A digital intervention to support childhood cognition after the COVID-19 pandemic: a pilot trial

Difficulties in executive functioning (EF) can result in impulsivity, forgetfulness, and inattention. Children living in remote/regional communities are particularly at risk of impairment in these cognitive skills due to reduced educational engagement and poorer access to interventions. This vulnerability has been exacerbated by the COVID-19 pandemic and strategies are needed to mitigate long-term negative impacts on EF. Here we propose a pilot trial investigating the benefits, feasibility, and acceptability of a school-based EF intervention for primary school students (6-8 years) living in regional, developmentally vulnerable, and socio-economically disadvantaged communities. Students were randomised to a digital intervention or teaching as usual, for 7 weeks. Children completed measures of EF and parents/educators completed ratings of everyday EF and social/emotional wellbeing at pre-intervention, post-intervention, and 3-month follow-up. Change in EFs (primary outcome), everyday EF, and social/emotional wellbeing (secondary outcomes) from pre- to post-intervention and pre-intervention to 3-month follow-up were examined. Feasibility and acceptability of the intervention was assessed through educator feedback and intervention adherence.Protocol Registration: The stage 1 protocol for this Registered Report was accepted in principle on 20 April 2023. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/WT3S2 . The approved Stage 1 protocol is available here: https://osf.io/kzfwn .

Self-construal modulates default mode network connectivity in refugees with PTSD

BACKGROUND

While self-construal and posttraumatic stress disorder (PTSD) are independently associated with altered self-referential processes and underlying default mode network (DMN) functioning, no study has examined how self-construal affects DMN connectivity in PTSD.

METHODS

A final sample of 93 refugee participants (48 with DSM-5 PTSD or sub-syndromal PTSD and 45 matched trauma-exposed controls) completed a 5-minute resting state fMRI scan to enable the observation of connectivity in the DMN and other core networks. A self-construal index was calculated by substracting scores on the collectivistic and individualistic sub-scales of the Self Construal Scale.

RESULTS

Independent components analysis identified 9 active networks-of-interest, and functional network connectivity was determined. A significant interaction effect between PTSD and self-construal index was observed in the anterior ventromedial DMN, with spatial maps localizing this to the left ventromedial prefrontal cortex (vmPFC), extending to the ventral anterior cingulate cortex. This effect revealed that connectivity in the vMPFC showed greater reductions in those with PTSD with higher levels of collectivistic self-construal.

LIMITATIONS

This is an observational study and causality cannot be assumed. The specialized sample of refugees means that the findings may not generalize to other trauma-exposed populations.

CONCLUSIONS

Such a finding indicates that self-construal may shape the core neural architecture of PTSD, given that functional disruptions to the vmPFC underpin the core mechanisms of extinction learning, emotion dysregulation and self-referential processing in PTSD. Results have important implications for understanding the universality of neural disturbances in PTSD, and suggest that self-construal could be an important consideration in the assessment and treatment of post-traumatic stress reactions.

Cultural differences in appraisals of control and posttraumatic stress disorder symptoms

Background: Appraisals are central to posttraumatic stress disorder (PTSD). Yet, few studies have examined how culture influences the associations between different types of trauma-related appraisals and PTSD symptoms.Objective: This study investigated cultural influences on appraisals of control and their associations with PTSD symptoms.Method: European Australian (n = 140, Mage = 35.80, SD = 12.44; 21 men, 97 women, 20 gender diverse/prefer not to report) and Chinese Australian (n = 129, Mage = 30.16, SD = 8.93, 21 men, 97 women, 20 gender diverse/prefer not to report) trauma survivors completed measures of appraisals, cultural values, and PTSD symptoms.Results: Findings showed that the Chinese Australian group was associated with greater Chinese cultural beliefs about adversity (i.e. emphasizing the value of adversity and people's ability to overcome adversity) and fewer fatalism appraisals (i.e. appraising one's destiny as externally determined), which in turn were atemporally associated with fewer PTSD symptoms; these atemporal indirect associations were moderated by self-construal and holistic thinking. The Chinese Australian group also reported fewer secondary control appraisals (i.e. attempts to change aspects of the self and accept current circumstances), which were atemporally associated with greater PTSD symptoms. In contrast, the European Australian group was associated with fewer primary control appraisals (i.e. perceived ability to personally change or control a situation), which were atemporally associated with greater PTSD symptoms.Conclusion: These findings highlight the importance of considering the influence of culture on appraisals in PTSD. However, it must be noted that causal relationships cannot be inferred from cross-sectional mediation analyses and thus, future longitudinal research is needed.

Psychological Problems in the Context of Political Violence in Afghan Children

PURPOSE OF REVIEW

This review provides an overview of recent literature examining psychological problems in the context of political violence among Afghan children.

RECENT FINDINGS

Using recent literature (2018-2023) we identified: 1) heightened levels of psychological problems experienced by children in Afghanistan; 2) the factors associated with these psychological problems, including loss of family and community members, poverty, continuous risk of injury and death, gender, substance use, war, daily stressors, and poor access to education; 3) psychological problems have potentially worsened since the 2021 political changes; 4) conflict and poverty have resulted in violence against children being a serious issue; 5) emerging psychological interventions have been adapted to Afghan contexts; and 6) there is a desperate need for psychological assistance and further research in the region. All children in Afghanistan have experienced conflict and political violence. While children are not responsible for this conflict, it has impacted their mental health. Further research is needed to examine the development and evaluation of interventions.

Does culture moderate the encoding and recognition of negative cues? Evidence from an eye-tracking study

Cross-cultural research has elucidated many important differences between people from Western European and East Asian cultural backgrounds regarding how each group encodes and consolidates the contents of complex visual stimuli. While Western European groups typically demonstrate a perceptual bias towards centralised information, East Asian groups favour a perceptual bias towards background information. However, this research has largely focused on the perception of neutral cues and thus questions remain regarding cultural group differences in both the perception and recognition of negative, emotionally significant cues. The present study therefore compared Western European (n = 42) and East Asian (n = 40) participants on a free-viewing task and a subsequent memory task utilising negative and neutral social cues. Attentional deployment to the centralised versus background components of negative and neutral social cues was indexed via eye-tracking, and memory was assessed with a cued-recognition task two days later. While both groups demonstrated an attentional bias towards the centralised components of the neutral cues, only the Western European group demonstrated this bias in the case of the negative cues. There were no significant differences observed between Western European and East Asian groups in terms of memory accuracy, although the Western European group was unexpectedly less sensitive to the centralised components of the negative cues. These findings suggest that culture modulates low-level attentional deployment to negative information, however not higher-level recognition after a temporal interval. This paper is, to our knowledge, the first to concurrently consider the effect of culture on both attentional outcomes and memory for both negative and neutral cues.

Investigating executive functioning and episodic future thinking in Iranian women with breast cancer

BACKGROUND

This study examined executive functioning and episodic future thinking among Iranian women with breast cancer.

METHOD

We recruited 40 healthy female community volunteers and 80 females with breast cancer (either currently undergoing chemotherapy n = 40 or not undergoing chemotherapy n = 40). Participants were assessed using cognitive tasks that assessed executive functioning and episodic future thinking and a measure of cancer-related fatigue.

RESULTS

Both cancer groups had poorer performance than controls on all measures of executive functioning and episodic future thinking. Those undergoing chemotherapy had poorer performance on all measures of executive functioning than those not undergoing chemotherapy. Cross-sectional mediation analyses revealed cancer-related fatigue had a significant mediator role between cancer group and executive functioning and episodic future thinking.

CONCLUSION

Those with breast cancer, particularly those undergoing chemotherapy, may be experiencing cognitive difficulties. These cognitive concerns should be considered by health teams as addressing these impairments may assist in improving quality of life and treatment adherence.

Cognitive factors as mediators of the relationship between childhood trauma and depression symptoms: the mediating roles of cognitive overgeneralisation, rumination, and social problem-solving

Background: Childhood trauma has negative immediate and long-term impacts on depression. Questions remain, however, regarding the cognitive factors influencing this relationship. This study aimed to investigate the role of three cognitive factors - cognitive overgeneralisation, rumination and social problem-solving - as mediating factors in the relationship between childhood trauma and symptoms of depression.Methods: We conducted a cross-sectional study in Iran from March to July 2023. Participants (N = 227; Mean age 32.44 ± 8.95 years) with depression completed measures of childhood trauma, depression, self-overgeneralisation, cognitive errors, memory specificity, rumination and social problem-solving. The conceptual model was assessed using structural equation modelling.Results: Structural equation modelling indicated that childhood trauma had a positive direct effect on depression symptoms. Childhood trauma had a positive indirect effect on depression symptoms through both self-overgeneralisation and rumination and a negative indirect effect on depression through effective social problem-solving strategies.Conclusions: The findings suggest increased exposure to childhood trauma may be associated with elevated depression and self-overgeneralisation, rumination, and effective social problem-solving strategies may play an important role in this relationship. These findings hold potential implications for those working with patients with depression and a history of childhood trauma.

Mental health literacy among Arab men living in high-income Western countries: A systematic review and narrative synthesis

While interest in mental health literacy (MHL) is growing rapidly, cross-cultural research focusing on MHL is developing more slowly. This inaugural systematic review explored the recognition and beliefs about the causes of mental health disorders amongst Arab men living in high income Western countries (HIWC), their help-seeking beliefs, behaviors, and sources of help, as well as barriers and facilitators to help-seeking. Six electronic database searches were conducted using Medline, Embase, ProQuest Dissertations & Theses Global, PsycINFO, Scopus, and Web of Science. These searches yielded a total of 9,460 citations. After applying inclusion criteria through both database and manual hand searches, 46 studies were identified. The findings corresponded with four of the socioecological model's five factors: intrapersonal, interpersonal, societal, and institutional. Intrapersonal factors included attributing mental health illness to life and migration stressors, and religious reasons. Interpersonal and societal factors included men favoring informal help-seeking sources as stigma was a barrier to formal help-seeking. Institutional factors around the perceived cultural competence of healthcare professionals and access difficulties were obstacles to seeking formal help. The growth in Arab migration to HIWC highlights the need for culturally tailored care. Research is needed to understand the perspectives of healthcare providers working with Arab men in addition to how men's stigmatizing attitudes are an obstacle to formal help-seeking. Interventions should be designed to address the unique mental health needs of Arab men, recognizing that some explanatory beliefs may not align with current Western models of mental health. Moreover, efforts should be made to integrate men's informal sources of support into treatment planning.

A qualitative study exploring the epistemology of suffering within a Malaysian Indigenous tribe

Despite the universal nature of suffering, few studies have examined how Indigenous ethnic minorities in non-western regions understand and respond to adversity. This study explored the epistemology of suffering among the Temiar ethnic group of Peninsular Malaysia using participant observation and semi-structured interviews. Interview transcripts of 43 participants were coded through inductive thematic analysis and a consensual qualitative approach. Three-tier themes were defined and named after subsequent analysis of core ideas and domains in the data. Major adversities reported included a lack of basic needs, lack of land-rights and unjust treatment from authorities, destruction of the forest environment and livelihood, and lack of accessibility and facilities, which were attributed to authorities' negligence of responsibilities, increasing human-animal conflict, environmental threats and imposed lifestyle changes. Faced with adversity, the Temiar endeavoured to survive by working crops and gathering forest resources. They utilized resources from family, fellow villagers, external agencies and spiritual-religious traditions. Theoretical mapping of attribution styles into the Ecological Rationality Framework revealed predominantly external-focused and concrete-perceptual rationalities privileged by strong-ties societies. These findings pointed to the resilience of a strong-ties community while adapting to the systemic suffering and risk factors stemming from a rationality mismatch with modernization and globalization trends. To conclude, we advocate for culture-sensitive mental health and psychiatric practices, as well as sustainable development for the well-being of Indigenous communities locally and globally.

Distinguishing between Iranian adolescents with posttraumatic stress disorder and high and low depressive symptoms: The role of cognitive and emotional variables

OBJECTIVE

This study aimed to investigate the role of cognitive and emotional variables in distinguishing between adolescents with posttraumatic stress disorder (PTSD) and either low or high symptoms of depression.

METHOD

Adolescents (N = 90) aged between 13 and 17 years (Mage = 15.53, SD = 1.13) who had been exposed to an earthquake in Iran and had (a) not developed PTSD (n = 30), (b) developed PTSD with low symptoms of depression (n = 30), and (c) developed PTSD with high symptoms of depression (n = 30) completed a clinical interview, cognitive tasks, and the Cognitive Emotion Regulation Questionnaire.

RESULTS

We found that those with PTSD had poorer performance on executive functioning (inhibition, cognitive flexibility, and working memory), episodic future thinking, and attention bias and had greater maladaptive emotion regulation strategies than healthy controls. Among those with PTSD, adolescents with high symptoms of depression performed worse on measures of executive function, attention bias, episodic future thinking, and the emotion regulation strategies of rumination and catastrophizing than adolescents with low depressive symptoms.

CONCLUSION

Exploring these cognitive and emotion difficulties can assist in further understanding PTSD and depression and improve targeted interventions among adolescents. This is of particular relevance in Iran where the need for policies and interventions targeting PTSD has been identified. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining the associations between control (primary and secondary) appraisals and posttraumatic stress disorder symptoms in Malaysian and Australian trauma survivors

Background

Little research has considered the influence of culture on control appraisals in the context of posttraumatic stress disorder (PTSD).

Objectives

This study aimed to investigate whether cultural group moderated the relationship between control (primary and secondary) appraisals and PTSD symptoms in trauma survivors from Western (Australian) and Asian (Malaysian) cultural contexts.

Methods

Trauma survivors (107 Australian with European cultural heritage; 121 Malaysian with Malay, Indian or Chinese cultural heritage) completed an online survey assessing PTSD symptoms and appraisals of control.

Results

Cultural group moderated the association between primary control and PTSD symptoms; the positive association was significant for the Australian group but not the Malaysian group. While cultural group did not moderate the association between secondary control and PTSD symptoms, there was an indirect pathway between secondary control appraisals and PTSD symptoms through interdependent self-construal for both cultural groups.

Conclusion

The findings indicate that cultural group and self-construal influence the associations between different types of control appraisals and PTSD. Further research exploring the role of culture and different appraisal types in PTSD is needed.

Against the use of the Strengths and Difficulties Questionnaire for Aboriginal and Torres Strait Islander children aged 2-15 years

OBJECTIVE

The Strengths and Difficulties Questionnaire is a widely used screening tool for emotional and behavioural problems in children. Recent quantitative analyses have raised concerns regarding its structural validity in Aboriginal and Torres Strait Islander communities. This paper aims to extend upon existing findings by analysing the factor structure of both the parent- and teacher-reported Strengths and Difficulties Questionnaire in this population across a broader age range than in previous studies.

METHODS

Participants were the caregivers and teachers of 1624 Aboriginal and Torres Strait Islander children (820 male, 804 female) aged 2-15 years from Waves 2-11 of the Longitudinal Study of Indigenous Children. The majority of children were Aboriginal living in major cities and inner regional areas. Internal consistency was estimated with McDonald's Omega. Exploratory structural equation modelling was conducted to investigate the factor structure of the parent-reported and teacher-reported versions of the Strengths and Difficulties Questionnaire.

RESULTS

Responses from teachers demonstrated higher internal consistency than responses from parents, which was unacceptably low across most age groups. The purported five-factor structure of the Strengths and Difficulties Questionnaire failed to be replicated across both parent- and teacher-reported questionnaires. The results of bifactor and hierarchical exploratory structural equation models also failed to approximate the higher-order summary scales. These results indicate that the Strengths and Difficulties Questionnaire subscales and summary scores do not provide a valid index of emotional and behavioural problems in Aboriginal and Torres Strait Islander children.

CONCLUSION

The Strengths and Difficulties Questionnaire should not be used with Aboriginal and Torres Strait Islander children.

Exploring expected reward and efficacy in enhancing cognitive control in patients with depression

BACKGROUND

Depression is associated with impairments in cognitive control. Considering the lack of mechanistic models accounting for cognitive control deficits in depression, the expected value of control (EVC) theory offers a mechanistic view for allocating cognitive control emphasizing motivational components (efficacy, value). Efficacy refers to the possibility that an effort leads to a special outcome and reward refers to the value (amount) associated with the outcome. This study aimed to examine the role of the EVC in depression.

METHOD

This study used a within-between-subject design. Participants with depression (n = 36) and healthy controls (n = 31) completed a clinical diagnostic interview, the Beck Depression Inventory-II, the General Health Questionnaire-12, and a computer-based incentivized Stroop Color-Word Paradigm in which levels of efficacy (high vs. low) and the amount of rewards (high vs. low) were presented as cues before target stimuli.

RESULTS

We found significant interaction effects of group × efficacy and efficacy × reward in terms of reaction time in the Stroop Paradigm. Follow-up analyses indicated the Depressed group were significantly slower than Controls on high efficacy trials, but the two groups did not differ significantly on low efficacy trials. Additionally, on high efficacy trials, reward did not influence performance, but on low efficacy trials, high reward improved performance in both groups.

LIMITATION

Lack of neurological measures and eye tracking techniques.

CONCLUSION

Overall, our findings suggest that reward and efficacy may jointly improve cognitive control allocation and highlight the need for further research examining EVC theory as a mechanistic account of cognitive control deficits in depression.

The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder

OBJECTIVE

The objective of this article was to provide an overview of the development and recommendations from the Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). The guideline aims to promote accurate and timely identification and diagnosis, and optimal and consistent treatment of ADHD.

METHODS

Development integrated the best available evidence with multidisciplinary clinical expertise and the preferences of those with lived experience, underpinned by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The 23 guideline development group members included psychiatrists, paediatricians, general practitioners, psychologists, speech pathologists, occupational therapists, educators, Indigenous psychologists, and people with a lived experience; with two independent chairs and a methodologist. Where appropriate, evidence reviews from the National Institute for Health and Care Excellence (NICE) 2018 'Attention Deficit Hyperactivity Disorder: Diagnosis and Management' guideline were updated. Fifty prioritised clinical questions were addressed in 14 systematic reviews (new and updated from NICE 2018) and 28 narrative reviews.

RESULTS

The 113 clinical recommendations apply to young children (5 years and under), children, adolescents and adults. They provide guidance for clinicians on identification, screening, diagnosis, multimodal treatment and support, including pharmacological and non-pharmacological interventions. The guideline and supporting information are available online: https://adhdguideline.aadpa.com.au/.

CONCLUSIONS

The guideline was approved by the National Health and Medical Research Council (NHMRC) of Australia and relevant medical and allied health professional associations. It is anticipated that successful implementation and uptake of the guideline by organisations, health care providers and other professionals will increase delivery of evidence-based treatment and improve health outcomes for the more than 800,000 Australians with ADHD.

The association between stressful experiences and OCD symptoms in young adults at transdiagnostic risk

BACKGROUND

It is unclear whether there is a specific association between stressful experiences and obsessive-compulsive symptoms or whether this relationship is due to stressful experiences increasing risk for psychopathology generally.

AIMS

The current study examined the association between stressful experiences and obsessive-compulsive symptom dimensions, while adjusting for coexisting psychiatric symptoms and psychological distress in a young adult transdiagnostic at-risk sample.

METHODS

Forty-three participants completed self-report measures assessing obsessive-compulsive symptoms, stressful experiences, and a range of other psychiatric symptoms. Regression models examined the relationship between stressful experiences and different obsessive-compulsive symptoms dimensions (i.e., symmetry, fear of harm, contamination, and unacceptable thoughts), adjusting for the influence of coexisting psychiatric symptoms and psychological distress.

RESULTS

The results showed that there was an association between stressful experiences and obsessive-compulsive symptoms dimension of symmetry. Symptoms of borderline personality disorder were positively associated with the obsessive-compulsive symptom dimensions of symmetry and fear of harm symptoms. Symptoms of psychosis were found to be negatively associated with the obsessive-compulsive symptoms dimension of fear of harm.

CONCLUSIONS

These findings have implications for understanding the psychological mechanisms that underlie symmetry symptoms and highlight the need to study OCS dimensions separately to inform more precise, mechanism-targeted interventions.

Pathways from childhood trauma to suicidal ideation: mediating through difficulties in emotion regulation and depressive symptoms

OBJECTIVE

Suicidal ideation is a clinical exigency heightening the risk of suicide at different levels of suicidal behavior. This study sought to explore crucial correlates of this phenomenon with a structural equation modeling approach. Accordingly, the mediating role of depressive symptoms and difficulties in emotion regulation between childhood trauma and suicidal ideation were explored.

METHOD

The sample consisted of 372 university students (57.3% females, M = 20.75, SD = 2.25) who completed self-report measures examining experiences of childhood trauma, depressive symptoms, difficulties in emotion regulation, and suicidal ideation. Structural equation modeling was employed, and mediation analysis was conducted. Confirmatory factor analysis was used to test the measurement model of each construct before evaluating the conceptual mediated model.

RESULTS

Findings indicate that depressive symptoms with difficulties in emotion regulation had the strongest association (r = 0.60, P = 0.001), then depressive symptoms and suicidal ideation (r = 0.58, P = 0.001), suicidal ideation with difficulties in emotion regulation (r = 0.45, P = 0.001) then suicidal ideation with childhood trauma (r = 0.39, P = 0.001), difficulties in emotion regulation with childhood trauma (r = 0.36 P = 0.001) and finally depressive symptoms and childhood trauma (r = 0.35, P = 0.001). Regarding indirect paths, difficulties in emotion regulation and depression function together (in a sequential path) to mediate the association between childhood trauma and suicidal ideation ( χ²(68) = 216.86, P < 0.01, CFI = 0.95, TLI = 0.93, RMSE = 0.077, CI [0.066 to 0.089], SRMR = 0.049).

CONCLUSION

Results demonstrate that childhood trauma, depressive symptoms, and difficulties in emotion regulation are linked to suicidal ideation, highlighting the necessity of recognizing and addressing suicidal ideation as well as the factors that contribute to suicidal ideation. Emotion regulation interventions can be effective in reducing the negative effects of childhood trauma and lowering the risk of suicide. These interventions can help in reducing depressive symptoms and improve overall mental well-being, leading to a lower risk of suicide.

Effect of the Memory Training for Recovery-Adolescent Intervention vs Treatment as Usual on Psychiatric Symptoms Among Adolescent Girls in Afghanistan: A Randomized Clinical Trial

Importance

Adolescents who experience conflict in humanitarian contexts often have high levels of psychiatric distress but rarely have access to evidence-based interventions.

Objective

To investigate the efficacy of Memory Training for Recovery-Adolescent (METRA) intervention in improving psychiatric symptoms among adolescent girls in Afghanistan.

Design, Setting, and Participants

This randomized clinical trial included girls and young women aged 11 to 19 years with heightened psychiatric distress living in Kabul, Afghanistan, and was conducted as a parallel-group trial comparing METRA with treatment as usual (TAU), with a 3-month follow-up. Participants were randomized 2:1 to receive either METRA or TAU. The study occurred between November 2021 and March 2022 in Kabul. An intention-to-treat approach was used.

Interventions

Participants assigned to METRA received a 10-session group-intervention comprised of 2 modules (module 1: memory specificity; module 2: trauma writing). The TAU group received 10 group adolescent health sessions. Interventions were delivered over 2 weeks.

Main Outcomes and Measures

Primary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms after the intervention. Secondary outcomes were self-reported measures of anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties. Assessments occurred at baseline, after modules 1 and 2, and at 3 months after treatment.

Results

The 125 participants had a mean (SD) age of 15.96 (1.97) years. Overall sample size for primary analyses included 80 adolescents in the METRA group and 45 adolescents in TAU. Following the intention-to-treat principle, generalized estimating equations found that the METRA group had a 17.64-point decrease (95% CI, -20.38 to -14.91 points) in PTSD symptoms and a 6.73-point decrease (95% CI, -8.50 to -4.95 points) in depression symptoms, while the TAU group had a 3.34-point decrease (95% CI, -6.05 to -0.62 points) in PTSD symptoms and a 0.66-point increase (95% CI, -0.70 to 2.01 points) in depression symptoms, with the group × time interactions being significant (all P < .001). METRA participants had significantly greater reductions in anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties than TAU participants. All improvements were maintained at 3-month follow-up. Dropout in the METRA group was 22.5% (18 participants) vs 8.9% for TAU (4 participants).

Conclusions and Relevance

In this randomized clinical trial, those in the METRA group had significantly greater improvements in psychiatric symptoms relative to those in the TAU group. METRA appeared to be a feasible and effective intervention for adolescents in humanitarian contexts.

Trial Registration

anzctr.org.au Identifier: ACTRN12621001160820.

Associations between the misinformation effect, trauma exposure and symptoms of posttraumatic stress disorder and depression

This research aimed to conduct an initial investigation into the relationships between the "misinformation effect" and trauma exposure, posttraumatic stress disorder (PTSD) and depression. Study 1 was a pilot study developing an online misinformation paradigm that could assess the influence of emotion and arousal on memory distortions. Participants (n = 162, M_age = 39.90; SD = 10.90) were recruited through TurkPrime. In Study 2 community members (n = 116, M_age = 28.96; SD = 10.33) completed this misinformation paradigm and measures of trauma exposure, PTSD, and depression. Study 1 found memory for central details was better for high-arousal than low-arousal and neutral-arousal images. Peripheral memory appeared worse for negative and neutral images than positive images. Study 2 found that, when controlling for age and gender, PTSD symptoms significantly predicted proportion of correct responses on control items. However, there was no evidence to indicate that trauma exposure, PTSD symptoms nor depression symptoms, were associated with proportion of correct responses on misled items. Valence and arousal did not influence these associations. These findings have important implications in clinical and legal contexts where individuals with a history of trauma, or who are experiencing symptoms of PTSD or depression, are often required to recall emotionally-laden events. There is a surprising dearth of research into the misinformation effect in clinical populations and further research is required.

Exploring the associations between social support and symptoms of posttraumatic stress disorder among Malaysian and Australian trauma survivors

Background: Social support is an important feature in understanding posttraumatic stress disorder (PTSD) and its treatment. Non-clinical research has identified distinct profiles of culturally appropriate social support. Despite this, little research has examined cultural influences on social support in the context of PTSD.Objective: This study examined cultural differences in the associations between social support and symptoms of PTSD.Method: The study employed a cross-sectional design. Australian (n = 91) and Malaysian (n = 91) trauma survivors completed an online survey assessing PTSD symptomatology and social support (explicit and implicit social support, perceived helpfulness of support provider, attitudes towards professional help-seeking). A quasi-experimental paradigm assessed the influence of mutual (i.e. the sharing of support between relationship partners) and non-mutual support (i.e. where one person constantly receives support, while the other person constantly provides support) on negative emotion and subjective distress.Results: First, explicit social support was negatively associated with PTSD symptoms for the Australian group but not the Malaysian group. Second, perceived helpfulness of support from family was negatively associated with PTSD symptoms for the Malaysian group but not the Australian group. Third, the Malaysian group reported significantly greater distress for non-mutual support and significantly fewer negative emotions and distress for mutual support than the Australian group. Fourth, the Malaysian group reported that they were significantly more open to acknowledging psychological problems and the possibility of seeking professional help for these problems than the Australian group.Conclusions: As the PTSD social support literature continues to evolve, it is essential that cultural influences are considered given the important theoretical and clinical implications.

A systematic review of the relationship between emotion and susceptibility to misinformation

Inaccurate memory reports can have serious consequences within forensic and clinical settings, where emotion and misinformation are two common sources of memory distortion. Many studies have investigated how these factors are related; does emotion protect memory or leave it more vulnerable to the distorting effects of misinformation? The findings remain diffused. Thus, the present review aimed to clarify the relationship between emotion and susceptibility to misinformation. 39 eligible studies were reviewed. Results varied according to the type and dimension of emotion measured. Level of arousal may be unrelated to susceptibility to misinformation when retrieval occurs without delay; studies including delayed retrieval were limited. Stimuli valence may be associated with increased susceptibility to peripheral misinformation but unrelated to other misinformation. The following results were reported by limited studies: short-term distress and moderate levels of stress may decrease susceptibility, while anger and greater cortisol response to stress may increase susceptibility to misinformation. Source memory may also be unaffected by emotion. The results have important potential implications for forensic and clinical practice, for example by highlighting the value of enquiring witnesses' source memory. Methodological recommendations for future studies are made.

Moral injury appraisals in young people from refugee backgrounds in Melbourne, Australia

OBJECTIVE

While moral injury can influence psychological outcomes experienced by adult refugees, no research to date has examined moral injury among young refugees. This study aimed to investigate the associations between moral injury and mental health in young people with refugee backgrounds.

METHOD

Participants were 85 young refugees (58.80% female), aged on average 20.78 years (SD = 2.29, range = 16-25 years), living in Melbourne Australia. This community sample completed measures of moral injury appraisals, traumatic stress, resilience, and mental health using an online survey.

RESULTS

Moral injury appraisals significantly correlated with poorer mental health. Regression analyses demonstrated that moral injury predicted differences on externalizing symptoms but not internalizing or PTSD symptoms. Further, the relationship between traumatic stress and externalizing symptoms was mediated by moral injury appraisals. Similarly, the relationship between postmigration living difficulties and internalizing symptoms was mediated by moral injury appraisals.

CONCLUSIONS

Findings indicated young people with refugee backgrounds also experience moral injury appraisals and these are associated with poor mental health. Further research is needed to understand the factors associated with psychological outcomes experienced by young refugees and to guide clinical assessments and novel interventions for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining MEmory Training for Recovery-Adolescent among Afghan adolescent boys: a pilot randomised controlled trial

Objective: To conduct a pilot randomised controlled trial examining the feasibility, acceptability and efficacy of MEmory Training for Recovery-Adolescent (METRA) in improving psychological symptoms among Afghan adolescent boys following a terrorist attack.Method: A pilot randomised controlled trial compared METRA to a Control Group, with a three-month follow-up. The study occurred in Kabul (June-November 2022). Fifty-eight boys aged 14-19 years (Mage = 16.70, SD = 1.26) with heightened posttraumatic stress disorder (PTSD) symptoms were recruited through a local school that had recently experienced a terrorist attack. Participants were randomised 1:1 to receive METRA (n = 28) (10 session group-intervention) or Control (n = 30) (10 group-sessions of study skills). Primary outcomes were self-reported PTSD symptoms at post-intervention. Secondary outcomes included self-reported anxiety, depression, Afghan-cultural distress symptoms and psychiatric difficulties.Results: There were challenges in youth participation related to security and competing education demands. For those who did complete METRA, METRA was deemed feasible and acceptable. Following the intent-to-treat principle, linear mixed effects models found at posttreatment the METRA group had a 20.89-point (95%CI -30.66, -11.11) decrease in PTSD symptoms, while the Control Group had a 1.42-point (95%CI -8.11, 5.27) decrease, with the group over time interaction being significant (p < .001). METRA participants had significantly greater reductions in depression, anxiety, Afghan-cultural distress symptoms and psychiatric difficulties than did Controls. All gains were maintained at three-month follow-up.Conclusions: With some modifications, METRA appears a feasible intervention for adolescent boys in humanitarian contexts in the aftermath of a terrorist attack.

Feasibility and acceptability of written exposure therapy in addressing posttraumatic stress disorder in Iranian patients with breast cancer

OBJECTIVE

This study examined the feasibility and acceptability of written exposure therapy (WET) in reducing symptoms of posttraumatic stress disorder (PTSD) in Iranian women with breast cancer. Secondary aims included examining the influence of WET on quality of life (QoL), overgeneral memory and illness perceptions.

METHOD

Forty-six females with breast cancer and clinical symptoms of PTSD referred to the Razi Hospital in Rasht, Iran were randomly assigned to either WET (n = 23) or control (n = 23) groups. WET is a 5-session low-intensity exposure-based intervention for treating PTSD. The control group had no additional contact. Measures assessing PTSD, illness perceptions, overgeneral memory, and QoL were administered at baseline, post-intervention and 3-month follow-up.

RESULTS

Acceptability of WET was high; all participants completed all WET sessions. At post-intervention, 95.65% of the WET group met criteria for reliable change and 100% met criteria for minimal clinically important difference (MCID) and clinically significant change in PTSD symptom improvement. At follow-up, all WET participants met criteria for reliable change, MCID and clinically significant change in PTSD symptom improvement. No participants in the control group met reliable change, MCID or clinically significant change. The WET group had improved QoL and memory specificity and decreased threatening illness perceptions at post-intervention and follow-up when compared to controls.

CONCLUSION

WET may be a useful intervention for use with breast cancer patients with PTSD symptoms and may be an important adjunct to medical and pharmacological treatments, particularly in low- and middle-income countries. This study indicates further research in this area is warranted.

Does culture moderate the relationships between rumination and symptoms of posttraumatic stress disorder and depression?

Brooding rumination is positively associated with symptoms of both depression and posttraumatic stress disorder (PTSD). However, non-clinical cross-cultural research indicates that culture may influence these associations. This study aimed to examine the moderating effect of cultural group (Australian versus Malaysian) on the associations between brooding rumination and symptoms of depression and PTSD. European Australians (n = 109) and Malaysians of varying Asian heritages (n = 144) completed an online questionnaire containing the Hospital Anxiety and Depression Scale, PTSD checklist for DSM-5 and the Ruminative Response Scale-Short Form. First, Malaysian participants had higher brooding rumination than Australian participants. Second, higher levels of brooding rumination were positively associated with depression and PTSD symptom severity. Third, contrary to our expectations, cultural group did not moderate the relationships between brooding rumination and symptoms of depression and PTSD. If replicable, these results suggest that existing assessment and treatment approaches that target brooding rumination may apply to Malaysian individuals with depression and PTSD.