Schutz- und Risikofaktoren für Traumafolgestörungen

A systematic review of risk and protective factors of mental health in unaccompanied minor refugees

In recent years, there has been a rising interest in the mental health of unaccompanied minor refugees (UMR), who are a high-risk group for mental disorders. Especially the investigation of predictive factors of the mental health of young refugees has received increasing attention. However, there has been no review on this current issue for the specific group of UMR so far. We aimed to summarize and evaluate the existing findings of specific risk and protective factors to identify the most verified influences on the mental health of UMR. Therefore, we conducted a systematic literature search. Study designs were limited to quantitative cross-sectional and longitudinal designs. Eight databases were searched in four different languages and article reference lists of relevant papers were screened. 27 studies were included (N = 4753). Qualitative synthesis revealed the number of stressful life events to be the most evaluated and verified risk factor for mental health of UMR. A stable environment and social support, on the other hand, can protect UMR from developing poor mental health. Besides that, several other influencing factors could be pointed out, such as type of accommodation, family contact, gender and cultural competences. Because of the large heterogeneity of outcome measures, quantitative synthesis was not possible. This review helps to improve our understanding of determinants of UMRs mental health and thus to provide more targeted treatment. Furthermore, it provides information on how to prevent the development of mental health problems by specifying factors that can be modified by different health and immigration sectors in advance. Further research is needed focusing on the interaction between the various predictive factors.

[Complex Posttraumatic Disorder and Work-Related Behavioral and Experience Patterns]

OBJECTIVE

This study examined differences in work-related behavioral and experiential patterns between patients with positive screening for complex PTSD (CPTSD), patients with positive screening for PTSD and patients with negative screening for trauma sequelae.

METHODS

Participants were 566 patients (mean age 50.96 +/- 8.73 years; 70.3 % female) of a psychosomatic rehabilitation clinic. Self-reported screening instruments were administered to participants at the beginning of their inpatient psychotherapy. Univariate analyses of variance were used to assess group differences in work-related experience- and behavioral patterns. The instrument identifies 11 dimensions of health-promoting or -endangering behavior and experiences in coping with work and occupational demands.

RESULTS

On 8 of 11 work-related dimensions, significant differences were found between the groups "without PTSD" and "CPTSD". The "PTSD" and "CPTSD" groups differed significantly on the dimensions of "resignation tendencies", "offensive coping" and "life satisfaction". The groups "without PTSD" and "PTSD" did not differ significantly.

DISCUSSION

Patients with a positive CPTSD screening represent a particularly burdened patient group in the working context. They reported problematic behavior and experience patterns that correspond to the problem areas of self-organization described in the diagnostic criteria of the ICD-11.

CONCLUSION

This suggests that for patients with CPTSD special interventions within the context of medical-professional oriented rehabilitation are useful to compensate these deficits and maintain participation in working life.

[The broad spectrum of psychological sequelae of accidential trauma : Typical clinical pictures and stepped-care therapy]

The somatic sequelae of accidents and violent events can vary from uninjured to fatal but the psychological impact can vary from integrity, to transient reactions up to severe and chronic trauma-related mental health disorders. In a dynamic interaction they determine the individual processing and coping in the aftermath, the mid-term and long-term outcome of medical treatment and of psychosocial rehabilitation.Appropriate consideration of the psychological sequelae of trauma requires attention and sensitization, knowledge about widespread complaints and symptoms after potential traumatic events and their typical courses over time. A careful perception of early warning signals and basic skills of clinical management are required. When more specific psychodiagnostic and psychotherapeutic interventions seem necessary, mental health specialists have to be consulted within a staged care model.

Supporting migrants and refugees with posttraumatic stress disorder: development, pilot implementation, and pilot evaluation of a continuing interprofessional education for healthcare providers

BACKGROUND

Refugees and migrants face an increased risk of developing posttraumatic stress disorder (PTSD). Adequate care can be insufficient due to language barriers, cultural differences, and knowledge deficits of health service providers. Therefore, professional associations requested that healthcare providers to be educated to provide culturally sensitive care. An evidence-based educational intervention in the form of a continuing interprofessional education (CIPE) for healthcare providers on the topic of PTSD in migrants and refugees was developed, pilot-implemented, and evaluated according to the first two levels of the Kirkpatrick evaluation model (reaction and learning).

METHODS

The development of a curriculum for the CIPE intervention was based on a narrative literature review. Its content was validated by experts (N = 17) in an online survey and analyzed using both the Content Validity Index and a thematic analysis. The evaluation of the CIPE intervention was performed by conducting a pilot study with a quasi-experimental single group, using a pre-posttest design. In total, there were 39 participants distributed among three pilot courses. We collected and analyzed data on satisfaction, knowledge, and feasibility.

RESULTS

The curriculum for a half-day course, consisting of 8 modules, showed almost excellent content validity (S-CVI = 0.92). In the pilot-implementation phase, participants were "very satisfied" with the pilot courses and a positive effect on their knowledge was detected. No correlation between satisfaction and knowledge gain was found.

CONCLUSIONS

The CIPE intervention can be considered feasible and seems promising in its effects on satisfaction and knowledge. The insights gained in this study can be used to adapt and optimize the educational intervention, whereby the feedback from course attendees is particularly useful. Future studies need to further examine the effects in larger samples and more robust study designs.

Secondary traumatization in first responders: a systematic review

Background: Finding precise definitions of secondary traumatic stress, vicarious traumatization, and compassion fatigue is not easy. While some researchers define these terms differentially, others use them interchangeably. In the present review, we refer to all three phenomena as secondary traumatization. Objectives: This systematic review aims to provide an overview of prevalence rates of secondary traumatization in first responders and to shed light on corresponding resilience and risk factors. Methods: After identifying 219 studies within the searched databases and 2192 references via hand searching, 31 studies were included in this review. We systematically searched the electronic databases PubMed, PsychINFO, and PSYNDEX (German database). The following inclusion criteria were applied: (1) participants had to be first responders working on-site: police officers, firefighters, search and rescue personnel, or emergency and paramedic team members; (2) secondary traumatization (secondary traumatic stress/vicarious traumatization/compassion fatigue) was assessed quantitatively with a validated questionnaire or subscale explicitly measuring secondary traumatization; and (3) English or German language original papers. Results: We found low levels of secondary traumatization in first responders. Several studies describe protective and risk factors for secondary traumatization, including pretraumatic (e.g. age, gender), peritraumatic (e.g. exposure, emotional exhaustion), and post-traumatic factors (e.g. social support, alcohol and tobacco use). Conclusion: Next to an immunizing effect, the low prevalence of secondary traumatization in first responders could be explained by social desirability and job-loss concerns. Therefore, we may be underestimating the prevalence of secondary traumatization in first responders. Some resilience (social support) and risk factors (female gender) are consistent with previous research in other populations. However, owing to the cross-sectional study designs, we must interpret resilience and risk factors with caution. Future research should focus on longitudinal study designs and preventive as well as curative interventions.

[Family-Based Trauma-Focused Cognitive Behavioral Therapy with Three Siblings of a Refugee Family]

Family-Based Trauma-Focused Cognitive Behavioral Therapy with Three Siblings of a Refugee Family The possibility and relevance of a joint trauma-therapy with siblings has yet received little attention in research and clinical practice. The following case study presents a joint family-based trauma-focused therapy process with a refugee family. All three siblings suffered from post-traumatic stress disorder (PTSD) before treatment. The treatment followed the manual of Trauma Focused Cognitive Behavioral Therapy (TF-CBT; Cohen, Mannarino, Deblinger, 2009). Measures were the short version of the Child and Adolescent Trauma Screen (CATS 7-17), as well as the Teacher's Report Form (TRF). After 18 treatment sessions together with the mother, all three children did no longer meet PTSD criteria. Benefits of the joint therapy were for all three siblings to be sharing and imitating each other's coping strategies. Furthermore, the protective factor of social support after experiencing a traumatic event became evident. The apprehension of the therapist not being sufficiently neutral towards all three siblings was not observed.

Post-Traumatic Stress Symptoms in Police Officers Following Violent Assaults: A Study on General and Police-Specific Risk and Protective Factors

Based on a study of 681 German police officers who were violently assaulted we analyze first general pre-, peri- and post-traumatic risk factors (e.g. trauma severity, psychological adjustment, social support) of post-traumatic stress symptoms, second police-specific factors (e.g. colleague support) and third differences in the impact of these factors comparing male and female officers. Using regression analysis we show that risk factors that were found to be important for the general population partly hold for the special group of victimized police officers. Regarding police-specific factors regular preparatory and follow-up sessions reduce post-traumatic stress symptoms, while facing legal action following the assault increases it. The findings also reveal that three factors are significantly more strongly correlated with post-traumatic stress symptoms for female compared to male officers.

[Interventions for mental health sequelae of accidents]

Emergency psychology and psychotraumatology deal with the psychological sequelae of traumatic experiences, i.e., the prevention and early intervention of posttraumatic mental health disorders. Accidents are the most prevalent traumatic events in the general population that may result in a range of severe trauma and adjustment disorders. Accidents happen suddenly, unexpectedly, and can gravely threaten health, personal integrity, and life. The prevalence of intermittent and chronic psychiatric disorders in the aftermath of severe accidents varies between 5 and 30 %. Victims suffer from unknown and frightening posttraumatic symptoms, often irreversible handicaps as a consequence of their injuries, impairments in everyday functioning, and negative impact on the quality of life. The direct and indirect burden for society is high. Comprehensive secondary prevention, starting with early detection and early intervention of post-accident disorders, is not well established in clinical care. In case of severe accidental injuries, emergency and medical treatment has absolute priority. But all too often, severe mental health problems remain undetected in later treatment phases and therefore cannot be addressed adequately. In primary care, knowledge of specific psychodiagnostic and treatment options is still insufficient. Prejudices, denial, and fear of stigmatization in traumatized victims as well as practical constraints (availability, waiting time) in the referral to special evidence-based interventions limit the access to adequate and effective support. This overview presents the objectives, concepts, and therapeutic tools of a stepped-care model for psychological symptoms after accidental trauma, with reference to clinical guidelines.

Bewältigungsverhalten in Notfallsituationen aus klinisch-psychologischer Perspektive

Ziel des vorliegenden Beitrags ist es, eine aktuelle Übersicht zu Annahmen und Befunden zu geben, die Hinweise darauf geben, welche Reaktionen bzw. welches Verhalten für die Bewältigung von Notfällen oder traumatischen Erlebnissen hilfreich bzw. gesundheitsförderlich sind. Ließen sich konkrete Aspekte von Bewältigungsverhalten während traumatischer Situationen identifizieren, die besonders adaptiv in Bezug auf die psychische bzw. psychobiologische Anpassung sind, so könnte dieses Wissen perspektivisch zur Entwicklung von Präventions- und Trainingsmaßnahmen genutzt werden. Der Beitrag beschreibt einleitend Traumareaktionen, psychische Traumafolgestörungen und deren Prävalenzraten und gibt eine knappe Übersicht über Prädiktoren für psychische Störungen in Folge traumatischer Erlebnisse. Im Unterschied zu dem Beitrag von Becker-Nehring, Witschen und Bengel (in diesem Heft) fokussiert unser Beitrag vor allem auf die Posttraumatische Belastungsstörung als Traumafolgestörung und auf Bewältigungsverhalten während einer Notfallsituation. Bewältigungsverhalten während und nach einer traumatischen Situation kann zum Teil auch im Forschungslabor experimentell untersucht werden, indem z. B. Methoden der Virtuellen Realität genutzt werden. Dies ist ein weiterer Fokus des Beitrags.

Psychophysiologische Belastungsreaktivität nach einem simulierten Feuer in einer Parkgarage

Theoretischer Hindergrund: Bewältigungsverhalten in Notfallsituationen wird meistens retrospektiv erfasst oder ist aufgrund der Verschiedenheit der Notfallsituationen schlecht vergleichbar. Methoden der Virtuellen Realität (VR) ermöglichen die Erfassung von Verhaltensparametern und psychophysiologischen Belastungsreaktionen während eines belastenden Ereignisses und erlauben zudem das standardisierte Wiederholen für mehrere Personen. Fragestellung: Ziel unserer Studie war es, ein neues Notfallszenario (Feuer in einer Parkgarage) in VR zu entwickeln und zu testen, ob sich anhand dessen substanzielle psychische und physiologische Belastungsreaktionen induzieren lassen. Methode: Mehrfach im Untersuchungsablauf wurden das emotionale Erleben und physiologische Parameter erhoben. Ergebnisse: Das VR Szenario führte bei den teilnehmenden Probanden sowohl zu subjektiven als auch zu physiologischen Veränderungen im Sinne einer Stressinduktion. Das von uns entwickelte Szenario erscheint daher brauchbar, Verhaltensstrategien und Bewältigungsverhalten in Notfallsituationen zu simulieren. Schlussfolgerungen: Möglichkeiten und Grenzen der VR-Methode mit Blick auf klinisch-psychologische Implikationen werden diskutiert.