David Johnson

Phoenix VA Health Care System, Phoenix, Arizona, United States

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Publications (8)7.86 Total impact

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    ABSTRACT: The objectives of this study were to assess differences in premigration, transit, and resettlement stressor exposure and post traumatic stress disorder (PTSD) symptoms as a function of demographic characteristics (i.e., gender, ethnicity, age, time in United States) and to examine the concurrent and longitudinal relations between stressor exposure and PTSD symptoms. The sample consisted of adult (18-78 years) Somali and Oromo refugee men and women (N = 437). Qualitative data regarding participants' self-nominated worst stressors collected at Time 2 (T2) informed the development of quantitative scales assessing premigration, transit, and resettlement stress created using items collected at Time 1 (T1). PTSD symptoms were measured at both T1 and T2. Quantitative analyses showed that levels of stressor exposure and PTSD symptoms differed as a function of refugee demographic characteristics. For example, Oromo, more recent, women, and older refugees reported more premigration and resettlement stressors. Oromo refugees and refugee men reported more PTSD symptoms in regression analyses with other factors controlled. Premigration, transit, and resettlement stressor exposure generally was associated with higher PTSD symptom levels. Results underscore the importance of assessing stress exposure comprehensively throughout the refugee experience and caution against overgeneralizing between and within refugee groups.
    American Journal of Orthopsychiatry 10/2013; 83(4):472-82. · 1.60 Impact Factor
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    ABSTRACT: First to compare two methods of inquiry regarding torture: i.e., the traditional means of inquiry versus a checklist of torture experiences previously identified for these African refugees. Second, we hoped to identify factors that might influence refugees to not report torture on a single query when checklist data indicated torture events had occurred or to report torture when checklist data indicated that torture had not occurred. Consisted of queries to 1,134 community-dwelling East African refugees (Somalia and Ethiopia) regarding the presence-versus-absence of torture in Africa (single query), a checklist of torture experiences in Africa that we had previously identified as occurring in these groups, demography, non-torture traumatic experiences in Africa, and current posttraumatic symptoms. Showed that 14% of the study participants reported a torture experience on a checklist, but not on a single query. Nine percent responded positively to the single query on torture, but then failed to check any torture experience. Those reporting trauma on an open-ended query, but not on a checklist, had been highly traumatized in other ways (warfare, civil chaos, robbery, assault, rape, trauma during flight out of the country). Those who reported torture on the checklist but not on the single query reported fewer instances of torture, suggesting that perhaps a "threshold" of torture experience influenced the single-query report. In addition, certain types of torture appeared more apt to be associated with a singlequery endorsement of torture. On regression analysis, a single-query self-report of torture was associated with traumatic experiences consistent with torture, older age, female gender, and nontorture trauma in Africa. Inconsistent reporting of torture occurred when two methods of inquiry (one openended and one a checklist) were employed in this sample. We believe that specific contexts of torture and non-torture trauma, together with individual demographic characteristics and severity of the trauma, affect the self-perception of having been tortured. Specific information regarding these contexts, demographic characteristics, and trauma severity are presented in the report.
    Torture: quarterly journal on rehabilitation of torture victims and prevention of torture 01/2011; 21(3):155-72.
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    ABSTRACT: Purpose was to assess whether a 4-symptom somatic screen, shown to correlate with current post-traumatic stress symptoms in 1 refugee group, could function as a screening instrument in another group of refugees. Sample consisted of 512 community-dwelling refugees from Ethiopia. Data collection included demography, types of torture and nontorture trauma experienced a decade earlier in Africa, and current posttraumatic stress symptoms. Somatic symptoms included headaches (H), appetite change (A), dizziness and faintness (D), and sleep problems (S), added with equal weighting into the HADStress Screen, ranging from 0 to 4. Results showed that age, gender, torture, and other trauma experiences from a decade ago, and current posttraumatic stress symptoms predicted current somatic symptoms on univariate analyses. On a negative binomial regression model, current posttraumatic stress symptoms, male gender, and number of torture types predicted a high HADStress score. Post hoc tests supported cut-off levels at 3 and at 4 symptoms. Conclusion is that the HADStress Screen can serve as an efficient, nonthreatening screen for posttraumatic stress symptoms among refugees.
    The Journal of nervous and mental disease 10/2010; 198(10):762-7. · 1.77 Impact Factor
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    ABSTRACT: Objective. To assess the characteristics and correlates of sleep problems in patients with lifetime posttraumatic stress disorder and ongoing sleep disturbance not due to obstructive sleep apnea or other diagnosed sleep disorders.Sample. Twenty-six veterans receiving psychiatric care at the Minneapolis Veterans Affairs Medical Center in Minneapolis, Minnesota.Data collection instruments. The Pittsburgh Sleep Quality Index, sleep logs, and actigraph along with three symptom ratings scales-posttraumatic checklist, clinician-administered posttraumatic stress disorder scale, and Beck Depression Inventory-were used.Results. Univariate analysis associated three symptom complexes with poorer sleep quality: posttraumatic avoidance, posttraumatic hypervigilance, and depressive symptoms. Borderline trends also existed between worse sleep quality and more severe clinician-rated posttraumatic stress, more self-reported awakenings from sleep, and greater actigraphy-determined sleep duration. Using linear regression, only posttraumatic hypervigilance symptoms were associated with sleep quality.Conclusion. Sleep quality among posttraumatic stress disorder patients in active treatment is worse in direct relation to more severe posttraumatic hypervigilance symptoms.
    Psychiatry 09/2010; 7(9):21-7.
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    ABSTRACT: To assess the correlates of daytime sleepiness in patients with a lifetime diagnosis of posttraumatic stress disorder (PTSD) and ongoing sleep disturbance not due to sleep apnea or other diagnosed sleep disorders. The sample consisted of 26 veterans receiving mental health care at the Minneapolis VA Medical Center, Minneapolis, Minnesota. The Epworth Sleepiness Scale was the primary outcome measure. Other sleep-related instruments consisted of the Pittsburgh Sleep Quality Scale, a daily sleep log, and daily sleep actigraphy. In addition, data included 3 symptom ratings (Posttraumatic Stress Disorder Checklist, Clinician Administered PTSD Scale [CAPS], and Beck Depression Inventory). Data were collected from 2003 to 2005. Current and lifetime PTSD diagnoses were based on DSM-IV criteria and were obtained by experienced psychiatrists using the CAPS interview. Univariate analyses showed that daytime sleepiness on the Epworth Sleepiness Scale was associated with daytime dysfunction on the Pittsburgh Sleep Quality Index (P < .001), less use of sleeping medication (P = .02), and more self-rated posttraumatic symptoms (P = .05). Within posttraumatic symptom categories, hypervigilance symptoms were more correlated with daytime sleepiness (P = .03) than were reexperiencing and avoidance symptoms (P = .09 for both). In this selected sample, daytime sleepiness was most strongly and independently associated with daytime dysfunction.
    The Primary Care Companion to The Journal of Clinical Psychiatry 01/2010; 12(2).
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    ABSTRACT: The goal of the study was to assess inter-rater reliability of the daily sleep log (a self-rating) with actigraphy (an objective measure of sleep based on activity) in veterans with Posttraumatic Stress Disorder (PTSD). This analysis focused on time asleep and number of awakenings during bedtime. Study participants consisted of 21 veterans with a lifetime diagnosis of Posttraumatic Stress Disorder and current sleep disturbance symptoms. Data collection included study participants' daily charting of sleep logs and actigraphy (utilizing study participants' activity level). Data analysis included the following: (1) interrater reliability for the tabulation of self-reported sleep logs by two trained raters using 99 nights of sleep from 10 cases; (2) comparison of sleep log data versus actigraphic findings for sleep time during 241 bedtimes; (3) comparison of sleep log data versus actigraphic findings for awakenings during 241 bedtimes. Findings showed that the two raters had intraclass correlation scores of .801 for time spent asleep and .602 for time spent in bed-acceptable scores for tabulation of the sleep logs. Comparison of patients' sleep logs versus actigraphy for 241 nights showed that 10 out of 21 study participants had acceptable intraclass correlations of 0.4 or above for duration of sleep. However, sleep logs and actigraphic data on number of sleep awakenings showed poor intraclass correlation, with only 1 subject having an intraclass correlation greater than .30. In conclusion, these data strongly suggest that sleep logs do not reproduce actigraphic records in patients with PTSD even though the sleep logs were reliably quantified. Sleep logs especially under-count awakenings in PTSD patients with sleep complaints.
    Journal of Anxiety Disorders 02/2007; 21(7):966-75. · 2.96 Impact Factor
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    ABSTRACT: This paper reports a study identifying the demographic characteristics, self-reported trauma and torture prevalence, and association of trauma experience and health and social problems among Somali and Oromo women refugees. Nearly all refugees have experienced losses, and many have suffered multiple traumatic experiences, including torture. Their vulnerability to isolation is exacerbated by poverty, grief, and lack of education, literacy, and skills in the language of the receiving country. Using data from a cross-sectional population-based survey, conducted from July 1999 to September 2001, with 1134 Somali and Oromo refugees living in the United States of America, a sub-sample of female participants with clearly identified parenting status (n = 458) were analysed. Measures included demographics, history of trauma and torture, scales for physical, psychological, and social problems, and a post-traumatic stress symptom checklist. Results indicated high overall trauma and torture exposure, and associated physical, social and psychological problems. Women with large families reported statistically significantly higher counts of reported trauma (mean 30, P < 0.001) and torture (mean 3, P < 0.001), and more associated problems (P < 0.001) than the other two groups. Women who reported higher levels of trauma and torture were also older (P < 0.001), had more family responsibilities, had less formal education (P < 0.001) and were less likely to speak English (P < 0.001). These findings suggest a need for nurses, and especially public health nurses who work with refugee and immigrant populations in the community, to develop a more comprehensive understanding of the range of refugee women's experiences and the continuum of needs post-migration, particularly among older women with large family responsibilities. Nurses, with their holistic framework, are ideally suited to partner with refugee women to expand their health agenda beyond the biomedical model to promote healing and reconnection with families and communities.
    Journal of Advanced Nursing 01/2007; 56(6):577-87. · 1.53 Impact Factor