title: Six-year trajectories of post-traumatic stress and severe psychological distress symptoms and associations with timing of trauma exposure, ongoing adversity and sense of injustice: a latent transition analysis of a community cohort in conflict-affected Timor-Leste.
abstract: OBJECTIVE
  To identify the 6-year trajectories of post-traumatic stress symptoms (PTSS) and psychological distress symptoms, and examine for associations with timing of trauma exposure, ongoing adversity and with the sense of injustice in conflict-affected Timor-Leste.
  
  
  METHODS
  A whole-of-household survey was conducted in 2004 and 2010 in Dili, the capital of Timor-Leste.
  
  
  METHODS
  1022 adults were followed up over 6 years (retention rate 84.5%). Interviews were conducted by field workers applying measures of traumatic events (TEs), ongoing adversity, a sense of injustice, PTS symptoms and psychological distress.
  
  
  RESULTS
  Latent transition analysis supported a 3-class longitudinal model (psychological distress, comorbid symptoms and low symptoms). We derived 4 composite trajectories comprising recovery (20.8%), a persisting morbidity trajectory (7.2%), an incident trajectory (37.2%) and a low-symptom trajectory (34.7%). Compared with the low-symptom trajectory, the persistent and incident trajectories reported greater stress arising from poverty and family conflict, higher TE exposure for 2 historical periods, and a sense of injustice for 2 historical periods. The persistent trajectory was unique in reporting greater TE exposure in the Indonesian occupation, whereas the incident trajectory reported greater TE exposure during the later internal conflict that occurred between baseline and follow-up. Compared with the low-symptom trajectory, the incident trajectory reported a greater sense of injustice relating to the periods of the Indonesian occupation and independence. The persistent trajectory was characterised by a sense of injustice relating to the internal conflict and contemporary times. The recovery trajectory was characterised by the absence of these risk factors, the only difference from the low-symptom trajectory being that the former reported a sense of injustice for the period surrounding independence.
  
  
  CONCLUSIONS
  Our findings suggest that the timing of both TE exposure and the focus of a sense of injustice may differentiate those with persisting and new-onset mental health morbidity in settings of recurrent conflict.
authors.affiliation: Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, New South Wales, Australia Academic Mental Health Unit, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: A K
authors.identifier: http://orcid.org/0000-0002-9330-3929
authors.initials: AK
authors.lastname: Tay
authors.affiliation: Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, New South Wales, Australia Academic Mental Health Unit, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Rees
authors.affiliation: St John of God Richmond Hospital, School of Psychiatry, University of New South Wales.
authors.forename: Z
authors.initials: Z
authors.lastname: Steel
authors.affiliation: Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, New South Wales, Australia Academic Mental Health Unit, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Tam
authors.affiliation: Alola Foundation, Dili, Timor-Leste.
authors.forename: Z
authors.initials: Z
authors.lastname: Soares
authors.affiliation: Alola Foundation, Dili, Timor-Leste.
authors.forename: C
authors.initials: C
authors.lastname: Soares
authors.affiliation: Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, New South Wales, Australia Academic Mental Health Unit, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: D M
authors.initials: DM
authors.lastname: Silove
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012935:Social Justice / Q000523:psychology* / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology*; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*; D013997:Time Factors; D049648:Timor-Leste / Q000453:epidemiology; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data
keywords: MENTAL HEALTH; PSYCHIATRY