Psychosocial response to mass conflict: examining the Adaptation and Development after Persecution and Trauma (ADAPT) model using a newly devised Refugee-Mental Health Assessment Package (R-MHAP) amongst refugees from West Papua.

摘要

This research program pursued two inter-related aims: to develop the Refugee-Mental Health Assessment Package (R-MHAP) and to apply it to assess aspects of the Adaptation and Development after Persecution and Trauma (ADAPT) model. The model infers that when the domains of safety/security, bonds/networks, access to justice, roles/identities, and existential meaning are undermined, the risk of mental disorder is increased. An additional aim of this research is to examine the validity of complex-post-traumatic stress disorder (C-PTSD) and intermittent explosive disorder (IED). The studies reported herein as published articles were conducted amongst refugees from West Papua (n=230). Chapter Two reports the development and testing of the core R-MHAP modules. The study supports the psychometric properties and validity of the modules of Traumatic Events (TEs), stressors, psychosocial impacts of conflict, and mental disorders. Chapter Three examines the mental health impacts of conflict-related TEs and adversities. The study found that TE exposure was associated with functional impairment; high exposure to stressors was associated with mental disorder. Chapter Four applies the ADAPT index to assess the psychosocial effects of mass conflict on symptoms of post-traumatic stress disorder (PTSD). The study found that the undermining of the foundations of society by conflict exerted a moderating effect on PTS symptoms. Chapters Five and Six investigate the coherence and correlates of PTSD/C-PTSD and IED, respectively, and associations with the ADAPT pillars of sense of insecurity and injustice, ongoing adversities, and conflict exposure. The data offer preliminary support to the independence of PTSD and IED (but not C-PTSD) in this distinctive cultural group. The generic constellation of C-PTSD may have direct relevance to survivors of extreme interpersonal traumas. Furthermore, the intrusion and avoidance domains of PTSD were associated with the interaction of witnessing murders and injustice. The IED constellation was associated with conditions of long-term displacement and separation experienced by the refugees. The research findings encourage a shift in conceptualization and future approaches in the field of post-conflict and refugee mental health. Development of psychopathology following mass violence may be viewed as a dynamic interplay of bio-psychosocial-cultural-spiritual factors. The implications of these findings are detailed in Chapter Seven.