Complex post-traumatic stress disorder and post-migration living difficulties in traumatised refugees and asylum seekers: the role of language acquisition and barriers.

Background: Numerous traumatic experiences and post-migration living difficulties (PMLDs) increase the risk of developing symptoms of complex post-traumatic stress disorder (CPTSD) among Afghan refugees and asylum seekers, living in Austria. Research has repeatedly associated higher levels of CPTSD with higher levels of PMLDs. Summarizing PMLDs into empirically derived factors might facilitate a further understanding of their interaction with symptom presentation within distinct clusters of CPTSD. Objective: The current study aimed to investigate homogeneous subgroups of ICD-11 CPTSD and their association with demographic variables, traumatic experiences, and empirically derived factors of PMLDs. Method: Within a randomized controlled trail (RCT) CPTSD, PMLDs, and traumatic experiences were assessed in a sample of 93 treatment-seeking Afghan refugees and asylum seekers through a fully structured face-to-face and interpreter-assisted interview using the ITQ, the PMLDC, and a trauma checklist. Underlying clusters of CPTSD, superior factors of PMLDs, and their associations were investigated. Results: In total, 19.4% of the sample met the diagnostic criteria for PTSD and 49.5% for CPTSD. We identified a 2-cluster solution consisting of two distinct subgroups as best fitting: (1) a CPTSD cluster and (2) a PTSD cluster. The multitude of PMLDs was summarized into four superior factors. CPTSD cluster membership was associated with childhood potentially traumatic experience types, and one of four PMLD factors, namely 'language acquisition & barriers'. Conclusions: The results suggest that not PMLDs in general, but rather specific types of PMLDs, are associated with CPTSD. An assumed bidirectional relationship between these PMLD factors and CPTSD symptoms might lead to a downward spiral of increasing distress, and could be considered in treatment strategies.