Omar M. Alhassoon

High levels of trauma-related psychological distress have been documented among ethnically diverse refugees. As the number of refugees worldwide continues to grow, determining the efficacy of established methods of trauma-focused therapy for this population is crucial. This meta-analysis examined the results of randomized controlled trials of psychotherapeutic intervention for traumatized adult refugees. Comparisons of 13 trauma-focused therapies to control groups from 12 studies were included in the analysis. The aggregate effect size for the primary outcome, posttraumatic stress disorder (PTSD), was large in magnitude, Hedge's g = .91, p < .001, 95% CI [.56, 1.52]. The aggregate effect size for depression, assessed in 9 studies, was also large g = .63, p < .001, 95% CI [.35, .92]. We used metaregression to evaluate potential moderators of the PTSD effect size. Number of sessions significantly predicted magnitude of the effect size, and studies that utilized an active control group (e.g., supportive counseling) had significantly smaller effect size than those with a passive control group. There was no difference in outcome for studies where an interpreter was used to facilitate sessions and those where no interpreter was used. There also was no difference in outcome based on type of PTSD assessment. Results provide evidence in the efficacy of trauma-focused models for treating refugees, and also shed light on important areas for future research.

HIV infection often results in neuropsychological (NP) impairment. In order to assess the impact that HIV-related NP deficits may have on automobile driving, we evaluated 68 HIV-seropositive drivers using an NP battery and two PC-based driving simulations. Thirty-two participants were classified as NP impaired; most (72%) evidenced only mild impairment, and none met criteria for HIV-associated dementia. After controlling for degree of immunosuppression and disease stage, NP-impaired participants failed a previously validated driving simulation at a much higher rate than cognitively intact participants [OR = 5.3, 95% CI (1.7, 17.0), p = .006]. Similarly, on a simulation of city driving, NP impaired participants were more likely to fail based upon the number of accidents [OR = 6.1, 95% CI (1.5, 24.6), p = .01]. Simulator performance was predicted by functioning in a number of NP domains, with NP tests accounting for 13-30% of the variance on the simulations. Although it would be premature to extrapolate these findings to impairment in on-the-road driving, they do argue for greater attention to the impact that even mild HIV-related NP deficits may have on driving skills.

BACKGROUND: Promising models for cognitive rehabilitation in alcohol treatment rest on a more nuanced understanding of the associated impairments in the multifaceted domains of executive functioning (EF) and impulsivity. OBJECTIVES: This meta-analysis examined the effects of alcohol on the individual subcomponents of EF and impulsivity in recently detoxified participants, including 1) Inhibition & Self-Regulation, 2) Flexibility & Set Shifting, 3) Planning & Problem Solving, 4) Reasoning & Abstraction, and 5) Verbal Fluency. Impulsivity was further examined through an analysis of motor, cognitive, and decisional subcategories. METHOD: Investigators searched, coded, and calculated effect sizes of impairments demonstrated in a broad range of neuropsychological tests for EF. A total of 77 studies were selected covering 48 years of research with a sample size of 5140. RESULTS: Findings ranged from a Hedges' g effect size of 0.803 for Inhibition to a Hedges' g of 0.359 for Verbal Fluency. Results also varied for the individual subcategories of Inhibition, including a large effect size for decisional impulsivity (g = 0.817) and cognitive impulsivity (0.860), and a moderate effect size for motor impulsivity (g = 0.529). The Hayling Test, Wisconsin Card Sorting Test, and Iowa Gambling Task were the measures most sensitive for alcohol effects. CONCLUSION: Planning, problem solving, and inhibitory abilities are significantly affected by alcohol abuse, with decisional and cognitive forms of impulsivity most impacted. Cognitive remediation targeting these deficits might increase the related functions that mediate the ability to moderate or abstain from alcohol, and so lead to improved treatment results.