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Background: Australia is an ethnically diverse nation. Research has demonstrated an elevated risk of developing a mental illness in culturally and linguistically diverse (CaLD) communities yet uptake of mental health services is low. To improve mental health treatment seeking and outcomes for CaLD individuals in Australia there is an urgent need to deeply understand barriers to treatment such as stigma. Using an exploratory qualitative approach, the aim of the study was to explore how CaLD communities' conceptualise and interpret mental illness and associated beliefs and experiences of stigma. Methods: The study focused on three key CaLD groups: the Congolese, Arabic-speaking and Mandarin-speaking communities residing in Sydney, Australia. A series of eight focus group discussions (n = 51) and 26 key informant interviews were undertaken online using Zoom during the period of November to December 2021. Focus group discussions and key informant interviews were digitally recorded, transcribed, and analysed using NVivo software. Results: Three major themes were identified. The first theme related to mental illness terminology used in the three communities. Despite variation in the terms used to refer to 'mental illness' all three communities generally distinguished between 'mental illness', a more severe condition and 'mental health problems', considered to arise due to stressors. The second theme centred on beliefs about mental illness; with all three communities identifying migration-related stressors as contributing to mental illness. Culturally related beliefs were noted for the Congolese participants with the perception of a link between mental illness and supernatural factors, whereas Mandarin-speaking participants highlighted lack of inter and intrapersonal harmony and failure to adhere to values such as filial piety as contributing to mental illness. The final theme related to mental illness related stigma and the various ways it manifested in the three communities including presence of collectivist public stigma felt across all three groups and affiliate (family) stigma reported by the Arabic and Mandarin-speaking groups. Conclusions: We found rich diversity in how these communities view and respond to mental illness. Our findings provide some possible insights on both service provision and the mental health system with a view to building effective engagement and pathways to care. [ABSTRACT FROM AUTHOR]

The current study sought to examine resettled Iraqi refugees' recognition of trauma-related psychopathology and the association between recognition and help-seeking. Participants were 66 men and women aged 18 to 70 years with clinically significant symptoms of posttraumatic stress disorder (PTSD) recruited from a larger, community-based sample in Western Sydney, Australia. Participants were presented with a vignette of a fictional character who had been exposed to trauma prior to leaving Iraq and who was suffering from symptoms of PTSD. Participants were then asked if they believed that they might currently have a problem such as the one described in the vignette. Approximately half (50.8%) of participants believed that they might currently have a problem such as the one described in the vignette and one third (33.3%) of participants had ever sought help for such a problem. Participants who believed that they might currently have a problem like the one described were 13 times more likely to have sought help for such a problem, controlling for demographic characteristics, trauma-related symptomatology, and levels of general psychological distress. Poor self-recognition level of trauma-related psychopathology among resettled Iraqi refugees may be a barrier to help-seeking and may therefore be an important target for health promotion and early intervention initiatives. [ABSTRACT FROM AUTHOR]

Background: Refugee populations have particularly high rates of mental health problems, including Posttraumatic Stress Disorder (PTSD) and depression. However, uptake of mental health care may be low even when severe depression and PTSD symptoms are present in individuals following resettlement. This is likely due, at least in part, to cultural influences on refugees' knowledge and beliefs about mental health problems and their treatment. We sought to provide preliminary evidence for the effectiveness of a culturally tailored mental health promotion program for Arabic-speaking refugees. Methods: A total of 33 Arabic-speaking refugees resettled in South Western Sydney were recruited and completed intervention which consisted of weekly three-hour sessions for 4 weeks delivered in Arabic. Key aspects of mental health literacy, help-seeking intentions and levels of general psychological distress were assessed, by means of a self-report survey, pre-intervention, (immediately) post-intervention and 3 months following intervention. Results: Of the 33 participants that completed the intervention, 31 completed the immediate post-intervention survey and 29 completed the 3 months follow-up survey. Improvements in most aspects of mental health literacy assessed were found immediately post-intervention and at follow-up, although only changes relating to stigmatising attitudes were statistically significant. Additionally, a statistically significant decrease in participants' levels of general psychological distress was observed immediately following the intervention, and this decrease was sustained at follow-up. Conclusion: While further research employing a more rigorous study design and larger sample size will be needed, results of this initial trial suggest that a culturally tailored mental health promotion program targeting key aspects of mental health literacy can improve the mental health of Arabic-speaking refugees resettled in a Western nation. [ABSTRACT FROM AUTHOR]

Purpose: To examine the prospective associations between body mass index (BMI) and health-related quality of life (HRQoL).Methods: Data were extracted from a longitudinal, nationally representative sample of 9916 men and women aged 18 years and over who were followed annually between 2006 and 2016 in the Household, Income and Labour Dynamics in Australia (HILDA) survey. HRQoL was assessed using the self-administered SF-36 questionnaire annually between 2006 (baseline) and 2016. BMI was calculated from self-reported height and weight and was classified into the following four categories of baseline BMI: underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (≥ 30 kg/m2). We used linear mixed-effects regression models to investigate the associations between change in BMI (kg/m2) and concurrent changes in HRQoL scores over 11 years.Results: BMI gain was associated with deterioration of Physical Component Summary (PCS) (P < 0.001), but not with change in Mental component summary (MCS) over the 11-year period. BMI gain was inversely associated (P < 0.001) with five of the eight HRQoL domains (physical functioning, role physical, bodily pain, general health and vitality) with a significant graded association according to baseline BMI category. Over the 11-year study period, every unit increase in PCS was associated with a decrease of 0.02 (P < 0.001), 0.03 (P < 0.001) and 0.04 (P < 0.001) BMI units per year among participants who were normal, overweight and obese at baseline, respectively. Five of the eight domains of HRQoL (physical functioning, role physical, bodily pain, general health and vitality) were inversely associated with BMI (P < 0.001) with a significant graded association according to baseline BMI category.Conclusions: Weight gain was not only associated with deterioration of HRQoL, and vice versa. The bi-directional association was stronger for physical than mental domains of HRQoL. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents with chronic physical health conditions are vulnerable to poor mental health outcomes. The measurement of mental health literacy of health professionals working with such populations is important because of their role in promoting early and appropriate help-seeking. This study sought to determine the beliefs regarding the causes of and risks factors for three types of mental illnesses amongst health professionals in United Arab Emirates. Method: A culturally validated mental health literacy survey presenting three vignettes of fictional characters meeting diagnostic criteria for posttraumatic stress disorder, depression with suicidal thoughts and psychosis was distributed. The survey measured health care professionals' beliefs regarding the causes of and risk factors for these disorders. Results: A total of 317 health care professional (> 90% nurses) were surveyed from across the UAE. Although 43.8% correctly endorsed exposure to a 'traumatic event' as the most likely cause for developing posttraumatic stress disorder, there was a more limited understanding of the contribution of biopsychosocial factors to the development of the mental illness, particularly for psychosis. Participant socio-demographic variables were associated with attributions of religious or spiritual beliefs and personal weakness as causal and/or vulnerability factors in the development of depression with suicidal thoughts and psychosis. Conclusions: Efforts to improve mental health systems and health care providers in UAE and other similar Middle Eastern countries requires targeted mental health literacy programs that seek to integrate biopsychosocial models of mental illness and their treatment with the positive aspects of religious and cultural beliefs that are dominant in this region. [ABSTRACT FROM AUTHOR]

Background: Refugees are particularly vulnerable to poor mental health outcomes due to exposure to pre migration trauma and post migration stressors. Research has demonstrated evidence to suggest that the professional help-seeking among refugee groups is low or problematic. This study seeks to examine help-seeking for emotional problems in two large samples of Iraqi and Afghan refugees in Australia.Methods: This study uses data from two waves of the Building a New Life in Australia, the longitudinal study of Humanitarian migrants. The data was collected face-to-face between 2013 and 2016, among humanitarian migrants. All participants held a permanent protection visa and had arrived in Australia or been granted their visa between period of May to December 2013. The study sample included 1288 participants born in Iraq and Afghanistan (aged 15 and over). In the Wave 3 interview (2015-2016) participants reported on professional help received to deal with emotional problems.Results: Approximately 36 and 37% of the Iraqi and Afghan groups respectively, reported seeking help for emotional problems. Within the Iraqi group, associations between mental health status, namely general psychological distress and PTSD and help-seeking were found but this was not present in the Afghan group, where age seemed to play a role in help-seeking. Frequency of help received was low with approximately 47% of the Iraqi and 57% of the Afghan groups reporting having received help 5 times or less in the last 12 months.Conclusions: Findings from this study provide clear directions on areas where culturally tailored mental health promotion programs should target in these two refugee communities. Further, the differences in help-seeking behaviour of these communities should be noted by both clinicians and policy makers as efforts to provide culturally responsive mental health services. [ABSTRACT FROM AUTHOR]

Purpose: Refugees are at greater risk of mental illness due to stressors encountered post-resettlement. However, few longitudinal studies have examined the within-person effects of these stressors, especially with respect to social integration. This study aims to examine what factors are associated with psychological distress in a longitudinal sample of refugees resettled in Australia.This study used data from three Waves of the Building a New Life in Australia study, collected between 2013 and 2018. The eligible sample included 1881 adult respondents, clustered in 1175 households. We conducted multilevel mixed-effects growth modelling incorporating time-variant and time-invariant covariates with psychological distress, using the Kessler Psychological Distress Scale (K6).Rates of high psychological distress increased across the 5-year follow-up period. Social integration stressors (e.g. discrimination, lower sense of belonging, loneliness, lower English proficiency) were associated with higher levels of psychological distress over time. Refugees reporting loneliness not only had a greater risk of elevated psychological distress at each time point, but the difference in risk increased over each time point. Refugees who were exposed to traumatic events, older, female and of Middle Eastern background were also more likely to report higher levels of psychological distress over time.These findings highlight the importance of identifying refugees who may encounter difficulties with social integration in the early years of resettlement. Newly arrived refugees may benefit from longer-term resettlement programmes that address post-migratory stressors, particularly with regards to loneliness, to reduce the prevalence of elevated psychological distress during the early years of resettlement.Methods: Refugees are at greater risk of mental illness due to stressors encountered post-resettlement. However, few longitudinal studies have examined the within-person effects of these stressors, especially with respect to social integration. This study aims to examine what factors are associated with psychological distress in a longitudinal sample of refugees resettled in Australia.This study used data from three Waves of the Building a New Life in Australia study, collected between 2013 and 2018. The eligible sample included 1881 adult respondents, clustered in 1175 households. We conducted multilevel mixed-effects growth modelling incorporating time-variant and time-invariant covariates with psychological distress, using the Kessler Psychological Distress Scale (K6).Rates of high psychological distress increased across the 5-year follow-up period. Social integration stressors (e.g. discrimination, lower sense of belonging, loneliness, lower English proficiency) were associated with higher levels of psychological distress over time. Refugees reporting loneliness not only had a greater risk of elevated psychological distress at each time point, but the difference in risk increased over each time point. Refugees who were exposed to traumatic events, older, female and of Middle Eastern background were also more likely to report higher levels of psychological distress over time.These findings highlight the importance of identifying refugees who may encounter difficulties with social integration in the early years of resettlement. Newly arrived refugees may benefit from longer-term resettlement programmes that address post-migratory stressors, particularly with regards to loneliness, to reduce the prevalence of elevated psychological distress during the early years of resettlement.Results: Refugees are at greater risk of mental illness due to stressors encountered post-resettlement. However, few longitudinal studies have examined the within-person effects of these stressors, especially with respect to social integration. This study aims to examine what factors are associated with psychological distress in a longitudinal sample of refugees resettled in Australia.This study used data from three Waves of the Building a New Life in Australia study, collected between 2013 and 2018. The eligible sample included 1881 adult respondents, clustered in 1175 households. We conducted multilevel mixed-effects growth modelling incorporating time-variant and time-invariant covariates with psychological distress, using the Kessler Psychological Distress Scale (K6).Rates of high psychological distress increased across the 5-year follow-up period. Social integration stressors (e.g. discrimination, lower sense of belonging, loneliness, lower English proficiency) were associated with higher levels of psychological distress over time. Refugees reporting loneliness not only had a greater risk of elevated psychological distress at each time point, but the difference in risk increased over each time point. Refugees who were exposed to traumatic events, older, female and of Middle Eastern background were also more likely to report higher levels of psychological distress over time.These findings highlight the importance of identifying refugees who may encounter difficulties with social integration in the early years of resettlement. Newly arrived refugees may benefit from longer-term resettlement programmes that address post-migratory stressors, particularly with regards to loneliness, to reduce the prevalence of elevated psychological distress during the early years of resettlement.Conclusions: Refugees are at greater risk of mental illness due to stressors encountered post-resettlement. However, few longitudinal studies have examined the within-person effects of these stressors, especially with respect to social integration. This study aims to examine what factors are associated with psychological distress in a longitudinal sample of refugees resettled in Australia.This study used data from three Waves of the Building a New Life in Australia study, collected between 2013 and 2018. The eligible sample included 1881 adult respondents, clustered in 1175 households. We conducted multilevel mixed-effects growth modelling incorporating time-variant and time-invariant covariates with psychological distress, using the Kessler Psychological Distress Scale (K6).Rates of high psychological distress increased across the 5-year follow-up period. Social integration stressors (e.g. discrimination, lower sense of belonging, loneliness, lower English proficiency) were associated with higher levels of psychological distress over time. Refugees reporting loneliness not only had a greater risk of elevated psychological distress at each time point, but the difference in risk increased over each time point. Refugees who were exposed to traumatic events, older, female and of Middle Eastern background were also more likely to report higher levels of psychological distress over time.These findings highlight the importance of identifying refugees who may encounter difficulties with social integration in the early years of resettlement. Newly arrived refugees may benefit from longer-term resettlement programmes that address post-migratory stressors, particularly with regards to loneliness, to reduce the prevalence of elevated psychological distress during the early years of resettlement. [ABSTRACT FROM AUTHOR]

Background: Australia is a multicultural nation with a humanitarian program that welcomes a large number of Iraqi refugees. Despite the high prevalence of trauma related disorders, professional help-seeking in this group is very low. This study sought to evaluate a face-to-face mental health literacy (MHL) Course that teaches community-based workers how to provide initial help to Iraqi refugees with depression and post-traumatic stress disorder (PTSD) related problems. Methods: An uncontrolled pre, post and follow-up design was used to measure improvement in MHL in community- based workers assisting Iraqi refugees. Results: Eighty-six participants completed the pre- and post-training questionnaires. Forty-five (52%) completed all 3-time point questionnaires. Fifty-six percent (48/86) of participants were able to correctly recognise 'PTSD' as the problem depicted in a vignette before the training. This increased to 77% (66/86) after training and was maintained at follow-up with 82% (37/45) correctly recognising the problem (p = 0.032). Recognition of depression also increased from 69% (59/86) at pre-training to 83% (71/86) after training and to 82% (37/45) at follow-up. There was a significant increase in perceived helpfulness of professional treatments for depression after training (p < 0.001 at post-training, p = 0.010 at follow-up). Significant changes were reported in confidence of participants when helping an Iraqi refugee with PSTD (p < 0.001 at post-training, p < 0.001 at follow-up) and depression (p < 0.001 at post-training, p = 0.003 at follow-up). A decrease were also found on social distance mean scores associated with PTSD (p = 0.006 at post-training, p < 0.001 at follow-up) and depression (p = 0.007 at follow-up). Changes were not significant following training for offering help and helping behaviours in both PSTD and depression vignettes and, the 'dangerous/unpredictable' subscale in the depression vignette. Conclusion: This training is a recommendable way to improve and better equip staff on how to respond to mental health crises and offer Mental Health First Aid in a culturally sensitive manner to Iraqi refugees. [ABSTRACT FROM AUTHOR]

Background: Psychological trauma, in particular, posttraumatic stress disorder (PTSD) and depression, are highly prevalent among resettled refugees. However, little is known regarding the mental health status and associated helpseeking behaviour of resettled Afghan refugees in Australia. Methods: A sample of 150 resettled Afghan refugees (74 males; mean age 32.8 years, SD = 12.2) living in Adelaide, South Australia were recruited. Self-reported measures of PTSD, depression, exposure to traumatic events, functional impairment, self-recognition of PTSD symptomatology and help-seeking behaviours were completed. Multivariate analysis of variables associated with help-seeking was conducted. Results: Forty-four percent of participants met criteria for clinically significant PTSD symptoms and all but one participant reported being exposed to 1 or more traumatic and/or conflict related events, such as 'losing your property and wealth'. Moreover, 14.7% of participants had symptoms suggestive of clinically significant depression. General practitioners were the most common source of help in relation to mental health problems, with very few participants (4.6%) seeking help from specialist trauma and torture mental health services. Self-recognition of having a PTSD related mental health problem and functional impairment levels were both found to be independent predictors of help-seeking (p = .05). Conclusions: The findings provide further evidence for high rates of PTSD symptomatology and low uptake of mental care among resettled refugees. Poor self-recognition of the presence and/or adverse impact of PTSD symptoms may need to be targeted in mental health promotion programs designed to improve "mental health literacy" and thereby promote early and appropriate help-seeking where this is needed. [ABSTRACT FROM AUTHOR]

Aim: To report participants' and facilitators' experiences of mental health promotion, prevention, and early‐intervention training program targeted at school nurses in the United Arab Emirates (UAE). Background: The UAE school healthcare service is staffed by full‐time nurses and part‐time doctors and linked to primary healthcare centers. This service supports children's physical and mental well‐being. However, school nurses' capacity to realize the potential of this service, particularly regarding mental health, has not yet been explored. Methods: We used an exploratory qualitative approach with data triangulation. Data were drawn from school nurses that participated in a targeted mental health promotion, prevention, and early‐intervention training program. Data were gathered through focus group interviews with participating school nurses, written reflections, and notes recorded by the program designers and trainers. All school nurses who participated in the training program (N = 15) were included in this study. This study adhered to the consolidated criteria for reporting qualitative research. Results: Nurses' narratives encompassed three main themes, which indicated the program was an enjoyable professional and personal journey that allowed professional discovery/development and personal growth. Program organizers/facilitators indicated the training program was important, but challenging to implement. Four themes emerged from their reflections that covered the structure of school nursing services, participants' competency and education, the UAE context, and teaching style. Conclusion: A well‐structured professional development program can contribute to improving mental healthcare in schools. Improved service structure and regulations to support this goal are essential. Implications for nursing practice, research, and policy: School nurses benefit professionally and personally from targeted mental health training, which also improves the care students receive. School healthcare service managers should consider increasing such training opportunities for nurses and focus on measuring service outcomes and evaluating effectiveness. It is also necessary to reassess the minimum qualification requirement for school nurses. Specific professional development programs for school nurses will improve their clinical practice and support the recruitment of competent and prepared staff. [ABSTRACT FROM AUTHOR]

Background: Resettled refugees are a vulnerable group for mental health problems and in particular, trauma-related disorders. Evidence suggests that poor 'mental health literacy' (MHL) is a major factor in low or inappropriate treatment- seeking among individuals with mental health problems. This study sought to determine the beliefs regarding the causes of and risk factors for post-traumatic stress disorder (PTSD) amongst two resettled refugee groups in Australia. Methods: Utilising a culturally adapted MHL survey method, 225 Iraqis and 150 Afghans of refugee background were surveyed. Results: Approximately 52% of the Iraqi participants selected 'experiencing a traumatic event' as the 'most likely' cause for the clinical vignette, whereas 31.3% of the Afghan sample selected 'coming from a war torn country' as their top cause. While both groups identified being 'born in war torn country' as the most likely risk, at 34.4 and 48% of the Iraqis and Afghans respectively, differences regarding other risk factors selected were noted. Conclusions: The results of this study indicate the need for culturally sensitive health promotion and early intervention programs seeking to improve MHL relating to PTSD in resettled refugee populations. There is also a need for mental health services to recognise that variation in MHL may be a function of both the cultural origin of a refugee population and their resettlement experiences. Such recognition is needed in order to bridge the gap between Western, biomedical models for mental health care and the knowledge and beliefs of resettled refugee populations. [ABSTRACT FROM AUTHOR]

Background: Refugees are one of the most vulnerable groups in Australian society, presenting high levels of exposure to traumatic events and consequently high levels of severe psychological distress. While there is a need for professional help, only a small percentage will receive appropriate care for their mental health concerns. This study aimed to determine cultural considerations required when providing mental health first aid to Iraqi refugees experiencing mental health problems or crises. Method: Using a Delphi method, 16 experts were presented with statements about possible culturally-appropriate first aid actions via questionnaires and were encouraged to suggest additional actions not covered by the questionnaire content. Statements were accepted for inclusion in a guideline if they were endorsed by ≥90 % of panellists as 'Essential' or 'Important'. Results: From a total of 65 statements, 38 were endorsed (17 for cultural awareness, 12 for cross-cultural communication, 7 for stigma associated with mental health problems, and 2 for barriers to seeking professional help). Conclusion: Experts were able to reach consensus about how to provide culturally-appropriate first aid for mental health problems to Iraqi refugees, demonstrating the suitability of this methodology in developing cultural considerations guidelines. This specific refugee study provided potentially valuable cultural knowledge required to better equip members of the Australian public on how to respond to and assist Iraqi refugees experiencing mental health problems or crises. [ABSTRACT FROM AUTHOR]

Background: Resources and training for aged care workers who are working with older people from refugee backgrounds are limited. Thus, a resource titled 'Enhancing the Lives of Older Refugees: A self-Improvement Resource for Community Service Providers' was developed in 2011, and later accompanied by a training program developed in 2012. The aim of the resource and accompanying training was to assist community aged care service providers, based in South Western Sydney and surrounding areas, to recognise an older refugee, increase their knowledge and skills in working with older refugees, have a greater understanding of older refugees' life experiences, and provide additional information that would allow them to offer appropriate services to those in their care. This paper reports on the evaluation of the training package provided to community aged care personnel. Methods: Eleven training sessions were conducted with all participants invited to take part in the research. One hundred and twenty-eight consenting participants completed a pre and post training evaluation questionnaire. Results: Analysis of the data indicated a positive change in participant's ability to define an older refugee, understanding older refugee's life experiences, loss and grief, the impact of the refugees' experience in old age and the capacity to locate and access information to support the care of older refugees. Conclusions: The findings lend support that this mode of training can provide information and resources to increase the capacity of aged care workers to better meet the needs of older people from a refugee background. [ABSTRACT FROM AUTHOR]

Background: Resettled refugees are at high risk of trauma-related mental health problems, yet there is low uptake of mental health care in this population. Evidence suggests poor 'mental health literacy' (MHL) may be a major factor influencing help-seeking behaviour among individuals with mental health problems. This study sought to examine the MHL of resettled Afghan refugees in Adelaide, South Australia. Methods: Interviews were completed with 150 (74 males; mean age 32.8 years, SD = 12.2) resettled Afghan refugees living in Adelaide, South Australia. A convenience sampling method was employed and participants were comprised of volunteers from the Afghan community residing in the northern suburbs of Adelaide. Following informed consent participants were presented a culturally appropriate vignette describing a fictional person suffering from posttraumatic stress disorder (PTSD). This was followed by a series of questions addressing participants' knowledge and understanding of the nature and treatment of the problem described. Self-report measures of PTSD symptoms and co-morbid psychopathology were also administered. Results: Thirty-one per cent of the respondents identified the problem depicted in the vignette as being PTSD, while 26 per cent believed that the main problem was 'fear'. Eighteen per cent of participants believed that 'getting out and about more/finding some new hobbies' would be the most helpful form of treatment for the problem described, followed by 'improving their diet' and 'getting more exercise' (16%). Conclusion: The results of this study demonstrate aspects of MHL that appear to be specific to Afghan refugees who have resettled in Australia. They indicate the need for health promotion and early intervention programs, and mental health services, to recognise that variation in MHL may be a function of both the cultural origin of a refugee population and their resettlement country. Such recognition is needed in order to bridge the gap between Western, biomedical models for mental health care and the knowledge and beliefs of resettled refugee populations. [ABSTRACT FROM AUTHOR]

Background: Psychological distress has been well identified in recently resettled refugee groups; however, evidence on psychological distress over time is not conclusive. Australia has welcomed a large refugee population in recent decades, including Iraqis who currently form one of the largest groups being resettled in Australia. Methods: This study aimed to explore psychological distress in two samples of Iraqi refugees, those who recently arrived (n = 225, average length of stay = 0.55 months) and those with a longer period of resettlement (n = 225, average length of stay = 58.5 months). To assess general symptoms of anxiety and depression, the Kessler Psychological Distress Scale was employed. Associations between participants' demographic characteristics and psychological distress levels were examined. Results: A significant difference between groups, t (441) = -2.149, p = 0.0324, was found, indicating that study participants with longer periods of resettlement were experiencing higher levels of psychological distress than recent arrivals. Conclusion: Our findings have implications for both for government and non-government funded organisations who should consider the provision of assistance programs beyond the initial arrival period. [ABSTRACT FROM AUTHOR]

A systematic review of literature reporting prevalence rates of posttraumatic stress disorder (PTSD) and depression amongst community samples of resettled Iraqi refugees was undertaken. A search of the electronic databases of Medline, PsychINFO, CINAHL, PILOTS, Scopus, and Cochrane, up to November 2013 was conducted. Following the application of the inclusion and exclusion criteria, eight empirical papers were included in the review and analysis. Specifically, six studies reported on PTSD prevalence (total n = 1,912), which ranged from 8 to 37.2 % and seven studies reported on rates of depression (total n = 1,647) noted to be 28.3 to 75 %. The overall interobserver agreement for the methodological quality assessment was good to excellent with a Kappa coefficient of 0.64. Iraqi refugees continue to represent one of the largest groups being resettled worldwide. This systematic review indicates that prevalence of PTSD and depression is high and should be taken into consideration when developing mental health early intervention and treatment services. [ABSTRACT FROM AUTHOR]

Background: To examine levels of psychological distress and help seeking behaviour in resettled refugees attending English tuition classes in Australia, and their associations with participants' demographic characteristics. Methods: Data was collected by bilingual interviewers between March and November 2013. A volunteer sample of attendees of Adult Migrant English Programs (AMEP) in Western Sydney were recruited. Participants were two hundred and twenty five Iraqi refugees resettled in Western Sydney, who had left Iraq no earlier than 1991, were fluent in Arabic and/or English, and were between the ages of 18 and 70. The chief outcome measures used were the Kessler Psychological Distress Scale (K-10) as well as The Harvard Trauma Questionnaire (HTQ). Results: On the K-10, 39.8% of participants had severe psychological distress, 19.4% moderate distress, and 40.7% had low to mild distress. Ninety-five percent of participants reported having experienced one or more potentially traumatic event (PTE) as defined by the HTQ prior to leaving Iraq, with a mean of 14.28 events (SD = 8.69). Thirty-one percent of participants met the threshold (≥2.5) for clinically significant PTSD symptomatology, with a significantly higher occurrence among participants with lower education attainment (?² (3) = 8.26, p = .04). Of those participants with clinically significant PTSD symptomatology according to the HTQ, only 32.9% reported ever having ever sought help for a mental health problem. Conclusions: The high level of distress found in this sample, combined with low uptake of mental health care, highlights the need for programs targeted to promote help-seeking among Iraqi refugees who have resettled in Australia. Further, the higher level of PTSD symptomatology found amongst those with lower education attainment has mental health promotion and treatment implications. Specifically, in designing service and treatment programs, consideration should be given to the possible impact excessive levels of psychological distress may have on learning in refugees, to ensure that those who have been unable to develop proficiency in the English language receive effective care. [ABSTRACT FROM AUTHOR]

Background To examine levels of psychological distress and help seeking behaviour in resettled refugees attending English tuition classes in Australia, and their associations with participants' demographic characteristics. Methods Data was collected by bilingual interviewers between March and November 2013. A volunteer sample of attendees of Adult Migrant English Programs (AMEP) in Western Sydney were recruited. Participants were two hundred and twenty five Iraqi refugees resettled in Western Sydney, who had left Iraq no earlier than 1991, were fluent in Arabic and/or English, and were between the ages of 18 and 70. The chief outcome measures used were the Kessler Psychological Distress Scale (K-10) as well as The Harvard Trauma Questionnaire (HTQ). Results On the K-10, 39.8% of participants had severe psychological distress, 19.4% moderate distress, and 40.7% had low to mild distress. Ninety-five percent of participants reported having experienced one or more potentially traumatic event (PTE) as defined by the HTQ prior to leaving Iraq, with a mean of 14.28 events (SD = 8.69). Thirty-one percent of participants met the threshold (=2.5) for clinically significant PTSD symptomatology, with a significantly higher occurrence among participants with lower education attainment (? 2 (3) = 8.26, p = .04). Of those participants with clinically significant PTSD symptomatology according to the HTQ, only 32.9% reported ever having ever sought help for a mental health problem. Conclusions The high level of distress found in this sample, combined with low uptake of mental health care, highlights the need for programs targeted to promote help-seeking among Iraqi refugees who have resettled in Australia. Further, the higher level of PTSD symptomatology found amongst those with lower education attainment has mental health promotion and treatment implications. Specifically, in designing service and treatment programs, consideration should be given to the possible impact excessive levels of psychological distress may have on learning in refugees, to ensure that those who have been unable to develop proficiency in the English language receive effective care. [ABSTRACT FROM AUTHOR]

Background: Resettled refugees are a particularly vulnerable group. They have very high levels of mental health problems, in particular, trauma-related disorders, but very low uptake of mental health care. Evidence suggests that poor “mental health literacy”, namely, poor knowledge and understanding of the nature and treatment of mental health problems is a major factor in low or inappropriate treatment-seeking among individuals with mental health problems. This study used a culturally adapted Mental Health Literacy Survey method to determine knowledge of, and beliefs about, helpfulness of treatment interventions and providers for posttraumatic stress disorder (PTSD) amongst resettled Iraqi refugees. Methods: 225 resettled Iraqi refugees in Western Sydney attending the Adult Migrant English Program (AMEP), federally funded English language tuition, were surveyed. A vignette of a fictional character meeting diagnostic criteria for PTSD was presented followed by the Mental Health Literacy Survey. PTSD symptomology was measured using the Harvard Trauma Questionnaire part IV (HTQ part IV), with Kessler Psychological Distress Scale (K10) used to measure levels of general psychological distress. Results: Only 14.2% of participants labelled the problem as PTSD, with “a problem with fear” being the modal response (41.8%). A total of 84.9% respondents indicated that seeing a psychiatrist would be helpful, followed by reading the Koran or Bible selected by 79.2% of those surveyed. There was some variation in problem recognition and helpfulness of treatment, most notably influenced by the length of resettlement in Australia of the respondents. Conclusions: These findings have important implications for the design and implementation of mental health promotion and treatment programs for resettled refugees and those who work with them. [ABSTRACT FROM AUTHOR]

Psychological distress experienced by resettling refugees has been well documented, with posttraumatic stress disorder (PTSD) and depression being prevalent outcomes. This study examined psychological and physiological measures of trauma exposure in 2 groups of Iraqi refugees resettled in Australia, those seeking psychological treatment (n= 25) versus those not seeking treatment (n= 22). Data from a group of healthy sex- and age-matched controls (n= 32) were collected to facilitate norm comparisons for physiological arousal. Continuous recording of electrocardiogram data examined resting heart rate (HR). Refugees seeking treatment had significantly higher levels of PTSD symptomology and depression levels compared to non-treatment-seeking refugees; however, there was no difference in the number of trauma events endorsed. Finally, resting HR was significantly higher in both refugee groups compared with healthy controls; however, there was no difference between the refugee groups. Clinical consideration of this excessive trauma exposure and elevated autonomic arousal is warranted. [ABSTRACT FROM AUTHOR]

Resettled refugees living in Western countries frequently report high levels of posttraumatic stress disorder (PTSD) and depression. This study sought to measure levels of physiological arousal in a group of resettled Iraqi refugees in Australia receiving psychological treatment. A continuous recording of electrocardiogram (ECG) data was used to examine baseline heart rate (HR) and heart rate variability (HRV) in refugees ( n = 25) and healthy age- and sex-matched controls ( n = 23). Descriptively, PTSD (48%) was the most commonly noted disorder followed equally by major depressive episode (36%) and dysthymia (36%) in the refugees. Examination of the physiological data indicated that the refugee group had increased resting HR compared with healthy controls (78.84 vs. 60.08 beats per minute, p < .001). No significant differences were noted in the HRV data with age, gender, and years of education included in the model. This finding highlights the importance of examining levels of arousal in refugees presenting with mental health complaints to provide appropriate treatment strategies. [ABSTRACT FROM AUTHOR]

Primary objective: To examine the effect of a patient's sex on measures of outcome in a matched sample of patients admitted for acute traumatic brain injury (TBI). Research design: A prospective multi-centred group comparison study based in metropolitan Sydney, Australia. Methods and procedures: Data was collected on 25 women admitted for treatment following non-penetrating TBI. Forty-five men were then matched with regards to age and injury severity. All subjects met the study criteria of having a moderate-to-severe TBI and aged 50 years old or younger. Exclusion criteria included history of previous head injury, psychiatric disturbance and significant alcohol and/or substance abuse. Data included injury details and physiological and psychometric measures of outcome. Main outcomes and results: Women demonstrated better outcomes as indicated by their Glasgow Outcome Scale scores (adjusted for initial injury severity and age at injury odds ratio [OR] 4.2, 95% CI 1.4-12.7) and having shorter Length of Stay (adjusted OR 9.03, 95% CI 3.13-26.08). Conclusions: Understanding the presence of sex differences in outcome following TBI is an emerging area of research. This study indicated that, after matching for initial injury severity and age at injury, women with severe TBI demonstrate a better early outcome than men. [ABSTRACT FROM AUTHOR]

Primary objective: To determine the incidence of autonomic arousal vs. Dysautonomia following traumatic brain injury (TBI) in an Intensive Care Unit (ICU) setting and to prospectively evaluate these groups against injury severity and outcome variables. Research design: Prospective observational group comparison (cohort) study of consecutive ICU admissions to a major trauma hospital over a 2-year period. Main outcomes and results: Eighty-nine of 113 subjects met inclusion and exclusion criteria, with consent gained for 79 subjects (61 male, 18 female: 89% of potential subjects). During the first 7 days post-injury, elevated autonomic parameters were almost universal in the sample (92%), predominantly hypertension and tachycardia. Nineteen of 79 subjects (24%) were autonomically aroused on day 7 (that is, had elevated heart rate, respiratory rate, blood pressure and temperature). Dysautonomia was diagnosed on day 14 post-injury in six of 79 subjects (8%) using previously published criteria. Autonomically aroused subjects had significantly more severe injuries, poorer outcomes and greater estimated costs than non-aroused subjects. Furthermore, Dysautonomic subjects within the autonomically aroused group had significantly worse outcome and, excluding early deaths, a greater period of hospitalization and higher estimated costs. Conclusions: The 8% incidence of Dysautonomia during ICU admission was in broad agreement with previous research. While day 7 autonomic arousal indicated a greater degree of injury, the diagnosis of Dysautonomia provided additional prognostic information. A coordinated multi-centre research effort into this condition appears appropriate. [ABSTRACT FROM AUTHOR]

Objective: There has been consistent evidence for a lower incidence and milder course of schizophrenia in women, yet there have been very few investigations of sex differences in brain function in this disorder. This study used a new high-temporal-resolution measure of functional brain connectivity to test the prediction that female patients would show relatively greater inter- and intrahemispheric connectivity than male patients, particularly in the early stage of schizophrenia. Method: Forty patients with chronic schizophrenia (20 women and 20 men) and 24 patients with first-episode schizophrenia (12 women and 12 men) and their respective matched comparison groups completed a conventional auditory odd- ball task. Phase synchronous gamma (40 Hz) activity was extracted from EEG recording during the task and time-locked to the oddball (target) stimuli. Results: Chronic schizophrenia subjects showed a reduction in global functional connectivity (lower gamma phase synchrony) relative to their matched healthy subjects. Unexpectedly, this reduction was most apparent in female patients. By contrast, while first-episode patients showed a general reduction in the speed of frontal connectivity, the speed of global connectivity was relatively faster in female patients. Conclusions: This is the first study to investigate sex differences in schizophrenia that used the functional connectivity measure of gamma phase synchrony. The results suggest that in female patients with schizophrenia, additional break- downs in brain network connectivity may develop with illness chronicity. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this work is to determine whether Gamma (40 Hz) synchronous activity has disturbed patients with severe traumatic brain injury (TBI).Methods: Using a conventional auditory oddball paradigm, the extent of Gamma synchrony across multiple scalp sites in specific frequency bands as a function of time was examined in 15 patients with severe TBI and 15 age- and sex-matched controls. Averaged Gamma synchrony was analyzed using within and between group multiple analyses of variance with region (left versus right hemisphere, anterior versus posterior region) as the within factor.Results: Compared to controls, subjects with TBI displayed significantly delayed early Gamma latency (from −150 to 150 ms) (F(1,28)=10.28, P<0.003) across all sites in addition to other specific regional disturbances. For late Gamma synchrony, subjects with TBI displayed delayed Gamma latency at the left hemisphere (from 200 to 450 ms) (F(1,28)=8.71, P<0.006) and posterior region (F(1,28)=9.18, P<0.006) in comparison to controls.Conclusions: Impaired integration of spatially distributed brain activity (‘40 Hz’ electroencephalogram rhythms) may be an important marker of deficits of cortical network binding postulated to be abnormal in people who have survived TBI. [ABSTRACT FROM AUTHOR]

Examines the association of gamma activity on female patients with schizophrenia. Occurrence of peak gamma activity; Investigation of brain structures in female patients; Characteristics of narrow band gamma activity.

Comparison of long-term mortality rates between patients with traumatic brain injury (TBI) and the general population has not been adequately investigated. This project aimed to obtain information on the long-term mortality rate of patients with TBI. Using a rehabilitation database of a major teaching hospital, the search identified 476 patients, of whom 27 were deceased. This mortality rate (5.7%) was compared with the expected mortality rate for an equivalent population without TBI (1.5%) using Australian Life Table data. It was found that patients with TBI had a significantly higher mortality rate than the general population (chi2 = 12.2, p < 0.001). Possible reasons for this finding are discussed. [ABSTRACT FROM AUTHOR]

While interest in mental health literacy (MHL) is growing rapidly, cross-cultural research focusing on MHL is developing more slowly. This inaugural systematic review explored the recognition and beliefs about the causes of mental health disorders amongst Arab men living in high income Western countries (HIWC), their help-seeking beliefs, behaviors, and sources of help, as well as barriers and facilitators to help-seeking. Six electronic database searches were conducted using Medline, Embase, ProQuest Dissertations & Theses Global, PsycINFO, Scopus, and Web of Science. These searches yielded a total of 9,460 citations. After applying inclusion criteria through both database and manual hand searches, 46 studies were identified. The findings corresponded with four of the socioecological model's five factors: intrapersonal, interpersonal, societal, and institutional. Intrapersonal factors included attributing mental health illness to life and migration stressors, and religious reasons. Interpersonal and societal factors included men favoring informal help-seeking sources as stigma was a barrier to formal help-seeking. Institutional factors around the perceived cultural competence of healthcare professionals and access difficulties were obstacles to seeking formal help. The growth in Arab migration to HIWC highlights the need for culturally tailored care. Research is needed to understand the perspectives of healthcare providers working with Arab men in addition to how men's stigmatizing attitudes are an obstacle to formal help-seeking. Interventions should be designed to address the unique mental health needs of Arab men, recognizing that some explanatory beliefs may not align with current Western models of mental health. Moreover, efforts should be made to integrate men's informal sources of support into treatment planning. • Arab men link mental illness to migration, interpersonal, and religious factors. • Men prefer informal sources of support including family and friends. • Stigma and worry about healthcare workers' cultural competence hinder seeking help. • Incorporate men's informal support networks into treatment planning. [ABSTRACT FROM AUTHOR]

Background: In 2014 the Islamic State of Iraq and Syria (ISIS) undertook a systematic and deliberate campaign against minority groups and non-Sunni Muslim communities. Amongst some of the greatest atrocities were those targeted towards Yazidi communities and in particular their women. The mental health outcomes of those women held in captivity requires investigation. This study sought to examine and compare levels of general psychological distress, depression, generalized anxiety, posttraumatic stress disorder (PTSD) and self-reported suicidal thoughts and behaviors amongst Yazidi women held in captivity compared with those without such experiences. Method: Between January to May 2019, a total 348 Yazidi women located in internal displaced person (IDP) camps were interviewed. Of these 348, 139 females were survivors of ISIS captivity. Measures used included Kessler Psychological Distress Scale (K10), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Harvard Trauma Questionnaire part IV (HTQ part IV). Results: Formerly enslaved Yazidi females showed a significantly higher prevalence of severe mental distress (97.1%; P < 0.001), more severe levels of depression (36.7%; P < 0.001) and general anxiety symptoms (37.4%; P < 0.001), greater rates of PTSD (90.6%; P < 0.001) and higher reported rates of suicidal ideation (38.1%; P < 0.001). Logistic regression analysis undertaken to examine the role of sociodemographic factors as predictors of the assessed mental health conditions. Amongst the formerly enslaved group, no such significance was found, however amongst the non-enslaved group, unemployment was found to statistically determine depression, generalized anxiety and PTSD. Specifically, women from the non-enslaved group who were unemployed were 2.5 times more likely to have depression, 3 times more likely to have generalized anxiety and 3.3 times more likely to have PTSD. Finally, amongst the non-enslaved group, those women with between 5 to 8 siblings were significantly less likely to have depression than those with fewer siblings. Conclusion: Rates of distress and trauma related symptomology were significantly higher amongst those with history of enslavement. Sociodemographic factors and duration of enslavement do not seem to predict mental disorders among enslaved females. [ABSTRACT FROM AUTHOR]

Background: Australia is an ethnically diverse nation with one of the largest refugee resettlement programs worldwide, including high numbers of refugees with an Arabic speaking background. Evidence suggests that refugees can demonstrate high levels of psychological distress and are at a higher risk of developing mental illness such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Notwithstanding, research has also shown Arabic speaking refugees have lower levels of professional help-seeking behaviours, postulated to be related to mental health literacy levels. Methods: A culturally sensitive mental health literacy (MHL) training program was developed and delivered in Arabic to Arabic speaking religious and community leaders using a 1-day training workshop format. An uncontrolled pre-, and post study design was used to provide a preliminary evaluation of improvement in PTSD-related knowledge, attitudes and help-seeking measures. Results: A total of 54 adults were trained, with 52 completing the pre- and post-intervention questionnaire. Significant differences were found post-training in measures such as the ability to recognise mental health problems (p = 0.035) and an increased recognition of the role that medication can play in the treatment of PTSD (p = 0.00). Further, an improvement in negative attitudes such as a desire for social distance (p = 0.042) was noted and participants reported more helpful strategies in line with promoting professional help-seeking following training (p = 0.032). Conclusion: Our findings indicated the training led to an improvement of some measures of MHL. To the best of our knowledge, this is the first time that the MHL program has been tailored for Arabic speaking religious and community leaders; who assist refugees with an Arabic background. By equipping community leaders with the knowledge to better respond to mental health problems, the overall goal of improving the mental health outcomes of Arabic speaking refugee communities is closer to being realised. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to explore the levels of resilience and hope among Yazidi women who survived captivity by Islamic State of Iraq and Syria (ISIS) and to examine its relationship with posttraumatic stress disorder (PTSD), generalized anxiety, and depressive symptoms. In this cross-sectional study, 139 formerly enslaved Yazidi women were assessed. The mean scores of resilience and hope were below the suggested cutoff means (M = 2.47, SD = 0.48, R = 1-5) and (M = 31.6, SD = 11.7, R = 8-64), respectively. Sociodemographic variables were not related to resilience and hope, other than those women who stayed in captivity for more than a 3-year period who reported significantly lower levels of hope (M = 28.36, SD = 11.69). Formerly enslaved Yazidi women who display higher levels of PTSD, generalized anxiety, and depression exhibit significantly lower levels of resilience and hope. Resilience and hope are therefore important concepts to explore in traumatized populations. [ABSTRACT FROM AUTHOR]

Background: Self-care strategies can improve mental health and wellbeing, however, the evidence on preferred strategies among Arabic-speaking refugees and migrants is unclear. This mixed methods systematic review aimed to identify and synthesise the global research on mental health self-care strategies used by these populations. Methods: English and Arabic language studies reporting on positive mental health self-care strategies to address symptoms of posttraumatic stress disorder, generalised anxiety and depression in the target populations were identified by systematically searching eight electronic databases and grey literature. Studies were deemed eligible if they were published from 2000 onwards and included Arabic-speaking migrants, refugees or asylum seekers aged 12 years and above. A narrative synthesis of study characteristics and relevant key findings was undertaken. The review protocol was registered on PROSPERO (registration number CRD42021265456). Results: Fifty-nine records reporting 57 studies were identified, the majority appearing after 2019. There were 37 intervention studies that incorporated a self-care component and 20 observational studies that reported on self-generated self-care practices. Across both study types, four broad groups of mental health self-care were identified—social, psychological, religious/spiritual, and other (e.g., expressive arts and exercise). Psychological strategies were the most reported self-care practice overall and featured in all intervention studies. Religious/spiritual and social strategies were more common in the observational studies. Intervention studies in diverse settings reported statistical improvements on a range of outcome measures. Observational studies reported a range of individual and community benefits. Linguistic, cultural and religious considerations, inherent in the observational studies, were variably addressed in the individual and group interventions. Conclusion: Overall, study participants experienced self-care as helpful although some encountered challenges in practicing their preferred strategies. Further research on mental health self-care strategies among Arabic-speaking refugees and migrants is needed in Western resettlement countries to guide mental health service delivery and primary healthcare initiatives for new arrivals and in transit countries. [ABSTRACT FROM AUTHOR]

Background: Arabic-speaking refugee and migrant populations form a significant proportion of Australia's population. Despite high levels of psychological distress among Arabic-speaking populations, low uptake of mental health services has been demonstrated. Evidence suggests poor levels of mental health literacy (MHL) and high levels of stigmatising attitudes among Arabic-speaking populations, which may act as barriers to help-seeking behaviours. This study aimed to explore the relationships between measures of mental illness stigma, socio-demographic factors and psychological distress, as well as to determine the factors associated with MHL (i.e., correct recognition of mental illness and knowledge of causes) among Arabic-speaking refugee and migrant populations in Australia. Methods: Participants were recruited from non-government organisations in Greater Western Sydney that provided support services to Arabic-speaking migrants and/or refugees. As this study is nested within an interventional pilot study evaluating a culturally tailored MHL program, only the pre-intervention survey responses for 53 participants were utilised. The survey measured key aspects of MHL (i.e., recognition of mental illness, knowledge of causes), levels of psychological distress (using K10 scale), and stigmatising attitudes towards mental illness (using Personal Stigma Subscales and Social Distance Scale). Results: The Personal Stigma subscale of 'Dangerous/unpredictable' was strongly positively correlated with participants' K10 psychological distress scores and strongly negatively correlated with years of education completed. There were moderate negative correlations between two Personal Stigma subscales ('Dangerous/unpredictable' and 'I-would-not-tell-anyone') and the length of stay in Australia. Being female was associated with an increase in personal stigma demonstrated by higher scores for 'I-would-not-tell-anyone' subscale than males. Similarly, increase in age was associated with a decrease on scores of the personal stigma 'Dangerous/unpredictable'. Conclusions: While future research with larger sample size are needed, the study findings can be considered as adding to the evidence base on mental illness related stigma in Arabic-speaking populations. Further, this study provides a starting point in developing the rationale for why population sub-group specific interventions are required to address mental illness stigma and improve MHL among Arabic-speaking refugee and migrant populations in Australia. [ABSTRACT FROM AUTHOR]

Stigma is of central importance to people with mental illness and their families. It impacts how they experience their illness and access available health services. An important principle in mental healthcare is empowering patients to live independently and productively, which requires optimal caring from family members. Stigma can seriously hinder this principle. This qualitative study was based on Straussian grounded theory. Participants were 25 family members of people with mental illness. Data were collected through semi-structured interviews, field notes and memos, and managed using Paillé data analysis. We extracted four interrelated categories: pasung (confinement), demonic/devil possession, alternative treatments and social isolation. Because of misunderstandings about mental illness, participants turned to alternative treatments provided by shamans and religious leaders. Participants reported being expelled from or isolated by their community, suggesting stigma is a reality experienced by families of people with mental illness in Indonesia. Addressing family stigma is important to ensure on-going support for patients and families. It is also important to develop and evaluate anti-stigma interventions in the Indonesian context. The present findings are relevant for mental healthcare professionals, related practice areas where families may be exposed to stigmatization and for international audiences with similar cultural and religious contexts. [ABSTRACT FROM AUTHOR]

Objective: Targeted public health campaigns are important in countries where health resources are limited. This is especially the case for countries such as Iraq since decades of sanctions, war and armed conflict have depleted the health system. The current study investigated the influence of sociodemographic characteristics on attitudes towards the novel coronavirus (COVID-19) relating to knowledge and behaviors held by people living in North Iraq. Method: A cross-sectional survey, conducted from 21st March to 12th April 2020, used an online platform. Multivariate analyses were used to examine the relationship between sociodemographic factors and respondents’ knowledge, attitude and behavioral practices in response to COVID-19. Results: Respondents with better self-reported health were most likely to report sleep impairment (OR=2.32,1.49-3.68) impaired eating (OR=1.84, 1.17-2.95) fear in response to social media news on COVID-19 (OR=1.92, 1.32-2.81) and were more likely to practice COVID-19 prevention measures (OR= 1.08, 1.01-1.14). On the other hand, those with better self-reported health (OR= 0.4; 0.27-0.59) were less likely to report good knowledge on COVID-19 whereas those with higher levels of education (OR= 3.59, 1.29-10.2) claimed to have higher knowledge of COVID-19. Men believed that war was more frightening than COVID-19 (OR=1.91, 1.33-2.75) compared to woman. Conclusion: Self-reported health and type of employment were the sociodemographic factors most frequently noted to influence knowledge, attitude and behaviors toward COVID-19 amongst the northern Iraqi population. In a country where health resources are scare and stretched because of a history of sanctions and prolonged war and community violence, these results provide directions for targeted approaches to support public health campaigns. [ABSTRACT FROM AUTHOR]

Background: The perception that eating disorders occur predominantly in young white upper-class women has been challenged. This study examined temporal differences to the demographic correlates of eating disorder behaviors over a 10-year period. Methods: Data from cross-sectional general population surveys in 1998 (n = 3010) and 2008 (n = 3034) were collected on demographics (sex, age, income, residency), current eating disorder behaviors (binge eating, extreme dieting, purging), and health-related quality of life (SF-36). Results: Below-median annual household income was associated with increased prevalence rates from 1998 to 2008 in binge eating, extreme dieting, and purging. Male sex was associated with increased prevalence rates in extreme dieting and purging. Age over 45 years was associated with increased prevalence rates in purging. In 2008 versus 1998, binge eating was associated with greater mental health-related quality of life impairment in males but not females; and greater physical health-related quality of life impairment in regional but not metropolitan areas. Extreme dieting was also associated with greater physical health-related quality of life impairment in 2008 versus 1998 in the lower but not the higher socioeconomic sector. Conclusions: Findings suggest the 'democratization' of disordered eating, with greatest levels of associated impairment being within marginalized demographic sectors. Implications include the need for broader intervention programs and recruitment of demographically representative samples in eating disorder research. [ABSTRACT FROM AUTHOR]

Background: Mental health literacy (MHL) is an essential competency for all healthcare professionals. In the United Arab Emirates, previous studies reported a low level of MHL among healthcare professionals working with vulnerable populations such as children and adolescents with chronic illnesses. Further in-depth exploration is necessary to build understanding of beliefs and knowledge about mental illness among pediatric health professionals. Methods: Written narratives exploring mental health knowledge were collected from pediatric nurses and analyzed using content analysis. These written narratives were extracted from responses to open-ended questions embedded in a questionnaire completed as part of previous studies. The Standards for Reporting Qualitative Research were followed in reporting this study. Results: The overarching theme that emerged from the data was that nurses struggled to negotiate the complexities of psychological distress and mental illness. Two overlapping sub-themes were identified: (1) professional knowledge was incomplete, confused, and lacking in clarity and (2) professional knowledge was impacted by cultural beliefs and stigma. A third sub-theme reflected how participants identified with others' suffering and felt powerless to help themselves or others. Participants described stress and mental exhaustion. Conclusions: Participants' narratives were characterized by struggles arising from insufficient knowledge, confusion, and deeply-held cultural and religious beliefs. Therefore, they were unable to resolve the conflict between professional knowledge, attitudes, and beliefs about mental illness and stigma arising from cultural and religious beliefs/attitudes. Culturally-specific education is needed for healthcare professionals that addresses contextual, cultural, and religious factors impacting on stigma while actively supporting the healthcare workforce and enabling access to mental health services. [ABSTRACT FROM AUTHOR]

Background: The immense social upheaval and ongoing humanitarian crisis created by the 2011 war in Syria has forced millions of civilians to flee their homeland, many of whom seek refugee status in Western nations. Whilst it is known that the prevalence of mental illness is higher within refugee populations, this systematic review and meta-analysis aims to pool the prevalence rates of common mental disorders (namely posttraumatic stress disorder, depression and generalized anxiety disorder) in adult Syrian refugees resettled in high income Western countries. Methods: Seven electronic databases (Medline, PsychInfo, CINAHL, PTSDpubs, SCOPUS, PubMed and Embase) were searched up to the 31st of December 2020. Using pre-determined inclusion and exclusion criteria, relevant articles were screened by title and abstract, and later by full text. A meta-analysis was used to estimate the prevalence rates for each mental illness. Results: Eleven studies met the eligibility criteria for the systematic review. Nine of these studies had a low-moderate risk of bias and were included in the meta-analysis. Of the 4873 refugees included in the meta-analysis, the total pooled prevalence rate of having any of the three mental disorders was 33% (CI 95%, 27-40%), 40% for anxiety (CI 95%, 31-50%), 31% for depression (CI 95%, 20-44%) and 31% for PTSD (CI 95%, 22-41%). A meta-regression revealed that the total pooled prevalence rate for having any of the three mental disorders was not influenced by age, host country, duration in host country, educational or marital status. Conclusions: Despite significant study heterogeneity, the prevalence rates of common mental disorders in adult Syrian refugees resettled in high-income Western countries are significantly higher than reported rates in the general population. [ABSTRACT FROM AUTHOR]

Background: Stigma refers to the discrediting, devaluing, and shaming of a person because of characteristics or attributes that they possess. Generally, stigma leads to negative social experiences such as isolation, rejection, marginalization, and discrimination. If related to a health condition such as mental illness, stigma may affect a person's illness and treatment course, including access to appropriate and professional medical treatment. Stigma has also been reported to affect patients' families or relatives, along with professionals who work in mental healthcare settings. Stigma is strongly influenced by cultural and contextual value systems that differ over time and across contexts. However, limited information is available on how types of stigma are experienced by patients with mental illness and mental health nurses in Indonesia. Method: We explored the stigma-related experiences of 15 nurses and 15 patients in Indonesia. The study design and analysis of interview data were guided by deductive (directed) content analysis. Results: Five themes emerged. Four themes were patient-related: personal/patients' stigma, public/social stigma, family stigma, and employment stigma. The fifth theme related to stigma toward healthcare professionals working with patients with mental illnesses, which we categorized as professional stigma. Conclusions: This study has achieved a deep understanding of the concept of stigma in the Indonesian context. This understanding is a prerequisite for developing appropriate interventions that address this phenomenon and thereby for the development of mental health services in Indonesia. This study may also be transferable to other countries that share similar cultural backgrounds and adhere to traditional and religious value systems. [ABSTRACT FROM AUTHOR]

Objective: To determine sex differences in the prevalence and impact of specific eating disorder features on health-related quality of life (HRQoL). Method: A general population sample of men ( n = 1,479) and women ( n = 1,555) completed interviews that assessed HRQoL (Medical Outcomes Study Short Form, SF-36), and current regular occurrence of binge eating, extreme dietary restriction, purging, and overevaluation of weight or shape. Results: Men constituted a substantial minority (23-41%) of participants reporting eating disorder features. Objective binge eating had a greater impact on mental health impairment in men versus women, whereas the overevaluation of weight or shape had a greater impact on general and mental health impairment in women compared with men. Discussion: Eating disorder features that impact on HRQoL are now common in men; however, the impact of specific features may differ between sexes. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013) [ABSTRACT FROM AUTHOR]

Objective: To examine temporal trends in the burden of eating disorder (ED) features, as estimated by the composite of their prevalence and impact upon quality of life (QoL) over a period of 10 years. Methodology: Representative samples of 3010 participants in 1998 and 3034 participants in 2008 from the South Australian adult population were assessed for endorsement of ED features (objective binge eating, extreme dieting, and purging were assessed in both years; subjective binge eating and extreme weight/shape concerns were also assessed in 2008) and QoL using the Medical Outcomes Study Short Form (SF-36). Principal Findings: From 1998 to 2008 significant increases in the prevalence of objective binge eating (2.7% to 4.9%, p<0.01) and extreme dieting (1.5% to 3.3%, p<0.01), but not purging, were observed. Lower scores on the SF-36 were significantly associated with endorsement of any of these behaviors in both 1998 and 2008 (all p<0.001). No significant difference was observed in the effect of the endorsement of these ED behaviors on QoL between 1998 and 2008 (all p>0.05). Multiple linear regressions found that in 1998 only objective binge eating significantly predicted scores on the mental health scale of the SF-36; however, in 2008 extreme weight/shape concerns, extreme dieting, and subjective binge eating were also significant predictors. Objective binge eating and extreme dieting were significant predictors of scores on the physical health scale of the SF-36 in both 1998 and 2008. Conclusions and Significance: The prevalence of ED behaviors increased between 1998 and 2008, while their impact on QoL remained stable. This suggests an overall increase in the burden of disordered eating from 1998 to 2008. Given that binge eating and extreme dieting predict impairment in QoL, the necessity of interventions to prevent both under- and over-eating is reinforced. [ABSTRACT FROM AUTHOR]

Primary objective: To investigate mortality trends in functionally dependent adults following traumatic brain injury (TBI). Methods: Data for 966 consecutive admissions to a specialist TBI rehabilitation service were reviewed. Details for 69 subjects who were functionally dependent at rehabilitation discharge were cross-referenced against the State Government Death Register. The observed mortality rate was compared to an equivalent population sample derived from Australian Life Tables. Results: Twenty-five subjects (36%) were deceased at an average 10.5 years post-injury (SD 5 years; range 1.7-18.8 years). The observed numbers of deaths far exceeded the expected population figure (1.9) for the same period (1989-2007) yielding a standardized mortality rate of 13.2. Mortality trends suggested a bimodal distribution, with more deaths in the first 5 years post-injury followed by no further deaths until 9 years post-injury. Conclusions: Mortality in this functionally-dependent group was significantly associated with age, male sex and degree of disability at discharge. The bimodal distribution of mortality data suggests different contributory mechanisms to early vs. late mortality in this group. [ABSTRACT FROM AUTHOR]

Objective: To examine the resettlement experiences of former refugees living in regional Australia, focusing on mental health and mental health and support services, including barriers to access. Design: A phenomenological approach utilising a combination of six qualitative, semi‐structured, face‐to‐face focus groups (n = 24) and seven individual interviews. Data were analysed thematically using NVivo 10 software. Setting: Launceston, Tasmania. Participants: Adult and youth former refugees from Afghanistan, Bhutan, Burma, Sierra Leone, Sudan and Iran, and essential service providers, residing in Launceston. Main outcome measures: Participants were asked about experiences of resettlement and mental health. Results: Participants reported that their mental health had improved since resettlement; however, major stressors impacted mental health and resettlement included employment and housing access and mastering the English language. Past experiences continued to impact current functioning, with trauma commonly experienced intergenerationally through parenting and attachment and ongoing trauma and feelings of guilt and responsibility experienced with families left behind. Participants noted barriers to accessing services: (a) Language difficulties including lack of interpreters; and (b) lack of culturally sensitive and trauma‐informed practices. Discrimination was experienced through the inconsistent provision of interpreters and lack of due consideration of cultural and religious differences. The use of children as interpreters enhanced a number of risk including miscommunication of medical information, exposure to age‐inappropriate information and the resulting increased risk of trauma for the child. Conclusion: Culturally sensitive, trauma‐informed and discrimination‐free practices should be employed across services, where Western‐views surrounding this medical model are not imposed, cultural differences are respected, and timely access to interpreters was provided. [ABSTRACT FROM AUTHOR]

Background: The need for improved research on ill health has been recognized internationally and locally in the United Arab Emirates (UAE). The UAE Nursing and Midwifery Council recently committed to enhancing the status and contributions of nursing in healthcare research across the UAE by establishing a National Committee for Research Development. This study using a Delphi method to identify research priorities from the perspective of nurses delivering frontline healthcare.Methods: A two-phase Delphi design was implemented with 1032 nurses participating in phase one of the study and 1339 in phase two.Results: The most important priority was patient safety and healthcare professionals' awareness of international patient safety goals (including staffing levels and shift length) and potential effects on patient safety. Other important priorities were infection control practices and management of communicable diseases.Conclusions: These priorities may inform nursing research programs to improve patient care and health outcomes in the UAE and similar contexts worldwide. [ABSTRACT FROM AUTHOR]

Background: To support promotion, prevention and early intervention for mental illness school nurses need to be mental health literate. Methods: Three hundred and thirty-nine school nurses employed in government and private schools from three Emirates in the UAE were surveyed. A culturally adapted Mental Health Literacy questionnaire comprising three vignettes of fictional characters meeting diagnostic criteria for the target conditions along with the Kessler Psychological Distress Scale (K10) was administered to ascertain school nurses' ability to correctly identify the conditions and to elicit beliefs about helpfulness of treatment interventions and of health care providers for these conditions. Results: Less than 50% of the respondents correctly identified the disorders presented, while accurate identification of evidence-based interventions was also limited. Correlations between level of psychological distress and level of inaccurate survey responses was also revealed, respondents who correctly identified the correct diagnosis of the vignette and the most appropriate interventions were those who had a significantly lower K10 score. Conclusions: Low levels of mental health literacy amongst respondents in combination with potential religious and cultural factors as reported in the literature, highlight the need for curriculum enhancements for future health professionals and a targeted program of culturally appropriate professional development focused on mental health promotion for those in clinical practice. The level of psychological distress noted in this cohort also signals a need to ensure that appropriate supports are available for clinical staff employed in schools. [ABSTRACT FROM AUTHOR]

Background: In the United Arab Emirates (UAE) 35% of the population are aged 0-24 years. A significant proportion of these young people are living with chronic conditions (e.g., asthma, type 1 diabetes, cardiac conditions, and geneticallytransmitted conditions such as thalassemia and cystic fibrosis). This group has increased vulnerability to developmental delays and mental health problems, and is increasingly coming to the attention of service providers in mainstream schools, primary healthcare centers, and pediatric hospitals. Despite the government directing attention to improving the mental health of the UAE population, there is concern that mental health services are not growing at the rate needed to meet the mental health needs of children and young people with chronic conditions. Method: A cross sectional survey design was used to determine the mental health literacy of nurses and other healthcare professionals working with children with chronic illnesses. Participants completed a culturally-adapted mental health literacy questionnaire comprising three vignettes of fictional characters meeting diagnostic criteria for posttraumatic stress disorder, psychosis, and depression with suicidal thoughts. Participants also completed the Kessler Psychological Distress Scale (K10). Results: Participants were 317 healthcare professionals from across the UAE. The majority were nurses. Correct identification of the diagnosis for each vignette was limited, with the highest level of accuracy achieved for the psychosis vignette (n = 113, 54.3%). Accurate identification of appropriate evidence-based interventions was also limited. K10 scores indicated 40% of participants had moderate to high levels of psychological distress. Conclusions: These findings are concerning and provide important data to inform the development of undergraduate and continuing education programs for nurses. The K10 scores suggest healthcare professionals are under considerable stress, highlighting the need to support healthcare professionals who experience multiple psychosocial stressors. [ABSTRACT FROM AUTHOR]

This article describes a pilot study that aimed to evaluate the effect of drama therapy on the quality of life (QoL) of elderly people with mild to moderate dementia, using a mixed method (quantitative and qualitative) approach. Study participants ( N = 13; age range 61–88 years; 1 female) were Australians of European descent, principally with Alzheimer's disease, living in the community in an east-coast Australian context. The drama therapy group ( N = 4) was compared with a group of participants ( N = 9) who watched movies over a four-month period. All participants were assessed for QoL using the quantitative Quality of Life Alzheimer's Disease (QoL-AD) scale of Logsdon, Gibbons, McCurry, & Teri (1999, Journal of Mental Health and Aging 5, 21) prior to and following 16 group meetings. Qualitative data were generated and examined using phenomenological methods including recording and transcribing body language and dialogue, as well as narrative, ethnography, group themes and metaphor. Although not statistically significantly different, the average QoL-AD score increased for the drama therapy group while it decreased for the movie group. Qualitative findings established an unambiguous participant ability to express ideas and feelings through drama therapy as well as an unveiling of conscious awareness of participants’ own wellbeing and QoL. The findings also indicate the potential worth of a future larger study along the lines exemplified here. [ABSTRACT FROM AUTHOR]

Objective: Studies that have investigated quality of life (QoL) in eating disorders (EDs) have been focussed on the impact of the ED on QoL and little is known regarding the possible reciprocal impact of QoL on EDs. The aim of this study was to provide a first-time investigation of possible bidirectional relationships between EDs and both health-related QoL (HRQoL) and psychological distress (PD). Method: Structural equation modeling was applied to longitudinal data collected from a community sample of Australian women (N = 828) surveyed at baseline, five annual follow-ups, and again after nine years. Participants reported height and weight (from which body mass index, BMI, was calculated) and completed measures of ED symptoms (Eating Disorder Examination Questionnaire), HRQoL (12-item Medical Outcomes Study Short Form), and PD (Kessler Psychological Distress Scale). Results: Overall, evidence was found for a bidirectional relationship, whereby ED symptoms predicted reduced HRQoL and greater PD over time, while lower levels of HRQoL and greater PD in turn predicted increased levels of ED symptoms. These relationships were stable, observable within 12 months, and remained observable over a time period of at least four years. However, also observed were some inconsistent findings where ED symptoms predicted a short term (one year) improvement in mental HRQoL. This short term boost was not sustained at longer follow-ups. Conclusions: Not only do ED symptoms impact on HRQoL and PD, but perceived poor HRQoL and PD also contribute to ED symptom development or exacerbation. This supports a movement away from symptom-centric approaches whereby HRQoL is conceptualized as a passive outcome expected to be rectified by addressing ED symptoms. Improvement in QoL and PD might rather be viewed as targets to be pursued in their own right under broader approaches in the treatment of EDs. [ABSTRACT FROM AUTHOR]