{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T05:30:47Z","timestamp":1786339847037,"version":"build-2736575974"},"reference-count":63,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec id=\"S2056472426120572_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Afghan refugees experience high levels of cumulative trauma and psychosocial adversity, yet attachment-related trauma has rarely been examined at the narrative level. Narrative attachment assessments may capture culturally embedded expressions of distress beyond post-traumatic stress disorder (PTSD)-focused symptom models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120572_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study examined narrative attachment-related trauma markers in Afghan refugees receiving out-patient psychological treatment. It investigated whether trauma marker frequency differed between resolved and unresolved attachment representations and whether it was associated with psychological symptom severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120572_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      In an exploratory cross-sectional study, 40 Afghan refugees (mean age = 25.4 years; 75% male) receiving out-patient psychological treatment completed the Adult Attachment Projective Picture System, a narrative-based attachment interview. Trauma markers were identified and quantified within the narratives. Associations with attachment representations (resolved versus unresolved) and psychological symptom severity were examined in a subsample with available self-report data (\n                      <jats:italic>n<\/jats:italic>\n                      = 27).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120572_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants with unresolved attachment representations showed higher trauma marker frequencies than those with resolved representations. Trauma marker frequency was positively associated with depressive symptoms and overall psychological distress (Spearman\u2019s effect size estimate (\n                      <jats:italic>r<\/jats:italic>\n                      ) = 0.40\u20130.51; 95% bias-corrected and accelerated (BCa) confidence intervals excluding zero) but not with PTSD symptom severity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120572_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Trauma markers captured clinically relevant distress in Afghan refugees beyond PTSD-specific symptomatology, particularly depressive symptoms and general psychological burden. Narrative, attachment-based approaches may be especially valuable in clinical encounters in which distress is conveyed implicitly, relationally, or in culturally contextualised ways rather than through explicit symptom reporting. Culturally sensitive applications of such methods, supported by well-trained interpreters, are essential for clinical understanding and meaningful clinical engagement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.12057","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T05:27:31Z","timestamp":1786339651000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Attachment-related trauma markers and symptom severity in Afghan refugees"],"prefix":"10.1192","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1445-3789","authenticated-orcid":false,"given":"Thomas","family":"Egger","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/054pv6659","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Innsbruck"},{"name":"Refugio Munich"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Buchheim","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/054pv6659","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Innsbruck"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britta","family":"Dumser","sequence":"additional","affiliation":[{"name":"Refugio Munich"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Gander","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/054pv6659","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Innsbruck"},{"name":"Medical University of Innsbruck"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"S2056472426120572_ref6","doi-asserted-by":"publisher","DOI":"10.1080\/20008066.2024.2400834"},{"key":"S2056472426120572_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.concog.2011.03.015"},{"key":"S2056472426120572_ref51","author":"Steinhauer","year":"2019"},{"key":"S2056472426120572_ref50","doi-asserted-by":"publisher","DOI":"10.1017\/gmh.2022.29"},{"key":"S2056472426120572_ref58","first-page":"77","volume-title":"The SAGE Encyclopedia of Intercultural Competence","author":"Nam","year":"2015"},{"key":"S2056472426120572_ref35","first-page":"27","volume-title":"The Adult Attachment Projective Picture System: Attachment Theory and Assessment in Adults","author":"George","year":"2012"},{"key":"S2056472426120572_ref52","doi-asserted-by":"publisher","DOI":"10.1177\/00207640211036169"},{"key":"S2056472426120572_ref59","first-page":"1","article-title":"A systematic review of effective intercultural communication in mental health","volume":"10","author":"Logan","year":"2014","journal-title":"Cross-Cult Commun"},{"key":"S2056472426120572_ref62","doi-asserted-by":"publisher","DOI":"10.1108\/17479891111176287"},{"key":"S2056472426120572_ref57","volume-title":"Beyond Culture","author":"Hall","year":"1976"},{"key":"S2056472426120572_ref49","doi-asserted-by":"publisher","DOI":"10.1177\/1363461517737198"},{"key":"S2056472426120572_ref20","doi-asserted-by":"publisher","DOI":"10.1017\/S0140525X0999152X"},{"key":"S2056472426120572_ref25","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2023.502"},{"key":"S2056472426120572_ref1","volume-title":"Mid-Year Trends 2025","year":"2025"},{"key":"S2056472426120572_ref4","doi-asserted-by":"publisher","DOI":"10.1093\/inthealth\/ihad055"},{"key":"S2056472426120572_ref31","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/12-058"},{"key":"S2056472426120572_ref39","doi-asserted-by":"publisher","DOI":"10.1177\/0022022193242002"},{"key":"S2056472426120572_ref41","doi-asserted-by":"publisher","DOI":"10.2224\/sbp.2006.34.9.1101"},{"key":"S2056472426120572_ref61","doi-asserted-by":"publisher","DOI":"10.1111\/ap.12181"},{"key":"S2056472426120572_ref63","doi-asserted-by":"publisher","DOI":"10.3389\/fgwh.2022.893957"},{"key":"S2056472426120572_ref30","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-07109-1_12"},{"key":"S2056472426120572_ref7","doi-asserted-by":"publisher","DOI":"10.1080\/20008066.2025.2582456"},{"key":"S2056472426120572_ref32","volume-title":"Loss \u2013 Sadness and Depression","author":"Bowlby","year":"2010"},{"key":"S2056472426120572_ref45","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1176\/ajp.144.4.497","article-title":"Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees","volume":"144","author":"Mollica","year":"1987","journal-title":"Am J Psychiatry"},{"key":"S2056472426120572_ref15","doi-asserted-by":"publisher","DOI":"10.1080\/00223891.2011.594133"},{"key":"S2056472426120572_ref26","first-page":"207","article-title":"Mental disorder or emotional distress? How psychiatric surveys in Afghanistan ignore the role of gender, culture and context","volume":"16","author":"Ventevogel","year":"2018","journal-title":"Interv J Ment Health Psychosoc Support Confl Affect Areas"},{"key":"S2056472426120572_ref60","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2015.09.002"},{"key":"S2056472426120572_ref38","doi-asserted-by":"publisher","DOI":"10.1007\/s10802-023-01141-1"},{"key":"S2056472426120572_ref48","doi-asserted-by":"publisher","DOI":"10.1080\/14616731003759732"},{"key":"S2056472426120572_ref5","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19159157"},{"key":"S2056472426120572_ref9","volume-title":"Attachment: Vintage Digital","author":"Bowlby","year":"2008"},{"key":"S2056472426120572_ref42","doi-asserted-by":"publisher","DOI":"10.1002\/jts.22059"},{"key":"S2056472426120572_ref16","doi-asserted-by":"publisher","DOI":"10.1017\/ipm.2017.27"},{"key":"S2056472426120572_ref47","unstructured":"47 Weathers, FW , Litz, BT , Keane, TM , Palmieri, PA , Marx, BP , Schnurr, PP. The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD, 2013 (https:\/\/www.ptsd.va.gov\/professional\/assessment\/adult-sr\/ptsd-checklist.asp)."},{"key":"S2056472426120572_ref27","doi-asserted-by":"publisher","DOI":"10.1177\/1363461509105813"},{"key":"S2056472426120572_ref21","doi-asserted-by":"publisher","DOI":"10.1002\/jts.21820"},{"key":"S2056472426120572_ref46","first-page":"36","article-title":"Hopkins Symptom Checklist 25 (HSCL-25): Manual; Cambodian, Laotian and Vietnamese versions","volume":"6","author":"Mollica","year":"1996","journal-title":"Torture"},{"key":"S2056472426120572_ref34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-096267"},{"key":"S2056472426120572_ref55","doi-asserted-by":"publisher","DOI":"10.2196\/44267"},{"key":"S2056472426120572_ref13","first-page":"552","volume-title":"Handbook of Attachment: Theory, Research, and Clinical Applications","author":"Hesse","year":"2008"},{"key":"S2056472426120572_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2009.08.006"},{"key":"S2056472426120572_ref36","doi-asserted-by":"publisher","DOI":"10.1080\/15299732.2018.1451803"},{"key":"S2056472426120572_ref44","first-page":"65","article-title":"A simple sequentially rejective multiple test procedure","volume":"6","author":"Holm","year":"1979","journal-title":"Scand J Stat"},{"key":"S2056472426120572_ref2","doi-asserted-by":"publisher","DOI":"10.1037\/pspp0000437"},{"key":"S2056472426120572_ref12","volume-title":"Adult Attachment Interview","author":"George","year":"1985"},{"key":"S2056472426120572_ref28","first-page":"S159","article-title":"Linguistic predictors of trauma pathology and physical health","volume":"15","author":"Alvarez-Conrad","year":"2001","journal-title":"Appl Cogn Psychcol"},{"key":"S2056472426120572_ref33","unstructured":"33 World Health Organization. Refugee and Migrant Mental Health. WHO, 2025 (https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/refugee-and-migrant-mental-health [updated 1 Sep])."},{"key":"S2056472426120572_ref43","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmh.2022.100144"},{"key":"S2056472426120572_ref53","doi-asserted-by":"publisher","DOI":"10.1177\/1363461508100785"},{"key":"S2056472426120572_ref23","first-page":"77","article-title":"Cross-cultural variation in emotion regulation: a systematic review","volume":"23","author":"Ramzan","year":"2017","journal-title":"Ann King Edward Med Univ"},{"key":"S2056472426120572_ref24","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmu017"},{"key":"S2056472426120572_ref3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003337"},{"key":"S2056472426120572_ref17","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci15050495"},{"key":"S2056472426120572_ref19","doi-asserted-by":"publisher","DOI":"10.14295\/bjs.v3i8.616"},{"key":"S2056472426120572_ref56","doi-asserted-by":"publisher","DOI":"10.21272\/bel.3(1).44-57.2019"},{"key":"S2056472426120572_ref10","first-page":"102","volume-title":"Handbook of Attachment: Theory, Research, and Clinical Applications","author":"Bretherton","year":"2008"},{"key":"S2056472426120572_ref14","doi-asserted-by":"publisher","DOI":"10.1080\/14616734.2024.2422045"},{"key":"S2056472426120572_ref8","doi-asserted-by":"publisher","DOI":"10.1080\/14616730010024771"},{"key":"S2056472426120572_ref22","first-page":"24","article-title":"Leadership orientation of Afghan and Japanese respondents: a study of \u2018Guzaara\u2019 or getting along in Asia","volume":"11","author":"Mujtaba","year":"2019","journal-title":"Inform Manage Business Rev"},{"key":"S2056472426120572_ref37","doi-asserted-by":"publisher","DOI":"10.4324\/9781003215431-2"},{"key":"S2056472426120572_ref54","doi-asserted-by":"publisher","DOI":"10.1037\/0002-9432.76.4.423"},{"key":"S2056472426120572_ref40","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2013.08.020"},{"key":"S2056472426120572_ref18","doi-asserted-by":"publisher","DOI":"10.1080\/14616734.2015.1124442"}],"container-title":["BJPsych Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2056472426120572","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T05:27:35Z","timestamp":1786339655000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2056472426120572\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":63,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["S2056472426120572"],"URL":"https:\/\/doi.org\/10.1192\/bjo.2026.12057","relation":{},"ISSN":["2056-4724"],"issn-type":[{"value":"2056-4724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e212"}}