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Zachary Steel

Publications and source records attributed to Zachary Steel.

17 recordsLinked to original sources
PubMed2006

Factor structure and interpretation of the K10.

The Kessler 10 Psychological Distress Scale (K10) is a brief 10-item questionnaire designed to measure the level of distress and severity associated with psychological symptoms in population surveys. It is being used widely, including in the World Health Organization World Mental Health Survey, and as a clinical outcome measure, although little information is available about the structure of the measure. The factorial composition of the K10 was examined in a prospective community survey and cross-validated in a separate large community survey. The K10 was found to consist of 4 factors and a 2-factor second-order factor structure. This was stable across the 2 waves of the prospective study and the Australian National Survey of Mental Health and Well-Being. The 4 factors, labeled Nervous, Negative Affect, Fatigue, and Agitation, were consistent with the original scales from which the items were taken. The 2 second-order factors represent Depression and Anxiety.

Data Interpretation, Statistical↗
PubMed2006

Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees.

OBJECTIVE: This paper explores the impact of pre-migration trauma, post-migration living difficulties and social support on the current mental health of 63 resettled Sudanese refugees. METHOD: A semistructured interview including questionnaires assessing sociodemographic information, pre-migration trauma, anxiety, depression and posttraumatic stress, post-migration living difficulties and perceived social support were administered assisted by a bilingual community worker. RESULTS: Resettled refugees from Sudan evidenced a history of trauma. Less than 5% met criteria for posttraumatic stress but 25% reported clinically high levels of psychological distress. The results indicate that social support--particularly perceived social support from the migrant's ethnic community--play a significant role in predicting mental health outcomes. Pre-migration trauma, family status and gender were also associated with mental health outcomes. CONCLUSIONS: Refugees in Australia may constitute a particularly vulnerable group in terms of mental health outcomes. Culturally specific sequelae in terms of social isolation and acculturation may be particularly problematic for these migrants.

Adaptation, Psychological↗
PubMed2006

Pathways to the first contact with specialist mental health care.

OBJECTIVE: To examine the pathways to mental health care followed by patients presenting for the first time to community- and hospital-based services and the degree to which individual characteristics, cultural background, illness type, severity and service-related variables influence the time and pathways taken to reach care. METHOD: One hundred and forty-six consecutive Australian-born, Asian and Arabic-speaking patients making their first lifetime contact with mental health services in two area health regions were included. Symptom severity was assessed using the Health of the Nations Outcome Scales. Illness explanatory models, social support, English-language proficiency and acculturation were also assessed. RESULTS: An average of three professional consultations were made prior to first contact with public mental health services. Family physicians occupied a pivotal role in the help-seeking pathway with 53% of patients consulting a general practitioner. The median time taken to reach specialist mental health services was 6 months, with significantly shorter time for patients with psychotic disorders. Individual variables such as gender, social support, ethnicity and English fluency were not associated with delays in receiving public mental health care. Ethnicity was associated with lower utilization of allied health professionals. CONCLUSIONS: The data suggest that social and cultural factors influence the range of professionals consulted by those with a mental illness but do not delay their presentation to public mental health services.

Acculturation↗
PubMed2006

Impact of immigration detention and temporary protection on the mental health of refugees.

BACKGROUND: Over the past decade, developed Western countries have supplied increasingly stringent measures to discourage those seeking asylum. AIMS: To investigate the longer-term mental health effects of mandatory detention and subsequent temporary protection on refugees. METHOD: Lists of names provided by community leaders were supplemented by snowball sampling to recruit 241 Arabic-speaking Mandaean refugees in Sydney (60% of the total adult Mandaean population). Interviews assessed post-traumatic stress disorder (PTSD), major depressive episodes, and indices of stress related to past trauma, detention and temporary protection. RESULTS: A multilevel model which included age, gender, family clustering, pre-migration trauma and length of residency revealed that past immigration detention and ongoing temporary protection each contributed independently to risk of ongoing PTSD, depression and mental health-related disability. Longer detention was associated with more severe mental disturbance, an effect that persisted for an average of 3 years after release. CONCLUSIONS: Policies of detention and temporary protection appear to be detrimental to the longer-term mental health of refugees.

Adult↗
PubMed2005

Disability and health service utilization associated with psychological distress: the influence of ethnicity.

This study examined levels of disability and use of health services, as a result of psychological distress, across various ethnic groups after taking into account selected sociodemographic factors such as age, gender, education, and employment. We have analyzed data from the 1997-1998 New South Wales Health Survey, Australia. A telephone interview of 35,025 adults aged 16 years and over selected from each of the 17 Health Service Areas in the state. While people from non-English speaking backgrounds were more likely to suffer high levels of disability as a result of psychological distress, they were less likely to utilize health services compared to those from English speaking backgrounds. This was particularly true for those born in Southern and South-East Asia as well as the Middle East and Africa. Further research into the reasons underlying these findings for each ethnic group is warranted.

Adolescent↗
PubMed2004

Legal and ethical implications of medically enforced feeding of detained asylum seekers on hunger strike.

The current practice of non-consensual medical treatment of hunger-striking asylum seekers in detention needs closer inquiry. An Australian Government regulation empowers the Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) to authorise non-consensual medical treatment for a person in immigration detention if they are at risk of physical harm, but there are doubts about whether the regulation would withstand legal challenge. Authorisation by DIMIA does not compel medical practitioners to enforce treatment if such action is contrary to their "ethical, moral or religious convictions". The World Medical Association has established guidelines for doctors involved in managing people on hunger strikes. The Declaration of Tokyo (1975) and the Declaration of Malta (1991) both prohibit the use of non-consensual force-feeding of hunger strikers who are mentally competent. If called upon to treat hunger strikers, medical practitioners should be aware of their ethical and legal responsibilities, and that they should act independently of government or institutional interests.

Australia↗
PubMed2004

Science and the common good: indefinite, non-reviewable mandatory detention of asylum seekers and the research imperative.

Despite a strong historical record of resettling and providing care for refugee populations, the Australian Federal Government has increasingly implemented harsh and restrictive policies regarding the treatment and management of asylum seekers. Most controversial of these has been the mandatory detention of asylum seekers, a policy applied indiscriminately and without discretion where individual cases have not been subject to judicial review or time constraints. From the outset health professionals have raised concerns about the possible adverse mental health impacts of prolonged detention. In contrast, government representatives have characterized conditions in detention as benign and comfortable, and have consistently contested criticism of detention, often citing a lack of scientific evidence as tacit support for the continuation of the policy. Nevertheless, requests for access to the detention centres to undertake rigorous scientific investigations have gone unheeded. In this context we argue that the Australian Government has failed to uphold its commitment to good governance by allowing transparency, openness and a willingness to have the impact of its policies scrutinized by scientists. The manifest conflict of interest in the government position leads to a breach in the normal social contract between mental health researchers and those responsible for the policy of detention. There is, we argue, a legitimate moral imperative in such situations for clinical researchers to breach the walls of enforced silence and give a voice to those who are afflicted. This imperative, however, must be carefully balanced against the risks that may face detainees agreeing to participate in such research.

Australia↗
PubMed2004

Comorbidity of PTSD and depression: associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia.

BACKGROUND: Posttraumatic stress disorder (PTSD) is common in refugees but its association with longer-term psychosocial dysfunction remains unclear. We examined whether a subgroup of refugees with comorbid PTSD and depression were at particularly high risk of disability. We also investigated whether specific trauma experiences were linked to this comorbid pattern. METHODS: Consecutive Bosnians (and one or two compatriots nominated by them) were recruited from a community centre, yielding a total sample of 126 participants (response rate 86%). Measures included a trauma inventory, the Clinician Administered PTSD Scale (CAPS) (Blake et al., 1995) and the depression module of the Structured Clinical Interview (SCID) (First et al., 1997). RESULTS: Three diagnostic groupings emerged: normals (n=39), pure PTSD (n=29), and comorbid PTSD and depression (n=58). Of four trauma dimensions derived from principle components analysis (human rights violations, dispossession and eviction, life threat and traumatic loss), life threat alone was associated with pure PTSD, with life threat and traumatic loss both being associated with comorbidity. Compared to normals and those with pure PTSD, the comorbid group manifested more severe PTSD symptoms as well as higher levels of disability on all indices (global dysfunction: odds ratio=5.0, P<0.001, distress: odds ratio=6.0, P<0.001, social impairment: odds ratio 5.9, P<0.001, and occupational disability: odds ratio 5.0, P<0.001). LIMITATIONS: Recruitment was not random, the sample size was modest, and trauma event endorsement was based on retrospective accounts. CONCLUSIONS: The combination of life threat and traumatic loss may be particularly undermining to the psychological well-being of refugees and consequent comorbidity of PTSD and depression may be associated with longer-term psychosocial dysfunction. The findings raise the question whether the comorbid pattern identified should be given more recognition as a core posttraumatic affective disorder.

Adolescent↗
PubMed2004

Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia.

OBJECTIVE: To document the psychiatric status of a near complete sample of children and their families from one ethnic group held for an extended period of time in a remote immigration detention facility in Australia. METHOD: Structured psychiatric interviews were administered by three same-language speaking psychologists by phone to assess the lifetime and current psychiatric disorders among 10 families (14 adults and 20 children) held in immigration detention for more than two years. RESULTS: All adults and children met diagnostic criteria for at least one current psychiatric disorder with 26 disorders identified among 14 adults, and 52 disorders among 20 children. Retrospective comparisons indicated that adults displayed a threefold and children a tenfold increase in psychiatric disorder subsequent to detention. Exposure to trauma within detention was commonplace. All adults and the majority of children were regularly distressed by sudden and upsetting memories about detention, intrusive images of events that had occurred, and feelings of sadness and hopelessness. The majority of parents felt they were no longer able to care for, support, or control their children. CONCLUSIONS: Detention appears to be injurious to the mental health of asylum seekers. IMPLICATIONS: The level of exposure to violence and the high level of mental illness identified among detained families provides a warning to policy makers about the potentially damaging effects of prolonged detention on asylum seekers. In their attempt to manage the international asylum crisis, it is important that Western countries do not inadvertently implement policies that cause further harm.

Adolescent↗
PubMed2004

An ethnographically derived measure of anxiety, depression and somatization: the Phan Vietnamese Psychiatric Scale.

This article describes the development and validation of the Phan Vietnamese Psychiatric Scale (PVPS). The PVPS was derived from Vietnamese idioms and cultural understandings of psychiatric and emotional distress identified from the Vietnamese literature and using ethnographic methods. The PVPS consists of a 26-item depression subscale, a 13-item anxiety subscale and a 14-item somatization subscale. Estimates of internal consistency for the three subscales ranged from .87 to .95, with 4-day interval test-retest reliability ranging from .81 to .89. Confirmatory factor analysis supported the subscale structure, with the depression subscale comprising two components 'general mood disturbance' and 'psychovegetative symptoms.' Multitrait-multimeasure analysis supported the construct validity of the scale. The PVPS demonstrated good criterion validity against case assignments by psychiatrists, naturalist healers, and structured diagnostic measures. The PVPS was rated as superior in clinical sensitivity and acceptability in comparison to other related measures.

Adolescent↗
PubMed2002

Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study.

BACKGROUND: What are the deleterious effects of mass trauma on the psychological wellbeing of refugees and other war-affected populations? Most epidemiological data are for short-to-medium term effects, leaving the possibility that early psychological reactions could reduce naturally over time. We aimed to assess the long-term effects of trauma on mental health and disability in Vietnamese refugees resettled in Australia. METHODS: In a population-based study, we identified a community sample of 1413 adult Vietnamese from census collection areas in Sydney, Australia. Participants were interviewed by trained bilingual workers who administered questionnaires to assess the frequency of international classification of disease, version 10 (ICD-10) mental disorders in the 12 months before interview; psychiatric symptoms, by use of a culturally-sensitive symptom measure; exposure to psychologically traumatic events; disability and use of health services; and social, economic, and cultural factors since migration. We did multivariate analyses with adjustment for stressors since migration to establish the risk factors for mental illness. FINDINGS: 1161 (82%) adults completed the interview. Mean length of residence in Australia was 11.2 years (SD 14.4) and mean time since the most severe traumatic event was 14.8 years (SD 10.8). 95 (8%) and 75 (7%) of participants had mental disorders defined by ICD-10 and the culturally-sensitive measure, respectively. Trauma exposure was the most important predictor of mental health status. Risk of mental illness fell consistently across time. However, people who had been exposed to more than three trauma events (199) had heightened risk of mental illness (23, [12%]) after 10 years compared with people with no trauma exposure (13, [3%]) (odds ratio 4.7, p<0.0001, 95% CI 2.3-9.5). INTERPRETATION: Most Vietnamese refugees were free from overt mental ill health. Trauma-related mental illness seemed to reduce steadily over time, but a subgroup of people with a high degree of exposure to trauma had long-term psychiatric morbidity. Our findings support the need to develop specialised mental health services to reduce disability in refugees whose exposure to extreme trauma puts them at risk of chronic psychiatric disability.

Adult↗
PubMed1998

Personality Disorders Among Pathological Gamblers.

The objective of this study was to investigate the prevalence of DSM-III-R diagnostic categories of personality disorders in pathological gamblers and to highlight the possible association between such disorders, psychological distress and selected forms of gambling. The Personality Disorders Questionnaire-Revised and a battery of psychometric measures were administered to a sample of 82 consecutive admissions to a behavioral treatment program for gambling problems at an impulse control disorders research unit in Sydney, Australia. Seventy-three percent of subjects were male. The total sample reported having gambled a mean of 15 years of which, on average, the last 6.4 years were associated with problems. Results indicated that the majority of subjects met diagnostic criteria for at least one Personality Disorder (93%), with an average of 4.6 personality disorders per subject. The majority of gamblers evidenced personality disorders from the Cluster B grouping with particularly high rates of borderline, histrionic, and narcissistic personality disorders which were found to be associated with high levels of impulsivity and affective instability. Antisocial personality disorder and narcissistic personality disorder were both found to be possible mediators of the severity of the problem gambling behaviours.

Journal Article↗
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

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

In protest.

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Attitude↗