13 at 3 months), one minor depression developed in the fluoxetine group (n = 13), and five minor depressions developed in the placebo group (n = 15; p <.05). When treatment was discontinued, nortriptyline-treated patients were more likely to develop depression and had significantly more severe depressive symptoms during the next 6 months compared with patients in the other two groups. Both nortriptyline and fluoxetine appeared to be efficacious in preventing depression after stroke. However, nortriptyline produced an increased vulnerability to depression for more than 6 months after it was discontinued. This finding suggests the need to extend prophylactic treatment and monitor patients carefully after the discontinuation of nortriptyline.

Traumatic stress responses in treatment-seeking earthquake survivors in Turkey.

Abstract: This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 1,027 earthquake survivors who were consecutively referred to a community center at a mean of 14 months after the August 1999 earthquake in Turkey. Seventy-seven percent of referrals were women. The estimated rates of PTSD and major depression were 63% and 42%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, lower education, loss of friends, shorter time since the earthquake, and material loss. More severe depression symptoms related to female gender, longer time since the earthquake, lower educational level, loss of a family member, and past psychiatric illness. In conclusion, long-term public mental health policies are needed for postearthquake psychological problems. These policies need to take into account the risk factors for traumatic stress and the gender differences in referral patterns. The differential stressor-response relationship may have important implications for treatment.

Science-based policy for psychosocial interventions in refugee camps: a Cambodian example.

Abstract: No longer are the high rates of psychiatric morbidity associated with mass violence in refugee populations invisible to the humanitarian assistance community. However, identification of mental health risk and protective factors that can be utilized by policy planners is still lacking. The objective of this report is to provide an analytic approach to determining these factors. A description is provided from the first large-scale epidemiological study of Cambodian refugees confined to the Thailand-Cambodian border in the 1980s and 1990s. The original data from this study are reanalyzed to evaluate the mental health impact of psychosocial factors subject to the influence of camp authorities, such as opportunities in the refugee camp environment and personal behaviors, in addition to trauma. The results suggest the extraordinary capacity of refugees to protect themselves against mental illness despite horrific life experiences. The recommendation emerges for refugee policy makers to create programs that support work, indigenous religious practices, and culture-based altruistic behavior among refugees. As refugee mental health policy receives increasing attention from the international community, it must consist of recommendations and practices based on scientific analysis and empirical evidence.

The effects of September 11 on traumatized refugees: reactivation of posttraumatic stress disorder.

Abstract: Secondary traumatization from the tragic events of September 11, 2001 was studied among an ethnically diverse group of refugees who had been previously traumatized in their native war torn countries. A brief clinically oriented questionnaire was developed and administered to a clinic population of Vietnamese, Cambodian, Laotian, Bosnian and Somalian refugees in the Intercultural Psychiatric Program at Oregon Health & Science University. Traumatic symptoms and responses to the widely televised images from September 11 were assessed among the five ethnic groups, and the differential responses among patients with posttraumatic stress disorder (PTSD), depression, and schizophrenia also were assessed. The strongest responses were among Bosnian and Somalian patients with PTSD, and the Somalis had the greatest deterioration in their subjective sense of safety and security. Regardless of ethnic group, PTSD patients reacted most intensely, and patients with schizophrenia the least. Although patients largely returned to their baseline clinical status after two to three months, this study shows that cross-cultural reactivation of trauma has a significant clinical impact. It is essential that clinicians anticipate PTSD symptom reactivation among refugees when they are reexposed to significant traumatic stimuli.

Future time perspective in pathological gamblers.

Abstract: The hypothesis that pathological gambling is associated with shortened time horizons was investigated by administering the Zimbardo Time Perspective Inventory (ZTPI) and the Future Time Perspective Inventory (FPTI) to a group of pathological gamblers and two comparison groups, psychiatric day patients and social gamblers. The South Oaks Gambling Screen (SOGS) was used to assess the severity of the participants' gambling. Sixty-six participants were recruited, of which 35 were women. The mean age of participants was 39 years. Results showed significantly shorter time horizons in pathological versus social gamblers but few differences between pathological gamblers and psychiatric patients. These results suggest that shortened time horizons are not a unique feature of addicted populations. The role of psychological distress as a possible explanatory variable is discussed.

Posttraumatic stress disorder symptoms influence health status of deployed peacekeepers and nondeployed military personnel

Abstract: Posttraumatic stress disorder (PTSD) is associated with depression and alcohol abuse. PTSD symptoms also contribute to poor health among military veterans. The aim of the present study was to test models pertaining to the direct and indirect influences of PTSD symptoms on the health status of deploy

The Mental Health of War-wounded Refugees : An 8-year Follow-up

Abstract: The complex nature of recent wars and armed conflicts has forced many war-injured persons into exile. To investigate their long-term mental health, three instruments for assessing mental health (HSCL-25, PTSS-10, and a Well-Being scale) were presented to 44 war-wounded refugees from nine different countries 8 years after arrival in Sweden. The prevalence of psychiatric symptoms was high and corresponds to findings in previous studies of refugee patient populations. A lower level of mental health was associated with higher education, unemployment, and poor physical health. The findings suggest a high psychiatric morbidity and a need for psychiatric interventions in this refugee group. Methodological issues to be considered in research on sequels of war traumas are discussed.