MB ChB (Hons) (Cape Town); MD (UNSW); FASSA, FRANZCP

Social Medicine
2018

I have taken a lead role in the field of refugee and post-conflict mental health in Australia and internationally in the past 30 years. My focus has been on integrating service development (the establishment of torture and trauma services in NSW and wider afield, the development of the first mental health service in post-conflict Timor-Leste) with research and policy development. The model that informs my work (The Adaptation and Development After Persecution and Trauma or ADAPT) attempts to integrate principles from the social sciences, human rights and development. I have focused on the indissoluble connections between social forces (mass trauma and violence, human rights violations, poverty, forced migration, gender) and mental health outcomes across a range of culturally diverse and migrant groups. Our team conducted the world first studies detailing the impact of restrictive policies on the mental health of asylum seekers both in the community and in detention, data that have been used extensively in human rights inquiries into the contemporary refugee policies.

Broader refugee studies have focused on a range of cultural groups including the Vietnamese in Australia and the home country, Bosnians, Cambodians, the Timorese, West Papuans, and refugees from Myanmar. The studies have been designed to test my ADAPT model which postulates the five broad social factors (insecurity, disruption of bonds and networks, exposure to gross injustice, loss of roles and identities, and threats to existential meaning) underpin the adaptations and, in the extreme case, frank mental disorder amongst refuges. A strong focus has been on identifying expressions of posttraumatic anger and its impact on the family and social environment amongst persons exposed to trauma based both on international and culturally specific manifestations. The work has extended to testing a cycles of violence model in which pathways leading form the traumas of human rights violations such as torture create difficulties in control explosive anger, a pattern which in turn lead to conflict in the home of the survivor, creating risk of a transgenerational transmission of mental disorder and aggression, and possibly contributing to recurrent periods of mass violence that are known to occur in fragile states that have been through prolonged periods of conflict and persecution. The ADAPT model is the basis of a novel psychosocial intervention (Integrated ADAPT Therapy) being trialed amongst refugees from Myanmar.

A major focus in the translation of our research findings into policy, practice guidelines and service models nationally and internationally. To advance this work, my team and I have established strong an enduring relationships with leading research units overseas (Harvard, Johns Hopkins University, the Karolinska Institute, University of Copenhagen, UNHCR, WHO) as well as with local agencies and organizations such as the peak women’s NGO in Timor-Leste, the Alola Foundation.

Wider areas of research and academic work focus on the global mental health needs of low and middle income countries (Global Mental Health), general traumatology including the factors that contribute to accidents and violence in civilian populations, and the definition of an adult form of separation anxiety in which our UNSW group has led the field internationally.

Visiting Professor, Karolinska Institute, Sweden;

Board Member, Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW.

FASSA, FRANZCP, AM

  1. Silove, D., Ventevogel, P., & Rees, S. (2017). The contemporary refugee crisis: an overview of mental health challenges. World Psychiatry, 16(2), 130-139.
  2. Silove D. M.,,Rees, S. (2017). Symptoms of post-traumatic stress disorder, severe psychological distress, explosive anger and grief amongst partners of survivors of high levels of trauma in post-conflict Timor-Leste. Psychological Medicine, 47(1), 149-159.
  3. Silove, D., Liddell, B., Rees, S., Chey, T., Nickerson, A., Tam, N., ... & Steel, Z. (2014). Effects of recurrent violence on post-traumatic stress disorder and severe distress in conflict-affected Timor-Leste: a 6-year longitudinal study. The Lancet Global Health, 2(5), e293-e300.
  4. Silove, D.,,de Jonge, P. (2015). Pediatric-onset and adult-onset separation anxiety disorder across countries in the World Mental Health Survey. American Journal of Psychiatry, 172(7), 647-656.
  5. Steel, Z…Silove, D. (2014). The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. International Journal of Epidemiology, 43(2), 476-493