Alvin Tay - Academia.edu (original) (raw)
Papers by Alvin Tay
British Journal of Psychiatry Open, Aug 24, 2018
Background Following years of controversy, a category of complex posttraumatic stress disorder (C... more Background Following years of controversy, a category of complex posttraumatic stress disorder (CPTSD) will be included in the forthcoming ICD-11. Aims To test whether refugees with CPTSD differ from those with other common mental disorders (CMDs) in the degree of exposure to childhood adversities, adult interpersonal trauma and posttraumatic hardship. Method Survey of 487 West Papuan refugees (response rate 85.5%) in Papua New Guinea. Results Refugees with CPTSD had higher exposure to childhood adversities (CPTSD: mean 2.6, 95% CI 2.5-2.7 versus CMD: mean 1.15, 95% CI 1.10-1.20), interpersonal trauma (CPTSD: mean 9, 95% CI 8.6-9.4 versus CMD: mean 5.4, 95% CI 5.4-5.5) and postmigration living difficulties (CPTSD: mean 2.3, 95% CI 2-2.5 versus CMD mean 1.85, 95% CI 1.84-1.86), compared with those with CMDs who in turn exceeded those with no mental disorder on all these indices. Conclusions The findings support the cross-cultural validity of CPTSD as a reaction to high levels of exposure to recurrent interpersonal trauma and associated adversities.
Epidemiology and Psychiatric Sciences, Aug 30, 2016
Aims. Grief symptoms and a sense of injustice may be interrelated responses amongst persons expos... more Aims. Grief symptoms and a sense of injustice may be interrelated responses amongst persons exposed to mass conflict and both reactions may contribute to post-traumatic stress disorder (PTSD) symptoms. As yet, however, there is a dearth of data examining these relationships. Our study examined the contributions of grief and a sense of injustice to a model of PTSD symptoms that included the established determinants of trauma events, ongoing adversity and severe psychological distress. The study involved a large population sample (n = 2964, response rate: 82.4%) surveyed in post-conflict Timor-Leste. Methods. The survey sites included an urban administrative area (suco) in Dili, the capital of Timor-Leste and a rural village located an hour's drive away. Culturally adapted measures were applied to assess conflict related traumatic events (TEs), ongoing adversity, persisting preoccupations with injustice, symptoms of grief, psychological distress (including depressive symptoms) and PTSD symptoms. Results. We tested a series of structural equation models, the final comprehensive model, which included indices of grief symptoms and injustice, producing a good fit. Locating grief symptoms as the endpoint of the model produced a non-converging model. In the final model, strong associations were evident between grief and injustice (β = 0.34, S.E. = 0.02, p < 0.01) and grief and PTSD symptoms (β = 0.14, S.E. = 0.02, p < 0.01). The sense of injustice exerted a considerable effect on PTSD symptoms (β = 0.13, S.E. = 0.03, p < 0.01). In addition, multiple indirect paths were evident, most involving grief and a sense of injustice, attesting to the complex interrelationship of these factors in contributing to PTSD symptoms. Conclusions. Our findings support an expanded model of PTSD symptoms relevant to post-conflict populations, in which grief symptoms and a sense of injustice play pivotal roles. The model supports the importance of a focus on loss, grief and a sense of injustice in conducting trauma-focused psychotherapies for PTSD amongst populations exposed to mass conflict and violence. Further research is needed to identify the precise mechanisms whereby grief symptoms and the sense of injustice impact on PTSD symptoms.
Psychological Medicine, Sep 29, 2016
Little is known about the mental health of partners of survivors of high levels of trauma in post... more Little is known about the mental health of partners of survivors of high levels of trauma in post-conflict countries. We studied 677 spouse dyads (n = 1354) drawn from a community survey (response 82.4%) in post-conflict Timor-Leste. We used culturally adapted measures of post-traumatic stress disorder (PTSD), psychological distress, explosive anger and grief. Latent class analysis identified three classes of couples: class 1, comprising women with higher trauma events (TEs), men with intermediate TEs (19%); class 2, including men with higher TEs, women with lower TEs (23%); and class 3, comprising couples in which men and women had lower TE exposure (58%) (the reference group). Men and women partners of survivors of higher TE exposure (classes 1 and 2) had increased symptoms of explosive anger and grief compared with the reference class (class 3). Women partners of survivors of higher TE exposure (class 2) had a 20-fold increased rate of PTSD symptoms compared with the reference class, a pattern that was not evident for men living with women exposed to higher levels of trauma (class 1). Men and women living with survivors of higher levels of trauma showed an increase in symptoms of grief and explosive anger. The manifold higher rate of PTSD symptoms amongst women living with men exposed to high levels of trauma requires replication. It is important to assess the mental health of partners when treating survivors of high levels of trauma in post-conflict settings.
Epidemiology and Psychiatric Sciences, 2022
Aims. We investigate the prevalence and risk factor profiles of Intermittent Explosive Disorder (... more Aims. We investigate the prevalence and risk factor profiles of Intermittent Explosive Disorder (IED) and comparison between two diagnostic measures for IED in a large population-based study of three ethnic groups of refugees (Chin, Kachin and Rohingya) from Myanmar resettled in Malaysia. Methods. Trained field personnel interviewed in total 2058 refugees, applying a clustered, probabilistic, proportional-to-size sampling framework and using the DSM-IV and DSM-5 criteria to diagnose IED. We used descriptive and bivariate analyses to explore associations of IED (using DSM IV or DMS 5) with ethnic group membership, sociodemographic characteristics and exposure to premigration traumatic events (TEs) and postmigration living difficulties (PMLDs). We also examined associations of IED with other common mental disorders (CMDs) (depression, anxiety and posttraumatic stress disorder) and with domains of functional impairment. Finally, we compared whether IED measured using DSM IV or DSM 5 generated the same or different prevalence. Results. For the whole sample (n = 2058), the 12-month prevalence of DSM-IV IED was 5.9% (n = 122) and for DSM-5, 3.4% (n = 71). Across the three ethnic groups, 12-month DSM-5 IED prevalence was 2.1% (Chin), 2.9% (Rohingya) and 8.0% (Kachin), whereas DSM-IV defined IED prevalence was 3.2% (Chin), 7% (Rohingya) and 9.2% (Kachin). Being single, and exposure to greater premigration TEs and PMLDs were each associated with IED. Over 80% of persons with IED recorded one or more comorbid CMDs. Persons with IED also showed greater levels of functional impairment compared with those without IED. Conclusions. The pooled IED prevalence was higher than global norms but there was substantial variation in prevalence across the three study groups. 10 Alvin Kuowei Tay et al.
British Journal of Psychiatry Open, Jun 1, 2022
This commentary discusses methodological and contextual factors that might account for variations... more This commentary discusses methodological and contextual factors that might account for variations in psychosocial treatment outcomes found in persons in low-and middle-income countries affected by humanitarian crises and refugees. Factors discussed are related to cultural adaptations, content and intensity of treatment, population characteristics and factors related to research design.
JAMA network open, May 3, 2019
IMPORTANCE Pregnancy may increase the risk of depression among women who self-identify as refugee... more IMPORTANCE Pregnancy may increase the risk of depression among women who self-identify as refugees and have resettled in high-income countries. To our knowledge, no large systematic studies among women with refugee backgrounds in the antenatal period have been conducted. OBJECTIVES To compare the prevalence of major depressive disorder (MDD), trauma exposure, and other psychosocial risk factors among women who identify as refugees, women from the same conflict-affected countries, and women from the host nation and to test whether self-identification as a refugee indicates greater likelihood of prevalence and risk. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was undertaken in 3 public antenatal clinics in Sydney and Melbourne, Australia, between January 2015 and December 2016. Overall, 1335 women (685 consecutively enrolled from conflict-affected backgrounds and 650 randomly selected from the host nation) participated. Data analysis was undertaken between June and September 2018. EXPOSURES One-hour interviews covering mental health, intimate partner violence, and other social measures. MAIN OUTCOME AND MEASURES World Health Organization measure for intimate partner violence and the Mini-International Neuropsychiatric Interview from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) for MDD. To make a diagnosis, 1 of 2 items relating to being consistently depressed for 2 weeks and 3 further symptoms that cause personal distress or psychosocial dysfunction were endorsed. RESULTS Overall, 1335 women (84.8% overall response rate), comprising 685 (51.3%) from conflictaffected countries (women self-identifying as refugees: 289 [42.2%]) and 650 (48.7%) from the host nation, participated. The mean (SD) age was 29.7 (5.4) years among women from conflictaffected backgrounds and 29.0 (5.5) years among women born in the host nation. Conflict-affected countries included Iraq (260 [38.0%]), Lebanon (125 [18.2%]), Sri Lanka (71 [10.4%]), and Sudan (66 [9.6%]). Women who identified as refugees reported higher exposure to 2 to 3 (67 [23.2%]) and 4 or more (19 [6.6%]) general traumatic events compared with women from the host nation (103 [15.8%] and 21 [3.2%], respectively). Women who identified as refugees also reported higher exposure to 1 (147 [50.9%]) and 2 or more (97 [33.6%]) refugee-related traumatic events compared with women from the host nation (86 [13.2%] and 20 [3.1%], respectively). Women who identified as refugees reported higher rates of psychological intimate partner violence than women born in the host nation (124 [42.9%] vs 133 [20.5%]; P < .001). Women who identified as refugees were less (continued) Key Points Question What is the prevalence and which risk factors are associated with major depressive disorder in women from conflict-affected backgrounds resettling in a high-income country, and does self-identification as a refugee signal a higher risk? Findings In this cross-sectional study of 1335 women (685 recruited from conflict-affected backgrounds and 650 from the host nation), the prevalence of major depressive disorder was 14.5% for women born in the host nation compared with 19.7% for women from conflict-affected backgrounds and 32.5% for women who identified as refugees. Meaning General and refugee-related traumatic events, intimate partner violence, low social support, and financial stress should be prioritized in resettlement policies and clinical settings to reduce major depressive disorder in women from conflictaffected backgrounds and those who identify as refugees.
American Psychological Association eBooks, 2021
![Research paper thumbnail of Corrigendum to “A mixed-method study of expert psychological evidence submitted for a cohort of asylum seekers undergoing refugee status determination in Australia” [Soc Sci Med 98 (2013) 106–115]](https://attachments.academia-assets.com/117592891/thumbnails/1.jpg)
](Social Science & Medicine, Aug 1, 2015
The authors regret that an error is present in author details for the above published article. Th... more The authors regret that an error is present in author details for the above published article. The author originally listed as 'Kuowei Tay' should be 'Alvin Kuowei Tay'. The authors would like to apologise for any inconvenience caused.
The Lancet Psychiatry, Feb 1, 2016
Epidemiology and Psychiatric Sciences, Aug 23, 2019
Aims. Refugees are confronted with the task of adapting to the long-term erosion of psychosocial ... more Aims. Refugees are confronted with the task of adapting to the long-term erosion of psychosocial systems and institutions that in stable societies support psychological well-being and mental health. We provide an overview of the theoretical principles and practical steps taken to develop a novel psychotherapeutic approach, Integrative Adapt Therapy (IAT), which aims to assist refugees to adapt to these changes. This paper offers the background informing ongoing trials of IAT amongst refugees from Myanmar. Methods. A systematic process was followed in formulating the therapy and devising a treatment manual consistent with the principles of the Adaptation and Development After Persecution and Trauma (ADAPT) model. The process of development and refinement was based on qualitative research amongst 70 refugees (ten from West Papua and 60 Rohingya from Myanmar). The therapeutic process was then piloted by trained interventionists amongst a purposively selected sample of 20 Rohingya refugees in Malaysia. Results. The final formulation of IAT represented an integration of the principles of the ADAPT model and evidence-based techniques of modern therapies in the field, including a transdiagnostic approach and the selective use of cognitive behavioural treatment elements such as problem-solving and emotional regulation techniques. The steps outlined in refining the manual are outlined in relation to work amongst West Papuan refugees, and the process of cultural and contextual modifications described during early piloting with Rohingya refugees in Malaysia. Conclusions. IAT integrates universal principles of the ADAPT model with the particularities of the culture, history of conflict and living context of each refugee community; this synthesis of knowledge forms the basis for participants gaining insights into their personal patterns of psychosocial adaptation to the refugee experience. Participants then apply evidence-based techniques to improve their capacity to adapt to the serial psychosocial changes they have encountered in their lives as refugees. The overarching goal of IAT is to provide refugees with a coherent framework that assists in making sense of their experiences and their emotional and interpersonal reactions to the challenges they confront within the family and community context. As such, the principles of a general model (ADAPT) are used as a springboard for making concrete, manageable and meaningful life changes at the individual level, a potentially novel approach for psychosocial interventions in the field.
The Lancet Psychiatry, Feb 1, 2016
Background The subject of post-confl ict mental health lacks studies that are nationally represen... more Background The subject of post-confl ict mental health lacks studies that are nationally representative or large enough to allow robust examination of levels of distress according to residency in geographical zones of confl ict and ethnic minority status. We undertook a nationwide study in Sri Lanka to address these issues. Methods We used tablet devices to survey 20 632 people across 18 of 25 districts in Sri Lanka, of which nine were purposefully selected and nine randomly selected districts. Based on their exposure to war and levels of population displacement, these districts were classifi ed as being in the severe, moderate, or minimal confl ict zones. Trained local fi eldworkers did private interviews with the participants in the local language; responses were entered directly into the tablet devices. The questions assessed exposure to a wide range of stresses, including ongoing adversities, threat or protection issues, and service access factors, and respondents provided categorical responses (yes/no) to a list of items. We used the 25-item Hopkins Symptom Checklist to measure depression and anxiety in participants. We used multivariate analysis and calculated population-attributable fractions to estimate potential improvement in mental distress if modifi able factors were addressed. Findings Our results showed a stepwise increase in symptoms of depression (10%, 33%, 40%) and anxiety (13%, 23%, 23%) across minimal, moderate, and severe confl ict zones, respectively. Membership of an ethnic minority group was associated with depression (Tamil odds ratio [OR] 2•4 [95% CI 1•8-3•1], other ethnic minority OR 2•7 [2•1-3•6]) and anxiety (Tamil OR 1•5 [1•1-2•0], other ethnic minority OR 1•5 [1•2-1•8]). Other fi xed characteristics associated with depression and anxiety were older age (both depression and anxiety; OR 2•7 [95% CI 2•0-3•7] for anxiety and 2•3 [1•7-3•0] for depression), being married (anxiety only; OR 1•5 [95% CI 1•1-2•1]), and time spent in camps for internally displaced people (anxiety only; OR 1•4 [95% CI 1•0-1•9]). Modifi able characteristics were threat or protection issues (depression OR 1•8 [95% CI 1•2-2•8], anxiety OR 1•8 [1•3-2•6]) and scarcity of food (depression OR 1•4 [1•2-1•6], anxiety OR 1•4 [1•2-2•7]), loss of job (OR 1•2 [95% CI 1•2-1•4] for anxiety), and proximity to army camps (OR 1•6 [95% CI 1•2-2•2] for depression). Allaying of safety concerns had the potential to reduce depression by 53% and anxiety by 57%, with other factors (removal of army camps from proximity and addressing food scarcity, loss of jobs and threat/protection issues) making smaller contributions to a reduction in depression and anxiety. Interpretation Our fi ndings off er a basis for detecting high-risk groups and provide directions in devising policies and programmes aimed at alleviating psychological distress in Sri Lanka. Restoration of safety seems to be crucial to mental health recovery.
BMC Psychiatry, May 10, 2016
Background: Cumulative exposure to potentially traumatic events (PTEs) increases risk for mental ... more Background: Cumulative exposure to potentially traumatic events (PTEs) increases risk for mental distress in conflict-affected settings, but the psychophysiological mechanisms that mediate this dose-response relationship are unknown. We investigated diminished heart rate variability (HRV)an index of vagus nerve function and a robust predictor of emotion regulation capacity-as a vulnerability marker that potentially mediates the association between PTE exposure, age and symptoms of posttraumatic stress disorder (PTSD), psychological distress and aggressive behavior, in a community sample from Timor-Lestea post-conflict country with a history of mass violence. Method: Resting state heart rate data was recorded from 45 cases of PTSD, depression and intermittent explosive disorder (IED); and 29 non-case controls. Results: Resting HRV was significantly reduced in the combined case group compared with non-cases (p = .021; Cohen's d = 0.5). A significant mediation effect was also observed, whereby a sequence of increased age, reduced HRV and elevated PTSD symptoms mediated the association between PTE exposure and distress (B = .06, SE = .05, 95 % CI = [.00-.217]) and aggression (B = .02, SE = .02, 95 % CI = [.0003-.069])). Conclusion: The findings demonstrate an association between diminished resting HRV and psychopathology. Moreover, age-related HRV reductions emerged as a potential psychophysiological mechanism that underlies enhanced vulnerability to distress and aggression following cumulative PTE exposure.
This study examines the extent to which trust in co-workers mediates the relationships between co... more This study examines the extent to which trust in co-workers mediates the relationships between coworkers' social undermining behaviour and employees' work behaviours. Two structured questionnaires were designed to collect data from employees and their co-workers. The mediating role was investigated using Structural Equation Modelling (SEM) from 502 employees in Malaysia. The SEM analysis showed that co-workers' social undermining behaviour had indirect relationships with employees' work behaviours via the mediating role of trust in co-workers. The results of this study highlighted the importance of curbing social undermining behaviour in the workplace in order to instil trust among employees and better work behaviours in the workplace.
The Lancet. Public health, May 1, 2022
Journal of Child and Family Studies, 2019
Objectives This study investigated the differences in parental beliefs about anxiety and parentin... more Objectives This study investigated the differences in parental beliefs about anxiety and parenting styles in Indian-and Australian-born mothers in Australia and whether these differentially related to child anxiety depending on maternal background and acculturation. Methods 51 mother-child dyads from Sydney participated, consisting of Indian-or Australian-born mothers and their 8-12year-old child. Mothers completed measures of their anxiety, their child's anxiety, their beliefs about their child's anxiety and their bi-dimensional acculturation (if Indian), i.e., an assessment of immersion into both Australian and native culture. Children completed a self-report of anxiety and a measure of their mother's parenting style. Results Indian mothers scored significantly higher on anxious rearing and negative beliefs about anxiety than Australianborn mothers. Moderated regression analysis revealed that Country of Birth did not significantly moderate the relationship between parenting and child anxiety, but acculturation did. Amongst mothers reporting low Indian cultural retention, negative beliefs about child anxiety and anxious rearing positively related to child anxiety. These relationships were reversed amongst mothers reporting high Indian cultural retention. Amongst mothers reporting high Australian cultural identification, emotional warmth negatively related to child anxiety; this was reversed for low Australian cultural identification. Conclusions Results highlight the importance of considering acculturation, specifically as a bi-dimensional construct, rather than COB when examining anxious behaviours and attitudes in migrants. Findings suggest that cultural adaptation of family treatment should look beyond COB and consider within-group differences in acculturative attitudes and status.
SAGE Open, 2017
It is widely acknowledged that the survivor's psychological response to the traumas of mass confl... more It is widely acknowledged that the survivor's psychological response to the traumas of mass conflict can affect adversely other family members. Yet, the focus of past epidemiological studies in the field has been confined to the individual survivor's posttraumatic stress symptom (PTSS) response. We report the first study of its kind in a postconflict country, in which we examine the effects of trauma exposure in one member of conjugal couples on the PTSS of the other. The study involved 677 conjugal couples drawn from a community survey (n = 1,354) in postconflict Timor-Leste. We used culturally adapted and psychometrically tested measures of traumatic events (TEs), preoccupations with injustice, explosive anger, family conflict, and PTSS. A multilevel actor-partner interdependence model (ML-APIM) demonstrated individual pathways involving exposure to murder and atrocities, preoccupations with injustice, explosive anger, and family conflict, leading to PTSS in both men and women when examined separately, with minor variations in paths by gender. Preoccupations with injustice in male survivors contributed to PTSS in the female partner, but not vice versa. Women may have a gender-specific propensity to identify with the male partner's preoccupations with injustice following exposure to murder and atrocities. Our findings offer novel clues to the possible factors contributing to the higher rates of PTSS among women.
British Journal of Psychiatry Open, Aug 24, 2018
Background Following years of controversy, a category of complex posttraumatic stress disorder (C... more Background Following years of controversy, a category of complex posttraumatic stress disorder (CPTSD) will be included in the forthcoming ICD-11. Aims To test whether refugees with CPTSD differ from those with other common mental disorders (CMDs) in the degree of exposure to childhood adversities, adult interpersonal trauma and posttraumatic hardship. Method Survey of 487 West Papuan refugees (response rate 85.5%) in Papua New Guinea. Results Refugees with CPTSD had higher exposure to childhood adversities (CPTSD: mean 2.6, 95% CI 2.5-2.7 versus CMD: mean 1.15, 95% CI 1.10-1.20), interpersonal trauma (CPTSD: mean 9, 95% CI 8.6-9.4 versus CMD: mean 5.4, 95% CI 5.4-5.5) and postmigration living difficulties (CPTSD: mean 2.3, 95% CI 2-2.5 versus CMD mean 1.85, 95% CI 1.84-1.86), compared with those with CMDs who in turn exceeded those with no mental disorder on all these indices. Conclusions The findings support the cross-cultural validity of CPTSD as a reaction to high levels of exposure to recurrent interpersonal trauma and associated adversities.
Epidemiology and Psychiatric Sciences, Aug 30, 2016
Aims. Grief symptoms and a sense of injustice may be interrelated responses amongst persons expos... more Aims. Grief symptoms and a sense of injustice may be interrelated responses amongst persons exposed to mass conflict and both reactions may contribute to post-traumatic stress disorder (PTSD) symptoms. As yet, however, there is a dearth of data examining these relationships. Our study examined the contributions of grief and a sense of injustice to a model of PTSD symptoms that included the established determinants of trauma events, ongoing adversity and severe psychological distress. The study involved a large population sample (n = 2964, response rate: 82.4%) surveyed in post-conflict Timor-Leste. Methods. The survey sites included an urban administrative area (suco) in Dili, the capital of Timor-Leste and a rural village located an hour's drive away. Culturally adapted measures were applied to assess conflict related traumatic events (TEs), ongoing adversity, persisting preoccupations with injustice, symptoms of grief, psychological distress (including depressive symptoms) and PTSD symptoms. Results. We tested a series of structural equation models, the final comprehensive model, which included indices of grief symptoms and injustice, producing a good fit. Locating grief symptoms as the endpoint of the model produced a non-converging model. In the final model, strong associations were evident between grief and injustice (β = 0.34, S.E. = 0.02, p < 0.01) and grief and PTSD symptoms (β = 0.14, S.E. = 0.02, p < 0.01). The sense of injustice exerted a considerable effect on PTSD symptoms (β = 0.13, S.E. = 0.03, p < 0.01). In addition, multiple indirect paths were evident, most involving grief and a sense of injustice, attesting to the complex interrelationship of these factors in contributing to PTSD symptoms. Conclusions. Our findings support an expanded model of PTSD symptoms relevant to post-conflict populations, in which grief symptoms and a sense of injustice play pivotal roles. The model supports the importance of a focus on loss, grief and a sense of injustice in conducting trauma-focused psychotherapies for PTSD amongst populations exposed to mass conflict and violence. Further research is needed to identify the precise mechanisms whereby grief symptoms and the sense of injustice impact on PTSD symptoms.
Psychological Medicine, Sep 29, 2016
Little is known about the mental health of partners of survivors of high levels of trauma in post... more Little is known about the mental health of partners of survivors of high levels of trauma in post-conflict countries. We studied 677 spouse dyads (n = 1354) drawn from a community survey (response 82.4%) in post-conflict Timor-Leste. We used culturally adapted measures of post-traumatic stress disorder (PTSD), psychological distress, explosive anger and grief. Latent class analysis identified three classes of couples: class 1, comprising women with higher trauma events (TEs), men with intermediate TEs (19%); class 2, including men with higher TEs, women with lower TEs (23%); and class 3, comprising couples in which men and women had lower TE exposure (58%) (the reference group). Men and women partners of survivors of higher TE exposure (classes 1 and 2) had increased symptoms of explosive anger and grief compared with the reference class (class 3). Women partners of survivors of higher TE exposure (class 2) had a 20-fold increased rate of PTSD symptoms compared with the reference class, a pattern that was not evident for men living with women exposed to higher levels of trauma (class 1). Men and women living with survivors of higher levels of trauma showed an increase in symptoms of grief and explosive anger. The manifold higher rate of PTSD symptoms amongst women living with men exposed to high levels of trauma requires replication. It is important to assess the mental health of partners when treating survivors of high levels of trauma in post-conflict settings.
Epidemiology and Psychiatric Sciences, 2022
Aims. We investigate the prevalence and risk factor profiles of Intermittent Explosive Disorder (... more Aims. We investigate the prevalence and risk factor profiles of Intermittent Explosive Disorder (IED) and comparison between two diagnostic measures for IED in a large population-based study of three ethnic groups of refugees (Chin, Kachin and Rohingya) from Myanmar resettled in Malaysia. Methods. Trained field personnel interviewed in total 2058 refugees, applying a clustered, probabilistic, proportional-to-size sampling framework and using the DSM-IV and DSM-5 criteria to diagnose IED. We used descriptive and bivariate analyses to explore associations of IED (using DSM IV or DMS 5) with ethnic group membership, sociodemographic characteristics and exposure to premigration traumatic events (TEs) and postmigration living difficulties (PMLDs). We also examined associations of IED with other common mental disorders (CMDs) (depression, anxiety and posttraumatic stress disorder) and with domains of functional impairment. Finally, we compared whether IED measured using DSM IV or DSM 5 generated the same or different prevalence. Results. For the whole sample (n = 2058), the 12-month prevalence of DSM-IV IED was 5.9% (n = 122) and for DSM-5, 3.4% (n = 71). Across the three ethnic groups, 12-month DSM-5 IED prevalence was 2.1% (Chin), 2.9% (Rohingya) and 8.0% (Kachin), whereas DSM-IV defined IED prevalence was 3.2% (Chin), 7% (Rohingya) and 9.2% (Kachin). Being single, and exposure to greater premigration TEs and PMLDs were each associated with IED. Over 80% of persons with IED recorded one or more comorbid CMDs. Persons with IED also showed greater levels of functional impairment compared with those without IED. Conclusions. The pooled IED prevalence was higher than global norms but there was substantial variation in prevalence across the three study groups. 10 Alvin Kuowei Tay et al.
British Journal of Psychiatry Open, Jun 1, 2022
This commentary discusses methodological and contextual factors that might account for variations... more This commentary discusses methodological and contextual factors that might account for variations in psychosocial treatment outcomes found in persons in low-and middle-income countries affected by humanitarian crises and refugees. Factors discussed are related to cultural adaptations, content and intensity of treatment, population characteristics and factors related to research design.
JAMA network open, May 3, 2019
IMPORTANCE Pregnancy may increase the risk of depression among women who self-identify as refugee... more IMPORTANCE Pregnancy may increase the risk of depression among women who self-identify as refugees and have resettled in high-income countries. To our knowledge, no large systematic studies among women with refugee backgrounds in the antenatal period have been conducted. OBJECTIVES To compare the prevalence of major depressive disorder (MDD), trauma exposure, and other psychosocial risk factors among women who identify as refugees, women from the same conflict-affected countries, and women from the host nation and to test whether self-identification as a refugee indicates greater likelihood of prevalence and risk. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was undertaken in 3 public antenatal clinics in Sydney and Melbourne, Australia, between January 2015 and December 2016. Overall, 1335 women (685 consecutively enrolled from conflict-affected backgrounds and 650 randomly selected from the host nation) participated. Data analysis was undertaken between June and September 2018. EXPOSURES One-hour interviews covering mental health, intimate partner violence, and other social measures. MAIN OUTCOME AND MEASURES World Health Organization measure for intimate partner violence and the Mini-International Neuropsychiatric Interview from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) for MDD. To make a diagnosis, 1 of 2 items relating to being consistently depressed for 2 weeks and 3 further symptoms that cause personal distress or psychosocial dysfunction were endorsed. RESULTS Overall, 1335 women (84.8% overall response rate), comprising 685 (51.3%) from conflictaffected countries (women self-identifying as refugees: 289 [42.2%]) and 650 (48.7%) from the host nation, participated. The mean (SD) age was 29.7 (5.4) years among women from conflictaffected backgrounds and 29.0 (5.5) years among women born in the host nation. Conflict-affected countries included Iraq (260 [38.0%]), Lebanon (125 [18.2%]), Sri Lanka (71 [10.4%]), and Sudan (66 [9.6%]). Women who identified as refugees reported higher exposure to 2 to 3 (67 [23.2%]) and 4 or more (19 [6.6%]) general traumatic events compared with women from the host nation (103 [15.8%] and 21 [3.2%], respectively). Women who identified as refugees also reported higher exposure to 1 (147 [50.9%]) and 2 or more (97 [33.6%]) refugee-related traumatic events compared with women from the host nation (86 [13.2%] and 20 [3.1%], respectively). Women who identified as refugees reported higher rates of psychological intimate partner violence than women born in the host nation (124 [42.9%] vs 133 [20.5%]; P < .001). Women who identified as refugees were less (continued) Key Points Question What is the prevalence and which risk factors are associated with major depressive disorder in women from conflict-affected backgrounds resettling in a high-income country, and does self-identification as a refugee signal a higher risk? Findings In this cross-sectional study of 1335 women (685 recruited from conflict-affected backgrounds and 650 from the host nation), the prevalence of major depressive disorder was 14.5% for women born in the host nation compared with 19.7% for women from conflict-affected backgrounds and 32.5% for women who identified as refugees. Meaning General and refugee-related traumatic events, intimate partner violence, low social support, and financial stress should be prioritized in resettlement policies and clinical settings to reduce major depressive disorder in women from conflictaffected backgrounds and those who identify as refugees.
American Psychological Association eBooks, 2021
Social Science & Medicine, Aug 1, 2015
The authors regret that an error is present in author details for the above published article. Th... more The authors regret that an error is present in author details for the above published article. The author originally listed as 'Kuowei Tay' should be 'Alvin Kuowei Tay'. The authors would like to apologise for any inconvenience caused.
The Lancet Psychiatry, Feb 1, 2016
Epidemiology and Psychiatric Sciences, Aug 23, 2019
Aims. Refugees are confronted with the task of adapting to the long-term erosion of psychosocial ... more Aims. Refugees are confronted with the task of adapting to the long-term erosion of psychosocial systems and institutions that in stable societies support psychological well-being and mental health. We provide an overview of the theoretical principles and practical steps taken to develop a novel psychotherapeutic approach, Integrative Adapt Therapy (IAT), which aims to assist refugees to adapt to these changes. This paper offers the background informing ongoing trials of IAT amongst refugees from Myanmar. Methods. A systematic process was followed in formulating the therapy and devising a treatment manual consistent with the principles of the Adaptation and Development After Persecution and Trauma (ADAPT) model. The process of development and refinement was based on qualitative research amongst 70 refugees (ten from West Papua and 60 Rohingya from Myanmar). The therapeutic process was then piloted by trained interventionists amongst a purposively selected sample of 20 Rohingya refugees in Malaysia. Results. The final formulation of IAT represented an integration of the principles of the ADAPT model and evidence-based techniques of modern therapies in the field, including a transdiagnostic approach and the selective use of cognitive behavioural treatment elements such as problem-solving and emotional regulation techniques. The steps outlined in refining the manual are outlined in relation to work amongst West Papuan refugees, and the process of cultural and contextual modifications described during early piloting with Rohingya refugees in Malaysia. Conclusions. IAT integrates universal principles of the ADAPT model with the particularities of the culture, history of conflict and living context of each refugee community; this synthesis of knowledge forms the basis for participants gaining insights into their personal patterns of psychosocial adaptation to the refugee experience. Participants then apply evidence-based techniques to improve their capacity to adapt to the serial psychosocial changes they have encountered in their lives as refugees. The overarching goal of IAT is to provide refugees with a coherent framework that assists in making sense of their experiences and their emotional and interpersonal reactions to the challenges they confront within the family and community context. As such, the principles of a general model (ADAPT) are used as a springboard for making concrete, manageable and meaningful life changes at the individual level, a potentially novel approach for psychosocial interventions in the field.
The Lancet Psychiatry, Feb 1, 2016
Background The subject of post-confl ict mental health lacks studies that are nationally represen... more Background The subject of post-confl ict mental health lacks studies that are nationally representative or large enough to allow robust examination of levels of distress according to residency in geographical zones of confl ict and ethnic minority status. We undertook a nationwide study in Sri Lanka to address these issues. Methods We used tablet devices to survey 20 632 people across 18 of 25 districts in Sri Lanka, of which nine were purposefully selected and nine randomly selected districts. Based on their exposure to war and levels of population displacement, these districts were classifi ed as being in the severe, moderate, or minimal confl ict zones. Trained local fi eldworkers did private interviews with the participants in the local language; responses were entered directly into the tablet devices. The questions assessed exposure to a wide range of stresses, including ongoing adversities, threat or protection issues, and service access factors, and respondents provided categorical responses (yes/no) to a list of items. We used the 25-item Hopkins Symptom Checklist to measure depression and anxiety in participants. We used multivariate analysis and calculated population-attributable fractions to estimate potential improvement in mental distress if modifi able factors were addressed. Findings Our results showed a stepwise increase in symptoms of depression (10%, 33%, 40%) and anxiety (13%, 23%, 23%) across minimal, moderate, and severe confl ict zones, respectively. Membership of an ethnic minority group was associated with depression (Tamil odds ratio [OR] 2•4 [95% CI 1•8-3•1], other ethnic minority OR 2•7 [2•1-3•6]) and anxiety (Tamil OR 1•5 [1•1-2•0], other ethnic minority OR 1•5 [1•2-1•8]). Other fi xed characteristics associated with depression and anxiety were older age (both depression and anxiety; OR 2•7 [95% CI 2•0-3•7] for anxiety and 2•3 [1•7-3•0] for depression), being married (anxiety only; OR 1•5 [95% CI 1•1-2•1]), and time spent in camps for internally displaced people (anxiety only; OR 1•4 [95% CI 1•0-1•9]). Modifi able characteristics were threat or protection issues (depression OR 1•8 [95% CI 1•2-2•8], anxiety OR 1•8 [1•3-2•6]) and scarcity of food (depression OR 1•4 [1•2-1•6], anxiety OR 1•4 [1•2-2•7]), loss of job (OR 1•2 [95% CI 1•2-1•4] for anxiety), and proximity to army camps (OR 1•6 [95% CI 1•2-2•2] for depression). Allaying of safety concerns had the potential to reduce depression by 53% and anxiety by 57%, with other factors (removal of army camps from proximity and addressing food scarcity, loss of jobs and threat/protection issues) making smaller contributions to a reduction in depression and anxiety. Interpretation Our fi ndings off er a basis for detecting high-risk groups and provide directions in devising policies and programmes aimed at alleviating psychological distress in Sri Lanka. Restoration of safety seems to be crucial to mental health recovery.
BMC Psychiatry, May 10, 2016
Background: Cumulative exposure to potentially traumatic events (PTEs) increases risk for mental ... more Background: Cumulative exposure to potentially traumatic events (PTEs) increases risk for mental distress in conflict-affected settings, but the psychophysiological mechanisms that mediate this dose-response relationship are unknown. We investigated diminished heart rate variability (HRV)an index of vagus nerve function and a robust predictor of emotion regulation capacity-as a vulnerability marker that potentially mediates the association between PTE exposure, age and symptoms of posttraumatic stress disorder (PTSD), psychological distress and aggressive behavior, in a community sample from Timor-Lestea post-conflict country with a history of mass violence. Method: Resting state heart rate data was recorded from 45 cases of PTSD, depression and intermittent explosive disorder (IED); and 29 non-case controls. Results: Resting HRV was significantly reduced in the combined case group compared with non-cases (p = .021; Cohen's d = 0.5). A significant mediation effect was also observed, whereby a sequence of increased age, reduced HRV and elevated PTSD symptoms mediated the association between PTE exposure and distress (B = .06, SE = .05, 95 % CI = [.00-.217]) and aggression (B = .02, SE = .02, 95 % CI = [.0003-.069])). Conclusion: The findings demonstrate an association between diminished resting HRV and psychopathology. Moreover, age-related HRV reductions emerged as a potential psychophysiological mechanism that underlies enhanced vulnerability to distress and aggression following cumulative PTE exposure.
This study examines the extent to which trust in co-workers mediates the relationships between co... more This study examines the extent to which trust in co-workers mediates the relationships between coworkers' social undermining behaviour and employees' work behaviours. Two structured questionnaires were designed to collect data from employees and their co-workers. The mediating role was investigated using Structural Equation Modelling (SEM) from 502 employees in Malaysia. The SEM analysis showed that co-workers' social undermining behaviour had indirect relationships with employees' work behaviours via the mediating role of trust in co-workers. The results of this study highlighted the importance of curbing social undermining behaviour in the workplace in order to instil trust among employees and better work behaviours in the workplace.
The Lancet. Public health, May 1, 2022
Journal of Child and Family Studies, 2019
Objectives This study investigated the differences in parental beliefs about anxiety and parentin... more Objectives This study investigated the differences in parental beliefs about anxiety and parenting styles in Indian-and Australian-born mothers in Australia and whether these differentially related to child anxiety depending on maternal background and acculturation. Methods 51 mother-child dyads from Sydney participated, consisting of Indian-or Australian-born mothers and their 8-12year-old child. Mothers completed measures of their anxiety, their child's anxiety, their beliefs about their child's anxiety and their bi-dimensional acculturation (if Indian), i.e., an assessment of immersion into both Australian and native culture. Children completed a self-report of anxiety and a measure of their mother's parenting style. Results Indian mothers scored significantly higher on anxious rearing and negative beliefs about anxiety than Australianborn mothers. Moderated regression analysis revealed that Country of Birth did not significantly moderate the relationship between parenting and child anxiety, but acculturation did. Amongst mothers reporting low Indian cultural retention, negative beliefs about child anxiety and anxious rearing positively related to child anxiety. These relationships were reversed amongst mothers reporting high Indian cultural retention. Amongst mothers reporting high Australian cultural identification, emotional warmth negatively related to child anxiety; this was reversed for low Australian cultural identification. Conclusions Results highlight the importance of considering acculturation, specifically as a bi-dimensional construct, rather than COB when examining anxious behaviours and attitudes in migrants. Findings suggest that cultural adaptation of family treatment should look beyond COB and consider within-group differences in acculturative attitudes and status.
SAGE Open, 2017
It is widely acknowledged that the survivor's psychological response to the traumas of mass confl... more It is widely acknowledged that the survivor's psychological response to the traumas of mass conflict can affect adversely other family members. Yet, the focus of past epidemiological studies in the field has been confined to the individual survivor's posttraumatic stress symptom (PTSS) response. We report the first study of its kind in a postconflict country, in which we examine the effects of trauma exposure in one member of conjugal couples on the PTSS of the other. The study involved 677 conjugal couples drawn from a community survey (n = 1,354) in postconflict Timor-Leste. We used culturally adapted and psychometrically tested measures of traumatic events (TEs), preoccupations with injustice, explosive anger, family conflict, and PTSS. A multilevel actor-partner interdependence model (ML-APIM) demonstrated individual pathways involving exposure to murder and atrocities, preoccupations with injustice, explosive anger, and family conflict, leading to PTSS in both men and women when examined separately, with minor variations in paths by gender. Preoccupations with injustice in male survivors contributed to PTSS in the female partner, but not vice versa. Women may have a gender-specific propensity to identify with the male partner's preoccupations with injustice following exposure to murder and atrocities. Our findings offer novel clues to the possible factors contributing to the higher rates of PTSS among women.