title: Patterns of separation anxiety symptoms amongst pregnant women in conflict-affected Timor-Leste: Associations with traumatic loss, family conflict, and intimate partner violence.
abstract: Adult separation anxiety (ASA) symptoms are prevalent amongst young women in low and middle-income countries and symptoms may be common in pregnancy. No studies have focused on defining distinctive patterns of ASA symptoms amongst pregnant women in these settings or possible associations with trauma exposure and ongoing stressors.
  
  
  
  In a consecutive sample of 1672 women attending antenatal clinics in Dili, Timor-Leste (96% response), we assessed traumatic events of conflict, ongoing adversity, intimate partner violence (IPV), ASA, post-traumatic stress disorder (PTSD) and severe psychological distress. Latent Class Analysis was used to identify classes of women based on their distinctive profiles of ASA symptoms, comparisons then being made with key covariates including trauma domains of conflict, intimate partner violence (IPV) and ongoing stressors.
  
  
  
  LCA yielded three classes, comprising a core ASA (4%), a limited ASA (25%) and a low symptom class (61%). The core ASA class reported exposure to multiple traumatic losses and IPV and showed a pattern of comorbidity with PTSD; the limited ASA class predominantly reported exposure to ongoing stressors and was comorbid with severe psychological distress; the low symptom class reported relatively low levels of exposure to trauma and stressors.
  
  
  
  The study is cross-sectional, cautioning against inferring causal inferences.
  
  
  
  The core ASA group may be in need of immediate intervention given the high rate of exposure to IPV amongst this class. A larger number of women experiencing a limited array of non-specific ASA symptoms may need assistance to address the immediate stressors of pregnancy.
authors.affiliation: Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia.
authors.forename: D M
authors.initials: DM
authors.lastname: Silove
authors.affiliation: Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia.
authors.forename: A K
authors.initials: AK
authors.lastname: Tay
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Tol
authors.affiliation: Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Tam
authors.affiliation: Alola Women's Foundation, Timor-Leste.
authors.forename: N
authors.initials: N
authors.lastname: Dos Reis
authors.affiliation: Alola Women's Foundation, Timor-Leste.
authors.forename: Z
authors.initials: Z
authors.lastname: da Costa
authors.affiliation: Alola Women's Foundation, Timor-Leste.
authors.forename: C
authors.initials: C
authors.lastname: Soares
authors.affiliation: Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia. Electronic address: s.j.rees@unsw.edu.au.
authors.forename: S
authors.initials: S
authors.lastname: Rees
mesh_terms: D000328:Adult; D001010:Anxiety, Separation / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D054541:Family Conflict / Q000523:psychology*; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence / Q000523:psychology*; D011247:Pregnancy; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D049648:Timor-Leste / Q000453:epidemiology; D014857:Warfare; D055815:Young Adult