Date of Award

Spring 6-21-2021

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Clinical Psychology (PhD)

Department

Clinical Psychology

First Advisor/Committee Member

Jacob Bentley

Second Advisor/Committee Member

Lynette Bikos

Third Advisor/Committee Member

Keyne Law

Abstract

Refugee and immigrant populations are at an increased risk of having posttraumatic stress disorder (PTSD) and exhibit a significant amount of variance in trauma treatment outcomes that may be impacted by sociocultural factors. This study examines the impact of demographic variables on treatment outcome and trajectory of PTSD symptoms in a clinic setting with trauma-focused treatments in refugee/immigrant and general populations. Data was collected from the electronic medical record at the Harborview Center for Sexual Assault and Traumatic Stress. A total of 817 participants completed intake, 58 of which self-identified as immigrant/refugee. One-way ANOVAs were conducted to examine group differences of sociocultural factors including income status, prior mental health history, and social support. Significant differences in baseline symptom and last symptom monitor were found for different sociocultural factors. Hierarchical multiple regression was conducted to examine effect of counseling visits on treatment outcome while controlling for baseline PTSD symptom. PTSD baseline symptom was significant in predicting 19.2% of variance in treatment outcome (R2 = 0.19; p < 0.001) while counseling visits did not add significant variance to the model. One-way ANOVA was conducted to examine the baseline symptoms between immigrant/refugee and non-immigrant/non-refugee groups. No significant difference was found for baseline symptoms between groups, but difference was found with last symptom monitor where immigrant/refugee group had higher mean symptom score (x̄ = 26.03 for immigrant/refugee and x̄ = 21.65 for others). Hierarchical linear modeling was used to analyze the trend of symptom progression. Results showed decrease of symptoms with flattening of the curve over time with no difference in progression for immigrant/refugee group. Distress level was different at baseline for different language groups. No significant differences were found in symptom progression with different language or education groups. Post-hoc analyses were conducted with results showing different symptom trajectory for income groups. Different baselines were found with different social support groups. For immigrant/refugee group, different trajectory was found in different language groups. Overall, sociocultural factors impact the trajectory of treatment differently. Addressing access to care with different barriers including language, social support network, and income status is important when considering treatment provision for immigrant/refugee.

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