Does one trauma fit all? Exploring the relevance of PTSD across cultures

Navigating the who, where, what, when, how and why of trauma exposure and response

Individual differences in the response to trauma are influenced by numerous contextual factors such as one's cultural background, the environment in which trauma occurs, the meanings attached to traumatic experiences, and various other social and cultural determinants both before and after traumatic exposure. This special issue of the European Journal of Psychotraumatology presents a series of papers conducted as part of the Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT); a programme of research which seeks to advance our understanding of the impact of trauma within diverse populations who are highly trauma exposed. Applying a context-specific focus, CONTEXT prioritised working closely with service users and those organisations delivering critical support in the wake of trauma exposure. The seven papers presented in this special issue are divided into those who are exposed to trauma either: (i) directly (survivors of childhood adversity in the USA; LGB youth in Northern Ireland; refugees and asylum seekers in the EU; and members of the general population exposed to conflict in Israel) or (ii) vicariously (fire fighters in the UK, humanitarian aid volunteers in Sudan, and child protection workers in Denmark). Together, findings from these studies demonstrate that social support, in its many different forms, is a universally important factor in the response to trauma. We discuss how traumatic stress can be compounded when, and can thrive within, contexts where necessary social support is absent or inadequate. We also emphasize the importance of recognizing the context specificity of trauma exposure and trauma response, as well as the need for collaboration between psychotrauma researchers and organisations who deliver support to traumatized populations to ensure rapid and effective translation of research findings into practice.

Treating posttraumatic stress disorder across cultures: A systematic review of cultural adaptations of trauma-focused cognitive behavioral therapies

OBJECTIVE

Although trauma-focused cognitive-behavioral therapies (CBTs) for posttraumatic stress disorder (PTSD) have been applied worldwide, the nature of how these Western-based interventions are applied in diverse settings has varied. This paper systematically reviewed the literature on how trauma-focused CBTs have been applied and adapted cross-culturally.

METHOD

A systematic review of studies that discuss the process of cultural adaptation of trauma-focused CBTs.

RESULTS

Seventeen papers were included and varied in the comprehensiveness of the adaptation process. Two studies stated that a theoretical framework was followed. Almost one-third of the studies did not report whether local stakeholders were involved in the process of application. Fifteen studies examined the efficacy of the adaptations and the results were positive, but the methodology and quality varied.

CONCLUSION

There are inconsistencies in how trauma-focused CBTs are culturally adapted. A systematic approach to the transportation of such therapies would enable greater investigation into the necessity and efficacy of such adaptations.

Representation of low and middle income countries in traumatic stress journals from 2006 to 2015

Although the majority of trauma survivors reside in low and middle income countries, these regions have historically been poorly represented in traumatic stress research. However, a recent review of geographic representation within traumatic stress journals is lacking. This study reviewed all articles published between 2006 and 2015 in six leading traumatic stress journals. When articles ( n = 2530) were categorised by region, less than one tenth (9.76%; n = 247) were representative of low and middle income countries. All articles categorised as being from a low and middle income country were then coded for the regional and country representations of samples, author affiliations, and funding sources, and for type of research methodology. The majority of primary author teams (56.28%) and funding sources (55.87%) for articles based in low and middle income countries were located in high-income countries. The majority of low and middle income country articles (71.66%) used structured symptom questionnaires of which more than two thirds (70.6%) assessed symptoms of posttraumatic stress disorder. These findings indicate that knowledge production about traumatic stress in domain-specific journals reflects a state of ongoing geographic inequality and that research published from low and middle income countries reflects predominantly etic methodologies centred on measuring posttraumatic stress disorder. The implications are discussed and recommendations are offered for developing a research base in domain-specific journals that better represents the experiences and needs of trauma survivors in low and middle income countries.

Post-traumatic stress and growth among CPR survivors in the southeast of Iran

Background

Almost 7.2%–10.6% of patients survive CPR in Iran. Most of them experience post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG). There are limited studies to assessing the correlation between these two psychological outcomes among CPR survivors.

Objective

This study aimed to examine the correlation between PTSD and PTG among CPR survivors in South-East Iran.

Subjects

Using Quota sampling, 163 CPR survivors in two provinces in the South-East of Iran were selected to participate in this study.

Method

A descriptive-correlational study was used to fulfill the aim of the study. The impact of Event Scale-Revised (IES-R) for assessing PTSD and Post-traumatic growth questionnaires were used to assess PTG.

Results

The mean score of PTSD was 39.89 and according to the cutoff point, 87.1% of participants suffered from PTSD. The mean score of PTG was 78.6. PTSD and PTG had significant negative correlation. The result of multi-variate logistic regression showed that only the PTG score predicted PTSD (Odds ratio = 0.79, CI = 0.72–0.87; and p < 0.001). The result of multi-variate linear regression indicated that PTSD, time passed since CPR, and physical disability caused by CPR predicted PTG score significantly.

Conclusion

This study provides CPR survivors and health care personnel with some valuable insights about cultural aspects of PTSD and PTG among CPR survivors and that PTG is positively influenced by physical disability and time passed since CPR. CPR survivors may gain positive experience and valuable insight in group meetings and discussions with their counterparts.

Does one size fit all? Nosological, clinical, and scientific implications of variations in PTSD Criterion A

Posttraumatic stress disorder (PTSD) is a psychiatric pathology wherein the precipitating traumatic event is essential for diagnostic eligibility (Criterion A). This link is substantiated throughout PTSD's development as a diagnosis. However, while traumatic events may vary considerably, this variation currently bears nearly no implications for psychiatric nosology. Consequently, PTSD remains a semi-unified diagnostic construct, consisting of no Criterion-A-determined subtypes of adult PTSD. The question addressed by the current paper is then does one size truly fit all? Making an argument for the negative, the paper briefly reviews complex PTSD (CPTSD), ongoing traumatic stress response (OTSR), and cumulative traumas, all of which are exemplars wherein Criterion A specification is crucial for understanding the emerging symptomatology and for devising appropriate interventions. Indicating several overlooked discrepancies in the PTSD literature, the paper urges for the necessity of a more fine-grained differential diagnostic subtyping of PTSD, wherein posttraumatic reactions are more closely associated with their precipitating traumatic events. The paper concludes by suggesting diagnostic, clinical and societal implications, as well as proposing directions for future research.