Patterns and predictors of PTSD in treatment-seeking African refugees and asylum seekers: A latent class analysis

Abstract

Background: Despite the empirical and clinical relevance of understanding posttraumatic stress disorder (PTSD) heterogeneity in refugees and asylum-seekers, very few studies have examined the manner in which PTSD symptoms manifest in such populations. Aims: This study sought to investigate patterns and predictors of DSM-5 PTSD in a treatment-seeking sample of African refugees. Methods: Participants were 122 African refugees and asylum-seekers living in Italy who completed measures of trauma exposure and PTSD symptoms. Latent class analysis (LCA) was used to identify PTSD symptom profiles, and predictors of class membership were identified via multinomial logistic regression. Results: Among participants, 79.5% had a probable diagnosis of PTSD. Three PTSD classes were identified by LCA: Pervasive (32.0%) with high probabilities of all symptoms, high-Threat (45.9%) with higher probabilities of intrusions and avoidance symptoms, moderate-Avoidance (22.1%) with high probability of thoughts/feelings avoidance. None of the examined variables (legal status, gender, age, education, months spent in Italy, number of traumatic events, employment) significantly predicted class membership with the relevant exception of reception conditions. Specifically, living in large reception centres (over 1,000 people) significantly predicted Pervasive PTSD class membership compared to high/Threat PTSD class and to moderate/Avoidance class. Conclusion: This study provides evidence for distinct patterns of PTSD symptomatology in refugees and asylum seekers. We identified three classes which present both qualitative and quantitative differences in symptoms: Pervasive class, high-Threat class and a new moderate class, characterised by avoidance symptoms. Reception conditions contributed to the emergence of the Pervasive PTSD profile characterised by the symptoms highest severity. These findings highlight that stressors in the post-migration environment, as inadequate reception conditions in large facilities, may have detrimental effect on refugees’ mental health. We emphasise the importance for host countries to implement reception models that provide effective protection and integration to this vulnerable population.

Trauma, Post-Traumatic Stress Disorder, and Mental Health Care of Asylum Seekers

“…The high prevalence of PTSD among trauma victims is in line with previous studies highlighting the vulnerability of asylum seekers and refugees to cumulative trauma [25,31,44,45]. Traumatic experiences occur in asylum seekers' countries of origin, along migratory routes, and in their post-migratory environment.…”

Meta-Analysis of Cultural Influences in Trauma Exposure and PTSD Prevalence Rates

“…Despite their knowledge and awareness of harmful cultural influences, in practice, culture was transactional. Unfortunately, the common sociopsychological symptom cluster in traumatized refugees is behavioral avoidance (Yuval & Bernstein, 2017) as a way of coping with detention, crowding, isolation, legal proceedings (Barbieri et al, 2020), discrimination, police harassment, violence, unemployment, and service barriers (Im et al, 2020). Health care strategies aimed at making culture a health protective factor might resolve these common treatment problems (Vaage et al, 2010).…”

Complex post-traumatic stress disorder and post-migration living difficulties in traumatised refugees and asylum seekers: the role of language acquisition and barriers

“…Taken together, to date, findings on CPTSD and its association with PMLDs in refugees are scarce, and the assumed complex and possibly varying relationships of different types of PMLDs with CPTSD remain unclear (Barbieri et al, 2020 ). We aimed to contribute to a better understanding of the patterns of CPTSD symptom presentation and their associations with traumatic experiences, distinct types of PMLDs, and demographic variables in treatment-seeking Afghan refugees and asylum seekers.…”