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Sulaiman-Hill R, Porter R, Schluter P, Beaglehole B, Dean S, Tanveer S, Boden J, Bell C. Research following trauma in minority ethnic and faith communities: lessons from a study of the psychosocial sequelae of the Christchurch mosque terror attacks. BJPsych Open 2024; 10:e27. [PMID: 38205604 PMCID: PMC10790214 DOI: 10.1192/bjo.2023.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/22/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024] Open
Abstract
Recruiting participants for research from highly traumatised ethnic and faith communities requires a participatory and trauma-informed approach that considers logistic barriers, as well as trauma-related and culture-specific issues. Active community engagement through every stage of the project and employing community members in research roles can help build trust, identify and mitigate concerns early, prevent re-traumatization, and ensure that findings will be of value to the community. Some of these research challenges are discussed in the context of the Christchurch mosque terror attacks. These insights may be helpful for researchers and clinicians working in similarly challenging environments.
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Affiliation(s)
| | - Richard Porter
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Philip Schluter
- Te Kaupeka Oranga – Faculty of Health, Te Whare Wānanga o Waitaha – University of Canterbury, New Zealand; and Primary Care Clinical Unit, School of Clinical Medicine, The University of Queensland, Australia
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Shaystah Dean
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Sandila Tanveer
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Joseph Boden
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Caroline Bell
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
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Svendsen ER, Runkle JR, Dhara VR, Lin S, Naboka M, Mousseau TA, Bennett C. Epidemiologic methods lessons learned from environmental public health disasters: Chernobyl, the World Trade Center, Bhopal, and Graniteville, South Carolina. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:2894-909. [PMID: 23066404 PMCID: PMC3447594 DOI: 10.3390/ijerph9082894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 07/18/2012] [Accepted: 08/08/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND Environmental public health disasters involving hazardous contaminants may have devastating effects. While much is known about their immediate devastation, far less is known about long-term impacts of these disasters. Extensive latent and chronic long-term public health effects may occur. Careful evaluation of contaminant exposures and long-term health outcomes within the constraints imposed by limited financial resources is essential. METHODS Here, we review epidemiologic methods lessons learned from conducting long-term evaluations of four environmental public health disasters involving hazardous contaminants at Chernobyl, the World Trade Center, Bhopal, and Graniteville (South Carolina, USA). FINDINGS We found several lessons learned which have direct implications for the on-going disaster recovery work following the Fukushima radiation disaster or for future disasters. INTERPRETATION These lessons should prove useful in understanding and mitigating latent health effects that may result from the nuclear reactor accident in Japan or future environmental public health disasters.
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Affiliation(s)
- Erik R. Svendsen
- Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, Tulane University Health Sciences Center, ENHS SL-29, 1440 Canal St., Suite 2100, New Orleans, LA 70112, USA
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA;
| | - Jennifer R. Runkle
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA;
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 62234, USA
| | | | - Shao Lin
- Bureau of Occupational and Environmental Epidemiology, State University of New York-Albany, Albany, NY 84870, USA;
| | - Marina Naboka
- Radioecological Center of the National Academy of Sciences, Kiev 04050, Ukraine;
| | - Timothy A. Mousseau
- Department of Biological Sciences, University of South Carolina, Columbia, SC 29208, USA;
| | - Charles Bennett
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA;
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Abstract
The current status of glucocorticoid alterations in post-traumatic stress disorder (PTSD) will be described in this chapter. Emphasis will be placed on data that suggest that at least some glucocorticoid-related observations in PTSD reflect pretraumatic glucocorticoid status. Recent observations have provided some evidence that pretraumatic glucocorticoid alterations may arise from genetic, epigenetic, and possibly other environmental influences that serve to increase the likelihood of developing PTSD following trauma exposure, as well as modulate attendant biological alterations associated with its pathophysiology. Current studies in the field of PTSD employ glucocorticoid challenge strategies to delineate effects of exogenously administered glucocorticoids on neuroendocrine, cognitive, and brain function. Results of these studies have provided an important rationale for using glucocorticoid strategies in the treatment of PTSD.
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Affiliation(s)
- Rachel Yehuda
- The Traumatic Stress Studies Program, Department of Psychiatry, The Mount Sinai School of Medicine, New York, New York, USA.
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Yehuda R, Bierer LM, Sarapas C, Makotkine I, Andrew R, Seckl JR. Cortisol metabolic predictors of response to psychotherapy for symptoms of PTSD in survivors of the World Trade Center attacks on September 11, 2001. Psychoneuroendocrinology 2009; 34:1304-13. [PMID: 19411143 PMCID: PMC2785023 DOI: 10.1016/j.psyneuen.2009.03.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 03/27/2009] [Accepted: 03/30/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND A proportion of subjects with symptoms of posttraumatic stress disorder (PTSD) are unresponsive to specialized psychotherapy, but a biological basis for this has not been described. To observe whether differences in cortisol or its metabolites predict or correlate with response to therapy for PTSD symptoms, cortisol and its metabolites were measured from urine samples at pre-treatment, at the conclusion of psychotherapy, and at 3-month follow-up. METHODS 28 survivors of the World Trade Center attacks on September 11, 2001 seeking psychological treatment for PTSD symptoms received four sessions of either exposure therapy or supportive counseling, followed by up to 10 sessions of prolonged exposure in a specialized PTSD treatment program at a private hospital serving the New York City metropolitan area. 24-h mean integrated cortisol excretion was assessed by radioimmunoassay (RIA); urinary free cortisol and metabolites cortisone, 5alpha-tetrahydrocortisol (5alpha-THF), 5beta-tetrahydrocortisol, and tetrahydrocortisone were assessed by gas chromatography-mass spectrometry (GC-MS); and indices of enzyme activity for 5alpha- and 5beta-reductase and for the 11beta-hydroxysteroid dehydrogenases were derived from the metabolite and glucocorticoid measures. RESULTS 5alpha-Reductase activity was significantly lower at pre-treatment among non-responders, whereas there were no significant pre-treatment differences between responders and non-responders in any other hormone or metabolite level. In repeated measures analyses across the three time points, 5alpha-reductase activity, as well as 5alpha-THF and total glucocorticoids, significantly differed between responders and non-responders. For urinary cortisol measured by RIA, there was a significant groupxtime interaction indicating that, although not different at pre-treatment, urinary cortisol levels declined over time in the non-responder group, such that by follow-up, lowered cortisol significantly distinguished non-responders from responders. Indices of 5alpha-reductase activity, including 5alpha-THF and total glucocorticoids, were significantly negatively correlated with avoidance symptom severity at pre-treatment. At follow-up, indices of 5alpha-reductase activity were significantly negatively correlated with severity of all three PTSD symptom clusters and with total PTSD severity scores. CONCLUSION Lower 5alpha-reductase activity is associated with avoidance severity and predicts non-responsiveness to psychological treatment for PTSD symptomatology. Relatively diminished 5alpha-reductase activity may mark a state of primary vulnerability, perhaps via attenuated peripheral catabolism of cortisol resulting in the suppression of hypothalamic-pituitary-adrenal axis responsiveness. Lower cortisol levels appear later in the progression to chronic, treatment-resistant PTSD.
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Affiliation(s)
- Rachel Yehuda
- Traumatic Stress Studies Division, Mount Sinai School of Medicine and James J. Peters Veterans Affairs Medical Center, Psychiatry 116/A - OOMH, Bronx, NY 10468-3904, USA.
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Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med 2009; 32:20-47. [PMID: 19030981 DOI: 10.1007/s10864-008-9184-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 10/22/2008] [Indexed: 05/25/2023]
Abstract
This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.
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Affiliation(s)
- David R Williams
- Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, 6th Floor, Boston, MA 02115, USA.
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Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med 2009; 32:20-47. [PMID: 19030981 PMCID: PMC2821669 DOI: 10.1007/s10865-008-9185-0] [Citation(s) in RCA: 1775] [Impact Index Per Article: 118.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 10/22/2008] [Indexed: 12/23/2022]
Abstract
This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.
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Affiliation(s)
- David R Williams
- Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, 6th Floor, Boston, MA 02115, USA.
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Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med 2008. [PMID: 19030981 DOI: 10.1007/s10865–008–9185–0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.
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Affiliation(s)
- David R Williams
- Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, 6th Floor, Boston, MA 02115, USA.
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Norris AE, Aroian KJ. Avoidance symptoms and assessment of posttraumatic stress disorder in Arab immigrant women. J Trauma Stress 2008; 21:471-8. [PMID: 18956451 PMCID: PMC4469283 DOI: 10.1002/jts.20363] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study investigates whether the avoidance symptom criterion required for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) diagnosis of posttraumatic stress disorder (PTSD) is overly conservative. Arab immigrant women (N = 453), many of whom reported experiencing multiple traumatic events, completed the Posttraumatic Diagnostic Scale in Arabic as part of a face to face interview. Analyses indicated all but one avoidance symptom was reported less frequently than reexperiencing and arousal symptoms. However, those who fully met reexperiencing, avoidance, and arousal symptom criteria had worse symptom severity and functioning than those who fully met reexperiencing and arousal symptom criteria, but only partially met avoidance symptom criterion. Study findings support importance of the PTSD avoidance symptom criterion.
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Affiliation(s)
- Anne E Norris
- College of Nursing, University of Central Florida, Orlando, FL 32816-2210, USA.
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Rhoads J, Pearman T, Rick S. Clinical presentation and therapeutic interventions for posttraumatic stress disorder post-Katrina. Arch Psychiatr Nurs 2007; 21:249-56. [PMID: 17904482 DOI: 10.1016/j.apnu.2007.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 05/03/2007] [Accepted: 05/23/2007] [Indexed: 10/22/2022]
Abstract
It has been almost 2 years since Hurricane Katrina struck the Gulf Coast. These 2 years can be characterized by constant struggle and pain as the people try to reattain some semblance of life as they knew it before Katrina struck. Some have chosen to leave their ancestral homes, homes where they were raised and where they, in turn, raised their own families. Those who did leave are able, in some way, to reestablish some semblance of normality, but those who stayed showed manifestations of and dealt with psychological trauma. These manifestations include regression, inattentiveness, aggressiveness, somatic complaints, irritability, social withdrawal, nightmares, and crying. Longer lasting effects may include depression, anxiety, adjustment disorders, and interpersonal or academic difficulties. These postdisaster manifestations can linger or remain hidden until well after the traumatic event and could persist for years. This article presents issues about the effects of Katrina on the mental health of the people of New Orleans. It discusses the profile of posttraumatic stress disorder and presents evidence-based review of interventions the health care provider can implement to care for those who continue to suffer the effects of this horrific disaster.
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Affiliation(s)
- Jacqueline Rhoads
- Primary Care Community Health Public Health Nursing Program, LSUHSC School of Nursing, New Orleans, LA 70112, USA.
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Koren D, Hemel D, Klein E. Injury increases the risk for PTSD: an examination of potential neurobiological and psychological mediators. CNS Spectr 2006; 11:616-24. [PMID: 16871128 DOI: 10.1017/s1092852900013675] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A growing number of common traumatic events involve both physical and emotional injuries. In contrast to previously held beliefs, the rapidly growing body of literature shows quite convincingly that physical injury, over and above exposure to the traumatic event itself, increases rather than decreases the risk for posttraumatic stress disorder (PTSD). A pertinent question becomes how bodily injury contributes to the risk of developing PTSD. In this article, we review contemporary findings regarding the neurobiological and psychological mechanisms by which bodily injury may augment or independently contribute to chronic posttraumatic stress. In addition, we propose three theoretical pathways through which physical injury can increase the risk for PTSD. These pathways are: additive, unique, and recovery impeding. Finally, we highlight unresolved issues pertaining to each one of these pathways and propose directions for future research to address them.
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Affiliation(s)
- Danny Koren
- Rambam Medical Center, Department of Psychology, University of Haifa, Haifa 31905, Israel.
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Abstract
Mental disorders cause more disability than any other class of medical illness in Americans between ages 15 and 44 years. The suicide rate is higher than the annual mortality from homicide, AIDS, and most forms of cancer. In contrast to nearly all communicable and most non-communicable diseases, there is little evidence that the morbidity and mortality from mental disorders have changed in the past several decades. Mental health advocates, including psychiatric researchers, have pointed to stigma as one of the reasons for the lack of progress with mental illnesses relative to other medical illnesses. This review considers how the expectations and goals of the research community have contributed to this relative lack of progress. In contrast to researchers in cancer and heart disease who have sought cures and preventions, biological psychiatrists in both academia and industry have set their sights on incremental and marketable advances, such as drugs with fewer adverse effects. This essay argues for approaches that can lead to cures and strategies for prevention of schizophrenia and mood disorders.
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Affiliation(s)
- T R Insel
- National Institute of Mental Health/NIH, Rm. 8235, 6001 Executive Boulevard, Bethesda, MD 20892, USA.
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