Alcohol dependence and post-traumatic stress disorder (PTSD) among Aboriginals and Torres Strait Islanders in Australia: a systematic literature review

this is the final project of the previous proposal.
1. read the marked proposal for this project
2. follow the template
3. make sure include all the appendix, at least 30 references
4. UK language using and grammar and spelling

                                                                                   MPH  Project Module 
Research Proposal
Title: Alcohol dependence and post-traumatic stress disorder (PTSD) among Aboriginals and Torres Strait Islanders in Australia: a systematic literature review
Name: Pun Sin-ming Kenwick
Supervisor name: Mr. John Corkery
Please complete all sections. In all sections where a maximum word count is given please provide total word count at the end of EACH section. 
Use Arial font size 12 for body of the proposal, line-spacing of 1.5, and UK English spell-checker and syntax-checker. 1. Simplified abstract (200 words – in plain English)
Aboriginals and Torres Strait Islanders represent hundreds of indigenous tribes in Australia. Individuals in these communities are faced with numerous social challenges such as poverty, marginalisation, and lack of access to good healthcare. Moreover, these social challenges have promoted substance use problems, including alcohol consumption. Post-traumatic stress disorder (PTSD) is a mental health condition triggered by a terrifying event, causing flashbacks, nightmares and severe anxiety. Individuals who face social problems can develop PTSD . This  research aims to assess the extent of alcohol dependence and PTSD among these communities. It will also focus on evaluating the effect of stressors on their mental health. The objectives include exploring the relationship between the factors and alcohol misuse and post-traumatic stress disorder among the target populations.  The study  will be done with the help of computerised and manual searching. Collecting credible data and information will be essential in determining the extent of alcohol dependence and the increase of cases of post-traumatic stress disorder among Aboriginals and Torres Strait Islanders in Australia, so that suggestions can be made about measures that should be implemented to improve the health and wellbeing of these communities, and to reduce demands on health services. 
Word count: 197
2. Background  (400 words)
It can be analyzed  that substance abuse and mental illness have an intricate connection as most addicted individuals are more likely to suffer from different medical conditions. For example, it has been identified that the treatment of persons who have alcohol use disorder (AUD) may be made complex by psychiatric conditions, including post-traumatic stress disorder (PTSD). The possible causes of PTSD are physical accidents, physical or sexual assault.  This has been determined to be true because individuals with substance use problems are more likely to develop systematic symptoms such as constant avoidance of stimuli and changes in moods and can also cause alterations in arousal and reactivity (Petrakis & Simpson, 2017). Importantly, it is essential to comprehend that individuals with PTSD are at high risk of abusing substances, including alcohol. Carter, Capone & Short (2011) explain that PTSD has become a critical issue  in the healthcare sector, particularly among populations that have suffered from trauma. 
AUD is associated with extreme stresses that are likely to promote PTSD. There is a close connection between heavy drinking, anxiety, and PTSD. Most often, people who are exposed to high stress may easily suffer from PTSD and may drink alcohol as a strategy for managing their symptoms (Neupane, Bramness & Lien, 2017). It has been argued that the Aboriginal and Torres Strait Islander people in Australia are likely to be exposed to numerous stressors that would impact their mental wellbeing and leave them at risk of AUD and PTSD. Aboriginals and Torres Strait Islanders in Australia have a relatively short life expectancy. This has been caused by different factors such as the historical widespread massacres across the country  and the increase of non-communicable diseases that have significantly affected the communities (Markwick et al., 2014). These stressors are likely to increase the levels of stress among people from these communities and would facilitate alcohol use and PTSD, among other mental conditions. Additionally, Aboriginals and Torres Strait Islanders in remote, regional and urban areas across the country that are vulnerable to food shortages, and this is promoted by a range of other different factors that may include low employment and income levels, high poverty levels and lack of access to healthy food (Davy, 2016). The exposure of the minority groups in Australia to these stressors increases their risk of misusing alcohol and developing PTSD.
Word count: 393
3. Aims and Objectives (250 words)
Research Aims
1. To evaluate the impact of alcohol dependence and post-traumatic stress disorder among Aboriginals and Torres Strait Islanders in Australia giving rise to PSTD
2. Identifying the factors leading to PSTD in these communities
3. Analysing the impact of these factors on these groups
4. Analysing the possible triggers of PSTD and its impact on public health of Aboriginals and Torres Strait Islanders in Australia 
Research objectives 
• To explore the effects of alcohol abuse and post-traumatic stress disorder among Aboriginals and Torres Strait Islanders in Australia
• To analyse the symptoms of PSTD in people of Torres Strait Islanders in Australia.
• To analyse the impact of mental, physical and sexual health abuse on health outcome of targeted population
• To suggest ways that would be evaluated to minimise the risk of mental health in the target population
The rationale for the present study  is to implement discussed  strategies to improve care coordination and provide smooth transitions of care for people with post-traumatic stress disorder (PTSD). The research will be critical in evaluating and examining essential issues associated with the extent of alcohol dependence and post-traumatic stress disorder among Aboriginals and Torres Strait Islanders in Australia. The research will identify and evaluate the stressors that increase the risk of the target populations to develop alcohol abuse disorder (AUD) and PTSD. These findings will be critical in the country’s public health systems because it outlines intervention measures that should be implemented to reduce cases of mental health among the indigenous communities across the country.
Word count: 248
4. Methodology (800 words)
Rationale and justification of the research 
Researchers have conducted studies to determine the extent of mental health among Aboriginals and Torres Strait Islanders in Australia. However, the studies have not examined the relationship between alcohol use and PTSD among these populations. Additionally, the research is critical because Aboriginals and Torres Strait Islanders form a significant portion of the country’s indigenous peoples and constitute about 3.3 percent of the country’s population (Das, Kini, Garg & Parker, 2018). Therefore, the research will be critical in determining how factors such as marginalisation, poverty, and racism among others increase the risk of the target groups to develop alcohol dependence problems and PTSD. 
Research strategy 
A systematic literature review can be considered as the best form of evidence for the clinicians.  There are various advantages and dis-advantages of making use of this method. In this the results of the study gain  will be unbiased in nature.  It is the evidence who is best in form and is made available to researchers.  If the research used is published then it can act as a threat to the review.  Additionally, there were also several limitations  which was been faced because of COVID-19, like there was limited time to get the ethical approval and other consent  to conduct the research. 
The research will utilise a systematic literature review as a critical means of finding and evaluating the available data. A two-staged search strategy will be employed in identifying the eligible studies that will be utilised in this study. First, only the articles reporting on the effect of alcohol use on posttraumatic stress disorder will be included and stage two will include evaluation of articles that offers information about how stressors that facilitate both alcohol dependence and post-traumatic stress disorder. Therefore, data will be collected from peer-reviewed articles  that will be collected through electronic searches from different databases that are available online such as PubMed , Medline, ERIC and EBSCO. Some of the ‘KEYWORDS ’ that will be used include Aboriginals, Torres Strait Islanders, alcohol dependence, alcohol use disorder and PTSD . This strategy will be effective in collecting credible data and information that will be essential in determining the extent of alcohol dependence and the increase of cases of PTSD among Aboriginals and Torres Strait Islanders in Australia and make practical suggestions that should be implemented.  
Data analysis 
There are different sets of information that will be extracted from the various studies obtained from different databases. For instance, the author, the year when the resource was published, this was critical in ensuring that outdated studies would not be considered. The population samples in each study, the study design applied and the measures of alcohol misuse and posttraumatic stress disorder that were applied. Additionally, in all studies included data will be extracted and cross-checked to determine that it has consistency. After the extraction of prevalence rates, Stata 11 will be applied in calculating corresponding confidence intervals. Besides, the data acquired from different studies will be reviewed qualitatively with the help of thematic analysis and descriptive strategy will be used to ensure that reliable research outcomes are acquired that will be crucial in determine the relationship between alcohol dependence and PTSD and among the target populations.
Research risks
There are various risks that the researcher is likely to encounter, these include evidence selection bias where the researcher is likely to be inclined towards specific resources from particular databases. Besides, in systematic reviews, researchers tend to exclude unpublished data that is statistically non-significant, and thus bias the research towards positive findings. Competing interests have huge implications in systematic reviews, yet this study is not funded by any sponsor, the researcher ensures that the objective outcomes. Also, bias can also occur during reporting where the researcher is likely to make choices of outcomes and include studies that may change significant findings, this problem can be avoided by ensuring that the review is carried out in line with written protocol that is developed before the systematic review. 
In July, the researcher will submit the proposal to the University. No consent is required in this study; therefore, researcher will get started on literature reviewing once the feedback received from supervisor . After finishing literature search, researcher would do the detailed review and analysis. At the same time, researcher should be able to compose the paper so that the research paper could be ready by late-August.  
Ethical/confidentiality issues
         Like primary researchers, systematic reviewers should reflexively engage with a variety of ethical issues associated that potential conflicts of interest and issues of voice and representation. Ethical consideration of launching a systematic review in educational research are not been discussed explicitly. The review board for ethical code of conduct has not provided the guidelines related to it. In the systematic review the decision made must be made ethical in nature. The subjectivity and reflexity while conducting the review must need to be followed. 
Word Count: 795
5. Implications  for public health (maximum of 200 words)
The results obtained from this research will be ideal in demonstrating the real situation of alcohol dependence and mental health conditions such as PTSD among Aboriginals and Torres Strait Islanders in Australia. Most importantly, the results will demonstrate the effectiveness of the interventions that have been implemented in the healthcare sector to promote mental wellbeing among the indigenous populations in Australia. Additionally, findings will demonstrate the extend of substance abuse among the target populations and gauge the usefulness of measures that have been developed and implemented in the Australian healthcare system to help individuals with substance-related problems. Furthermore, the research outcomes will examine possible sustainable changes that should be made to the existing healthcare policies to ensure there are appropriate measures undertaken to prevent the increase of mental health conditions among the vulnerable communities in Australia, such as Aboriginals and Torres Strait Islanders. The outcomes of the study may demonstrate health inequalities existing in the public health system between the indigenous and non-indigenous communities in Australia and facilitate changes. Most importantly, the research will act as the foundation for other health-focused studies that are aimed at evaluating mental health issues among indigenous communities in Australia.
Word Count: 195
 6. References 
Carter, A.S., Capone, C. & Short, E.E. (2011). Co-occurring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veteran Populations. Journal of Dual Diagnosis, 7(4), 285–299.Das, M., Kini, R., Garg, G. & Parker, R. (2018). Australian aboriginal and torres strait islanders' mental health issues: A litany of social causation. Indian Journal of Social Psychiatry, 34(4), 328-332.Daveney, J., Hassiotis, A., Katona, C., Matcham, F., & Sen, P. (2019). Ascertainment and prevalence of post-traumatic stress disorder (PTSD) in people with intellectual disabilities. Journal of Mental Health Research in Intellectual Disabilities.12(3-4). 211-233.Davy, D. (2016). Australia’s Efforts to Improve Food Security for Aboriginal and Torres Strait Islander Peoples. Health and Human Rights, 18(2), 209–218.Dikmen-Yildiz, P., Ayers, S., & Phillips, L. (2018). Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors. Journal of affective disorders.229. 377-385.Hyland, P., Shevlin, M., Brewin, C. R., Cloitre, M., Downes, A. J., Jumbe, S., ... & Roberts, N. P. (2017). Validation of post‐traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire. Acta Psychiatrica Scandinavica, 136(3), 313-322.Jasbi, M., Sadeghi Bahmani, D., Karami, G., Omidbeygi, M., Peyravi, M., Panahi, A., ... & Brand, S. (2018). Influence of adjuvant mindfulness-based cognitive therapy (MBCT) on symptoms of post-traumatic stress disorder (PTSD) in veterans–results from a randomized control study. Cognitive behaviour therapy.47(5). 431-446.Koek, R. J., Roach, J., Athanasiou, N., van't Wout-Frank, M., & Philip, N. S. (2019). Neuromodulatory treatments for post-traumatic stress disorder (PTSD). Progress in Neuro-Psychopharmacology and Biological Psychiatry, 92, 148-160.Markwick, A., Ansari, Z., Sullivan, M., Parsons, L. & McNeil, J. (2014). Inequalities in the social determinants of health of Aboriginal and Torres Strait Islander People: a cross-sectional population-based study in the Australian state of Victoria. International Journal for Equity in Health, 13(91). Navarrete, M. V. (2009). Qualitative and quantitative methods in health research. InternationalJjournal of Integrated Care, 9(5). Neupane, S.P., Bramness, J.G. & Lien, L. (2017). Comorbid post-traumatic stress disorder in alcohol use disorder: relationships to demography, drinking and neuroimmune profile. BMC Psychiatry, 17, 321.Olff, M. (2017). Sex and gender differences in post-traumatic stress disorder: an update. European Journal of Psychotraumatology, 8(sup4), 13512Petrakis, I.L. & Simpson, T.L. (2017). Posttraumatic Stress Disorder and Alcohol Use Disorder: A Critical Review of Pharmacologic Treatments. Alcoholism: Clinical and Experimental Research, 41(2), 226–237.Schweizer, S., Samimi, Z., Hasani, J., Moradi, A., Mirdoraghi, F., & Khaleghi, M. (2017). Improving cognitive control in adolescents with post-traumatic stress disorder (PTSD). Behaviour Research and Therapy. 93,88-94.