Beyond Trauma‐Focused Psychiatric Epidemiology: Bridging Research and Practice With War‐Affected Populations

University of Chicago, Chicago, Illinois, United States
American Journal of Orthopsychiatry (Impact Factor: 1.36). 09/2006; 76(4):409 - 422. DOI: 10.1037/0002-9432.76.4.409
Source: PubMed


This article examines the centrality of trauma-focused psychiatric epidemiology (TFPE) in research with war-affected populations. The authors question the utility of the dominant focus on posttraumatic stress disorder and other disorders of Western psychiatry, and they identify a set of critical research foci related to mental health work with communities affected by political violence. Core assumptions of TFPE and its roots in logical positivism and the biomedical model of contemporary psychiatry are explored. The authors suggest that an alternative framework—social constructivism—can serve as a bridge between researchers and practitioners by helping to refocus research efforts in ways that are conceptually and methodologically more attuned to the needs of war-affected communities and those working to address their mental health needs.

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Available from: Kenneth E Miller
    • "Explanations for this trend centre on the different hardships faced by men versus women during war, with women more likely to face sexual assault (Liebling and Kiziri-Mayengo, 2002) and the loss of spouse (Morina and Emmelkamp, 2012), and men dealing with detention, abduction , and combat (Somasundaram and Sivayokan, 1994). Other analyses attribute differences in mental health to cultural mores which impose unique hardships for women (Miller et al., 2006) and reduce their access to resources such as housing, education, employment, and healthcare (Husain et al., 2007;Shin et al., 2009). There has been little in-depth qualitative exploration of women's perspectives on how conflict and displacement has impacted their well-being. "
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    ABSTRACT: Losses experienced by conflict-affected civilians in low and middle income countries is a relatively unexplored area. The aim of our paper is to explore the concept of resource loss in the accounts of internally displaced women in Georgia. We use Hobfoll's Conservation of Resources (COR) theory to guide our approach by examining the loss of objects, personal characteristics, conditions, and energies. Semi-structured interviews were conducted on 42 purposively-selected Georgian women residing in internally displaced persons settlements during fieldwork in Georgia from December 2012 to February 2013. Line-by-line open-coding was conducted on translated and transcribed interviews using Nvivo. The conservation of resources theory was utilised to guide the 'mapping' of the relationships between losses which occurred in the post-conflict period. War-related trauma led to the loss of property, which caused the loss of livelihood and subsequent loss of social networks and mental and physical health. The mental and physical health losses, along with the loss of livelihood, constituted a loss spiral in which losses in one area perpetuated on-going losses in the other areas. Interventions at supporting livelihoods are needed in order to address the cascade of losses resulting from war.
    No preview · Article · Jan 2016 · Social Science [?] Medicine
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    • "Two studies used a mixed method design [44,45] (Table 2). The most common practice settings identified were primary healthcare (n = 10) [42,44,53,59-62,64,65,82], followed by post-graduate educational settings (n = 7) [39-41,43,45,65,81], and mental health clinical environments (n = 5) [50,52,58,78,80] (Table 3). Nursing was the professional group most frequently targeted in the papers (20 of 35 included studies), alone [42,43,47,53,55,60-62,77], or along with physicians [64,82], patients [44], or interdisciplinary teams [38,39,48,51,57,65,76,79]. Psychologists/psychiatrists was another identified group (n = 5) [50,52,58,78,80]. "
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    ABSTRACT: Background Use of theory is essential for advancing the science of knowledge translation (KT) and for increasing the likelihood that KT interventions will be successful in reducing existing research-practice gaps in health care. As a sociological theory of knowledge, social constructivist theory may be useful for informing the design and evaluation of KT interventions. As such, this scoping review explored the extent to which social constructivist theory has been applied in the KT literature for healthcare professionals. Methods Searches were conducted in six databases: Ovid MEDLINE (1948 – May 16, 2011), Ovid EMBASE, CINAHL, ERIC, PsycInfo, and AMED. Inclusion criteria were: publications from all health professions, research methodologies, as well as conceptual and theoretical papers related to KT. To be included in the review, key words such as constructivism, social constructivism, or social constructivist theories had to be included within the title or abstract. Papers that discussed the use of social constructivist theories in the context of undergraduate learning in academic settings were excluded from the review. An analytical framework of quantitative (numerical) and thematic analysis was used to examine and combine study findings. Results Of the 514 articles screened, 35 papers published between 1992 and 2011 were deemed eligible and included in the review. This review indicated that use of social constructivist theory in the KT literature was limited and haphazard. The lack of justification for the use of theory continues to represent a shortcoming of the papers reviewed. Potential applications and relevance of social constructivist theory in KT in general and in the specific studies were not made explicit in most papers. For the acquisition, expression and application of knowledge in practice, there was emphasis on how the social constructivist theory supports clinicians in expressing this knowledge in their professional interactions. Conclusions This scoping review was the first to examine use of social constructivism in KT studies. While the links between social constructivism and KT have not been fully explored, the Knowledge to Action framework has strong constructivist underpinnings that can be used in moving forward within the broader KT enterprise.
    Full-text · Article · May 2014 · Implementation Science
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    • "At the moment, our model is limited by the practical constraints that emerge in crisis and emergency contexts and by the particular isolation of Israeli/Palestinian society; it is still not sufficiently attentive to the involvement of the community, which remains, in our opinion, one of the main protective factors in the development of post-traumatic reactions (Weine et al., 2006). One future development of the model could be to increasingly engage community representatives, such as religious leaders, teachers and other key figures, in the intervention, along with the family (Miller et al., 2006). As things currently stand in the specific context in which our intervention was tested, the solidarity of the Palestinian community living inside the state of Israel is jeopardised by the fragmented fabric of Arab society and by the cultural impoverishment imposed by the Zionist institutions. "
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    ABSTRACT: The aim of this study was to analyse the phases of an innovative in vivo exposure intervention in which all family members were present at the scene of a traumatic incident. Clinical practice has borne out the efficacy of family intervention and its benefits for traumatised individuals and family groups. The intervention discussed here was conducted with a Palestinian family that had suffered trauma in a missile attack during the Israeli–Lebanese war of summer 2006. Narrative and meaning-reconstruction methods were combined with cognitive-behavioural techniques. The study highlights the limitations of the intervention as well as suggesting future directions for integrated models of crisis intervention; development of an evidence-based model is recommended.
    Full-text · Article · Apr 2014 · British Journal of Guidance and Counselling
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