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Biomedical subjects

Derrick Silove

Publications and source records attributed to Derrick Silove.

29 records · Page 2Linked to original sources
PubMed2002

The asylum debacle in Australia: a challenge for psychiatry.

OBJECTIVE: To examine the mental health consequences of contemporary Australian policies pertaining to asylum seekers and to consider the possible roles of psychiatrists in responding to this issue. METHODS: Historical and political factors driving policy are considered. The results of Australian studies examining the mental health of asylum seekers are reviewed. RESULTS: Available research shows high rates of trauma, posttraumatic stress disorder (PTSD) and depression in asylum seekers. The conditions of the postmigration environment influence outcomes. Psychiatrists working with other agencies continue to advocate for this group. Important roles include the provision of clinical services, undertaking and disseminating research, acting as expert witnesses and consultants, and writing reports for refugee applicants. CONCLUSIONS: Complex political motivations steer asylum policy. Psychiatric formulations are important in considering the impact of contemporary policy, but a wider ecological model is needed to understand acts of desperation displayed by asylum seekers,particularly those in long-term detention. Sustained effort will be needed to alter a policy of exclusion that has become entrenched.

Australia↗
PubMedDate not supplied

Complicated grief in Bosnian refugees: associations with posttraumatic stress disorder and depression.

Complicated grief is likely to be common among refugee populations exposed to war trauma. However, there have been few studies investigating the traumatic antecedents and correlates of complicated grief in refugees, and the relationship of that symptom pattern with other common disorders such as posttraumatic stress disorder (PTSD) and depression. We studied Bosnian refugees recruited from a community center in Sydney, Australia, with the sample being supplemented by a snowball method (N = 126; response rate, 86%). Measures included a trauma inventory, the Clinician Administered PTSD Scale (CAPS), the depression module of the Structured Clinical Interview (SCID), and the Core Bereavement Items (CBI). A dimension of traumatic loss derived from the trauma inventory was a specific predictor of complicated grief, with exposure to human rights violations being associated with images of the traumatic events surrounding the lost person. There was no link between PTSD and grief other than for a low-order association with the PTSD intrusion dimension. In contrast, depression was strongly associated with grief and its subscales. Only the subgroup with comorbid grief and depression reported higher levels of traumatic loss. The results suggest that complicated grief in refugees can become persistent and associated with depression. While PTSD and grief share common symptoms of intrusion, the two symptom domains are sufficiently distinct to warrant independent assessment of grief in refugee populations.

Adolescent↗
PubMedDate not supplied

Can structured interviews for posttraumatic stress disorder assist clinical decision-making after motor vehicle accidents? An exploratory analysis.

Motor vehicle accidents (MVAs) represent one of the most common causes of posttraumatic stress disorder (PTSD) worldwide. Predicting those MVA survivors who are likely to experience PTSD in the longer-term has attracted substantial research attention, but most investigators have concluded that early traumatic stress symptoms have only moderate predictive power. The present study focuses on a decision-tree approach that might be useful to clinicians attempting to identify subgroups of MVA survivors with graduated degrees of risk. Eighty-three consecutive MVA admissions (response rate, 65%) were assessed by structured clinical interview within 2 weeks of the accident and at 18 months follow-up. Meeting full criteria for PTSD (other than the time criterion) at baseline achieved a positive predictive power of 0.92 in identifying those who had PTSD over the following 18 months. For the remainder, the PTSD "arousal" domain achieved a positive predictive power of 0.81 for predicting those with either subthreshold PTSD or full PTSD over the 18-month follow-up period. The implications for further research into a stepped approach to intervention and monitoring are discussed.

Accidents, Traffic↗
PubMedDate not supplied

Challenges and early experiences in the development of an anxiety clinic in the public health sector.

This paper argues the importance of establishing specialist anxiety clinics within the public sector of the Australian health system. It describes the development of such a service and summarizes the characteristics of the first 1000 clients. Factors such as staffing, utilization trends, referral patterns, assessment and treatment procedures, and the clinical and demographic characteristics of the first 1000 cases are reviewed and discussed. The model of the clinic, which operates in partnership with community mental health and an academic research unit, has proven itself to be a suitable, cost-effective and efficient prototype in the treatment of anxiety disorders. Anxiety disorders exact a high social and economic cost. At a time of global funding cuts and savings in the mental health system, it is vital to think ethically as well as cost-efficiently, considerations that require that we offer the most efficient treatment to the greatest number of people.

Adult↗
PubMedDate not supplied

The challenges facing mental health programs for post-conflict and refugee communities.

The majority of refugees and communities exposed to warfare and oppression live in low-income countries with few resources or special skills. Yet, epidemiological studies have identified high levels of traumatic stress reactions in such populations. These stress reactions can be intensified by harsh policies aimed at deterring survivors from seeking refuge in technologically advanced societies. The scale of the problem of mass violence and displacement creates formidable challenges for mental health professionals in their efforts to develop practical frameworks for responding to the extensive needs of displaced persons. In this article, a model is proposed for low-income, post-conflict countries, based on a two-tiered formulation. At the eco-social level, mental health professionals can play a supportive, but not a lead, role in facilitating recovery of core adaptive systems that hasten natural recovery from stress for the majority of the population. Where small-scale, community mental health services are established, the emphasis should be on assisting persons and their families who are at greatest survival and adaptive risk. Training and promotion of local workers to assume leadership in such programs are essential. In technologically advanced societies in which refugees are in a minority, torture and trauma services can focus more specifically on traumatic stress reactions, acculturation, and resettlement. In a historical epoch in which displaced persons are facing particularly harsh treatment, there is a pressing need for consensus amongst mental health professionals in advocating for their needs.

Humans↗
PubMedDate not supplied

The impact of torture on post-traumatic stress symptoms in war-affected Tamil refugees and immigrants.

The present study examines the effect of torture in generating post-traumatic stress disorder (PTSD) symptoms by comparing its impact with that of other traumas suffered by a war-affected sample of Tamils living in Australia. Traumatic predictors of PTSD were examined among a subsample of 107 Tamils (refugees, asylum seekers, and voluntary immigrants) who had endorsed at least one trauma category on the Harvard Trauma Questionnaire. Principal components analysis (PCA) yielded five trauma factors that were applied to predicting PTSD scores. Tamils exposed to torture returned statistically higher PTSD scores than other war trauma survivors after controlling for overall levels of trauma exposure. The torture factor identified by the PCA was found to be the main predictor of PTSD in a multiple regression analysis. Although limited by sampling constraints and retrospective measurement, the present study provides support for the identification of torture as a particularly traumatic event, even when the impact of other war-related trauma is taken into account.

Adult↗
PubMedDate not supplied

Indices of social risk among first attenders of an emergency mental health service in post-conflict East Timor: an exploratory investigation.

OBJECTIVE: Little is known about the profile of patients treated in mental health services in low-income, post-conflict countries, especially in the post-emergency phase. We postulated that patients attending the first community mental health service in East Timor would be characterized not only by mental disturbance but by high levels of social vulnerability. METHOD: Drawing on existing methods and on consultations with East Timorese mental health staff, five social indicators were identified: dangerousness; inability to undertake life-sustaining self-care; bizarre behaviour; incapacitating distress; and social unmanageability. Adequate levels of interrater reliability (65-91%) were achieved in identifying these indicators from case notes. Forty-eight randomly selected case notes were analyzed to ascertain the prevalence of social risk factors as well as the referral source and broad diagnostic groupings. RESULTS: Major referral sources were the family, humanitarian agencies and the police. Twenty-nine percent met criteria for dangerousness; 42% for inability to undertake self-care; 58% for bizarre behaviour; 75% for distress; and 19% for unmanageability. Ninety-eight percent fulfilled at least one social indicator, with the modal score being 2. CONCLUSIONS: Although the approach to documentation and analysis was preliminary, the data suggest that a focus on social risk indicators may assist in determining those mentally disturbed persons in need of priority care in resource-poor post-conflict countries.

Adult↗
PubMedDate not supplied

In protest.

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Attitude↗