title: Pathways from conflict-related trauma and ongoing adversity to posttraumatic stress disorder symptoms amongst West Papuan refugees: The mediating role of anxiety and panic-like symptoms.
abstract: BACKGROUND
  Although the relationship involving exposure to traumatic events (TEs), conditions of adversity, and posttraumatic stress disorder (PTSD) is well established in the refugee field, the psychological factors mediating the relevant pathways are not as clearly delineated. In the present path analysis, we examined a model in which anxiety and panic-like symptoms mediated the path between conflict-related TEs, ongoing adversity, and PTS symptoms amongst 230 refugees from West Papua.
  
  
  METHODS
  Culturally adapted measures were applied to assess TE exposure, ongoing adversity, anxiety, panic-like, PTS, and depressive symptoms.
  
  
  RESULTS
  Our model identified two pathways leading from conflict-related exposure to PTS symptoms, one a direct path, the other mediated by a sequence of ongoing adversity, anxiety and panic-like symptoms. Older refugees from West Papua had higher levels of anxiety and panic-like symptoms than the younger adult generation born in PNG.
  
  
  CONCLUSIONS
  Our findings suggest that a focus on reducing anxiety and panic together with addressing social deprivations and threats may improve anxiety and panic amongst refugees, ultimately improving outcomes for PTS symptoms.
authors.affiliation: Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia. Electronic address: alvin.tay@unsw.edu.au.
authors.forename: Alvin Kuowei
authors.initials: AK
authors.lastname: Tay
authors.affiliation: Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Rees
authors.affiliation: Simpson Centre for Health Services Research, University of New South Wales.
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.affiliation: Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia.
authors.forename: Moses
authors.initials: M
authors.lastname: Kareth
authors.affiliation: Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia.
authors.forename: Derrick
authors.initials: D
authors.lastname: Silove
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D000068337:Armed Conflicts / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D010219:Papua New Guinea / Q000453:epidemiology; D012036:Refugees / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*