title: Associations of adult separation anxiety disorder with conflict-related trauma, ongoing adversity, and the psychosocial disruptions of mass conflict among West Papuan refugees.
abstract: Refugees commonly experience traumatic events that threaten the self and close others, suggesting the possibility that they may experience overlapping symptoms of posttraumatic stress disorder (PTSD) and separation anxiety disorder (SAD). We examine this possibility among West Papua refugees (n = 230) displaced to Port Moresby, Papua New Guinea. We also examine associations between the combined PTSD-SAD construct and indices of past trauma exposure, ongoing adversity, and the psychosocial disruptions caused by mass conflict and displacement. We applied culturally adapted interview modules to assess symptoms of PTSD, SAD, traumatic events (TEs), ongoing adversity, and 5 psychosocial dimensions. Latent class analysis identified a PTSD class (23%), a posttraumatic (PT) SAD class (22%), and a low-symptom class (55%). Compared with the low-symptom class, both the PTSD and PT-SAD classes endorsed higher levels of exposure to all domains of TEs (conflict-related trauma, witnessing murder, childhood related adversities, traumatic losses, and health stress) and ongoing adversity (access to health care, displacement/separation, safety in the community, and access to basic needs), but the 2 comorbid groups did not differ on these indices. The PT-SAD class alone scored higher than the low-symptom reference class in relation to disruptions to the psychosocial domains (safety/security, bonds/network, access to justice, roles/identities, existential meaning) and higher than the PTSD class on safety/security, justice and roles/identities. Our findings suggest that the PT-SAD pattern may represent a response to the most severe forms of psychosocial disruptions of mass conflict among refugees. A focus on separation anxiety may enhance psychotherapies designed to treat PTSD in refugees. (PsycINFO Database Record
authors.affiliation: Academic Mental Health Unit, Liverpool Hospital.
authors.forename: Alvin Kuowei
authors.identifier: 0000-0002-9330-3929
authors.initials: AK
authors.lastname: Tay
authors.affiliation: Academic Mental Health Unit, Liverpool Hospital.
authors.forename: Susan
authors.initials: S
authors.lastname: Rees
authors.affiliation: Academic Mental Health Unit, Liverpool Hospital.
authors.forename: Moses
authors.initials: M
authors.lastname: Kareth
authors.affiliation: Academic Mental Health Unit, Liverpool Hospital.
authors.forename: Derrick
authors.initials: D
authors.lastname: Silove
mesh_terms: D000328:Adult; D001010:Anxiety, Separation / Q000453:epidemiology*; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010219:Papua New Guinea; D011569:Psychiatric Status Rating Scales; D012036:Refugees / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*