Alexander Mcfarlane

Alexander Mcfarlane
University of Adelaide · Centre for Traumatic Stress Studies

About

478
Publications
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Publications

Publications (478)
Article
Full-text available
Background This research examined the mental health of a cohort of asylum-seeking children, adolescents and their primary caregiver affected by insecure residency while living in the community, compared to refugees and immigrants. Methods The project investigated the prevalence of psychosocial problems among Iranian and Afghani asylum seeker, refu...
Article
Background and objectives Problem anger is highly destructive, and is one of the most commonly reported issues in military and veteran populations. The goal of this study was to use ecological momentary assessment (EMA) to explore and characterize moment-to-moment experiences of problem anger in a sample of Australian veterans. Methods Sixty veter...
Article
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Background and aims Veterans who have recently left the military (i.e., transitioned) may be vulnerable to the development of psychiatric disorders, but little is known about gambling problems in this population. This study investigated the prevalence and risk factors of gambling problems, help-seeking amongst veterans with gambling problems, and r...
Article
Background Posttraumatic stress disorder (PTSD) is heritable and a potential consequence of exposure to traumatic stress. Evidence suggests that a quantitative approach to PTSD phenotype measurement and incorporation of lifetime trauma exposure (LTE) information could enhance the discovery power of PTSD genome-wide association studies (GWAS). Meth...
Article
Due to climate change, catastrophic events such as landscape fires are increasing in frequency and severity. However, relatively little is known about the longer-term mental health outcomes of such events. Follow-up was conducted of 709 adults exposed to smoke from the 2014 Hazelwood mine fire in Morwell, Victoria, Australia. Participants completed...
Article
Climate change and an increase in the number of major fire events occurring around the world have drawn attention to the importance of understanding the association between air pollution events and mental health. In 2014, the Morwell open-cut brown coal mine adjacent to the Hazelwood power station in the Latrobe Valley region of Victoria, Australia...
Article
Background Problem Problem anger is increasingly identified as an important issue, and may be associated with suicidality and violence. This study investigates the relationship between problem anger, suicidality, and violence amongst veterans and military personnel. Methods Cross-sectional survey data from n = 12,806 military personnel and veteran...
Article
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Transitioning out of the military can be a time of change and challenge. Research indicates that altered threat monitoring in military populations may contribute to the development of psychopathology in veterans, and interventions that adjust threat monitoring in personnel leaving the military may be beneficial. Australian Defence Force personnel (...
Article
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The current Russian war against Ukraine is of global concern. It builds on the annexation of Crimea in 2014 and subsequently the war in the Donbas region of Ukraine, and has become a large-scale Russian invasion of Ukraine from three directions, Crimea in the south, Russia in the east, and Belarus in the north. Despite the geopolitical background t...
Article
Background The mental health impact of the initial years of military service is an under-researched area. This study is the first to explore mental health trajectories and associated predictors in military members across the first 3–4 years of their career to provide evidence to inform early interventions. Methods This prospective cohort study sur...
Article
Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the...
Preprint
Climate change and an increase in the number of major fire events occurring around the world have drawn attention to the importance of understanding the association between air pollution events and mental health. In 2014, the Morwell open-cut brown coal mine adjacent to the Hazelwood power station in the Latrobe Valley region of Victoria, Australia...
Preprint
Due to climate change, catastrophic events such as landscape fires are increasing in frequency and severity. However, relatively little is known about the longer-term mental health outcomes of such events. Follow-up was conducted of 709 adults exposed to smoke from the 2014 Hazelwood mine fire in Morwell, Victoria, Australia. Participants completed...
Article
We investigated the association between respiratory symptoms and psychological distress in the context of a prolonged smoke event, and evaluated whether smoke exposure, or pre-existing respiratory and mental health conditions, influenced the association. 3096 residents of a rural town heavily exposed to smoke from the six-week Hazelwood coal mine f...
Article
Objective Problem anger and poor sleep are common, particularly in military and veteran populations, but the nature of the relationship is poorly understood, and treatment approaches would benefit from improved understanding of how these constructs interact. Ecological momentary assessment (EMA) is suitable for monitoring day-to-day fluctuations in...
Article
This study examined the prevalence of somatic symptoms in post-traumatic stress disorder (PTSD) in a population-based military sample (N = 14,445). Descriptive statistics explored somatic symptom endorsement in the entire sample. A latent class analyses was conducted on participants with a posttraumatic stress checklist (PCL) score ≥29 (n = 2433),...
Article
The issue of aggressive behaviours among military populations is important for a number of reasons, including the potential associated occupational, social and functional impacts. Controlled aggressive behaviour is an adaptive requirement of some military roles, however, this aggression can become maladaptive when uncontrolled, or contextually inap...
Article
Objective This paper describes the development of the third edition of the National Health and Medical Research Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, posttraumatic stress disorder and Complex posttraumatic stress disorder, highlighting key changes in scope, methodology, format and treatment recommendations...
Article
Objective: Anger is a salient feature of posttraumatic mental health which is linked to posttraumatic stress disorder (PTSD) and may have implications for treatment. However, the nature of associations involving anger and PTSD remains unclear. The aim of the present study was to examine bidirectional influences involving anger and International Cl...
Article
Objective: The risk of suicide in contemporary serving and ex-serving Australian Defence Force personnel is an area of significant concern, driving government-directed inquiries, community campaigns and most recently, the establishment of a permanent National Commissioner for Defence and Veteran Suicide Prevention. This concern is mirrored in inte...
Preprint
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Background Many patients drop out of guideline-recommended treatments for posttraumatic stress disorder (PTSD), yet there has been little systematic investigation of this issue. We aimed to examine dropout proportions from randomized controlled trials (RCTs) of guideline-recommended treatments for PTSD and whether proportions differed by type of tr...
Preprint
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Insomnia is a risk factor for the development of Posttraumatic Stress Disorder (PTSD) while it is also plausible that PTSD symptoms can maintain insomnia symptoms. The present study examined longitudinal bidirectional relationships between insomnia and PTSD symptoms in treatment-seeking veterans. Participants were 693 ex-serving members of the Aust...
Article
There is little available research on what constitutes a culturally informed program to treat mental health conditions among military, veteran, and emergency services personnel. The current study presents the qualitative participant evaluations of a modified group Skills Training in Affective and Interpersonal Regulation (STAIR) program. Participan...
Preprint
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Improved metrics of PTSD treatment response that extend beyond a focus on symptom reduction to incorporate meaningful, patient‐centred indicators of functioning are needed in veteran populations. The aim of this study was to extend previous research by investigating whether indicators of functioning can successfully distinguish against symptom resp...
Article
There is currently no uniform definition of treatment response for posttraumatic stress disorder (PTSD) to guide researchers and clinicians in the area of posttrau-matic mental health. The aim of this systematic review was to explore the operationalization of PTSD treatment response, by reviewing and synthesizing the key criteria used to define tre...
Preprint
In February 2014, the coalmine adjacent to the Hazelwood Power Station in the Latrobe Valley of Victoria, Australia, caught fire, with residents from the nearby town of Morwell and the wider area exposed to smoke for six weeks. Although there was evidence linking the mine-fire event with psychological distress, no studies have evaluated the degree...
Article
Background Many refugees experience bereavement, and as a result they suffer elevated rates of prolonged grief disorder. Evidence also indicates that elevated rates of psychological disturbance in refugee children can be associated with parental mental health. This study examined the extent to which prolonged grief disorder in refugees is associate...
Article
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In most disasters that have been studied, the underlying dangerous cause does not persist for very long. However, during the COVID-19 pandemic a progressively emerging life threat remains, exposing everyone to varying levels of risk of contracting the illness, dying, or infecting others. Distancing and avoiding company have a great impact on social...
Article
Military and veteran populations may exhibit heightened vulnerability to gambling problems; however, there is scant relevant evidence outside the US, and few studies of transition periods, including return from operational deployment. The aim of this study was thus to highlight the extent, risk-factors, and implications of gambling problems among c...
Article
In February 2014, the coalmine adjacent to the Hazelwood Power Station in the Latrobe Valley of Victoria, Australia, caught fire, with residents from the nearby town of Morwell and the wider area exposed to smoke for six weeks. Although there was evidence linking the mine-fire event with psychological distress, no studies have evaluated the degree...
Article
Data routinely collected in the emergency department after trauma have the potential to predict those at risk of later PTSD, which shows promise for computational psychiatry.
Preprint
Full-text available
There is currently no uniform definition of treatment response for posttraumatic stress disorder (PTSD) to guide researchers and clinicians in the area of posttraumatic mental health. The aim of this systematic review was to explore the operationalization of PTSD treatment response, by reviewing and synthesizing the key criteria used to define trea...
Article
Introduction Post-traumatic stress disorder (PTSD) is a severe and debilitating condition affecting a significant proportion of the veteran community. A substantial number of veterans with PTSD fail to benefit from trauma-focused psychological therapies or pharmacotherapy or are left with residual symptoms, and therefore, investigation of new and i...
Article
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Background In the aftermath of disaster, a large proportion of people will develop psychosocial difficulties that impair recovery, but for which presentations do not meet threshold criteria for disorder. Although these adjustment problems can cause high distress and impairment, and often have a trajectory towards mental health disorder, few evidenc...
Article
Objective: Rates of suicidality are higher in military than comparable civilian populations. The period of transition from regular military service may be a time of particular vulnerability. In order to best inform early intervention and prevention strategies, we sought to investigate the childhood determinants (trauma and disorder) of self-report...
Article
Background Anxiety and depression may hamper a smooth transition from military to civilian life and may be important predictors of longer-term health and functioning. However, it is as yet unclear to what extent they are determined by childhood factors in a recently transitioned population. Methods We utilised logistic regression and Generalised S...
Article
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This systematic review examined the efficacy of all augmentation approaches for first‐line posttraumatic stress disorder (PTSD) interventions. From 9,890 records, 34 trials were eligible for inclusion, covering 28 different augmentation approaches. Overall, augmentation approaches were ineffective if they targeted a mechanism similar to the first‐l...
Article
The transition period from military-to-civilian life can be one of the most significant and stressful periods in the military life cycle. We explore the psychosocial factors associated with psychological distress and functional impairment among those who recently transitioned from the Australian Defence Force (ADF) and those currently serving in 20...
Article
Full-text available
Childhood maltreatment is highly prevalent and serves as a risk factor for mental and physical disorders. Self-reported childhood maltreatment appears heritable, but the specific genetic influences on this phenotype are largely unknown. The aims of this study were to (1) identify genetic variation associated with self-reported childhood maltreatmen...
Article
Firefighting is a high-risk occupation that accounts for vulnerability to a range of mental health problems and addictive behaviours. However, no research has addressed whether this vulnerability extends to gambling problems, and the aim of this study was thus to provide new data on frequency and implications of such problems in this occupational c...
Article
We aimed to retrospectively investigate childhood trauma and childhood mental disorder in military and employed civilian men aged 18 to 54 years. Data, derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Australian Bureau of Statistics National Survey of Mental Health and Wellbeing Study, w...
Article
Study Objectives Sleep problems are common, serving as both a predictor and symptom of posttraumatic stress disorder (PTSD), with these bidirectional relationships well established in the literature. While both sleep phenotypes and PTSD are moderately heritable, there has been a paucity of investigation into potential genetic overlap between sleep...
Article
Current paradigms regarding the effects of traumatic exposures on military personnel do not consider physical symptoms unrelated to injury or illness as independent outcomes of trauma exposure, characteristically dealing with these symptoms as comorbidities of psychological disorders. Our objective was to ascertain the proportions of deployed milit...
Article
Background and objectives: This study assessed the psychological impacts of six weeks of smoke exposure from the 2014 Hazelwood open-cut coalmine fire in the Latrobe Valley, Victoria, Australia, between two and three years after the incident. Design and Methods: A cross-sectional survey of adults investigated outcomes for the most exposed communit...
Article
Full-text available
Background: This study assessed the association between coal-mine-fire-related fine particulate matter (PM2.5) and medical-service utilization, following a 6-week coal-mine fire in Australia, in 2014. Areas in the immediate vicinity of the mine experienced hourly mine-fire-related PM2.5 concentrations of up to 3700 μg/m3. Methods: Data on medica...
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The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5–20%, varying by sex. Three genom...
Article
To identify early life factors associated with posttraumatic stress disorder (PTSD), we investigated the association between childhood trauma and mental disorders with International Classification of Diseases (ICD)-diagnosed past-year PTSD in employed military and civilian men. Data were derived from the 2010 Australian Defence Force (ADF) Mental H...
Article
Objective: Among military personnel posttraumatic stress disorder is strongly associated with non-specific health symptoms and can have poor treatment outcomes. This study aimed to use machine learning to identify and describe clusters of self-report health symptoms and examine their association with probable PTSD, other psychopathology, traumatic...
Article
Full-text available
Aims Despite the frequency that refugees suffer bereavement, there is a dearth of research into the prevalence and predictors of problematic grief reactions in refugees. To address this gap, this study reports a nationally representative population-based study of refugees to determine the prevalence of probable prolonged grief disorder (PGD) and it...
Preprint
Full-text available
Childhood maltreatment is highly prevalent and serves as a risk factor for mental and physical disorders. Self-reported childhood maltreatment appears heritable, but the specific genetic influences on this phenotype are largely unknown. The aims of this study were to 1) identify genetic variation associated with reported childhood maltreatment, 2)...
Article
Physical symptoms are highly comorbid with posttraumatic stress disorder (PTSD). As PTSD is underdiagnosed, this study explored the value of self-reported physical symptoms in screening for 30-day PTSD in military personnel. Two physical symptom scales were constructed using items from a 67-item health symptom checklist, clinical interviews were us...
Article
Childhood factors are pivotal to understanding mental health over the lifespan. However, there is a dearth of research exploring childhood trauma and childhood disorder simultaneously in determining adult mental disorder. We aimed to analyze childhood trauma and childhood disorder in determining past-year disorder in military and civilian employed...
Article
It is widely accepted many health and mental health conditions experienced by veterans may be prevented or reduced in severity through early primary health-care intervention, yet research suggests high levels of health-care avoidance in this population. The aim of this study was to examine the meanings military personnel attached to health and how...
Article
Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with t...
Article
Objective: The number of refugees worldwide is unprecedented in recent history. Little is known, however, about profiles of psychological symptoms following persecution and displacement. Methods: This study reports on a latent class analysis that identified profiles of posttraumatic stress disorder (PTSD), depression and anxiety symptoms in a na...
Article
Background Childhood adversity is associated with mental disorder following military deployment. However, it is unclear how different childhood trauma profiles relate to developing a post-deployment disorder. We investigated childhood trauma prospectively in determining new post-deployment probable disorder. Methods In total, 1009 Regular male ADF...
Article
Introduction Military service can involve exposure to physical and psychological stressors. There has been little systematic research into the health and wellbeing of military personnel after they leave the services. Methods 4326 Transitioned ADF (transitioned from regular Australian Defence Force service between Jan 2010–Dec 2014) (18% response)...
Preprint
Objectives: This mixed method study assessed the psychological impacts of six weeks of exposure to smoke and ash from the 2014 Hazelwood mine fire in the Latrobe Valley in Victoria, Australia. The quantitative component compared residents from the most exposed community (Morwell) with those from a similar, but minimally-exposed, control community (...
Chapter
The issue of treatment resistance in PTSD has had little consideration in the literature. This may be due to the dominance of particularly psychotherapeutic approaches that has encourage an overly optimistic view of the treatment outcomes. It has become particularly apparent in veterans’ populations that the majority of patients are left with the d...
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Full-text available
Current international literature suggests a higher prevalence of respiratory conditions in military personnel during and following deployment to the Middle East for reasons that are not well understood. Therefore, a systematic review of research into the impacts of deployment on respiratory function among international and Australian contemporary m...
Article
Limited research has examined the impacts of coal mine fire smoke on human health. The aim of this study was to assess the association between prolonged smoke PM2.5 exposure from a brown coal mine fire that burned over a seven week period in 2014 and medications dispensed across five localities in South-eastern Victoria, Australia. Spatially resolv...
Article
Background To better understand the associations of childhood trauma and childhood disorder with past-year suicidality (thoughts, plans or attempts), we compared male military and civilian populations aged 18–60 years old. Methods Data derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Au...
Article
Full-text available
Post-traumatic stress disorder (PTSD) is a common and debilitating disorder. The risk of PTSD following trauma is heritable, but robust common variants have yet to be identified by genome-wide association studies (GWAS). We have collected a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls. We first demonstrate significant g...
Preprint
Disasters are often termed traumatic events that happen unexpectedly, are dangerous and overwhelming for those who are impacted by them (Aslam, 2010). All disasters however, are not the same. Events of long duration create less immediate danger of injury and fatality but nonetheless pose indirect, insidious threats to those exposed, particularly fo...