Exposure to intimate partner violence (IPV), posttraumatic stress disorder (PTSD), depressive symptoms, and functional impairment among women of reproductive age are pressing public health and human rights issues in conflict-affected settings. However, to better inform policy and influence positive change, there is a need to understand the trajectories and relationships between these issues over time. We aimed to characterize the trajectories and associations between IPV, depressive symptoms, PTSD, and functional impairment over time among women of reproductive age in conflict-affected, low-resource Timor-Leste. Data are from a prospective cohort study of 854 women, conducted from 2013 to 2020 in Timor-Leste. Participants were assessed at four time points: second trimester of pregnancy (from Weeks 13 to 27) and when the child was 18 months, 36 months, and 60 months old. Latent growth curve modeling and bivariate analyses were used to explore the trajectories and associations. At each wave, PTSD and depressive symptoms were positively correlated with functional impairment and past conflict trauma. IPV was consistently associated with risk of PTSD, depressive symptoms, and impaired functioning among women over time. IPV was reported at a high rate at each time point, whereas PTSD and depressive symptoms improved over time. Findings indicate the need for IPV prevention programs and stronger legal and social sanctions to reduce men's violence. Improvements in women's mental health may be due to the time that has elapsed since conflict trauma or since the birth of the child. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Introduction Regular physical activity is important for physical and mental health. Despite the benefits, over 30% of the global population do not meet the World Health Organisation (WHO) physical activity guidelines, with the risk greater for women, especially during reproductive years, compared to men. However, women of this age face many barriers to participation and there are significant gaps in our understanding of the impact of psychological and social adversity on participation levels. This study aimed to identify adversity factors associated with physical inactivity or reduced activity. Methods Data from 623 women in the WATCH prospective cohort study, a representative sample of women recruited during the antenatal phase, including half from refugee backgrounds, were analyzed to assess the association between prior theoretically supported adversities (e.g., financial stress, living difficulties, intimate partner violence, refugee status and mental health issues) and current physical activity levels. Physical activity was assessed via self-report, using the Physical Activity Vital Sign. A categorical indicator was constructed to describe participants average activity per week based on WHO physical activity and muscle strengthening guidelines; inactive, below recommendation and at or exceeds recommendation. Binary multinomial logistic regression analyses were conducted to examine the crude and demographically adjusted association between each variable and physical activity with. At or exceeds recommendation as the reference group. Results N = 122 (20 %) of the total sample reported no physical activity (0 min) during the previous week. Meanwhile, n = 445 (71 %) engaged in some physical activity but did not meet the recommended guidelines, and n = 56 (9 %) met the guidelines. The odds of being inactive were significantly higher for women from refugee backgrounds OR = 5.79, 95 % CI 2.70 to 12.41, p < .001. In addition, women who have experience previous trauma, living difficulties, or mental health symptoms had significantly higher odds of being inactive. Conclusion High rates of physical inactivity among reproductive-age women were observed. Interventions aimed at increasing physical activity should consider adversity factors identified in this study which impact participation levels, including refugee status, trauma exposure, intimate partner violence, living difficulties, and mental disorder symtoms in their design and implementation.

BACKGROUND:The maternal experience of intimate partner violence is associated with a range of emotional and behavioural problems in young children. OBJECTIVE:To prospectively examine the impact of maternal perinatal intimate partner violence experiences on children's risk trajectories of social-emotional development, including theoretically relevant social, economic, maternal mental health and trauma factors, as well as refugee status. PARTICIPANTS:870 mother-child dyads in the WATCH mental health cohort study, half from refugee background. METHOD:Multigroup trajectory modelling of annually collected longitudinal data at 5 timepoints, from when the children were 18-24 months to 60 months of age. RESULTS:The trajectory modelling revealed 4 distinct trajectories of child social-emotional development: (1) "none or low risk" trajectory (n = 710, 81.6 % of the sample); (2) "declining risk" trajectory (n = 66, 7.6 %); (3) "intermittent risk" trajectory (n = 64, 7.4 %); and (4) "high increasing risk" trajectory (n = 30; 3.4 %). Compared to the group 1 "none or low risk", maternal IPV exposure to physical abuse at baseline was associated with 2.45 times greater odds of children following the "intermittent risk" development trajectory, and 4.90 times greater odds of children following the "high increasing risk" trajectory. Children in trajectory 4 "high increasing risk" were more likely to be male, and mothers were more likely to be born in Australia, have no tertiary education, and experience social and economic difficulties. CONCLUSIONS:The study contributes significantly to understanding the deleterious impact of IPV on child development over time, including unique evidence that socially relevant and modifiable risk factors are more strongly associated with adverse child development than traditionally emphasised factors such as maternal mental health and child attachment factors.

BACKGROUND:Hesitancy about the COVID-19 vaccine in high-income countries can be caused by diverse psychological and social factors. Few studies on vaccine concerns have examined the interplay of the effects of mental disorders, social and economic factors, gender and refugee status. To investigate these issues, this article reports findings from the 2023 wave of a longitudinal study involving 709 women who are mothers of young children in Australia, both refugees and Australian-born. METHODS:Respondents were asked if they had any worries or fears about receiving the COVID-19 vaccine. In previous waves they completed standardized assessments of mental health and sociodemographic factors. An open-ended question provided insights into the reasons for self-reported vaccine concerns. Descriptive statistics and binary logistic regression analyses were conducted, and demographic adjusted logistic regression undertaken separately for Australian-born and refugee women. Formal comparisons of effect sizes between Australian-born and refugee women were performed, with Cohen's d quantifying the magnitude of these differences. Qualitative responses were coded by topic and ranked by frequency. FINDINGS:More than half of the respondents reported worries about receiving a COVID-19 vaccine. Concerns were significantly higher for younger age women, those with a lower educational level and those with a history of mood disorder, panic disorder or separation anxiety disorder. Vaccine hesitancy was associated with poorer quality of life, living difficulties and disability among refugee women only. Separation anxiety disorder and a younger age were associated with an increased odds among Australian-born women only. The newness of the vaccine and concern about side effects were the greatest concerns among respondents who reported hesitancy. CONCLUSIONS:Young mothers with mental health problems and lower education need to be sensitively targeted to improve COVID-19 vaccine uptake. Mental health and public health professionals need to be aware of differences reported for women from refugee background. Improved quality of life and economic status will increase vaccine uptake among socioeconomically challenged communities.

Background:There is a lack of empirical research on the mental health risks faced by populations living in high-income multicultural countries during a war in their country of origin. We examined mental health and psychosocial outcomes associated with a period during the 2023-2025 Middle East conflict (primarily involving Israel, Palestine and Lebanon) on Australian resident women including those who arrived from Lebanon, Gaza and other Palestinian Territories. Methods:The mental health study assessed 410 Australian resident women at two points: one 12-18 months prior, and one period during the current Middle Eastern conflict extending from October 7, 2023, to December 2024. The three groups included those directly connected by birth or family to the conflict-affected regions: Lebanon, Gaza and other Palestinian territories (Middle East-LGP), Other Migrants not from the region, and Australian Born (AB) women with no connection to the region. Measures included the Mini-International Neuropsychiatric Interview to assess symptoms of panic disorder (PD), mood disorder (MDD), post-traumatic stress disorder (PTSD), separation anxiety disorder (SEPAD), Quality of Life, Worry about Family and Separation from Family overseas. Generalised linear mixed models and cumulative link mixed models were used to examine the trajectory of mental disorder symptoms over time for each group compared with the AB group. The analysis adjusted for age, marital status, financial difficulties, and COVID-19 stress. Findings:Generalised linear and cumulative link mixed models revealed significant interaction effects, indicating that Middle East-LGP women experienced a significantly greater increase in PD symptoms (β = 1.26, SE = 0.54, p = 0.02) and poorer quality of life (β = 0.10, SE = 0.04, p = 0.009) from Time 1 to Time 2 compared to AB women. The Middle East-LGP women reported significantly greater increases in concerns about family overseas (log odds = 4.04, SE = 1.25, p = 0.001) and the ability to return home in an emergency (log odds = 3.41, SE = 1.20, p = 0.005). Interpretation:This is a unique study of women's mental health in a multicultural, high-income country, undertaken during conflict occurring in another region of the world. Panic Disorder symptoms, poorer quality of life and other psychosocial stress increased only in the group connected by migration to the conflict-affected region. Funding:National Health and Medical Research Council, Australia (2018/GNT1164736).

Early childhood exposure to maternal experiences of intimate partner violence is associated with a range of emotional and behavioural problems. Using five timepoints of annually collected data from the WATCH mental health cohort study of 870 mother-child dyads, half from refugee background, we prospectively examined the impact of maternal perinatal intimate partner violence exposure on children’s risk trajectories of social-emotional development from around two to five years of age. Maternal IPV exposure to physical abuse with or without psychological abuse at baseline was independently associated with 2.45 times greater odds of children following the “intermittent risk” development trajectory, and 4.90 times greater odds of children following the “high increasing risk” trajectory, compared to those in the “none or low risk” group. Children in the “high increasing risk” trajectory were more likely to be male, and mothers were more likely to be born in Australia, have no tertiary education, and experience social difficulties. The study contributes significantly to understanding the deleterious impact of IPV on child development over time, and the risk and protective factors relevant for safeguarding women and ensuring the optimal development of children.

Despite the well-established benefits of antenatal education (ANE) and breastfeeding for mothers, there is a paucity of evidence about the uptake of ANE and breastfeeding amongst women from refugee backgrounds or its associations with sociodemographic factors. The current study is a cross-sectional survey at two time points examining the prevalence of ANE attendance, breastfeeding, and intimate partner violence (IPV) amongst 583 women refugees resettled in Australia and a control group of 528 Australian-born women. Multi-logistic regression was used to explore bivariate associations between ANE attendance, breastfeeding, IPV, and sociodemographic characteristics (parity, maternal employment, and education). Refugee-background women compared to Australian-born women have lower ANE utilization (20.4% vs. 24.1%), higher rates of breastfeeding on hospital discharge (89.3% vs. 81.7%), and more IPV reports (43.4% vs. 25.9%). Factors such as nulliparity, higher level of education, and employment predict higher rates of ANE and breastfeeding adoption. In contrast, IPV is a risk factor for ANE underutilization. Further, of the women from refugee backgrounds who accessed ANE services, 70% attended clinics designed for women from non-English-speaking backgrounds. These findings support the need to ensure effective screening and interventions for IPV during antenatal care and to better understand the role of culture as a protective or risk factor for breastfeeding initiation.

[This corrects the article DOI: 10.1371/journal.pgph.0002073.].

Among the many dire consequences of the Israel–Gaza war that began in October 2023, the impact on the mental health of populations living in multicultural Western countries is significant and should not be overlooked. The psychosocial reverberations of the conflict are felt in societies throughout the world, embodying unique characteristics of trauma and adding to the complexity of the mental health risk for people living in Western countries. The threat to mental health status is higher for those who have had family members killed, harmed or gone missing, and for those with previous exposure to war, including in Lebanon, Iraq and Syria. The level of stress has been exacerbated by its enduring nature, including systematic oppression, economic hardship, violence, human rights violations and national struggle.1, 2 The groups affected have experienced collective historical traumas. The Jewish people live with stark memories of the Holocaust and centuries of displacement and persecution; and Palestinians have experienced generations of forced displacement, dispossession and oppression living under occupation and precarious socio-economic conditions.1, 3 Both groups have been subject to a complex form of transgenerational trauma characterised by a deep sense of injustice and victimisation, promoting feelings of collective resentment, anger and distrust. In that context, collective trauma plays a major role in exacerbating and complicating individual traumatic stress reactions that are triggered by further exposure or reminders of threat to self and others. Mental distress in these populations can be severe, and trauma of this nature can have deleterious impacts for years to come.4 It is instructive to draw on some concrete examples of the immediate stress reactions from our current longitudinal mental health study of 1335 women from refugee background (the WATCH cohort) and its research assistants, more than half of whom are from the Middle East, including from Lebanon and Palestine.5, 6 All quotes below from study participants have been deidentified and approved by the person who shared it with us. It is vital for health professionals and support agencies to be aware of the wide-ranging stress responses and indirect expressions of these reactions that occur among people from migrant and refugee backgrounds. There are various types of reactions that reflect underlying stress in community members. Graphic news stories, social media reports, racial abuse and inadequate public recognition for community level distress can be major sources for mental disturbance. Trauma is described as witnessing or experiencing an extreme stress that overwhelms a person's ability to cope or contradicts one's worldview.7 Studies of war-affected populations show a definite increase in the incidence and prevalence of mental disorders.8 Women are more affected than men, and other groups vulnerable to traumatic stress are children and older people.9, 10 Prevalence rates in conflict-affected populations are associated with the degree of trauma, and the availability of physical and emotional support.9 Harvard Professor of Psychiatry Richard Mollica, in his work with refugees exposed to war, describes trauma as an “invisible wound”, denoting it as a stress reaction following a severe threat to a person's health and life, but often one that is relatively hidden and easily ignored.11 War and conflict-related trauma occurs in its primary form from exposure to or direct involvement in violent conflict, threat to one's life, witness to the death or loss of loved ones and compatriots, fear (including from bombs exploding and the ensuing devastation), rape and sexual assault, kidnapping, torture and arbitrary detention, dislocation from home, and shortage of essentials including food, water and medicine.4, 12 Secondary traumatic stress, often conflated with the term “vicarious trauma”, results from hearing about or seeing images of first-hand trauma experienced by another person. Although the literature commonly discusses such stress responses among therapists or first responders assisting trauma-affected individuals, the risk for trauma symptomology applies to any person connected to the event.13, 14 The closer one is to identifying with the individual or group, such as a family member or a home village, the higher the risk for adverse psychological impact.15 The psychological response to trauma that is either from direct or secondary exposure can include unwanted and intrusive memories of past traumatic events, sleep disturbance, avoidance, and nightmares. These symptoms characterise post-traumatic stress disorder (PTSD), which is a condition that can be debilitating and follows acute exposure to trauma, in some cases remaining or re-emerging many years after the traumatic event.16 Complex PTSD is particularly relevant to the Israel–Gaza war because it is characterised by prolonged and repeated traumatic incidents that occur over a long period. Complex PTSD has added features including negative impact on self-esteem and emotional dysfunction.14, 17 Prolonged grief, depression, anxiety and somatisation can co-occur in trauma-affected individuals.18 Incidents that are intentional, criminal or unjust are strongly associated with anger and resentment as well as grief and despair.19 We note that normal grief and anger responses among those impacted by secondary trauma can be exacerbated by feelings of victimisation, marginalisation and stigmatisation at the community level. Health professionals may expect to see a higher number of presentations with acute traumatic disturbance, re-emergence of previously controlled mental illness, and presentations for somatic and unexplained illnesses. On watching news of the Israel–Gaza conflict, a participant from our WATCH study,5 from Lebanon, spontaneously remembered Israeli attacks on her village and said: “This made me recall exactly where I was sitting at that time we were bombed, as a child, wondering why this is happening to us, and why can other people have a normal life. It is like I know what they feel.” Other spontaneous descriptions from the study include “that deep feeling of fear when we could hear the explosions, then the bomb hit the side of our shelter, we ran barefoot into the street to escape”, and “remembering my child's face and seeing children of the same age now, I feel frozen with helplessness”. These reactions echo a body of knowledge and evidence describing the psychological response being strongly tied to the re-emergence of traumatic memory, the embodied and visceral recollection of fear, loss and helplessness. Trauma-related impairment of coping and functioning was articulated by another participant who said: “It is like I am walking in slow motion; I am not happy as I was, it is burning me inside.” Secondary traumatic responses can also include externalised expressions of anger as well as intense feelings of separation anxiety from members of the immediate family. A participant from the affected region said: “I send my children off to school, but I think about them all day, and worry about them excessively. This has not happened to me in this way before.” In the tradition of a trauma-informed care approach, health professionals should be mindful of the various manifestations of trauma, and how they may be impacting people's lives.20 Patients may not be aware that their presenting symptoms are related to the current trauma, or they may fear disclosing their concerns about the war in case it is met with an adverse or unsupportive response. Direct questions to adults about how the conflict is affecting them are usually preferred over indirect questions about how they are feeling. Health professionals should explore the psychological and physical effects of traumatic stress on the client and their children, being sensitive to the patient's tolerance of how much they can disclose without losing control of their emotions. It is empowering to reassure clients that they are not alone in feeling this way, and that many others are finding this a stressful and harrowing time. Make a referral for specifically targeted services if required. Advise clients not to focus excessively on social and other media, and to limit exposure to a window of one or two hours daily.21 Remind them to ensure media sources are accurate and informed. Encourage people to stay connected with family and friends and use exercise and lifestyle strategies to reduce stress, including meditation and relaxation. Although they are often overlooked, cultural and religious coping strategies are vital in providing comprehensive and strengths-based community care.9, 22 Our current experience conducting refugee-focused research further unveiled the acute risk of secondary trauma among practitioners and researchers listening to trauma stories. Secondary traumatic responses are compounded for practitioners and researchers who have lived in war zones or have personal connections to the war. These “wounded healers” need to be supported and encouraged to care for their mental wellbeing and seek professional interventions if needed.23 A broad public health position that extends beyond attending to the trauma responses among individuals is for health and social leaders at the community level to be advocates. Advocates for mental health during this traumatic period should advise against taking a partisan position, and instead promote an understanding of human rights, historical trauma, and current mental distress among those affected by the war. The consequences of not advocating for bipartisan human rights has already been felt in Australia by way of racialised hate speech and racism, including anti-Semitic sentiment and verbal assaults targeting women wearing hijabs.24, 25 It is critical for community leaders to demonstrate and advocate for a measured public response to this war, promoting understanding, validation, and the need to maintain order and peace in our country. We are a multicultural country with large populations of people who will be seriously impacted by the trauma of this war that has been occurring in their homeland, or because the region has political, cultural or religious significance to them. Health professionals need to be aware of the complexity of the traumatic stress reactions that conflict-affected communities can manifest under these circumstances, and the importance of offering multilevel interventions to address these reactions, drawing on all the resources available to provide support for patients and their families. Open access publishing facilitated by University of New South Wales, as part of the Wiley - University of New South Wales agreement via the Council of Australian University Librarians. No relevant disclosures. Not commissioned; externally peer reviewed.

In a world where opportunities are increasingly limited, young people are encouraged to become resilient and entrepreneurial in their pursuit of the traditional markers of adulthood. Social enterprise and community organisations dedicated to supporting young people seek to recast these expectations by providing supportive work and training environments and cultures and encouraging young people to find passion and hope in economic conditions that have failed to deliver the security and wellbeing that was promised. These organisations identify and respond to complex issues like unemployment and disengagement, homelessness and housing precarity, and provide personal development, support, education, training and employment options. In this paper, we explore how youth-focused social enterprise and community organisation programmes shape dispositions of resilience and entrepreneurialism. Drawing on the work of Butler and Anthanasiou and Dey and Mason, we argue that social organisations re-imagine the ‘social therapeutics’ that young people may require in relation to their participation in neoliberal forms of governmentality. We hope to challenge conceptualisations of such interventions as purely bounded by neoliberal and pro-capitalist therapeutic logics, by identifying the complex and sometimes contradictory goals that community organisations and social enterprises work towards in supporting young people to navigate a precarious economic landscape.

Purpose The Women Aware with Their Children study was created because prospective data are required to accurately guide prevention programmes for intimate partner violence (IPV) and to improve the mental health and resettlement trajectories of women from refugee backgrounds in Australia. Participants 1335 women (685 consecutively enrolled from refugee backgrounds and 650 randomly selected Australian-born) recruited during pregnancy from three public antenatal clinics in Sydney and Melbourne, Australia. The mean age was 29.7 years among women from refugee backgrounds and 29.0 years among women born in the host nation. Main measures include IPV, mood, panic, post-traumatic stress disorder, disability and living difficulties. Findings to date Prevalence of IPV at all three time points is significantly higher for refugee-background women. The trend data showed that reported IPV rates among Australian-born women increased from 25.8% at time 1 to 30.1% at time 3, while for refugee-background women this rate declined from 44.4% at time 1 to 42.6% at time 3. Prevalence of major depressive disorder (MDD) at all three time points is higher for refugee-background women. MDD among Australian-born women significantly declined from 14.5% at time 1 to 9.9% at time 3, while for refugee-background women it fluctuated from 25.1% at time 1 to 17.3% at time 2 and to 19.1% at time 3. Future plans We are currently examining trajectories of IPV and mental disorder across four time points. Time 4 occurred during the COVID-19 pandemic, enabling a unique opportunity to examine the impacts of the pandemic over time. Time 5 started in August 2021 and time 6 will begin approximately 12 months later. The children at time 5 are in the early school years, providing the capacity to examine behaviour, development and well-being of the index child.

Recent research has drawn upon the social determinants of health (SDH) framework to attempt to systematize the relationship between social enterprise and health. In this article, we adopt a realist evaluation approach to conceptualize social enterprises, and work integration social enterprises in particular, as 'complex interventions' that necessarily produce differential health outcomes for their beneficiaries, communities and staff. Drawing upon the findings from four social enterprises involving a range of methods including 93 semi-structured interviews with employees, managers and enterprise partners, together with participant observation, we demonstrate that these health outcomes are influenced by a limitless mix of complex and dynamic interactions between systems, settings, spaces, relationships and organizational and personal factors that cannot be distilled by questions of causality and attribution found in controlled trial designs. Given the increased policy focus on the potential of social enterprises to affect the SDH, this article seeks to respond to evidence gaps about the mechanisms and contexts through which social enterprises promote or constrain health outcomes, and thereby provide greater clarity about how research evidence can be used to support the social enterprise sector and policy development more broadly.

Background Previous research on employee well-being for those who have experienced social and economic disadvantage and those with previous or existing mental health conditions has focused mainly on programmatic interventions. The purpose of this research was to examine how organisational structures and processes (such as policies and culture) influence well-being of employees from these types of backgrounds. Methods A case study ethnographic approach which included in-depth qualitative analysis of 93 semi-structured interviews of employees, staff, and managers, together with participant observation of four social enterprises employing young people. Results The data revealed that young people were provided a combination of training, varied work tasks, psychosocial support, and encouragement to cultivate relationships among peers and management staff. This was enabled through the following elements: structure and space; funding, finance and industry orientation; organisational culture; policy and process; and fostering local service networks . . The findings further illustrate how organisational structures at these workplaces promoted an inclusive workplace environment in which participants self-reported a decrease in anxiety and depression, increased self-esteem, increased self-confidence and increased physical activity. Conclusions Replicating these types of organisational structures, processes, and culture requires consideration of complex systems perspectives on implementation fidelity which has implications for policy, practice and future research.

Intimate Partner Violence (IPV) is a major public health issue, including during pregnancy where it poses a serious risk to the woman’s health. Influenza-Like Illness (ILI) also causes significant morbidity for women during pregnancy. It may be possible that ILI in pregnancy is associated with IPV, and that depression and trauma history play a role in the connection. 524 Australia-born women and 578 refugee-background women participated in the study. Baseline participants were randomly recruited and interviewed from antenatal clinics between January 2015 and March 2016, and they were reinterviewed six months post-partum. Bivariate and path analysis were used to assess links between IPV, depression and ILI. One in 10 women (10%; 111 out of 1102) reported ILI during their pregnancy period and this rate was significantly (p < 0.001) higher for women born in conflict-affected countries (13%; 76 out of 578) as compared to Australian-born women (7%; 35 out of 524). In both groups, Time 1 traumatic events, IPV and depression symptoms were significantly associated with ILI at Time 2. A significant association between IPV at Time 1 and ILI at Time 2 was fully mediated by depression symptoms at Time 1 (Beta = 0.36 p < 0.001). A significant direct path was shown from depression symptoms to ILI (Beta = 0.26, p < 0.001). Regardless of migration history, pregnant women who have experienced IPV and depression are more likely to report influenza-like symptoms in pregnancy. This may suggest that trauma and depression negatively affect immunity, although it could also indicate a connection between depressive symptoms and physical experiences of ILI.

Background The aim was to compare, for the first time in a large systematic study, women born in conflict-affected countries who immigrated to Australia with women born in Australia for attitudes towards gender roles and men's use of IPV and the actual prevalence of IPV. The study also examined if any associations remained across the two timepoints of pregnancy and postpartum. Methods Women were interviewed during their first visit to one of three Australian public hospital antenatal clinics and re-interviewed at home six months after giving birth. A total of 1111 women completed both interviews, 583 were born in conflict-affected countries and 528 born in Australia. Associations between attitudes towards gender roles and men's use of IPV, socio-demographic characteristics and reported actual experiences of IPV were examined using bivariate and multiple logistic regression analyses. Results Attitudes toward inequitable gender roles including those that condone men's use of IPV, and prevalence of IPV, were significantly higher (p<0.001) among women born in conflict-affected countries compared to Australia-born women. Women born in conflict-affected countries with the strongest held attitudes towards gender roles and men's use of IPV had an adjusted odds ratio (aOR) of 3.18 for IPV at baseline (95% CI 1.85-5.47) and an aOR of 1.83 for IPV at follow-up (95% CI 1.11-3.01). Women born in Australia with the strongest held attitudes towards gender roles and IPV had an aOR of 7.12 for IPV at baseline (95% CI 2.12-23.92) and an aOR of 10.59 for IPV at follow-up (95% CI 2.21-50.75). Conclusions Our results underscore the need for IPV prevention strategies sensitively targeted to communities from conflict-affected countries, and for awareness among clinicians of gender role attitudes that may condone men's use of IPV, and the associated risk of IPV. The study supports the need for culturally informed national strategies to promote gender equality and to challenge practices and attitudes that condone men's violence in spousal relationships.

Background: The inclusion of complex post-traumatic stress disorder (CPTSD) in ICD-11 represents a turning point for the field of traumatic stress, with accumulative evidence of this disorder in refugees and displaced populations. Objective: The objectives of this systematic review are to examine, in refugee and displaced populations: 1) the prevalence of CPTSD; 2) factors contributing to CPTSD; and 3) and associations between CPTSD and other common mental disorders including: PTSD, depression, anxiety and somatisation. Method: We followed the Joanna Briggs Institute Methodology for Systematic Reviews. Papers published in English language were included, with date of publication between 1987 and June 2019. We searched six relevant databases: MEDLINE, PsycINFO, Embase, Scopus, CINAHL, and PILOTS, and the grey literature. We included observational studies with prevalence data on CPTSD. Results: 19 articles met all inclusion criteria. Quality assessment was performed on each included study using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Based on this, 13 moderate and high-quality studies were included in our narrative synthesis. The included studies reported prevalence of CPTSD in refugees and displaced populations ranging from 2% to 86%. Conclusions: Reasons for the wide variation in prevalence may include contextual and geographical differences, the influence of post-migration difficulties, and sample population characteristics such as treatment seeking versus general population. We found higher prevalence rates (range: 16-82%) in more studies with treatment seeking samples, followed by convenience and snowball samples (40-51%), and lower rates in more studies utilising random sampling techniques (2-86%). Consistent with the broader literature, the studies in our review supported an association for complex post-traumatic stress disorder with prolonged, repeated trauma, and post-migration living difficulties, with the latter association being specific to refugee and displaced populations. Further research on this construct in this population group, including effective treatments, is required.

AIMS:Despite the magnitude and protracted nature of the Rohingya refugee situation, there is limited information on the culture, mental health and psychosocial wellbeing of this group. This paper, drawing on a report commissioned by the United Nations High Commissioner for Refugees (UNHCR), aims to provide a comprehensive synthesis of the literature on mental health and psychosocial wellbeing of Rohingya refugees, including an examination of associated cultural factors. The ultimate objective is to assist humanitarian actors and agencies in providing culturally relevant Mental Health and Psychosocial Support (MHPSS) for Rohingya refugees displaced to Bangladesh and other neighbouring countries. METHODS:We conducted a systematic search across multiple sources of information with reference to the contextual, social, economic, cultural, mental health and health-related factors amongst Rohingya refugees living in the Asia-Pacific and other regions. The search covered online databases of diverse disciplines (e.g. medicine, psychology, anthropology), grey literature, as well as unpublished reports from non-profit organisations and United Nations agencies published until 2018. RESULTS:The legacy of prolonged exposure to conflict and persecution compounded by protracted conditions of deprivations and displacement is likely to increase the refugees' vulnerability to wide array of mental health problems including posttraumatic stress disorder, anxiety, depression and suicidal ideation. High rates of sexual and gender-based violence, lack of privacy and safe spaces and limited access to integrated psychosocial and mental health support remain issues of concern within the emergency operation in Bangladesh. Another challenge is the limited understanding amongst the MHPSS personnel in Bangladesh and elsewhere of the language, culture and help-seeking behaviour of Rohingya refugees. While the Rohingya language has a considerable vocabulary for emotional and behavioural problems, there is limited correspondence between these Rohingya terms and western concepts of mental disorders. This hampers the provision of culturally sensitive and contextually relevant MHPSS services to these refugees. CONCLUSIONS:The knowledge about the culture, context, migration history, idioms of distress, help-seeking behaviour and traditional healing methods, obtained from diverse sources can be applied in the design and delivery of culturally appropriate interventions. Attention to past exposure to traumatic events and losses need to be paired with attention for ongoing stressors and issues related to worries about the future. It is important to design MHPSS interventions in ways that mobilise the individual and collective strengths of Rohingya refugees and build on their resilience.

IMPORTANCE Pregnancy may increase the risk of depression among women who self-identify as refugees and have resettled in high-income countries. To our knowledge, no large systematic studies among women with refugee backgrounds in the antenatal period have been conducted. OBJECTIVES To compare the prevalence of major depressive disorder (MDD), trauma exposure, and other psychosocial risk factors among women who identify as refugees, women from the same conflict-affected countries, and women from the host nation and to test whether self-identification as a refugee indicates greater likelihood of prevalence and risk. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was undertaken in 3 public antenatal clinics in Sydney and Melbourne, Australia, between January 2015 and December 2016. Overall, 1335 women (685 consecutively enrolled from conflict-affected backgrounds and 650 randomly selected from the host nation) participated. Data analysis was undertaken between June and September 2018. EXPOSURES One-hour interviews covering mental health, intimate partner violence, and other social measures. MAIN OUTCOME AND MEASURES World Health Organization measure for intimate partner violence and the Mini-International Neuropsychiatric Interview from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) for MDD. To make a diagnosis, 1 of 2 items relating to being consistently depressed for 2 weeks and 3 further symptoms that cause personal distress or psychosocial dysfunction were endorsed. RESULTS Overall, 1335women (84.8% overall response rate), comprising 685 (51.3%) from conflict-affected countries (women self-identifying as refugees: 289 [42.2%]) and 650 (48.7%) from the host nation, participated. The mean (SD) age was 29.7 (5.4) years among women from conflict-affected backgrounds and 29.0 (5.5) years among women born in the host nation. Conflict-affected countries included Iraq (260 [38.0%]), Lebanon (125 [18.2%]), Sri Lanka (71 [10.4%]), and Sudan (66 [9.6%]). Women who identified as refugees reported higher exposure to 2 to 3 (67 [23.2%]) and 4 or more (19 [6.6%]) general traumatic events compared with women from the host nation (103 [15.8%] and 21 [3.2%], respectively). Women who identified as refugees also reported higher exposure to 1 (147 [50.9%]) and 2 or more (97 [33.6%]) refugee-related traumatic events compared with women from the host nation (86 [13.2%] and 20 [3.1%], respectively). Women who identified as refugees reported higher rates of psychological intimate partner violence than women born in the host nation (124 [42.9%] vs 133 [20.5%]; P<.001). Women who identified as refugees were less likely to identify 5 or more supportive family or friends compared with women born in the host nation (36 [12.5%] vs 297 [45.7%]; P<.001). A greater proportion of women who identified as refugees reported experiencing 3 or more financial stressors compared with women born in the host nation (65 [22.5%] vs 41 [6.3%]; P<.001). Women who identified as refugees had the highest prevalence of MDD (94 [32.5%]), followed by women from other conflict-affected backgrounds (78 [19.7%]), and women born in the host nation (94 [14.5%]). CONCLUSION AND RELEVANCE Women identifying as refugees reported a higher prevalence of MDD and all the indicators of adversity related to that disorder. Even after risk factors were accounted for, refugee status was associated with risk of MDD. Assessing whether women attending an antenatal clinic self-identify as refugees may offer an important indicator of risk of MDD and a range of associated psychosocial adversities.