Assessing the impact of psychological distress on the daily functioning of refugees: Creating a high-risk symptom profile for disability among nonwestern trauma survivors
The goal of this study was to evaluate the relationship between psychological distress (Posttraumatic Stress Disorder and depression) and functional disability among nonwestern trauma survivors in the U.S., and to identify which symptom pattern(s) present the greatest threat to their adaptive functioning. Specifically, this study tested the hypotheses that certain theoretically-related symptoms from within PTSD and depression profiles would load together in confirmatory factor analysis (CFA); and that a unique higher-order “Morbid Dysphoria” factor subsuming these symptoms would uniquely contribute to disability. The CFA results supported the hypothesized higher-order structure. Preliminary regression analyses supported the hypotheses that global disability would be significantly associated with a novel measure of postmigration (legal and vocational) functioning, and that both functioning measures would be associated with PTSD and depression scores. Subsequent regression analyses comparing the associations of CFA-derived symptom factors with functional outcomes also supported several study hypotheses. As expected, the higher-order “Morbid Dysphoria” symptom factor predicted global disability above and beyond the impact of the of PTSD and depression classifications and a competing CFA-derived factor composed of “pure” PTSD symptoms (“Traumatic Activation”). Morbid Dysphoria also predicted postmigration legal functioning above and beyond the impact of depression or Traumatic Activation, but was not a stronger predictor of legal functioning than PTSD. Overall, results support Morbid Dysphoria as a uniquely disabling posttraumatic syndrome. Among a number of covariates controlled for in this study, age and general health status remained significantly associated with functioning outcomes in a number of regression models. Limitations of this research include a newly developed (and therefore unvalidated) measure of postmigration functioning, inherent limitations of translated and self-report measures, and a cross-sectional study design. Clinical and policy implications are discussed, and directions for future research are suggested.
Sachs, Emily, "Assessing the impact of psychological distress on the daily functioning of refugees: Creating a high-risk symptom profile for disability among nonwestern trauma survivors" (2011). ETD Collection for Fordham University. AAI3495880.