Place and Posttraumatic Stress Disorder

Trauma and its consequences in Iran: cross-cultural adaption and validation of the Global Psychotrauma Screen in a representative sample

BACKGROUND

Potentially traumatic events may lead to the development of a wide range of adverse psychological responses, including symptoms of anxiety, depression, and (complex) posttraumatic stress disorder (PTSD). Despite the high prevalence of potentially traumatic events in Iran, there is no population data nor evidence-based instrument to screen for cross-diagnostic psychological responses to trauma. The Global Psychotrauma Screen (GPS) is a transdiagnostic self-report instrument for the detection of trauma-related symptoms, as well as risk and protective factors related to the impact of potentially traumatic events.

OBJECTIVE

The present study seeks to 1) translate and cross-culturally adapt the GPS in the Persian (Farsi) language and 2) examine the psychometric properties of the Persian GPS.

METHOD

The translation and adaptation were performed using the Sousa and Rojjanasrirat (2011) method. A pilot study (n = 30) was carried out to test the content validity and test-retest reliability of the GPS. Next, in a representative sample (n = 800) of residents of Kermanshah City, the GPS, the General Health Questionnaire (GHQ) and the PTSD Checklist for DSM-5 (PCL-5) were administered. Construct validity of the Persian GPS was assessed using exploratory and confirmatory factor analysis. Additionally, we evaluated the convergent validity and internal consistency of the GPS.

RESULTS

Exploratory and confirmatory factor analyses indicated a three-factor model as the best solution with factors representing 1) Negative Affect, 2) Core PTSD symptoms and 3) Dissociative symptoms. The GPS total symptom score had high internal consistency and high convergent validity with related measures. A GPS total symptom cut-off score of nine was optimal for indicating a probable PTSD diagnosis based on the PCL-5. About half (52%) of the current sample met criteria for probable PTSD.

CONCLUSIONS

The current findings suggest that the GPS can be effectively adapted for use in a non-Western society and, specifically, that the Persian GPS represents a useful, reliable and valid tool for screening of trauma-related symptoms in Iran.

Reducing Shame, Promoting Dignity: A Model for the Primary Prevention of Complex Post-Traumatic Stress Disorder

Complex post-traumatic stress disorder (CPTSD) refers to the complex psychological and psychosocial sequelae caused by prolonged interpersonal abuse. Contemporary approaches to CPTSD are dominated by individualized psychological interventions that are long term and costly. However, accumulating evidence indicates that CPTSD is a high prevalence mental illness implicated in significant social problems, with a pattern of lateral and intergenerational transmission that impacts on already disadvantaged communities. Consequently, there have been calls for a public health model for the prevention of CPSTD; however, there has been a lack of clarity as to what this should entail. This article argues that empirical and conceptual shifts framing CPTSD as a shame disorder offers new preventative opportunities. The article presents a series of interconnected literature reviews including a review of available prevalence data on CPTSD, the public health implications of CPTSD, the role of shame and humiliation in CPTSD, and current scholarship on dignity in public policy and professional practice. Drawing on these reviews, this article develops a social ecological model of primary prevention to CPTSD with a focus on the reduction of shame and the promotion of dignity at the relational, community, institutional, and macrolevel. A broad overview of this model is provided with examples of preventative programs and interventions. While the epidemiology of CPTSD is still emerging, this article argues that this model provides the conceptual foundations necessary for the coordination of preventative interventions necessary to reduce to the risk and prevalence of CPSTD.

Incorporating community-level risk factors into traumatic stress research: Adopting a public health lens

Infusing community-level risk factors into traumatic stress research can broaden intervention targets. The Neighborhood Deprivation Index (NDI) and the Index of Concentration at the Extremes (ICE) are two common community-level risk factors derived from U.S. census data. We provide R scripts facilitating the computation of these risk factors and demonstrate their relationship with PTSD symptomatology in 74 injury survivors assessed at 2-weeks, 6-weeks, and 3-months post-injury. The NDI and the ICE were computed using the Census Data Application Programming Interface, then matched to participants' census tracts using their residential addresses. Results indicated that after controlling for person-level characteristics, both risk factors were associated with PTSD symptom severity at follow up time points (Cohen's f² =0.011,.14). This study provides an easy method for computing the NDI and ICE, demonstrates the increased mental health risk that they convey in the aftermath of injury, and highlights their value in intervention efforts.

Posttraumatic Stress Disorder Among Low-Income Adolescents Experiencing Family-Neighborhood Income Disparities

Certain neighborhood factors may increase the risk of exposure to trauma, therefore increasing the risk of posttraumatic stress disorder (PTSD). Other aspects of neighborhoods can be protective, such as neighborhood-based social relationships, which provide social support that buffers the risk of developing PTSD. The strength of these social relationships may not be as dependent on neighborhood conditions as much as they are contingent on socioeconomic similarities between neighborhood residents. Using a nationally representative sample of hospital emergency department admissions in the United States (N = 13,669,251), this study hypothesized that an interaction between family-level income and neighborhood-level income would be associated with adolescent PTSD. The results show that female adolescents who resided in the highest income areas were 1.39 times more likely, 95% CI [1.09, 1.77], to be diagnosed with PTSD than those who lived in the lowest income areas. This association was not statistically significant for male adolescents. Additionally, low-income female youth were nearly one-third more likely than their non-low-income counterparts to be diagnosed, odds ratio (OR) = 1.29, 95% CI [1.12, 1.48], whereas low-income male youth were nearly twice as likely than their non-low-income counterparts to be diagnosed, OR = 1.95, 95% CI [1.62, 2.34]. Furthermore, there was an interaction among both male and female adolescents such that lower-income adolescents living in higher-income areas had higher odds of a PTSD diagnosis compared to their higher-income peers in areas that were in the same median household income quartile.

Posttraumatic Stress Disorder in Maltreated Children Grown Up: The Influence of Neighborhood

In this study, we examined the effects of childhood neighborhood characteristics on the development of posttraumatic stress disorder (PTSD) in a sample of abused and neglected individuals and matched controls followed into adulthood (N = 1,132). Using generalized linear models (GLM), the results indicated that growing up in more advantaged neighborhoods (middle- and upper-class) was associated with the development of fewer PTSD symptoms, R2  = .09, p < .001. In contrast, growing up in more economically disadvantaged areas was associated with more PTSD symptoms, but only for nonmaltreated controls, R2  = .09, p < .001. We did not find that neighborhood characteristics were associated with PTSD in terms of the number of traumatic events reported, R2  = .60, p < .001, or being the victim of more than one type of maltreatment, pseudo R2  = .11, p < .001. The results generally supported the premise that characteristics of one's residential environment in childhood, especially factors reflecting social and economic advantage and disadvantage, have an influence on mental health functioning later in life. Future research should examine the mechanisms that might explain the impact of childhood neighborhood on PTSD outcomes and the aggravating effects of pretrauma vulnerabilities associated with neighborhood disadvantage.

Modeling Health Disparities and Outcomes in Disenfranchised Populations

The Health Disparities and Outcomes (HDO) model originally created to explain the complexity of obtaining healthcare in rural settings has been revised and updated using emerging theoretical models of adversity and inequity and two decades of empirical work by the authors. With a strong orientation to explaining population-based health inequities, the HDO is applied to individuals with Serious Mental Illness (SMI), to explain their high rates of morbidity and mortality compared to the general population. Individual-, community-, and system-level factors that reflect an understanding of life-long risk, accrued hazards associated with multiple and intersecting disadvantages, and difficulty obtaining healthcare that meets accepted standards are described. The revised HDO can be applied to populations with disproportionate health challenges to identify multi-level factors that affect illness trajectory and overall health outcomes.

Broken (windows) theory: A meta-analysis of the evidence for the pathways from neighborhood disorder to resident health outcomes and behaviors

The criminological "broken windows" theory (BWT) has inspired public health researchers to test the impact of neighborhood disorder on an array of resident health behaviors and outcomes. This paper identifies and meta-analyzes the evidence for three mechanisms (pathways) by which neighborhood disorder is argued to impact health, accounting for methodological inconsistencies across studies. A search identified 198 studies (152 with sufficient data for meta-analysis) testing any of the three pathways or downstream, general health outcomes. The meta-analysis found that perceived disorder was consistently associated with mental health outcomes, as well as substance abuse, and measures of overall health. This supported the psychosocial model of disadvantage, in which stressful contexts impact mental health and related sequelae. There was no consistent evidence for disorder's impact on physical health or risky behavior. Further examination revealed that support for BWT-related hypotheses has been overstated owing to data censoring and the failure to consistently include critical covariates, like socioeconomic status and collective efficacy. Even where there is evidence that BWT impacts outcomes, it is driven by studies that measured disorder as the perceptions of the focal individual, potentially conflating pessimism about the neighborhood with mental health.

Chromosomes to Social Contexts: Sex and Gender Differences in PTSD

PURPOSE OF REVIEW

This review highlights recent research on sex- and gender-related factors in the prevalence, symptom expression, and treatment of PTSD. Further discoveries about the underlying mechanisms of sex and gender effects have the potential to shape innovative directions for research.

RECENT FINDINGS

The prevalence of PTSD is substantially higher among women, but women show a modest advantage with respect to treatment response. There is evidence of greater heritability among females. Women are more likely to experience sexual and intimate violence, childhood trauma exposure, and repeated trauma exposures. Specific characteristics of social contexts act as gender-linked risks for PTSD. Among individuals diagnosed with PTSD, men and women are similar in phenotypic expression. Though research has yet to fully account for the factors that explain sex- and gender- related effects on PTSD, emerging research suggests these effects occur across multiple levels. Shared risk factors for trauma exposure and PTSD merit further investigation. Both social and biological contexts merit investigation to understand sex-linked differences in heritability.

The Healthy Neighborhood, Healthy Families Initiative

: media-1vid110.1542/5799877332001PEDS-VA_2018-0261Video Abstract : Extreme poverty and the associated effects, such as blight, housing insecurity, and crime, have debilitating consequences on child development. Health care institutions are largely ineffective in changing those outcomes 1 child at a time. We present a case study of a hospital treating the adjacent neighborhood as a "patient" to address social determinants. The community represents a largely impoverished and housing-unstable neighborhood that underwent an assessment by community partners and treatment with a multifaceted housing intervention. Marked improvement in vacancy rates occurred, although outcome assessments for children are still being gathered. Several case learnings are presented, but the involvement and investment of pediatric health care clinicians and institutions increased the speed and size of neighborhood development after 80 years of redlining and institutional racism.

Role of social context in posttraumatic stress disorder (PTSD)

Research has increasingly focused on the role that social circumstances before, during, and after trauma exposure play in risk for posttraumatic stress disorder (PTSD). In this article, we provide an overview of conceptual and methodological challenges to the study of social context's role in PTSD and propose strategies that can mitigate these challenges. Throughout the article, we draw from the current literature to illustrate how attention to these issues can lead to advances in our knowledge of the role of social context in PTSD.