A Mixed-Methods Analysis of Iraqi Refugees with Potential Trauma Histories

Posttraumatic Stress Disorder (PTSD) is the dominant paradigm for understanding reactions to traumatic events. The majority of individuals exposed to traumatic events do not develop long-term pathological responses. However, refugees are believed to be especially vulnerable due to increased exposure to traumatic events in premigration combined with transitional and resettlement stress. Extant research has thus far provided inconclusive results regarding long-term psychopathological risk. Moreover, studies that indicate high rates of PTSD in refugees should be interpreted with caution given that most studies assume the positivistic position that PTSD is a universal disorder and thereby adopt etic-only methodological approaches that carry important limitations. Findings from a small body of culturally-sensitive behavioral research that adopts combined emic-etic methods suggest that PTSD may not be the most relevant framework for understanding reactions to traumatic stressors in some cultures, and in fact that exposure to PTSD discourse may even increase the likelihood of having the disorder. This study adopted a combined emic-etic approach to explore responses to potentially traumatic events in an understudied population, Iraqi refugees. It was hypothesized that the relative rate of PTSD in this sample would be lower than other psychiatric symptoms, and familiarity with Western trauma discourse rather than exposure to traumatic events would be associated with PTSD. Participants were recruited in the United States (n = 19) through chain referral convenience sampling, and completed a culturally-sensitive and linguistically-specific semi-structured interview followed by self-report measures administered in person or electronically. The sample experienced a high number of “criterion ßΩA” traumatic events, but the majority did not meet criteria for any psychiatric disorder assessed. The prevalence of PTSD exceeded the US civilian past year prevalence rate but the number of clinically symptomatic cases, as well as the severity of symptoms, was significantly greater for mood and anxiety symptoms than for PTSD. Familiarity with Western trauma discourse and acculturation were positively associated with a diagnosis of PTSD but largely not associated with non-PTSD symptoms and diagnoses. There was no association between Criterion A events and PTSD. The findings challenge the dominant paradigm by suggesting that PTSD in its current formulation may not best describe reactions to traumatic stressors in Iraqi refugees. The results also support the theory that the onset and maintenance of PTSD may be due in part to suggestibility. The willingness of participants to be so open about psychiatric symptoms underscores the importance of using culturally-sensitive methods in such investigations.M.S., Psychology -- Drexel University, 201