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Symptoms of post-traumatic stress disorder, severe psychological distress, explosive anger and grief amongst partners of survivors of high levels of trauma in post-conflict Timor-Leste

Published online by Cambridge University Press:  29 September 2016

D. M. Silove ,
A. K. Tay ,
Z. Steel ,
N. Tam ,
Z. Soares ,
C. Soares ,
N. dos Reis ,
A. Alves  and
S. Rees
D. M. Silove
Affiliation:
Academic Mental Health Unit and Ingham Institute, University of New South Wales and South Western Sydney Local Health District, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, NSW 2170, Australia
A. K. Tay
Affiliation:
Academic Mental Health Unit and Ingham Institute, University of New South Wales and South Western Sydney Local Health District, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, NSW 2170, Australia
Z. Steel
Affiliation:
St John of God Richmond Hospital, School of Psychiatry, University of New South Wales, North Richmond, NSW 2754, Australia
N. Tam
Affiliation:
Academic Mental Health Unit and Ingham Institute, University of New South Wales and South Western Sydney Local Health District, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, NSW 2170, Australia
Z. Soares
Affiliation:
Alola Foundation, Dili, Timor-Leste
C. Soares
Affiliation:
Alola Foundation, Dili, Timor-Leste
N. dos Reis
Affiliation:
Alola Foundation, Dili, Timor-Leste
A. Alves
Affiliation:
Alola Foundation, Dili, Timor-Leste
S. Rees*
Affiliation:
Academic Mental Health Unit and Ingham Institute, University of New South Wales and South Western Sydney Local Health District, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, NSW 2170, Australia
*
*Address for correspondence: S. Rees, Psychiatry Research and Teaching Unit, University of New South Wales, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, NSW 2170, Australia. (Email: s.j.rees@unsw.edu.au)
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Abstract

Background

Little is known about the mental health of partners of survivors of high levels of trauma in post-conflict countries.

Method

We studied 677 spouse dyads (n = 1354) drawn from a community survey (response 82.4%) in post-conflict Timor-Leste. We used culturally adapted measures of post-traumatic stress disorder (PTSD), psychological distress, explosive anger and grief.

Results

Latent class analysis identified three classes of couples: class 1, comprising women with higher trauma events (TEs), men with intermediate TEs (19%); class 2, including men with higher TEs, women with lower TEs (23%); and class 3, comprising couples in which men and women had lower TE exposure (58%) (the reference group). Men and women partners of survivors of higher TE exposure (classes 1 and 2) had increased symptoms of explosive anger and grief compared with the reference class (class 3). Women partners of survivors of higher TE exposure (class 2) had a 20-fold increased rate of PTSD symptoms compared with the reference class, a pattern that was not evident for men living with women exposed to higher levels of trauma (class 1).

Conclusions

Men and women living with survivors of higher levels of trauma showed an increase in symptoms of grief and explosive anger. The manifold higher rate of PTSD symptoms amongst women living with men exposed to high levels of trauma requires replication. It is important to assess the mental health of partners when treating survivors of high levels of trauma in post-conflict settings.

Keywords

Angergriefpost-conflictpost-traumatic stress disordertrauma
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 1 , January 2017 , pp. 149 - 159
Copyright
Copyright © Cambridge University Press 2016 

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References

Ben Arzi, N, Solomon, Z, Dekel, R (2000). Secondary traumatization among wives of PTSD and post-concussion casualties: distress, caregiver burden and psychological separation. Brain Injury 14, 725–736.Google Scholar
Brooks, R, Silove, D, Steel, Z, Steel, CB, Rees, S (2011). Explosive anger in postconflict Timor Leste: interaction of socio-economic disadvantage and past human rights-related trauma. Journal of Affective Disorders 131, 268–276.Google Scholar
Collins, LM, Fidler, PL, Wugalter, SE, Long, JD (1996). Goodness-of-fit testing for latent class models. Multivariate Behavioural Research 28, 375–389.Google Scholar
Dekel, R, Solomon, Z (2006). Secondary traumatization among wives of Israeli POWs: the role of POWs’ distress. Social Psychiatry and Psychiatric Epidemiology 41, 27–33.Google Scholar
Francisković, T, Stevanović, A, Jelusić, I, Roganović, B, Klarić, M, Grković, J (2007). Secondary traumatization of wives of war veterans with posttraumatic stress disorder. Croatian Medical Journal 48, 177–184.Google Scholar
Furukawa, TA, Kessler, RC, Slade, T, Andrews, G (2003). The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychological Medicine 33, 357–362.CrossRefGoogle ScholarPubMed
Greene, T, Lahav, Y, Bronstein, I, Solomon, Z (2014). The role of ex-POWs’ PTSD symptoms and trajectories in wives’ secondary traumatization. Journal of Family Psychology 28, 666–674.Google Scholar
Hinton, DE, Rasmussen, A, Nou, L, Pollack, MH, Good, MJ (2009). Anger, PTSD, and the nuclear family: a study of Cambodian refugees. Social Science and Medicine 69, 1387–1394.Google Scholar
Klarić, M, Frančišković, T, Obrdalj, EC, Petrić, D, Britvić, D, Zovko, N (2012). Psychiatric and health impact of primary and secondary traumatization in wives of veterans with posttraumatic stress disorder. Psychiatria Danubina 24, 280–286.Google ScholarPubMed
Ledermann, T, Macho, S (2009). Mediation in dyadic data at the level of the dyads: a structural equation modeling approach. Journal of Family Psychology 23, 661–670.Google Scholar
Liddell, BJ, Silove, D, Tay, K, Tam, N, Nickerson, A, Brooks, R, Rees, S, Zwi, AB, Steel, Z (2013). Achieving convergence between a community-based measure of explosive anger and a clinical interview for intermittent explosive disorder in Timor-Leste. Journal of Affective Disorders 150, 1242–1246.Google Scholar
Maercker, A, Brewin, CR, Bryant, RA, Cloitre, M, van Ommeren, M, Jones, LM, Humayan, A, Kagee, A, Llosa, AE, Rousseau, C, Somasundaram, DJ, Souza, R, Suzuki, Y, Weissbecker, I, Wessely, SC, First, MB, Reed, GM (2013). Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World Psychiatry 12, 198–206.CrossRefGoogle ScholarPubMed
Modvig, J, Pagaduan-Lopez, J, Rodenburg, J, Salud, CMD, Cabigon, RV, Panelo, CIA (2000). Torture and trauma in post-conflict East Timor. Lancet 356, 1763.Google Scholar
Mollica, RF, Caspi-Yavin, Y, Bollini, P, Truong, T, Tor, S, Lavelle, J (1992). The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease 180, 111–116.CrossRefGoogle ScholarPubMed
Nylund, KL, Asparouhov, T, Muthen, B (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Structural Equation Modeling 14, 535–569.Google Scholar
Peraica, T, Vidović, A, Petrović, ZK, Kozarić-Kovačić, D (2014). Quality of life of Croatian veterans’ wives and veterans with posttraumatic stress disorder. Health and Quality of Life Outcomes 12, 136.Google Scholar
Porter, M, Haslam, N (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. Journal of the American Medical Association 294, 602–612.Google Scholar
Rees, S, Silove, D, Verdial, T, Tam, N, Savio, E, Fonseca, Z, Thorpe, R, Liddell, B, Zwi, A, Tay, K, Brooks, R, Steel, Z (2013). Intermittent explosive disorder amongst women in conflict affected Timor-Leste: associations with human rights trauma, ongoing violence, poverty, and injustice. PLOS ONE 8, e69207.Google Scholar
Rees, S, Thorpe, R, Tol, W, Fonseca, M, Silove, D (2015). Testing a cycle of family violence model in conflict-affected, low-income countries: a qualitative study from Timor-Leste. Social Science and Medicine 130, 284–291.CrossRefGoogle ScholarPubMed
Rees, SJ, Tol, W, Mohsin, M, Tay, AK, Tam, N, Dos Reis, N, Da Costa, E, Soares, C, Silove, DM (2016). A high-risk group of pregnant women with elevated levels of conflict-related trauma, intimate partner violence, symptoms of depression and other forms of mental distress in post-conflict Timor-Leste. Translational Psychiatry 6, e725.Google Scholar
Silove, D, Brooks, R, Bateman Steel, CR, Steel, Z, Hewage, K, Rodger, J, Soosay, I (2009). Explosive anger as a response to human rights violations in post-conflict Timor-Leste. Social Science and Medicine 69, 670–677.CrossRefGoogle ScholarPubMed
Silove, D, Ivancic, L, Rees, S, Bateman-Steel, C, Steel, Z (2014 a). Clustering of symptoms of mental disorder in the medium-term following conflict: an epidemiological study in Timor-Leste. Psychiatry Research 219, 341–346.Google Scholar
Silove, D, Liddell, B, Rees, S, Chey, T, Nickerson, A, Tam, N, Zwi, AB, Brooks, R, Sila, LL, Steel, Z (2014 b). Effects of recurrent violence on post-traumatic stress disorder and severe distress in conflict-affected Timor-Leste: a 6-year longitudinal study. Lancet Global Health 2, e293–e300.CrossRefGoogle ScholarPubMed
Silove, D, Zwi, AB, le Touze, D (2006). Do truth commissions heal? The East Timor experience. Lancet 367, 1222–1224.Google Scholar
Sipsma, HL, Falb, KL, Willie, T, Bradley, EH, Bienkowski, L, Meerdink, N, Gupta, J (2015). Violence against Congolese refugee women in Rwanda and mental health: a cross-sectional study using latent class analysis. BMJ Open 5, e006299.CrossRefGoogle ScholarPubMed
Solomon, Z, Waysman, M, Levy, G, Fried, B, Mikulincer, M, Benbenishty, R, Florian, V, Bleich, A (1992). From front line to home front: a study of secondary traumatization. Family Process 31, 289–302.CrossRefGoogle Scholar
Steel, Z, Chey, T, Silove, D, Marnane, C, Bryant, RA, Ommeren, M (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302, 537–549.CrossRefGoogle ScholarPubMed
Summerfield, D (2001). The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. British Medical Journal 322, 95–98.Google Scholar
Tay, AK, Rees, S, Steel, Z, Tam, N, Soares, Z, Soares, C, Silove, D (2016). 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. British Medical Journal Open 6, e010205.Google Scholar
Tolin, DF, Foa, EB (2006). Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychological Bulletin 132, 959–992.Google Scholar
Van Ommeren, M, Sharma, B, Thapa, S, Makaju, R, Prasain, D, Bhattarai, R, De Jong, J (1999). Preparing instruments for transcultural research: use of the translation monitoring form with Nepali-speaking Bhutanese refugees. Transcultural Psychiatry 36, 285–301.Google Scholar
Zerach, G, Greene, T, Solomon, Z (2015). Secondary traumatization and self-rated health among wives of former prisoners of war: the moderating role of marital adjustment. Journal of Health Psychology 20, 222–235.Google Scholar
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