Emotional vs. social loneliness and prolonged grief: a random-intercept cross-lagged panel model

Background: Bereavement following death, with loneliness as a prominent feature, can result in enduring stress and compromised health.Objective: Building on Weiss's ([1973]. Loneliness: The experience of emotional and social isolation. MIT Press) proposal of two distinct types of loneliness, this study investigated within-person associations between emotional loneliness (EL) and prolonged grief symptoms (PGS) (aim 1), as well as social loneliness (SL) and PGS (aim 2) over four years following spousal loss. Additionally, we examined the impact of gender, age, and education on the main factors.Methods: We used random-intercept cross-lagged panel modelling (RI-CLPM) to analyse self-reported data from 338 Danish spousal-bereaved adults (58% female; mean age = 72.1; range 65-81 years) on EL and SL (single-item questions) and PGS (Inventory of Complicated Grief, short version) at 6, 13, 18, and 48 months post-loss.Results: We found (1) within-person associations between EL and PGS; (2) no within-person associations between SL and PGS. In our model, PGS predicted EL over time, with no reciprocal effect. In contrast, PGS and SL were unrelated. Age did not link with EL, SL, or PGS. More years of education were associated with less EL and SL, but not with PGS. Gender influenced the association between SL and PGS.Conclusions: This study enhances our understanding of longitudinal, within-person associations between EL, SL, and PGS. Consistent with Weiss's (1973) relational theory of loneliness in widowhood, results highlight the unique role of EL. While replication is needed due to limitations like single-item measures and varying intervals, these findings emphasize EL's importance in widowhood and offer a basis for better understanding and addressing PGS. Monitoring the relationship between loneliness and grief may help healthcare providers offer timely, targeted interventions.

The coping experiences in patients with hepatocellular carcinoma and their spouses following postoperative recurrence: A dyadic qualitative study

Objective

Dyadic coping practices can vary depending on cultural contexts, socioeconomic factors, and the stages of the cancer journey. This study aimed to explore the dyadic coping experiences of hepatocellular carcinoma (HCC) patients and their spouses following postoperative recurrence in the Chinese cultural context, where cancer recurrence is frequently seen as a death sentence, and family-centered care is prioritized.

Methods

A descriptive qualitative research design was used, involving face-to-face, in-depth semi-structured interviews with 13 pairs of hepatocellular carcinoma patients and their spouses at a tertiary cancer hospital from July to October 2023. The interview guide was designed based on the Actor-Partner Interdependence Model (APIM) framework. Data were analyzed using thematic analysis, and the study adhered to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist.

Results

Three themes were identified: (1) active coping strategies, (2) negative coping tendencies, and (3) the need for systematic coping support. The majority of couples perceived hepatocellular carcinoma recurrence as a death sentence, which prompted them-especially the spouses-to adopt proactive strategies, such as striving to seek advanced treatments and concealing unfavorable information. In contrast, patients, particularly those with a hereditary hepatocellular carcinoma background, often exhibited passivity, withdrawal, and contemplation of treatment abandonment. Spouses frequently felt overwhelmed and unable to alleviate their partners' anxiety about recurrence and death, particularly in the absence of support from health care professionals. They expressed a strong need for professional guidance and targeted interventions to address end-of-life concerns, emphasizing the need for increased financial support, empowerment through knowledge, and access to peer support networks.

Conclusions

This research emphasizes the importance of recognizing the interdependent coping experiences of recurrent HCC patients and their spouses. Health care professionals are encouraged to implement culturally sensitive, dyadic interventions that foster collaborative coping, address death-related anxiety, and empower couples in managing recurrence together, thereby enhancing their coping strategies and confidence.

Imagery Rescripting (ImRs) and Eye Movement Desensitization and Reprocessing (EMDR) as treatment of childhood-trauma related post-traumatic stress disorder (Ch-PTSD) in adults: effects on Schema Modes

Background: Many patients with post-traumatic stress disorder (PTSD) due to childhood trauma (Ch-PTSD) also suffer from comorbid personality pathology. Little is known about the effectiveness of treatments for Ch-PTSD in reducing the comorbid personality pathology. Schema Modes are an operationalization of personality pathology according to schema therapy and can be measured with the Schema Mode Inventory (SMI). Therefore, we evaluated the effects of two treatments for adult patients with Ch-PTSD on Schema Modes.Method: Participants (n = 114) of the Imagery Rescripting and Eye Movement Desensitization and Reprocessing (IREM) Randomized Clinical Trial (Boterhoven de Haan, K. L., Lee, C. W., Fassbinder, E., Voncken, M. J., Meewisse, M., Van Es, S. M., Menninga, S., Kousemaker, M., & Arntz, A. (2017). Imagery rescripting and eye movement desensitization and reprocessing for treatment of adults with childhood trauma-related post-traumatic stress disorder: IREM study design. BMC Psychiatry, 17(1), 1-12, Boterhoven de Haan, K. L., Lee, C. W., Fassbinder, E., van Es, S. M., Menninga, S., Meewisse, M.-L., Rijkeboer, M., Kousemaker, M., & Arntz, A. (2020). Imagery rescripting and eye movement desensitization and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: Randomised clinical trial. The British Journal of Psychiatry, 217(5), 609-615) with Ch-PTSD who filled in the SMI next to other outcomes, were randomly allocated to a 12-session treatment of Imagery Rescripting (ImRs) or Eye Movement Desensitization and Reprocessing (EMDR). The SMI was collected at waitlist, pre-treatment, mid-treatment, posttreatment, and 8-week and 1-year follow-up.Results: For both treatments, patients reported large reductions in the Maladaptive Schema Modes and improvements in the Adaptive Schema Modes (Cohen's d = .94-1.18) from pre-treatment to posttreatment, 8-week follow-up, and 1-year follow-up. No statistically significant differences were found between ImRs and EMDR regarding changes in Schema Modes over time. No significant changes were observed during the waitlist period.Conclusions: ImRs and EMDR showed improvements in Schema Modes when primarily targeting Ch-PTSD. The results indicate the possible value of both treatments in reducing comorbid personality pathology.

The impact of trauma and how to intervene: a narrative review of psychotraumatology over the past 15 years

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

The interpersonal theory of suicide risk in male US service members/veterans: the independent effects of perceived burdensomeness and thwarted belongingness

Introduction: Suicide rates remain high among US military service member/veteran (SM/V) males with overall trends showing an upward trajectory. Several empirical studies and official US government reports show that interpersonal challenges can substantially increase suicide risk. One theory, the Interpersonal Theory of Suicide (IPT), focuses thwarted belongingness, perceived burdensomeness, capability for suicide, and their interactions, as key contributors to suicide risk. Extant military studies are subscribed to specific subsamples and/or do not test the full theory. This has resulted in mixed findings or findings with limited generalizability. The current study addressed these limitations.Method: A convenience sample of 508 male SM/Vs completed self-report measures of lifetime suicide ideation, likelihood of making a future attempt, thwarted belongingness, perceived burdensomeness, capability for suicide, and demographics. Suicide ideation and risk was regressed on IPT variables, relevant interactions, and covariates.Results: The variance accounted for in suicide ideation and likelihood of a future attempt was 32% and 62%, respectively. Higher perceived burdensomeness was associated with suicide ideation, and higher thwarted belongingness had a marginally significant association with suicide ideation. The presence of suicide ideation and higher thwarted belongingness were associated with the likelihood of making a future attempt. Capability for suicide was not associated with the likelihood of making a future attempt.Discussion: Perceived burdensomeness, suicide ideation, and thwarted belongingness appear to individually create risk for future suicide behaviour among US military service members and veterans. Additional work is needed to establish comprehensive theories of suicide risk in this population.

Experiences with a guided trauma-focused internet- and mobile-based intervention: a qualitative study of youth's perspectives

Introduction: Research on internet-interventions for youth with post-traumatic stress symptoms (PTSS) is limited, despite promising results in adults. A non-randomised feasibility study of a therapist-guided trauma-focused internet- and mobile-based intervention (IMI) showed potential in reducing PTSS but revealed challenges with adherence and individual fit. Insights from qualitative studies can enhance intervention quality by addressing personal needs. This study explores participants' views on the feasibility of a therapist-guided trauma-focused IMI to improve digital trauma interventions.Methods: Semi-structured interviews based on theoretical models of acceptance and human support in IMIs were conducted with 17 of 32 participants from a self-help-based trauma-focused IMI with therapist guidance. Audio-recorded interviews were transcribed and analyzed using deductive-inductive content analysis. Independent coding resulted in good agreement (κ = .76).Results: 20 themes were identified and organised under nine dimensions: participation motivation and expectations; recruitment process; treatment adherence and everyday use of therapeutic exercises; trauma processing; non-trauma processing intervention components; technology, structure, and design of the IMI; human support; individual fit; and active factors and efficacy. The technology, structure, and design of the IMI and other non-trauma-focused components were rated positively. Trauma processing presented challenges for many but was still perceived as a helpful and relevant active factor. Some felt a lack of therapeutic support, and greater personalisation of guidance was a frequent suggestion for improving the individual fit. The IMI's efficacy was most often perceived in its effects on improved coping with trauma and symptoms.Discussion: The study identified key themes for the feasibility of a trauma-focused IMI for youth, showing general acceptance of its design, structure, and technology. While trauma processing in IMIs poses challenges similar to face-to-face therapy, these can be addressed by clarifying the therapy rationale, making trauma processing an important active factor. Further research is needed to improve individualisation and therapeutic support intensity.Trial registration: German Clinical Trials Register identifier: DRKS00023341..

Impact of perceived side-effects of psychotropic treatments on quality of life in patients with severe mental illness

BACKGROUND

Psychotropic medications are critical in managing severe mental illnesses (SMI) such as schizophrenia, major depressive disorder (MDD) and bipolar disorder. However, these treatments often lead to adverse side effects that can impair patients' quality of life (QoL) and affect treatment adherence.

OBJECTIVE

This study aims to investigate the specific side effects of psychotropic treatments that contribute to a decline in QoL among patients with SMI, independently of treatment adherence.

METHODS

We conducted a cross-sectional study with 1248 patients diagnosed with SMI, recruited from a university psychiatric unit in Marseille, France. QoL was assessed using the Schizophrenia Quality of Life Scale (SQoL-18), and side effects were measured using the UKU Side Effect Rating Scale. Treatment adherence was evaluated using the Medication Adherence Rating Scale (MARS). Statistical analyses included Pearson correlations and multiple linear regression models to identify predictors of QoL.

RESULTS

The study found that side effects, as identified by the UKU scores, could significantly predict a reduction in QoL across multiple domains, including multiple dimensions of QoL and the overall QoL index, independent of treatment adherence. Patients on antipsychotics and benzodiazepines reported higher levels of adverse side effects, which correlated with lower QoL scores. An increase in the number of psychotropic treatment classes was also associated with a significant decline in QoL (p < 0.001).

CONCLUSION

Managing psychic side effects and minimising polypharmacy are critical to improving QoL in patients with SMI. Clinicians should consider these factors when developing personalised treatment strategies to enhance patient outcomes.

Self-compassion mediates treatment effects in MDMA-assisted therapy for posttraumatic stress disorder

Background: Posttraumatic stress disorder (PTSD) is a severe condition often complicated by co-occurring disorders, such as major depression, alcohol use disorder, and substance use disorders. A well-powered phase 3 randomized, placebo-controlled trial has shown that MDMA-assisted therapy (MDMA-AT) may be an effective treatment for severe PTSD. However, the psychological mechanisms driving the therapeutic effects of MDMA-AT remain unclear. One potential mechanism is self-compassion, which is commonly conceptualized as a balance between compassionate self-responding (CS) - encompassing self-kindness, common humanity, and mindfulness - and uncompassionate self-responding (UCS) - encompassing self-judgment, isolation, and over-identification.Objective: This secondary analysis aimed to explore whether MDMA-AT enhances aspects of self-compassion and if changes in self-compassion mediate the therapy's effectiveness in reducing PTSD severity, depressive, and alcohol and substance use symptoms.Method: Eighty-two adults diagnosed with severe PTSD participated in a double-blind trial comparing three sessions of either MDMA-AT or placebo combined with therapy. Measures of PTSD severity, depressive symptoms, alcohol and substance use, and self-compassion were collected at baseline and 18 weeks later.Results: MDMA-AT led to statistically significant improvements in both UCS and CS. Significant improvements were also observed across all six subscales of the Self-Compassion Scale, including self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification, most with large effect sizes. Changes in UCS and CS significantly and fully mediated the effects of MDMA-AT compared to placebo plus therapy in reducing PTSD severity and depressive symptoms. Findings were not significant for alcohol and substance use outcomes.Conclusions: These findings suggest that self-compassion may play a critical role in the therapeutic effects of MDMA-AT. Further research is needed to investigate the role of self-compassion in MDMA-AT to refine and develop more targeted, effective interventions for individuals with PTSD and co-occurring depression.

The influence of childhood trauma on social media-induced secondary traumatic stress among college students: the chain mediating effect of self-compassion and resilience

Background: Studies have shown that media exposure to critical public events can lead to secondary traumatic stress (STS). Personal trauma history, self-compassion and resilience are important factors influencing STS in healthy professionals. However, whether these variables are associated with social media-induced STS in college students and the underlying mechanisms remain unclear. The purpose of this study was to explore the complex relationship linking childhood trauma to social media-induced STS in a large sample of college students.Methods: A total of 1151 Chinese college students from Chengdu, Sichuan Province of China completed a web-based cross-sectional survey, which included standard assessments of childhood trauma, self-compassion, resilience and social media-induced STS, as well as sociodemographic questionnaires. The chain mediation model was tested using the PROCESS macro programme in SPSS software.Results: There was a moderate correlation between childhood trauma and social media-induced STS (r = 0.34, p < .001). This association was significantly mediated by self-compassion (indirect effect [95% CI] = 0.14[0.11, 0.17]) and resilience (indirect effect = 0.03[0.01, 0.04]), respectively. Further, a chained mediating effect was observed with self-compassion and resilience consecutively mediated the relationship between childhood trauma and social media-induced STS (indirect effect = 0.02[0.01, 0.03]). These results persisted after sociodemographic characteristics were included as controlling variables.Conclusions: Early life trauma impacts STS induced by exposure to traumatic materials on social media through self-compassion and resilience among Chinese college students. Psychological interventions targeting self-compassion and resilience can be implemented to reduce the risk of STS, especially in vulnerable individuals.

The pain of PTSD: integrating persistent or chronic pain within emotional processing theory of posttraumatic stress disorder

Background: Posttraumatic stress disorder (PTSD) and chronic pain are devastating conditions that often co-occur. Current understanding of comorbid PTSD and chronic pain is limited, and treatment options are undereffective.Objective: This paper presents a theoretical basis for conceptualising chronic pain symptoms within Emotional Processing Theory (EPT), the foundation for Prolonged Exposure (PE), an effective treatment for PTSD. EPT conceptualises the development and treatment of PTSD using a trauma structure that strongly overlaps with pain's neurobiology.Method: This paper proposes a model of shared aetiology and treatment of comorbid PTSD and chronic pain, emphasising these shared neurobiological underpinnings. Discussion details how the comorbidity is maintained through parallel avoidance processes focused on: (1) trauma memories and reminders in PTSD preventing reduction of negative affect (extinction) and inhibitory learning, and (2) physical pain in chronic pain fuelling increased pain and reduced function.Results: A conceptualisation is presented on how PTSD and chronic pain symptomology can be addressed within the EPT framework, increasing the confidence of providers and patients while addressing an important gap in the literature. Finally, recommendations for providers using PE with patients with PTSD and pain are provided including a case example and treatment plan based on real patients.Conclusions: This model provides a clinically useful understanding of the underlying neurobiology for the co-occurrence of PTSD and chronic pain and offers direction for future research.

The interplay between sleep and cancer-related fatigue in breast cancer: A casual and computer-simulated network analysis

Objective

Sleep problems and cancer-related fatigue are common symptoms in women for breast cancer, during and after treatment. Identifying key intervention targets for this symptom cluster may improve patient reported outcomes. This study aimed to explore the relationship between sleep and cancer-related fatigue to identify optimal intervention targets.

Methods

In the "Be Resilient to Breast Cancer" program, self report data were collected on sleep and cancer-related fatigue the Multidimensional Fatigue Symptom Inventory-Short Form and the Pittsburgh Sleep Quality Index. Gaussian network analysis was employed to identify central symptoms and nodes, while a Bayesian network explored their causal relationships. Computer-simulated interventions were used to identify core symptoms as targets for intervention.

Results

General fatigue (Str ​= ​0.95, Bet ​= ​7, Clo ​= ​0.007) was considered the node with the strongest centrality. The daytime dysfunction item on the Pittsburgh sleep quality index had the strongest bridge strength. Core symptoms were identified as targets for intervention by the computer-simulated analysis.

Conclusions

Sleep quality is the strongest predictor of cancer-related fatigue from a casual networking perspective. Sleep latency and daytime dysfunction should be targeted to break the chained symptom interaction between sleep and cancer-related fatigue.

Cultural differences in diagnosis and treatment perceptions: Turkish collectivistic representations of common mental disorders

PURPOSE

Attention-deficit/hyperactivity disorder (ADHD) is less diagnosed among Turkish children, and Turkish clients drop out more often from depression treatments than Dutch clients. This article proposes that cultural differences in collectivistic versus individualistic perceptions of getting an ADHD diagnosis and being treated for depression might explain these ethnic disparities, which have been explored in this study.

METHODS

Nine focus group discussions with Turkish individuals and 18 interviews with primary mental health practitioners were conducted.

RESULTS

Findings show that Turkish participants do not view ADHD symptoms as problematic. Parents generally do not want children to be labelled as such and get professional help because they fear this will cause interpersonal problems. Depression is seen as problematic, as it disturbs social relationships and communities. However, Turkish participants prefer mediation to cognitive behavioural therapy, since the latter does not solve interpersonal problems.

CONCLUSIONS

Our findings highlight a dissonance between individualistic/biomedical and collectivistic/socioecological views on health and wellbeing, in which the focus is on the individual for the Dutch versus the social group for the Turkish. To match Turkish clients' needs, mental health professionals should tread carefully in ADHD labelling. With depression, professionals might consider interventions such as mediation in interpersonal conflicts to improve treatment adherence and outcomes.

'We're all in this together': the protective role of belongingness in the contribution of moral injury to mental health among participants in Israel's civil protest movement

Background: Participating in long-term protests against government actions can affect protesters' mental health and expose protesters to potentially morally injurious events (PMIEs), such as the betrayal by leaders they once trusted. This study aimed to shed light on the potential psychological buffers against the deleterious effects of exposure to PMIEs of betrayal among protesters and to examine the moderating role of belongingness in the relationships between protesters' exposure to PMIEs and stress, PTSD and depression levels.Method: The study sample comprised 4036 Israeli protesters (Mage = 54.27, SD = 12.45; 75.6% females) who took part in the unfolding civil protest movement against the government-led judicial and constitutional overhaul between January 2023 and August 2023. Protesters completed validated self-report questionnaires that included measures of PMIEs, stress, depressive and PTSD symptoms (PTSS).Results: Beyond demographic and protest-related characteristics, exposure to PMIEs of betrayal was found to contribute to both PTSD and depression levels. The indirect effects of PMIE-betrayal on PTSS/depressive symptoms through stress levels were significant, particularly when belongingness levels were low. Thus, a greater sense of PMIE-betrayal contributes to stress symptoms, which, in turn, is linked to higher levels of PTSS and depressive symptoms for protesters having low levels of belongingness.Conclusions: The study's findings highlight the critical contribution of PMIE-betrayal to both PTSS and depression levels, which were mediated by levels of stress. Moreover, experiencing belongingness moderated these relationships. Clinicians treating protesters coping with PTSS and depressive symptoms should also adopt therapeutic aims of establishing belongingness and social support among the protesters.

Relationship between early maladaptive schemas (EMSs), adverse childhood experiences and mental health in adulthood among transgender individuals

Background: Transgender individuals experience a high level of distress over the lifespan and are at a higher risk of experiencing mental health conditions.Objective: The present study mainly aimed to investigate the complex relationship between early maladaptive schemas (EMSs), adverse childhood experiences and mental health conditions in adulthood among transgender individuals.Method: 220 participants completed an anonymous online study assessing sociodemographic and medical status, experience of childhood adversity (CTQ), EMSs (YSQ-S3), transgender specific quality of life (ETLI), current depression (PHQ-8), and generalised anxiety severity (GAD-7).Results: Transgender individuals tended to have a high prevalence for experiencing childhood adversity as well as for depressive and generalised anxiety symptoms and low quality of life in adulthood, while assigned female at birth (AFAB) transgender tend to be more vulnerable than assigned male at birth (AMAB) transgender. In general, transgender individuals showed an elevated pronounced level of EMSs, while AFAB transgender tended to focus more on the negative aspects in life, to strive more to pursue perfection and tended more to be highly critical towards others and especially themselves, as well as tended to believe that people should be harshly punished for making mistakes than AMAB transgender. According to the network analysis, schema domain and their EMSs were related to all assessed psychopathological outcomes, especially the schema domains Disconnection and Rejection and Impaired Autonomy and Performance seemed to be related to experience of childhood adversity and quality of life in adulthood.Conclusions: Transgender individuals seem to experience a high level of childhood adversity, which possibly leads to the development of an elevated level of EMSs. EMSs and their schema domains are associated with elevated depressive and generalised symptoms, as well as lower quality of life.

Comparative analysis of emotional factors in patients with somatic symptom disorder and panic disorder

OBJECTIVE

This study investigated the emotional symptom profiles and treatment responses in patients exhibiting overlapping physical symptoms to compare differences between Somatic Symptom Disorder (SSD) and Panic Disorder (PD).

METHODS

Pharmacotherapy outcomes were analysed in 208 outpatients with SSD (n = 94) and PD (n = 114). Stepwise multivariable logistic regression identified predictors of treatment response, considering variables such as the Clinical Global Impression-Severity (CGI-S), Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory, and State-Trait Anger Expression Inventory. Network analysis explored emotional patterns by estimating network structures for each group.

RESULTS

The overall response rate to pharmacotherapy was 23.6% (49/208), with no significant difference between groups. Baseline CGI-S and BDI-II scores were significant predictors of treatment response in both groups, while social phobia score was a significant predictor in PD. Depression and anxiety were related to physical symptoms in both groups, but anger was significantly associated only in SSD. Network analysis revealed that depression was central to other symptoms in SSD, while anxiety was the core symptom in PD, indicating different emotional drivers between the disorders.

CONCLUSIONS

This study suggests the differences in emotional symptom profiles between SSD and PD. Findings suggest different mechanisms, considering the role of anger in SSD, highlighting the need for more personalised treatments for each disorder.

Maximizing expectancy violation and exposure outcomes in patients with PTSD

Background: It has been proposed that maximizing expectancy violation enhances the efficacy of exposure therapy. The clinical utility of expectancy violation remains unclear and it has not yet been studied in PTSD.Objective: We aimed to test whether explicitly focusing on expectancy violation leads to superior exposure outcomes.Method: Adult treatment-seeking patients with PTSD (N = 60) were randomly assigned to one 90-minute exposure session focusing on either expectancy violation or a control condition without an expectancy focus. Assessments occurred before the session and one week later, measuring changes in fear responses during a script-driven imagery task, and PTSD symptoms.Results: Using multilevel analyses, we found no between-condition differences. On average, fear responses to the imagery and PTSD symptoms decreased over time. The expectancy violation condition exhibited a greater decrease in threat appraisal, which appeared to mediate symptom reduction.Conclusions: We found no evidence that explicitly focusing on expectancy violation led to superior immediate effects. However, it may lead to more changes in expectancies which could affect symptom improvement over an extended period. Further research is needed to determine whether emphasizing expectancy violation in exposure therapy for PTSD is advantageous.

Comparison of neurological and psychiatric profiles of people with epilepsy based on the presence and timing of potentially psychologically traumatic experiences

Objective: While psychological trauma in people with epilepsy (PWE) is a major issue, there is limited research on the interactions between such trauma and epilepsy. Therefore, our primary aim is to describe types and timing of potentially psychologically traumatic experiences (PPTE) in relation to epilepsy onset. Our secondary objective is to evaluate the impact of the timing of the PPTE on patients' psychiatric and neurological profiles.Methods: We conducted an observational study involving 182 PWE, excluding patients with comorbid functional/dissociative seizures. All participants underwent a comprehensive psychiatric evaluation, including biographical, neurological, psychiatric, and traumatic data collection through a semi-structured clinical interview and standardized scales. We compared the neurological and psychiatric characteristics of three groups of patients: those without PPTE, those with PPTE occurring before the onset of epilepsy, and those with PPTE occurring after the onset of their epilepsy.Results: Sixty-one patients (33.5%) reported having experienced PPTE before the onset of epilepsy, 65 patients (35.7%) reported having experienced PPTE after the onset of their epilepsy, and 56 patients (30.8%) had no history of PPTE neither before nor after the onset of epilepsy. The 'before' group had a significantly higher prevalence of epilepsy localized in the temporal lobe (p = .043). The 'after' group showed significantly more general psychiatric symptoms (p = .026), as well as more postictal mood and anxiety symptoms (p = .014). Additionally, the 'before' group reported a higher number of past traumatic experiences, with childhood traumatic experiences being more prevalent. According to our multinomial logistic regression model, higher temporal localization (p = .028) and fewer febrile seizures (p = .030) were significant predictors for the 'before' group.Significance: This study highlights the potential impact of the timing of PPTE on patients' psychiatric and neurological profiles. It underscores the importance of systematically assessing psychiatric and posttraumatic comorbidities in PWE. The role of trauma in temporal epilepsy requires further investigation.

Enduring intensity for healing: the patient perspective of intensive outpatient treatment for PTSD

BACKGROUND

Prolonged exposure is widely regarded as a first-line treatment for alleviating symptoms of post-traumatic stress disorder (PTSD); however, it is often associated with high dropout rates and may not always be sufficiently efficacious. Intensified treatment has been suggested as a solution to increase treatment efficacy and reduce dropout rates, but little is known about patients' preferences for this type of treatment.

OBJECTIVE

To investigate patients' experiences of prolonged exposure delivered in an intensive format (iPE).

METHOD

Semi-structured interviews were conducted with 12 participants after completion of iPE.

RESULTS

Thematic analysis of the data yielded one overarching theme 'Brutal Yet Worth It,' accompanied by five subthemes: Building Blocks of Commitment, Strength through collective support, Overcoming challenges of the intensive treatment week, Therapeutic gains of the intensive treatment, and Facilitating and Enabling Treatment Progress. The participants described short-term discomfort and demands, contrasted with the recognition of substantial benefits that extended beyond PTSD symptom reduction. The interplay of individual attributes and experience of social support emerged as crucial factors shaping the experience.

CONCLUSIONS

Participants described the iPE experience as intense and demanding, yet transformative and worthwhile in the interviews. These findings highlight the complex and multifaceted experiences of patients undergoing PE delivered in an intensive format. The findings could offer valuable insights for designing more well-received PTSD treatments, leading to enhancements in the overall quality of intensified treatment approaches.

Childbirth-related posttraumatic stress symptoms: exploring the predictive potential of intrapartum hotspots

Childbirth-related posttraumatic stress symptoms (CB-PTSS) affect around 12% of postpartum individuals. While the subjective experience of childbirth is a key predictor of CB-PTSS, the specific defining characteristics of negative birth experiences remain poorly understood. This study aims to refine our understanding of negative birth experiences by investigating intrapartum hotspots, i.e. moments of extreme distress, and their association with CB-PTSS. In a cross-sectional study of N = 1,140 individuals who had given birth eight to ten weeks before, we examined the following: the types of hotspots, differences in hotspot-related distress, interpersonal difficulties during the hotspot, and CB-PTSS between the various types of hotspots and whether hotspot-related distress and interpersonal difficulties independently predicted CB-PTSS. Participants completed several items based on previous qualitative work [1] to assess the worst hotspot, hotspot-related distress, and interpersonal difficulties during the hotspot and the City Birth Trauma Scale to measure CB-PTSS, alongside relevant pregnancy- and birth-related questions. Medical interventions were the most frequently experienced worst hotspot and separation from the child was associated with the highest levels of hotspot-related distress, interpersonal difficulties, and CB-PTSS. Hotspot-related distress and interpersonal difficulties independently predicted CB-PTSS. Examining intrapartum hotspots poses a promising approach to define highly negative birth experiences.

The lived experiences of childhood trauma in war: has post-traumatic growth occurred?

Background: This study seeks to explore the Post-Traumatic Growth (PTG) condition, a transformative psychological process that promotes improved cognitive functioning and resilience in individuals who suffered childhood trauma, including those affected by the Iran-Iraq war. PTG denotes positive psychological changes, such as enhanced reasoning abilities and emotional strength (Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1-18)).Method: This study views trauma responses as complex and multidimensional, including not only negative outcomes but also coping strategies and psychological growth. Data was collected through semi-structured interviews with 11 participants who witnessed the Iran-Iraq war during childhood. Participants were from a broad spectrum of ethnic backgrounds, reflecting the multiethnic diversity of the war-affected areas. This is significant as their cultural background could affect how they process and heal from trauma due to the multiplicity of values, beliefs, and behaviours. Also, participants' socio-economic backgrounds ranged from low to middle-income, allowing for an investigation of how trauma and growth are impacted by financial resources and constraints. Data were analyzed using Moustakas's phenomenological analysis approach.Results: The findings revealed eight primary and twelve secondary themes ranging from psychological effects and long-term coping mechanisms and wartime recollections. The analysis also revealed distinct patterns of trauma symptoms and growth in adults approaching middle age. The available evidence points to the fact that, although the war-afflicted participants had to contantly live with the lingering effects of trauma across different stages of their lives, they continued to flourish and remain resilient with efficient stress management.Conclusions: The study emphasizes that, in theoretical terms, unexpected developmental steps are crucial, suggesting that childhood trauma, while commonly associated with negative outcomes, can also lead to growth and resilience in certain circumstances.

Childhood maltreatment and non-suicidal self-injury: the mediating role of mentalization and depression

Background: Childhood maltreatment (CM) is recognized as one of the primary factors increasing the risk of non-suicidal self-injury (NSSI).Objectives: This study aims to further understand the impact of different types of CM on the mechanisms underlying NSSI risk by examining the potential mediating roles of mentalization and depression.Method: A self-report survey was conducted with 1645 Chinese youths (933 males, 712 females; mean age = 18.25, SD = 0.64) to evaluate their experiences of CM, depression, mentalization, and NSSI frequency over the past year. Structural equation modelling was utilized to examine the direct and indirect pathways linking CM to NSSI risk via mentalization and depression.Results: The study found that emotional abuse, physical abuse, mentalization, and depression had significant direct effects on NSSI risk. Moreover, mentalization and depression mediated the relationship between emotional abuse and NSSI risk, while emotional neglect and physical neglect indirectly influenced NSSI risk only through depression. Physical abuse had a significant direct effect on NSSI risk, whereas sexual abuse did not show any direct or indirect effects.Conclusions: The findings suggest that childhood emotional abuse has a markedly different impact compared to other forms of CM. Interventions focused on improving mentalization may be particularly effective in addressing the effects of emotional abuse, mitigating depression, and reducing the risk of NSSI.

Maternal-infant probiotic transmission mitigates early-life stress-induced autism in mice

Autism, a disorder influenced by both genetic and environmental factors, presents significant challenges for prevention and treatment. While maternal-infant gut microbiota has been a focus in autism research, preventive strategies targeting maternal gut microbiota remain underexplored. This study demonstrates that prenatal probiotic intake can effectively prevent maternal separation-induced autistic-like behaviors in offspring without altering the embryonic neurodevelopment in mice. Using specific PCR primers and cross-fostering experiments, we traced the vertical transmission of probiotics, primarily via fecal/vaginal contamination. Early probiotic colonization conferred resilience against stress-induced gut pathogenic microbes and Th17-mediated peripheral inflammation while significantly inhibiting hypermyelination and neuroinflammation linked to systemic inflammation. Microbial metabolites like tyrosol and xanthurenic acid alleviated neuroinflammation and hypermyelination in vitro, though the causal relationship among neuroinflammation, hypermyelination, and autism in vivo requires further validation. These findings underscore the importance of the maternal-infant microbiota transmission window in autism prevention and highlight the clinical potential of prenatal probiotic interventions.

Understanding and supporting parenting in parents seeking PTSD treatment: a qualitative study

Background: Parental post-traumatic stress disorder (PTSD) can impact parenting and child psychosocial wellbeing. Complementing trauma-focused psychotherapy with parenting interventions can thus have important preventive value. Understanding parents' lived experiences is necessary to tailor such interventions to their needs.Objective: This study addressed the question: how can preventive parenting support be shaped to the needs of parents entering specialized psychotherapy for PTSD? To answer this question, we investigated parenting challenges, parent-child communication about PTSD, strengths, and social support experiences of parents with PTSD.Method: The sample included 14 parents seeking PTSD treatment at a tertiary mental healthcare institution, while parenting children aged 4-17. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis.Results: On the one hand, parental dysregulation (e.g. exploding or shutting down) was an important challenge. On the other hand, parents' attempts to remain regulated (e.g. through overcontrol and overprotectiveness) also affected family life. When talking to their child about PTSD, parents were guided by what they considered beneficial for the child to know. An important strength was that parents tried to remain attuned to the child's needs, regardless of their own struggles. Parents also described experiences that could be understood as post-traumatic growth through parenting. Generally, parents experienced a lack of social support.Conclusion: Our findings illustrate that parents entering PTSD treatment are highly motivated to do what is best for their child. Based on parents' lived experiences, preventive parenting interventions should address the impacts of both dysregulation and overcontrolling regulation attempts. Another important goal is reducing feelings of incompetence. Integrating the parenting role in psychotherapy for PTSD could also be beneficial. For example, setting parenting-related therapy goals can be motivating. Furthermore, parent-child interactions can be a mirror that reflects the parents' inner state: considering these interactions can help recognize changes in symptomatology.

ICD-11 posttraumatic stress disorder and complex PTSD: prevalence, predictors, and construct validity in Swiss older adults

Background: This study assessed the prevalence rates, construct validity, predictors, and psychosocial factors linked to ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD), as assessed by the International Trauma Questionnaire (ITQ) in a German-speaking sample of Swiss older adults.Method: Participants were N = 1526 older adults aged 65+ (Mage = 72.34; SD = 6.20 years; age range = 65-95; female = 72.0%). Confirmatory factor analysis (CFA) tested alternative models of the latent structure of the ITQ. Risk factors and psychological outcomes associated with the ITQ subscales were also examined.Results: From the total sample, 86.2% had experienced at least one potentially traumatic event (PTE), with a median of three PTEs per person. Probable PTSD and CPTSD prevalence was 0.4% and 2.4%, respectively. CFA results indicated that a two-factor second-order model best captured the latent structure of the ITQ. Female gender and specific traumas, such as physical and sexual assault, were uniquely associated with PTSD. Fewer, non-specific factors were linked to disturbances in self-organization (DSO; encompassing affective dysregulation, a negative self-view, and difficulties in relationships). The PTSD and CPTSD factors were significantly associated with loneliness, anxiety, depression, and well-being.Conclusions: Results found that despite high trauma exposure among Swiss older adults, the prevalence of ICD-11 PTSD and CPTSD was low, with no significant gender differences. A two-factor second-order model provided the best fit for the ITQ. These findings indicate significant trauma exposure in Swiss older adults and the need for targeted interventions that address the trauma-specific and associated psychosocial challenges (i.e. loneliness, anxiety, depression, well-being) facing older adults.

Symptoms associated with concurrent chemoradiotherapy in patients with cervical cancer: Application of latent profile analysis and network analysis

Objective

This study aims to explore symptom subgroups and influencing factors among patients undergoing concurrent chemoradiotherapy (CCRT) for cervical cancer, to construct a symptom network, and to identify core symptoms within the overall sample and its various subgroups.

Methods

A cross-sectional survey was conducted with 378 patients undergoing CCRT for cervical cancer from June 2023 to May 2024 at a tertiary hospital in Anhui Province. Participants completed the General Information Questionnaire, the Symptom Assessment Scale for Patients Undergoing CCRT for Intermediate and Advanced Cervical Cancer, and the Dyadic Coping Inventory. Latent profile analysis (LPA) identified symptom subgroups, while multivariate logistic regression examined influences on these subgroups. Symptom networks were developed using R language to analyze centrality indices and identify core symptoms.

Results

Patients were classified into three subgroups: low symptom burden (n ​= ​200, 52.91%), moderate symptom burden with prominent intestinal response (n ​= ​75, 19.84%), and high symptom burden (n ​= ​103, 27.25%). Multivariate logistic regression indicated that age, tumor stage, chemotherapy frequency, and dyadic coping (DC) were predictive of subgroup membership (P ​< ​0.05). Network analysis revealed sadness (r s  ​= ​1.320) as the core symptom for the overall sample, nausea (r s  ​= ​0.801) for the low symptom burden group, and vomiting (r s  ​= ​0.705, 0.796) for both the moderate symptom burden with intestinal response prominence group and the high symptom burden group.

Conclusions

Three symptom subgroups exist among patients undergoing CCRT for cervical cancer, with sadness, nausea, and vomiting identified as core symptoms. Health care professionals should provide individualized symptom management tailored to these subgroups.

The role of long-term hair steroids as diagnostic and intervention-related biomarkers in a multimorbid inpatient sample with posttraumatic stress disorder

Background: Steroid hormone dysregulations have frequently been implicated in posttraumatic stress disorder (PTSD) pathogenesis. However, the translation into naturalistic clinical settings as markers of symptomatology and treatment success remains complex. Particularly, there is little longitudinal data on steroid secretion over the course of interventions.Objective: This study examined the potential of long-term steroid hormone secretion assessed in hair as diagnostic and intervention-related biomarkers among medicated, multimorbid inpatients with PTSD.Method: As part of a secondary analysis of a randomised controlled trial, 54 female inpatients with a primary diagnosis of PTSD received standardised treatment and provided hair samples at pre-treatment, post-treatment, and 3-month follow-up. Cortisol, cortisone, and dehydroepiandrosterone (DHEA) were determined, alongside clinical assessments.Results: Cross-sectional results showed a negative association of pre-treatment DHEA with anxiety symptoms and a trend-level association with lifetime trauma exposure. While inpatients improved in PTSD symptomatology during treatment, neither pre-treatment steroids, nor treatment-induced steroid changes predicted PTSD symptoms at post-treatment or 3-month follow-up.Conclusion: The study highlights the challenges of establishing biomarkers in naturalistic clinical populations. While the association of attenuated DHEA with anxiety symptoms warrants further exploration, our data points towards the potential necessity of patient sub-sample selection to understand, and in the long run clinically target, the endocrine mechanisms in PTSD.

Trauma exposure, prevalence and associated factors of complex PTSD in mainland China: a cross-sectional survey

Background: The ICD-11 distinguishes Complex Post-Traumatic Stress Disorder (CPTSD) as a separate trauma-related disorder from PTSD. While numerous studies have examined these conditions globally, no nationwide research has yet investigated their one-month prevalence and associated factors in the general population of China.Objective: This study aimed to determine the one-month prevalence of ICD-11 CPTSD and identify associated factors within a general adult sample in mainland China.Methods: A total of 2,115 adults living in mainland China participated in an online survey. PTSD and CPTSD were assessed using the International Trauma Questionnaire (ITQ) based on ICD-11 criteria. Trauma exposure was measured via the International Trauma Exposure Measure (ITEM). Multinomial logistic regression identified associated factors for PTSD and CPTSD.Results: Among participants, 88.2% reported at least one traumatic exposure. The prevalence of PTSD and CPTSD was 4.9% and 4.5%, respectively. Shared predictors for both conditions included a greater number of siblings, broader interpersonal trauma exposure during adolescence, and more frequent and recent index trauma events. Specific predictors for CPTSD included female gender, older age, being left behind by migrant parents, lower socioeconomic status, and broader trauma exposure in adulthood.Conclusion: This study provides the first estimates of ICD-11 PTSD and CPTSD prevalence in the general population of mainland China, revealing relatively high rates compared to other mental disorders. Findings highlight key associated factors and offer intervention recommendations for at-risk groups.

Prevalence of war-related posttraumatic stress disorder in adolescents: a systematic review and meta-analysis

Background: Posttraumatic stress disorder is common in civilians who are currently experiencing, or who have experienced, war. Most previous studies have focused on adult populations and, despite the recognised detrimental effect of war trauma on adolescent mental health, there remains a paucity of evidence on the prevalence of war-related PTSD in adolescents.Objective: This pre-registered (https://osf.io/dqg2z) systematic review and meta-analysis aims to understand the prevalence of PTSD, as well as both risk and protective factors for developing PTSD, in adolescents aged 10-24 years from across the world who are experiencing, or have experienced, war-related traumatic events, described in papers published in a 10 year period (2013-2023). We also examine how the choice of PTSD diagnostic assessment tool influences prevalence rates.Method: Medline (PubMed), PsycINFO (EBSCOhost), and PTSDpubs (ProQuest) were searched, which resulted in 21 papers eligible for inclusion. Data was searched, extracted and synthesised using the software tool Covidence.Results: The age range of adolescents in the included papers was 11-19 years. The average prevalence of PTSD was 29.4% (95% CI [18.7%, 43.0%]), although prevalence rates across studies were highly inconsistent (I2 = 99.4%). Prevalence rates were significantly higher in studies conducted longer after war exposure, and the PTSD diagnostic assessment tool used influenced prevalence.Conclusions: There is high prevalence of PTSD in adolescents during and after war. The prevalence of war-related PTSD increases with time in the post-war period, highlighting the need for access to psychological services following war. This study underscores the importance of defining age ranges and using validated and culturally sensitive assessment tools when interpreting prevalence rates of PTSD in adolescents.

MBSR effects on positive psychological traits and experiential avoidance in head and neck cancer: a randomized controlled trial

Background: Data on the effects of mindfulness-based stress reduction (MBSR) positive psychological traits and experiential avoidance (EA) among cancer patients are lacking.Objective: This randomized controlled trial (RCT) aimed to: (1) compare the efficacy between MBSR and treatment-as-usual (TAU) control groups in increasing posttraumatic growth (PTG), hope, and optimism and reducing EA across time measurements (T0, T1, and T2) among head and neck cancer (HNC) patients and (2) evaluate the mediation effects of hope, optimism, and EA on the relationship between MBSR and PTG.Methods: A total of 80 HNC participants were randomized to MBSR (n = 40) and TAU (n = 40) groups with the researchers and data analyst blinded, and the group allocation of the participants was concealed. A one-hour MBSR session was conducted once a week, with 45 minutes of home assignments, for six weeks in the MBSR group. The outcomes across time measurements were compared using a mixed linear model following intention-to-treat (ITT) analysis. Mediation effects of hope, optimism, and EA on the relationship between MBSR and PTG were assessed with PROCESS.Results: MBSR significantly increased the degree of optimism from T0 to T1 (mean difference = 1.825, 95% CI = 0.907-2.743, SE = 0.381, p < .001) with a medium effect size (d = 0.563) and from T1 to T2 (mean difference = 1.650, 95% CI = 0.829-2.470, SE = 0.328, p < .001) with a medium effect size (d = 0.630). Initially, MBSR did not increase the degree of hope from T0 to T1 (p = .677), but it significantly increased hope from T1 to T2 (mean difference = 2.524, 95% CI = 1.676-3.373, SE = 0.340, p < .001) with a medium effect size (d = 0.735). Conversely, MBSR did not sustain the changes in the degree of PTG and EA beyond T1. EA partially mediated the relationship between MBSR and PTG, but not hope and optimism.Conclusion: MBSR can be recommended as part of the treatment regimen for HNC patients.Trial registration: ClinicalTrials.gov identifier: NCT04800419.

Sharing traumatic stress research data: assessing and reducing the risk of re-identification

Background: FAIR Data practices support data sharing and re-use and are essential for advancing science and practice to benefit individuals, families, and communities affected by trauma. In traumatic stress research, as in other health and social science research, ethical, legal, and regulatory frameworks require careful attention to data privacy. Most traumatic stress researchers are aware of basic methods for de-identifying/anonymising datasets that are to be shared. But our field has not generally made use of systematic, data analytic approaches to reduce the risk of re-identification of study participants or disclosure of personal or sensitive information.Objective: To facilitate safe and ethical data sharing by better preparing traumatic stress researchers to systematically assess and reduce re-identification risk using contemporary data analytic methods.Method: In two case studies using publicly available trauma research datasets from international, multi-language projects, we applied a systematic approach guided by the Checklist for Reducing Re-Identification Risk in Traumatic Stress Research Data.Results: For each case study dataset, we identified specific recommended actions to further reduce the risk of re-identification, and we then communicated these recommendations to the original investigators. After implementing the recommended changes, each dataset is judged to be at very low re-identification risk.Discussion: The particular nature of traumatic stress research, i.e. its content, data, and study designs, can influence the likelihood and potential impact of re-identification or disclosure. The two worked case examples in this paper demonstrate the utility of applying a systematic approach to assess and further mitigate re-identification risk in shared datasets. At each stage of the research data lifecycle, there are research practices and choices relevant to reducing re-identification risk. This paper presents practical tips for research teams to facilitate FAIR data practices while attending to data privacy.

Childhood abuse and neglect and adult body attitude

Background: The body is the medium through which humans experience the world, and the body is key to most suffering, healing, and clinical mental diagnoses. Body attitude refers to the affective, cognitive, and behavioural aspects of embodiment, which typically is more negative in clinical samples.Objective: We examine how adult body attitude is associated with self-reported childhood abuse and neglect. We hypothesised that child sexual abuse is associated stronger with a negative adult body attitude than emotional or physical abuse/neglect would. Second, we expected that the association between body attitude and childhood sexual abuse was gender equivalent. Third, we expected a more positive body attitude in men than women after childhood physical abuse/neglect or emotional abuse/neglect.Method: Body attitude was measured with the Dresden Body Image Questionnaire (DBIQ-NL) and the severity and type of childhood trauma with the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in 749 Dutch adults aged 18-77. We fit multiple regression models and focused on childhood abuse and neglect with moderate to severe intensity.Results: Childhood sexual abuse (∼15%), physical neglect (∼14%), emotional abuse (∼20%) and emotional neglect (∼30%) are associated with a more negative body attitude, while childhood physical abuse (moderate/severe, ∼6%) associated with a slightly more positive adult body attitude. Body attitude associations with childhood abuse/neglect were similar for both genders (no moderation).Conclusion: Child maltreatment seems to precede the development of a more negative adult body attitude and more negative body experiences compared to individuals without child maltreatment.

Latent profile analysis of emotional inhibition in older adults with gastrointestinal tumors: A cross-sectional study

Objective

This study aimed to explore the current status of emotional inhibition in older adults with gastrointestinal tumors and to analyse its influencing factors.

Methods

From September to November 2024, 362 older adults with gastrointestinal tumors completed a self-designed questionnaire on demographic and clinical characteristics, an emotional inhibition scale, a self-esteem scale, and a multidimensional scale of perceived social support. Latent profile analysis was used to classify emotional inhibition in the participants, and multiple logistic regression was used to analyse the factors influencing each subgroup.

Results

Based on the level of emotional inhibition, older adults with gastrointestinal cancer were divided into three subgroups: "low emotional inhibition-active disclosure" (40.0%), "medium emotional inhibition" (41.2%), and "high emotional inhibition-disguise feelings group" (18.8%). The multivariate logistic regression analysis showed that sex, living conditions, disease stage, self-esteem level, and perceived social support were factors influencing participants' emotional inhibition (P ​< 0.05).

Conclusions

Emotional inhibition levels vary among older adults with gastrointestinal cancer. Medical staff should consider the characteristics, self-esteem, and perceived social support of the patients. Additionally, more targeted interventions, such as cognitive-behavioural group therapy or mindfulness-based cognitive therapy, should be developed to reduce patients' emotional inhibition.

Exposure to warfare and demoralization: acute stress symptoms and disengaged coping as a mediators

Background: Demoralization in the face of adversity is a common existential state. However, it has not been examined in reaction to warfare, and the mediators between the extent of exposure to war and demoralization in this context are also unknown.Objective: This study explored the associations of indirect exposure to war, acute stress symptoms, disengaged coping, and demoralization. Additionally, it examined the serial mediation of acute stress symptoms and disengaged coping in the relationship between indirect exposure to war and demoralization.Method: The survey was conducted 4 weeks after the 7 October war broke out and included 393 Israeli citizens (women and men, Jews and Arabs) indirectly affected by the threatening situation in Israel. Questionnaires measured acute stress symptoms, disengaged coping, and demoralization. War-related exposure and demographic data were collected.Results: The analysis revealed that the higher the indirect exposure to war, the higher the acute stress symptoms, use of disengaged coping, and demoralization. Additionally, individuals with acute stress disorder had higher demoralization. The serial mediation model showed partial mediation: acute stress symptoms and the use of disengaged coping mediated the relationships between indirect exposure to war and demoralization (although the direct association between the extent of exposure and demoralization remained significant).Conclusions: In the face of traumatic events, such as warfare, professionals should identify individuals with high levels of acute stress symptoms and provide help to reduce the use of disengaged coping and long-term negative consequences such as demoralization.

From digital harm to recovery: a multidisciplinary framework for First Aid after Online Sexual Abuse

Online sexual abuse in adolescence encompasses various forms of digital exploitation, including grooming, sexting, sextortion, and image-based sexual abuse. Current research indicates that a significant proportion of minors are exposed to online sexual abuse. The psychological impact on victims includes severe mental health issues, such as depression, anxiety, and post-traumatic stress symptoms. Responses to online sexual abuse disclosures often require a multidisciplinary approach. In the Netherlands, Sexual Assault Centers (SACs) utilize the First Aid after Online Sexual Abuse protocol. This approach addresses immediate safety and (forensic) medical concerns, facilitates the removal of image-based content, and supports natural recovery while providing referrals for psychological treatment if needed. This paper highlights the urgent need for a comprehensive, multidisciplinary response to online sexual abuse, emphasizing the importance of integrating psychological, medical, and legal support to tackle the complex challenges posed by online abuse, ensuring effective, context-sensitive interventions, and supporting victims' recovery and well-being.

Social determinants of hazardous alcohol use in a Ugandan population cohort

BACKGROUND

There is a limited population-based data on hazardous alcohol use and associated social determinants in many African countries.

OBJECTIVES

To examine patterns of hazardous alcohol use across a range of social determinants of health in Uganda, with a particular focus on gender differences.

METHODS

This cross-sectional study used data collected in 2021-2022 from an open population cohort spanning urban, semi-urban, and rural communities. Alcohol use was assessed with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Covariates were selected according to the WHO's Social Determinants of Health framework. Poisson regression with robust variance was used for data analysis.

RESULTS

Of the 3459 participants, 2085 (60%) were women. Overall, the prevalence of hazardous alcohol use was 5% among women and 18% among men. Strong positive associations with hazardous use were found for individuals residing in semi-urban areas (female aPR 2.1 [95% CI 1.3-3.3], male aPR 1.8 [95% CI 1.4-2.5]), past-year perpetration of intimate partner violence (female aPR 2.2 [95% CI 0.8-5.6], male aPR 1.4 [95% CI 0.9-2.2]), smoking, middle age for men (aPR 1.6 [95% CI 1.2-2.2]), and employment as a vendor in a restaurant or bar for women (aPR 1.5 [95% CI 1.0-2.2]). Strong negative associations were found for high educational attainment, Muslim or Pentecostal religion, and living in a marriage or union for women (aPR 0.7 [95% CI 0.5-1.0]).

CONCLUSIONS

Hazardous alcohol use was prevalent, especially among men, in a representative Ugandan population sample. Specific target groups for public health and clinical interventions were identified, such as women working in the hospitality sector. Residents of semi-urban communities may encounter unique risks for hazardous alcohol use, compared with rural and highly urban populations.

Trait dissociation in borderline personality disorder: influence on immediate therapy outcomes, follow-up assessments, and self-harm patterns

Background: Dissociative symptoms are suggested to compete with the effectiveness of psychotherapeutic treatment and frequently co-occur with early life trauma and self-harm patterns, including self-injury, suicidal ideation, and suicide attempts, which are characteristic for borderline personality disorder (BPD).Objective: We explore the connections between dissociation and other BPD features like self-harm and childhood traumatization and examine the impact of trait dissociation on both immediate and follow-up psychotherapy outcomes.Method: In this naturalistic prospective evaluation study, we investigated psychopathology including general psychological distress (SCL-90), depression (BDI-II), and borderline-specific pathology (BSL) in 131 patients with BPD pre and post of a certified 8-week inpatient Dialectical Behaviour Therapy (DBT), as well as 3- and 6-month post inpatient treatment. Prior to therapy, we evaluated trait dissociation (Dissociative Experience Scale), early life trauma (Childhood Trauma Questionnaire), and self-harm patterns (clinical interview). We performed a network analysis to explore the interplay between dissociation, self-harm, and childhood traumatization. To analyse the influence of dissociation on treatment outcomes, we employed linear mixed models.Results: Psychopathology (SCL-90, BDI-II and BSL) exhibited significant reductions at post-treatment and follow-up assessments when compared to baseline measurements. Higher levels of trait dissociation were consistently related to higher psychopathology but did not suggest poorer symptom reduction during DBT. However, trait dissociation predicted reduced 6-month follow-up benefits from DBT, regardless of the baseline symptom burden. The network analysis revealed a close association between self-injury and derealization/depersonalization, while the frequency of suicide attempts was more closely connected to childhood emotional abuse, which was identified as a central node of the network.Conclusions: Dissociation was not related to poorer outcomes regarding inpatient DBT. However, trait dissociation predicted reduced follow-up benefits, highlighting the need to address dissociation during psychotherapeutic interventions. Based on the estimated network structure, treating dissociative symptoms could potentially mitigate self-injury while especially childhood emotional abuse was linked with suicide attempts.

The International Trauma Interview (ITI): development of a semi-structured diagnostic interview and evaluation in a UK sample

Background: The International Trauma Interview (ITI) is a structured clinician-administered measure developed to assess posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined in the 11th version of the International Classification of Diseases (ICD-11). This study aimed to investigate a psychometric evaluation of the ITI and to finalise the English language version.Method: The latent structure, internal consistency, interrater agreement, and convergent and discriminant validity were evaluated with data from a convenience sample, drawn from an existing research cohort, of 131 trauma exposed participants from the United Kingdom reporting past diagnosis for PTSD or who had screened positively for traumatic stress symptoms. A range of self-report measures evaluating depression, panic, insomnia, dissociation, emotion dysregulation, negative cognitions about self, interpersonal functioning and general wellbeing were completed.Results: Confirmatory factor analysis supported an adjusted second-order two-factor model of PTSD and disturbances in self-organisation (DSO) symptoms, allowing affect dysregulation to also load onto the PTSD factor, over alternative models. The ITI scores showed acceptable internal consistency, and interrater reliability was strong. Findings for convergent and discriminant validity were mostly as predicted for PTSD and DSO domains. Correlations with the ITQ were good but coefficients for the level of agreement of PTSD diagnosis and CPTSD diagnosis between the ITI and the ITQ were weaker, and item level agreement was variable.Conclusion: Results provide support for the reliability and validity of the ITI as a measure of ICD-11 PTSD and CPTSD. Final revisions of the ITI are described.

"They are just as different as the rest of us" - a focus group study of primary teachers' perceptions of children with ADHD who struggle socially

PURPOSE

Difficulties in peer interactions are common among children with ADHD and associated with severe consequences. Prevailing interventions have been criticized for not accounting for the significance of context and for limited effect on important social outcomes. Given the importance of the school environment and the teacher for children's social development, we wanted to explore how teachers perceive their own role and responsibilities when children are struggling socially, and how they intervene in their daily practice.

METHODS

We conducted semi-structured interviews in five focus groups of primary school teachers in Bergen, Norway and analysed the data through reflexive thematic analysis.

RESULTS

We discerned two overarching themes, each with several subthemes. The first theme, "Monitoring and Attending to Individual Needs in a Context", represents teachers' perceptions of their role and responsibilities. The second theme, "Tailoring Interventions Through Continuous Assessments", represents the teachers' strive to fulfil this role in their everyday practice.

CONCLUSION

Our findings reflect a complex, contextual understanding of social difficulties, acknowledging the uniqueness of each child, regardless of diagnosis. The teachers' practice was characterized by continuous tailoring to accommodate the specific, contextualized needs of each child, both "behind the scenes" and trough participating in children's everyday social interactions.

Dissociative experiences in individuals with subclinical psychosis and a history of developmental trauma: a qualitative study

Background: Among individuals with psychotic experiences, those with a history of developmental trauma face greater symptom severity and worse clinical outcomes compared to those without. Dissociation constitutes a prominent, characteristic of this group's clinical presentation, whose nuances and associated characteristics remain however understudied in psychosis research. We aimed to address this gap by conducting a qualitative study to investigate the phenomenology, context, and impact of dissociative experiences in individuals with subclinical psychosis and a history of developmental trauma.Methods: 25 UK-based participants with a history of developmental trauma and meeting criteria for subclinical psychosis, based on the CAPE-15, were recruited via social media. Participants attended semi-structured interviews online, which were transcribed verbatim and analysed with thematic analysis by two researchers.Results: Thematic analysis yielded the following themes: (1) Phenomenology of Dissociation; (2) Context of Dissociation; (3) Impact of Dissociation; (4) Dissociation and Psychotic-like Phenomena. Participants described experiences of detachment and compartmentalisation, which when experienced were confusing and often distressing. Dissociation was linked to affective experiences, their history of developmental trauma and psychotic-like experiences.Conclusion: This study elucidates the complex and varied nature of dissociative experiences in individuals with subclinical psychosis with a history of developmental trauma. These findings highlight the need for further research to understand the manifestation of dissociation in this population and the links with distress and other aspects of psychopathology. Importantly, it is essential to use this understanding to inform the development of interventions and improve clinical recognition and management.

Treatment stigma mediates relationships between morally injurious events and depression, PTSD and anxiety symptoms

Background: Morally injurious events (MIEs), encompassing personal transgressions, witnessing others commit transgressions, or experiencing betrayal by leaders, can conflict with one's moral/ethical principles, evoking outrage and profound mistrust. Although MIEs are associated with depression, PTSD, and anxiety, the mechanisms linking MIEs to psychiatric symptomatology remain unclear, especially among civilians in times of collective trauma.Objective: This study explored one potential mechanism: stigma toward mental-health treatment, which can deter help-seeking and exacerbate guilt, shame, and mistrust.Method: We focused on civilians (N = 1,052) exposed to MIEs in conflict zones in southern and northern Israel following the 7 October 2023 attack. Participants were recruited using an online platform and assessed for depression, PTSD, and anxiety symptoms. We hypothesised that stigma toward treatment would mediate relationships between MIE exposure levels and depression, PTSD, and anxiety symptoms.Results: Results showed high MIE exposure levels and symptomatology among civilians in conflict zones. Moreover, we found significant indirect effects of stigma toward treatment on all three symptom types.Conclusions: Our findings suggest that while MIEs directly link to symptoms, stigma toward treatment plays a significant role in understanding this link. These findings emphasise the importance of addressing stigma toward treatment for individuals experiencing MIEs and underscore the need for targeted interventions in conflict zones.

'Man up and get on with it': a qualitative exploration of UK ex-serving personnel's experiences of seeking help for self-harm and suicidal behaviours

Background: A substantial proportion of UK military personnel experiencing mental health problems do not seek professional support. Although the promotion of help-seeking is a key suicide prevention strategy, little is known about help-seeking for self-harm and suicidal behaviours among the UK Armed Forces.Objective: This study aimed to explore UK ex-serving personnel's experiences of seeking help for self-harm, suicidal ideation, and suicide attempts.Method: Participants were recruited via an existing longitudinal cohort study exploring the health and well-being of the UK Armed Forces. A subgroup of ex-serving personnel reporting lifetime self-harm and/or suicidal behaviours was invited to participate in semi-structured interviews and 15 individuals participated, representing help-seekers/non-help-seekers and formal/informal support. Interviews were analysed using reflexive thematic analysis.Results: Five distinct but related and interacting themes were developed: (1) military mindset; (2) stigma; (3) fear of consequences; (4) access to and awareness of support; and (5) facilitators to help-seeking.Conclusions: Help-seeking decisions and experiences were influenced by several barriers and facilitators. Providing an environment where military populations feel willing and able to access support for self-harm and suicidal behaviours could lessen the impact on their health and well-being and ultimately save lives.

C-METTA reduces PTSD-related guilt and shame following interpersonal violence

Background: PTSD patients who experienced interpersonal violence are susceptible to trauma-related guilt and shame and often show unsatisfactory treatment response. C-METTA combines cognitive techniques and loving-kindness meditation. It has shown promising effects in reducing trauma-related guilt and shame.Objective: We examined the effectiveness of C-METTA within a quasi-experimental one-group pretest-posttest trial focusing on survivors of interpersonal violence, who suffered from trauma-related guilt and shame. An additional objective was to examine variables potentially associated with lower treatment response (childhood trauma, cumulative trauma, and PTSD chronicity).Method: We treated 25 individuals (age = 19-61, 96% women) with PTSD following interpersonal violence. We predicted that C-METTA would significantly reduce (a) PTSD symptoms (measured by the Clinician Administered PTSD Scale, the PTSD Symptom-Checklist Version 5, and the Posttraumatic Cognitions Inventory), (b) feelings of guilt (measured by the Trauma Related Guilt Inventory) and (c) feelings of shame (measured by the Trauma Related Shame Inventory). To analyse treatment effects, we conducted repeated-measures MANOVAs. Further, we investigated the impact of childhood trauma, cumulative trauma and PTSD chronicity symptoms on treatment effectiveness exploratively via additional MANCOVAs.Results: Analyses showed significant and large effects of C-METTA on reducing PTSD symptoms (ranging from d = 1.12 to d = 1.67), feelings of guilt (d = 1.54) and shame (d = 1.26). Childhood trauma, cumulative trauma and PTSD chronicity did not affect treatment effectiveness.Conclusion: Our findings support previous research concerning the effectiveness of C-METTA and add promising evidence for the effectiveness of C-METTA to reduce PTSD following interpersonal violence. Effectiveness was independent of childhood trauma, trauma-duration and PTSD chronicity. Regression to the mean should be considered as a confounding factor. We suggest more research to support the results. C-METTA might increase PTSD treatment diversity and offer patients a greater bandwidth of options according to their preferences and the respective symptomatology.

Low neuroticism as an indicator of resilience: a longitudinal study of Danish soldiers before, during and after deployment

Background: Posttraumatic stress disorder (PTSD) is a serious and debilitating condition among military veterans. Exposure to potentially traumatic events (PTEs) may lead to PTSD and PTE sensitivity may be influenced by the personality trait neuroticism.Objective: The current investigation aims to test whether exposure to PTEs during deployment is associated with changes in PTSD symptoms, and whether individual levels of neuroticism are related to resilience or sensitivity to such exposures.Methods: The study sample included 701 Danish soldiers deployed to Afghanistan in 2009. PTSD symptoms were measured pre-, peri- and post-deployment (T1-T3) with the PTSD Checklist-Civilian Version. PTSD symptom load was modelled in a mixed linear model along with an extensive list of covariates. Interactions between time, exposure, and neuroticism were tested in order to assess whether neuroticism moderated the effect of PTEs upon PTSD symptoms.Results: On average, PTSD symptoms decreased from T1 through T3. Factors associated with higher PTSD symptom levels included number of past trauma, neuroticism, and low age at deployment. Interaction analyses showed that individuals with low and medium neuroticism levels displayed no significant change in PTSD symptoms, and individuals with high neuroticism displayed a significant decrease in PTSD symptoms. These changes were consistent across levels of perceived exposure to danger and combat and witnessing the consequences of war.Conclusions: Results indicate that low levels of neuroticism appear to be related to resilience. Individuals with high levels of neuroticism displayed elevated PTSD symptoms across all time points, but contrary to expectations, they reported a significant decrease in PTSD symptoms from pre- to post-deployment.

Therapists perspectives on the Early Intervention after Rape study: a qualitative process evaluation of a randomized controlled trial

ABSTRACTBackground: Early interventions using trauma-focused cognitive behavioural therapy have the potential to alleviate post-traumatic stress symptoms in individuals who have experienced recent sexual assault. Specialized Sexual Assault Centers (SACs) in Norway offers psychosocial support, however, this support varies across SACs and its efficacy has not been researched. The Early Intervention after Rape (EIR) study is a multisite randomized controlled trial designed to assess the efficacy and effectiveness of training SAC nurses and social workers to deliver a modified version of prolonged exposure therapy shortly after rape.Objective: This article aims to present a qualitative process evaluation of the implementation of the EIR study across three SACs in Norway, from the perspective of nurses and social workers.Method: We conducted semi-structured interviews with fifteen nurses and social workers, ten of whom received training in prolonged exposure therapy (mPE). We used Thematic Analysis to identify themes and subthemes.Results: Thematic analysis yielded four significant themes for process evaluation: (1) The quality of the new intervention modified prolonged exposure was considered satisfactory through training and supervision and delivered with good adherence to the manual, although some therapists perceived the manual as too rigid; (2) Adoption dynamics within the SACs are complex and include both enthusiasm for clinical research as well as resistance to change; (3) Narrow inclusion criteria and burden with participation for patients may limit reach and representativeness of the RCT; (4) Unintended consequences were identified, such as delayed start, conflicting advices and cross-contamination, underscoring the ongoing necessity for process evaluation alongside RCTs.Conclusion: This qualitative process evaluation offers insight into real-world clinical challenges with implementing a new intervention and conducting a multisite RCT within SACs in Norway. This study may inform opportunities to advance evidence-based practices for rape survivors seeking help.Trial registration: ClinicalTrials.gov identifier: NCT05489133..

Helpful but not enough: exploring participants' experiences of a digital therapist-guided prolonged exposure treatment for PTSD

Background: Post-traumatic stress disorder (PTSD) can be a severe psychiatric condition, and access to timely evidence-based treatment is often limited. Prolonged exposure is recommended as first line treatment in clinical guidelines. There is limited research on how digital formats of prolonged exposure used to increase treatment availability impact user experience. Therefore, we wanted to investigate patients' experiences of prolonged exposure in a therapist-guided internet-delivered format (HOPE; Huddinge Online Prolonged Exposure), as part of an uncontrolled feasibility study.Method: Semi-structured interviews were conducted with a total of 14 participants upon their completion of HOPE.Results: Thematic analysis revealed that participants found HOPE to be helpful and effective, especially valuing the flexibility in the digital treatment format. However, a subset of participants reported that HOPE did not meet their needs entirely, indicating room for improvement and tailoring of treatment to individual preferences and needs.Conclusion: This study represents the first exploration of internet-delivered prolonged exposure therapy within a Swedish psychiatric setting, comprising participants characterized by moderate to severe PTSD and self-rated complex PTSD. The results could help guide the development of more accessible and acceptable treatments for PTSD, ultimately improving treatment quality.

Experiences and impact of moral injury in prisons

Moral injury is the persistent mental or emotional distress resulting from events that challenge one's moral beliefs. It is characterised by intense shame, guilt, worthlessness, disgust or anger and can contribute towards the development of serious mental disorders. The nature of working in prisons means that staff often face physically and psychologically challenging scenarios, and prison staff report high rates of mental ill-health and suicidal thoughts. Equally, detainees may be especially vulnerable to moral injury-related mental health difficulties having engaged in illicit actions and been found guilty by a jury of their peers as well as, in high profile cases, the court of public opinion. Despite this, there is an evidence gap about the extent of moral injury in both prison staff and detainee populations, and about how prison staff/detainees can be better supported. How struggling with moral injury may be linked to reoffending amongst detainees and burnout or resignations in prisons staff is currently unknown. In resource strapped prison settings, emerging treatments for moral injury-related mental health difficulties are unlikely to be appropriate or feasible. In this article, we highlight the contexts in which moral injury may arise; the unique challenges to treatment and support for moral injury in prison settings; and offer targeted recommendations for future research and clinical practice.

Recall bias secondary to major trauma: results from a prospective study of the Beirut Port Blast

Background: Traumatic events are often perceived as unforgettable, yet scientific evidence highlights the complexity of memory recall in the aftermath of traumatic experiences. While some studies observed amplification of traumatic memory, others reveal rapid forgetfulness and falsification of details.Objective: The primary objective of this study is to investigate how initial memories of the Beirut Port Blast in 2020 fluctuate over time. Going beyond full-threshold self-reported post-traumatic stress disorder (PTSD) and self-reported acute stress disorder (ASD), the research aims to explore subthreshold self-reported PTSD and individual self-reported ASD symptoms as potential predictors of recall bias among healthcare workers.Method: This study draws on data from four waves of the ongoing B.L.A.S.T. (Beirut Longitudinal Assessment Study of Trauma) study which spans so far over a period of two years.Results: Being a clinical professional and having higher self-reported ASD symptoms in wave 1, specifically intrusion symptoms, were associated with recall diminishment. Higher self-reported PTSD, subthreshold self-reported PTSD diagnoses (six plus or majority) and higher anxiety scores were significantly associated with exaggeration of recall.Conclusion: The study underscores the importance of assessing a broad range of symptoms, beyond conventional diagnoses, to gain a comprehensive understanding of how traumatic memories are recalled and potentially altered over time.

COVID-19 hardship and mental health in Chilean parents: the role of disaster exposure and family resilience

Background: The negative mental health effects of the pandemic on families are well documented, while factors that buffer or increase such effects still need further investigation. Previous exposure to adversity might increase the negative impact of pandemic experiences. On the other hand, family resilience may protect against these negative effects, and may also be regarded as a mediator explaining the negative association between pandemic hardship and mental health.Objective: The current study focused on the effects of COVID-19-related hardship on parental mental health. We evaluated the impact of the individual experiences with the COVID-19 pandemic on mental health among Chilean parents from a community sample, who were exposed in varying levels to a destructive earthquake and tsunami approximately 10 years earlier.Method: Participants (N = 219) completed online measures of pandemic hardship, mental health, disaster hardship related to the past earthquake, and family resilience. We examined the moderating role of disaster exposure and the moderating and mediating role of family resilience on the current impact of the pandemic on mental health.Results: Individual exposure levels of COVID-19 hardship were associated with mental health complaints. Both previous disaster hardship and family resilience were associated with mental health complaints. However, previous disaster hardship did not moderate the relationship between pandemic hardship and mental health complaints, nor did family resilience moderate or mediate it.Conclusions: These results align with the evidence of the negative emotional impact of pandemic-related stressors, and propose family resilience and past disaster exposure as relevant predictors of mental health during the sanitary emergency. Findings are discussed in the broader social context in Chile and warrant adjusting public policies towards those underserved groups heavily affected by the pandemic.

Accuracy of the Pediatric Emotional Distress Scale - Early Screener to predict the risk for developing PTSD in young children after accidental injury

Early identification of posttraumatic stress disorder (PTSD) in children is important to prevent chronic symptoms and long-term negative consequences. However, PTSD often goes unrecognized in the emergency setting of hospitals and screening methods for young children are lacking.

To evaluate the accuracy of an early screening tool for PTSD in a sample of young children (0-7 years) after unintentional injury.

The Pediatric Emotional Distress Scale - Early Screener (PEDS-ES) was administered to parents of children referred to the Emergency Department within 7 days post-accident (n = 82), and a validated interview for PTSD was administered 3 months after the accident as criterion measure: the Diagnostic Infant and Preschool Assessment (DIPA). Diagnostic accuracy of the PEDS-ES was inspected using area under the curve analyses including sensitivity, specificity, Positive and Negative Predictive Value.

After three months PTSD diagnosis was established in 21% of the children. Use of the PEDS-ES within 7 days after the injury showed fair accuracy with AUC = .727. Sensitivity (0.65) and specificity (0.73) for the suggested cutoff of 8 were moderate for predicting PTSD diagnosis 3 months after the injury. The examination of cutoff values that achieve enhanced sensitivity in a screening context - where sensitivity is prioritized - while maintaining a high level of specificity suggests that a lower cutoff of around 6 points may serve as a more sensitive (sensitivity: 0.82; specificity: 0.56) valid alternative cutoff score.

The PEDS-ES allows for successful early screening of risk for traumatic stress symptoms in young children after single accidental injury. It enables early identification of individuals who are at risk for developing PTSD and need further monitoring of symptoms, diagnostic assessment and treatment.

Identifying traumatization in young children through structured play: validation of the Odense Child Trauma Screening (OCTS) in Lithuania

Background: There is a need for valid methods to evaluate young children's (4-8 years) psychological difficulties related to traumatic experiences. The Odense Child Trauma Screening (OCTS), developed by Danish researchers, is a play-based story stem assessment tool developed to screen for indicators of traumatization in young children. Just a few studies of the OCTS have been published so far.Objective: The current study aimed to test the reliability and convergent validity of the OCTS in the Lithuanian community and risk subsamples of young children aged 4-8 years.Method: The total sample consisted of 209 participants (58.9% girls) from the community (47.4%) and risk (52.6%) subsamples, Mage = 6.29 (SD = 1.48). All children were screened with the OCTS, and caregivers completed self-report questionnaires: demographics, the Child and Adolescent Trauma Screen-Caregiver (CATS-C), and the Strengths and Difficulties Questionnaire (SDQ).Results: The data suggests that the OCTS has good inter-rater reliability. The OCTS, SDQ, and CATS-C scores were significantly higher in the risk subsample, with small to large effect sizes. Boys and younger children (3-4-year-olds) scored higher on the OCTS. Out of all the OCTS stories, the Burnt hand story had significant correlation coefficients with all the CATS-C PTSD symptoms.Conclusions: The study provides initial information about the reliability and the validity of the OCTS and calls for further exploration of this instrument. There were also variations in scores between the Lithuanian data and an earlier study of the Danish sample. Future studies on the OCTS would benefit from further cross-cultural, reliability and the validity examination.