The Relative Impact of Traumatic Experiences and Daily Stressors on Mental Health Outcomes in Sri Lankan Adolescents

Advancing trauma studies: A narrative literature review embracing a holistic perspective and critiquing traditional models

Background

Trauma is commonly understood as a psychological and emotional response to distressing events. The subjective nature of trauma experiences has led to ongoing debates about the best theoretical frameworks for understanding and addressing trauma. This review aims to comprehensively critique traditional biomedical and psychological models and advocates for more inclusive and culturally sensitive frameworks.

Methods

A narrative literature review was conducted, synthesizing data from 96 peer-reviewed journal articles, books, and authoritative reports from databases such as PubMed, PsycINFO, and Google Scholar. The review focused on studies related to trauma, post-traumatic stress disorder (PTSD), complex trauma, and related disorders, emphasizing both individual and socio-cultural aspects.

Results

The review identifies several key criticisms of trauma models. For biological models, critiques include the oversimplification of trauma experiences, insufficient developmental considerations, failure to capture diverse trauma responses, limited cultural sensitivity, and inadequacy of the categorical approach. For psychological models, criticisms encompass an overemphasis on internal processes, neglect of developmental impacts, limited focus on symptom diversity, challenges in addressing socio-cultural contexts, and incomplete integration of emotional and relational aspects. These findings underscore the need for more comprehensive, culturally sensitive, and developmentally informed trauma frameworks.

Conclusion

The findings emphasize the importance of adopting a holistic perspective in trauma research and treatment. By integrating individual, interpersonal, and socio-cultural dimensions, future research and interventions can better support trauma survivors. This approach necessitates ongoing interdisciplinary collaboration and the inclusion of diverse voices, including those of trauma survivors, to refine current methodologies and enhance therapeutic outcomes.

Mental health burden following extreme weather events in South-east Asia: A systematic review and meta-analysis

Background

Exposure to extreme weatherly events potentially develops mental disorders among affected individuals.

Aim

To synthesize the burden of mental disorders following impact of extreme weather events in South-east Asian (SEA) countries.

Methods

Proposal was registered in PROSPERO register [CRD42023469788] and reported as per PRISMA-2020 guidelines. Studies reporting prevalence of mental health disorders following extreme weather events from SEA countries during 1990 and 2023 were searched on Embase, PubMed, and Scopus databases. Study quality was assessed using Appraisal tool for Cross-Sectional Studies. Overall pooled prevalence was computed using DerSimonian-Laird method for random-effects model and reported as 95% confidence intervals.

Results

On screening 12,046 records, we included 155 studies (2,04,474 participants) for analysis. Overall burden of mental disorders was 35.31% (95%CI: 30.42%-40.21%). In subgroup analysis, studies on cyclones, India, local residents, children and adolescents, rural settings, and community settings reported higher burden of mental disorders. Depression (28.58%; 95%CI: 24.05%-33.1%) and PTSD (29.36%; 95%CI: 26.26%-32.46%) had similar prevalence. Visiting tourists to SEA region experienced fear, fear of recurrence of tsunami, nightmares, and sense of helplessness. Mental health outcomes were relatively higher in studies conducted within 1 year of events. Heterogeneity and possibility of publication bias exists among the reported studies.

Conclusion

With the significant rise in episodes of extreme weather events in SEA region over the last three decades, mental disorders are documented in different proportions. We suggest prioritizing well-informed policies to formulate inclusive and resilient strategies on effectively identifying and treating mental health concerns among victims of extreme weather events.

The association between posttraumatic stress disorder and mental health of adolescents who exposed to the worst disaster of the century: Extensive data from southeast Turkey

PROBLEMS

This study was conducted to examine the association between posttraumatic stress disorder and mental health status of adolescents exposed to the worst disaster of the century.

METHODS

This study was descriptive, cross-sectional, and correlational. This research was conducted between March 31 and July 1, 2023. The study was conducted with earthquake survivors who migrated from Kahramanmaraş, the epicenter of the earthquake, and Adıyaman and Hatay, the other two cities where it was most effective, to Şanlıurfa. The study was conducted with a total of 947 adolescents. "Personal Information Form," "Child Posttraumatic Stress Reaction Index," and "Symptom Distress Check List- (SCL-90)" were used to collect data. Linear regression method was used in the analysis of the research. Path analysis was performed using PATH analysis.

FINDINGS

The mean age of the adolescents participating in the study was 16.69 ± 1.41 years. It was found that the Global Severity Index (GSI) of the adolescents was at the pathological level with a mean of 2.36 ± 0.68. Posttraumatic stress reactions of the adolescents who experienced the earthquake was found to explain 97.2% of their mental symptoms (anxiety, depression, somatization, anger-hostility, obsession-compulsion, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychotic symptoms, other problems, and GSI) (p < 0.001). It was found that the age of the adolescents, total number of losses in the earthquake, the time they stayed under the rubble, the time they waited for siblings to be pulled from under the rubble and the state of having loss due to the earthquake explained 74.4% of the posttraumatic stress reactions (p < 0.001).

CONCLUSIONS

As a conclusion, it was found that the adolescents who experienced the earthquake experienced severe posttraumatic stress symptoms. It was also found that adolescents who experienced high levels of trauma symptoms showed pathological mental symptoms. After the earthquake, adolescents should be evaluated periodically in terms of posttraumatic stress symptoms. In the evaluations to be made, it is important to determine how adolescents are affected especially mentally. In this context, interventions should be implemented for the identified mental symptoms (anxiety, depression, somatization, etc.).

A conceptual study on the relationship between daily stressors, stressful life events, and mental health in refugees using network analysis

Introduction

There is growing recognition that daily stressors, such as social and material deficiencies, can be highly detrimental to the mental health of refugees. These stressors are in addition to stressful life events, which have been widely studied in the context of migration and forced displacement. Despite increasing evidence for an ecological model, there is still no consensus regarding the conceptualization of these highly influential factors. In particular, the demarcation of daily stressors from stressful life events and the categorization of daily stressors require further examination in order to develop usable and accurate tools for researchers, design effective interventions for practitioners and assist politicians in designing meaningful policies.

Methods

To address these challenges, we used data from a sample of 392 unaccompanied young refugees from diverse backgrounds and employed network analysis to examine the relationships between daily stressors, stressful life events, and symptoms of depression, anxiety, and post-traumatic stress.

Results

Our findings highlight the significant relationship between daily stressors and mental health, particularly depression. Meaningful clusters of daily stressors include material stressors, social stressors, and social exclusion stressors.

Conclusion

Our results demonstrate the importance of considering daily stressors in the mental health of refugees and suggest that using a network approach offers a viable way to study these complex interrelationships. These findings have implications for researchers, practitioners, and policymakers in understanding and addressing the mental health needs of refugees.

Sometimes Less is More: Switching Influence of Social Support on Posttraumatic Growth over Time after a Natural Disaster

Few studies have investigated the causal link between social support and posttraumatic growth. Using a four-wave longitudinal design, the present study examined the reciprocal relationship between posttraumatic growth and social support in family and school contexts. A total of 285 adolescents (61.3% female) were recruited to complete self-report questionnaires 12, 18, 24, and 30 months after the Wenchuan earthquake. The data were analyzed using a random intercept cross-lagged panel model. Results revealed a trend for total social support initially promoting posttraumatic growth, followed by no influence, and finally a hindering of growth. This pattern varied between different sources of support. Specifically, the influence of support from parents and peers was consistent with the pattern for total support, whereas that from teachers and others prevented posttraumatic growth during later stages. These results suggest that timing is an important issue in posttraumatic growth and that providing more support for a prolonged period following a traumatic event constrains adolescents' autonomy and thus inhibits posttraumatic growth.

Daily stressors and mental health following disaster: A school-based assessment of adolescent disaster survivors in China and Nepal

Postdisaster daily stressors, the economic and social challenges caused or exacerbated by disasters, have significant consequences for mental health but are rarely investigated in child and adolescent populations. We assessed posttraumatic stress symptoms (PTSS), depression, and anxiety among adolescents affected by disasters in China and Nepal and examined the specific contributions of disaster-related trauma exposure and daily stressors across mental health outcomes. A school-based, cross-sectional study was conducted with a stratified random sampling design. Adolescents living in disaster-affected areas of southern China and Nepal (N = 4,215, 52.7% female, age range: 15-19 years) completed translated, validated measures. Mixed effects logistic regression analyses were conducted using a priori risk factors. PTSS were reported by 22.7% of participants and were higher among Nepali adolescents but did not differ between genders. Depressive symptoms were reported by 45.2% of the sample and were higher among Nepali adolescents and girls in both countries. Across all settings, disaster-related trauma exposure was a significant risk factor for PTSS, depressive, and anxiety symptoms, China: odds ratios (ORs) = 1.44-2.06, Nepal, ORs = 1.21-2.53. High levels of household and interpersonal daily stressors further improved the models and contributed significantly to all mental health difficulties, China: ORs = 1.77-1.98, Nepal: ORs = 1.49-1.90. Postdisaster economic insecurity and interpersonal stressors are thus, likely to worsen adolescent mental health outcomes. Programs that identify and address structural inequalities for adolescents in disaster-affected settings will have cascading effects for mental health.

Examining post-conflict stressors in northern Sri Lanka: A qualitative study

Forcibly displaced individuals typically encounter daily stressors, which can negatively impact mental health above and beyond direct exposure to war-related violence, trauma and loss. Understanding the perspectives of war affected communities regarding daily stressors can enhance the integration of mental health into local primary care. The aim of the current study was to explore how daily stressors are conceptualized in a post-conflict setting. Data collection was completed with 53 adult participants who were recruited from primary healthcare clinics in Northern Province, Sri Lanka. Individual interviews were conducted in Tamil, audio-recorded, translated from Tamil to English, and transcribed. Themes emerging from the data were organized into an analytical framework based on iterative coding and grounded in the daily stressors framework. Stressors were conceptualized as chronic stressors and systemic stressors. Findings indicate that chronic stressors, such as loss of property, permeate daily life and have a profound impact on psychological wellbeing. Interviewees additionally reported that systemic stressors stemmed from unresolved grief for missing family members and limited support from institutions. The results of the current study complement existing literature, suggesting the value of multipronged approaches which identify and address symptoms of complicated bereavement while simultaneously alleviating financial hardship. An understanding of stressors experienced by conflict-affected populations in times of chronic adversity can be informative for the design and implementation of culturally-tailored interventions.

The influence of social support on posttraumatic stress symptoms among children and adolescents: a scoping review and meta-analysis

BACKGROUND

Several risk and protective factors play a role in the development of posttraumatic stress symptoms (PTSS) in children and youth. The evidence for social support (SS) as a protective factor is rising; however, a review of the evidence is lacking.

OBJECTIVE

This scoping review and meta-analysis aims to map out and synthesize the present research on the influence of social support on PTSS in children and adolescents.

METHOD

The literature searched through PubMed, MEDLINE, Embase, PsycInfo, and CINAHL identified 3629 abstracts. Ninety articles published from 1999 to 2020 were selected, including a total of 77,439 participants.

RESULTS

Most papers focused on social and emotional support from family members (36/88) and peers (26/88); other types of support (e.g., informational support and support from professionals) were not widely reported. The cross-sectional studies illustrated an overall significant, but weak, negative correlation between global social support and PTSS. A similar weak negative association was found between family support and PTSS. The association between peer support and PTSS was not significant. For longitudinal studies, 4 of 5 indicated that SS was a significant negative predictor of PTSS.

CONCLUSIONS

There was conceptual, methodological, and statistical heterogeneity of the identified studies. This review suggests a weak negative relationship between global SS and PTSS in children and adolescents. Higher global SS was related to less PTSS. The evidence regarding family support revealed a more stable negative relationship with PTSS than that for peer support. Investigating social support without specifying the form of support confounds the effect. Studies on informational, teacher, or professional support seem to be lacking. More studies are needed on the longitudinal effects of SS on PTSS.

The Consequences of COVID-19 Toward Human Growth: The Role of Traumatic Event and Coping Strategies Among Indonesian Sample

COVID-19 has brought a massive psychological impact on individuals' life. The current study sets a significant purpose to test the model whether post-traumatic stress and coping strategies affect stress-related growth regarding the COVID-19 event. One hundred and ninety-nine participants have participated in an online survey in the period of lockdown. The proposed hypotheses model is further tested using PLS-SEM. The first model explains a significant moderate, 46% amount of variance for stress-related growth. With gender as moderator, the second model explains a significant 29% amount of variance for stress-related growth, which is also moderate. This study shows that active coping strategies and positive affirmation significantly influence individual stress-related growth. The trauma event (COVID-19) does not significantly affect growth. Women experience trauma compared to men, besides active coping with the COVID-19 situation is higher in men than women. Using the Bio-centric perspective, having a positive connection through acceptance and awareness of the situation, self-care, and affective interaction with others would develop growth regarding traumatic situations. Further, interventions about coping skills and positive affirmations are essential to give, especially to vulnerable groups such as women.

Mental Health of Refugees and Migrants during the COVID-19 Pandemic: The Role of Experienced Discrimination and Daily Stressors

The COVID-19 pandemic is a defining global health crisis of our time. While the impact of COVID-19, including its mental health impact, is increasingly being documented, there remain important gaps regarding the specific consequences of the pandemic on particular population groups, including refugees and migrants. This study aims to uncover the impact of the COVID-19 pandemic on the mental health of refugees and migrants worldwide, disentangling the possible role of social and daily stressors, i.e., experiences of discrimination and daily living conditions. Descriptive analysis and structural equation modeling were used to analyze the responses of N = 20,742 refugees and migrants on the self-reporting global ApartTogether survey. Survey findings indicated that the mental health of refugees and migrants during the COVID-19 pandemic was significantly impacted, particularly for certain subgroups, (i.e., insecure housing situation and residence status, older respondents, and females) who reported experiencing higher levels of increased discrimination and increases in daily life stressors. There is a need to recognize the detrimental mental health impact of the COVID-19 pandemic on particular refugee and migrant groups and to develop interventions that target their unique needs.

Traumatic experiences and resilience: Associations with mental health, death attitudes, and religion in university students

Resilience may be related to mental health and profound beliefs and attitudes. Utilizing a survey design, we examined relationships among resilience, clinical syndromes, death attitudes, and religion. Mexican university students (N = 161) answered a sociodemographic questionnaire, the Global Post-Traumatic Stress Scale, the Millon Multiaxial Inventory, the Connor-Davidson Resilience Scale, and the Death Attitudes Profile. Pearson correlation analyses showed that resilience correlated inversely with clinical syndromes and fear of death and positively with approach acceptance. Religion entailed higher death attitudes and resilience. Regression analysis revealed that lower anxiety, alcohol use, persistent depression, and higher delusion and death approach acceptance explained resilience.

The impact of liquefaction disaster on farming systems at agriculture land based on technical and psychosocial perspectives

This research aims to determine the attitudes of the farmers whose lands are affected by liquefaction in Jono Oge, Central Sulawesi Province, The Republic of Indonesia. The methods used here were integrated survey and experimental design. The survey approach was intended to figure out the attitudes of the farmers viewpoints: (1) to return to their activities on the agricultural lands affected by liquefaction; (2) to consume their own agricultural products; and (3) of their willingness to be relocated. The experimental design approach was used to figure out the effectiveness of organic material input combined with the SP-36 fertilizer. The obtained results were analyzed using the Likert Scale, diversity test, correlational test, and regression test. The results showed that the farmers persevered farming on the lands affected by liquefaction (Index = 88.82%) yet refused to consume their own agricultural products with the reason that corpses remained buried beneath their lands (Index = 27.82%); and they also refused to be relocated (Index = 28.80%). The continued production suitability of the affected land was also investigated. Terrain profile identification results in Jono Oge showed the disaster impact was dominantly landslide as it still showed a clear characteristic horizon between the topsoil and the sub soil. This contrasts to terrain at Petobo, Central Sulawesi Province, where the high mix of the topsoil with the sub soil of agricultural land affected by liquefaction, prevented demarcation of the horizon. The land treatment of organic material and SP-36 fertilizer showed that the combined dose (M) of 40-kg ha-1 with P 300-kg ha-1 had the highest effect by changing the field pH from 5.7 to 6.41, increased the availability of P and increased the corncob indicator plant weight. Based on these indications, the lands affected by the liquefaction in Jono Oge can still be used as agricultural lands through restoration, from both social and technical aspects.

The Long-Term Mental Health Consequences of Torture, Loss, and Insecurity: A Qualitative Study Among Survivors of Armed Conflict in the Dang District of Nepal

Background and Objectives: Nepal has witnessed several periods of organized violence since its beginnings as a sovereign nation. Most recently, during the decade-long Maoist Conflict (1996-2006), armed forces used excessive violence, including torture, resulting in deaths and disappearances. Moreover, there is widespread gender-, ethnic- and caste-based discrimination, and grossly unequal distribution of wealth in the country. While the immediate mental health effects of the conflict are well studied, less is known about the long-term effects of the conflict. This article sets out to explain how Nepalese survivors of violence perceive their wellbeing and mental health, search for help and construct their health care pathways and therapeutic itineraries. The aim is to provide a better understanding of local explanatory models and healthcare behaviors. Methods: Semi-structured interviews were carried out with 25 people (14 men, 11 women) aged 30 to 65 in Dang district in 2013. To elicit illness narratives, a translated and culturally adapted version of the McGill Illness Narrative Interview (MINI) was used. Additionally, participants were interviewed about their war experiences and present-day economic and social situations. The transcripts were coded using deductive and inductive approaches and analyzed through thematic analysis. Results: The study provides insight into temporal narratives of illness experience and explanatory modules. Symptoms were found to be widespread and varied, and were not solely attributed to violent experiences and memories, but also to everyday stressors related to survivors' economic, social, and familial situations. In terms of help- and health-seeking behavior it was found that participants resorted to various coping strategies such as social activities, avoidance, withdrawal, and substance use. Many participants had received biomedical treatment for their psychosocial problems from doctors and specialists working in public and private sector clinics and hospitals as well as different forms of traditional healing. Conclusions: These results shed light on the long-term impact of the Nepalese conflict on survivors of extreme violence, highlighting local explanatory models and help- and health-seeking behaviors. These findings inspire recommendations for the development of context specific and holistic psychosocial interventions focusing on well-being, social determinants of health, and human rights.

Supportive Relationships in Children and Adolescents Facing Political Violence and Mass Disasters

PURPOSE OF REVIEW

We identify trends and gaps in the literature on the role of social support in the psychopathology and risky behavior of youths exposed to political violence and mass disasters. We also discuss the implications of recent research's findings and suggest directions for future research.

RECENT FINDINGS

Political violence and natural disasters inflict serious blows to adolescents' mental and physical health and may have reverberating, negative impacts throughout the nested social systems in which youths develop. However, many adolescents are not adversely affected, suggesting the presence of resilience. While the beneficial effects of social support from close others are well documented, along with situations under which perceived support may even increase stress, the exact mechanisms behind social support's protective effects have not been thoroughly studied. Different personality attributes and/or different concepts of the self may possibly contribute to-or harm-youths' resilience. There is considerable variability in research on adolescents' social support in the context of political violence and mass disasters, stressors that may erode social support. Thus, further investigation of social support's protective effects via longitudinal studies is highly important.

Gender moderates diurnal cortisol in relation to trauma and PTSD symptoms: A study in Sri Lankan adolescents

Trauma exposure and posttraumatic stress disorder (PTSD) have been linked to aspects of diurnal cortisol secretion in adolescents, but little is known about gender differences in these associations. A school-based sample of Sri Lankan adolescents aged 13-16 years took part in this study 4.5 years after the 2004 tsunami had impacted many of their lives to varying degrees. Saliva samples were obtained 4 times a day for 3 days in 84 participants, who also completed measures of lifetime trauma, current stressors, and posttraumatic stress symptoms (PTSS). We used multilevel regression to estimate effects of trauma exposure and symptoms on cortisol level, diurnal slope, and awakening response (CAR). Results indicated higher cortisol in girls and older adolescents. Although trauma, PTSS, and recent PTSD had non-significant main effects, these three variables interacted with gender, with higher cortisol in girls than in similarly traumatized or symptomatic boys. Co-occurrence of internalizing symptoms and PTSS was also associated with higher cortisol. The 28 adolescents with recent PTSD displayed flatter diurnal slopes, reflecting relatively low morning cortisol. Among the 56 trauma-exposed participants, negative trauma appraisals were associated with higher cortisol. Girls were more likely than boys to display elevated cortisol in relation to re-experiencing and hyperarousal symptoms. In contrast to significant findings for cortisol level and diurnal slope, the CAR showed no association with either trauma or PTSS, irrespective of gender. Findings, viewed in light of normative gender differences in HPA activity during adolescence, can contribute to understanding heightened female vulnerability to posttraumatic stress disorder.