Trauma and PTSD in the WHO World Mental Health Surveys

The impact of trauma and how to intervene: a narrative review of psychotraumatology over the past 15 years

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

The pain of PTSD: integrating persistent or chronic pain within emotional processing theory of posttraumatic stress disorder

Background: Posttraumatic stress disorder (PTSD) and chronic pain are devastating conditions that often co-occur. Current understanding of comorbid PTSD and chronic pain is limited, and treatment options are undereffective.Objective: This paper presents a theoretical basis for conceptualising chronic pain symptoms within Emotional Processing Theory (EPT), the foundation for Prolonged Exposure (PE), an effective treatment for PTSD. EPT conceptualises the development and treatment of PTSD using a trauma structure that strongly overlaps with pain's neurobiology.Method: This paper proposes a model of shared aetiology and treatment of comorbid PTSD and chronic pain, emphasising these shared neurobiological underpinnings. Discussion details how the comorbidity is maintained through parallel avoidance processes focused on: (1) trauma memories and reminders in PTSD preventing reduction of negative affect (extinction) and inhibitory learning, and (2) physical pain in chronic pain fuelling increased pain and reduced function.Results: A conceptualisation is presented on how PTSD and chronic pain symptomology can be addressed within the EPT framework, increasing the confidence of providers and patients while addressing an important gap in the literature. Finally, recommendations for providers using PE with patients with PTSD and pain are provided including a case example and treatment plan based on real patients.Conclusions: This model provides a clinically useful understanding of the underlying neurobiology for the co-occurrence of PTSD and chronic pain and offers direction for future research.

C-METTA reduces PTSD-related guilt and shame following interpersonal violence

Background: PTSD patients who experienced interpersonal violence are susceptible to trauma-related guilt and shame and often show unsatisfactory treatment response. C-METTA combines cognitive techniques and loving-kindness meditation. It has shown promising effects in reducing trauma-related guilt and shame.Objective: We examined the effectiveness of C-METTA within a quasi-experimental one-group pretest-posttest trial focusing on survivors of interpersonal violence, who suffered from trauma-related guilt and shame. An additional objective was to examine variables potentially associated with lower treatment response (childhood trauma, cumulative trauma, and PTSD chronicity).Method: We treated 25 individuals (age = 19-61, 96% women) with PTSD following interpersonal violence. We predicted that C-METTA would significantly reduce (a) PTSD symptoms (measured by the Clinician Administered PTSD Scale, the PTSD Symptom-Checklist Version 5, and the Posttraumatic Cognitions Inventory), (b) feelings of guilt (measured by the Trauma Related Guilt Inventory) and (c) feelings of shame (measured by the Trauma Related Shame Inventory). To analyse treatment effects, we conducted repeated-measures MANOVAs. Further, we investigated the impact of childhood trauma, cumulative trauma and PTSD chronicity symptoms on treatment effectiveness exploratively via additional MANCOVAs.Results: Analyses showed significant and large effects of C-METTA on reducing PTSD symptoms (ranging from d = 1.12 to d = 1.67), feelings of guilt (d = 1.54) and shame (d = 1.26). Childhood trauma, cumulative trauma and PTSD chronicity did not affect treatment effectiveness.Conclusion: Our findings support previous research concerning the effectiveness of C-METTA and add promising evidence for the effectiveness of C-METTA to reduce PTSD following interpersonal violence. Effectiveness was independent of childhood trauma, trauma-duration and PTSD chronicity. Regression to the mean should be considered as a confounding factor. We suggest more research to support the results. C-METTA might increase PTSD treatment diversity and offer patients a greater bandwidth of options according to their preferences and the respective symptomatology.

Therapists perspectives on the Early Intervention after Rape study: a qualitative process evaluation of a randomized controlled trial

ABSTRACTBackground: Early interventions using trauma-focused cognitive behavioural therapy have the potential to alleviate post-traumatic stress symptoms in individuals who have experienced recent sexual assault. Specialized Sexual Assault Centers (SACs) in Norway offers psychosocial support, however, this support varies across SACs and its efficacy has not been researched. The Early Intervention after Rape (EIR) study is a multisite randomized controlled trial designed to assess the efficacy and effectiveness of training SAC nurses and social workers to deliver a modified version of prolonged exposure therapy shortly after rape.Objective: This article aims to present a qualitative process evaluation of the implementation of the EIR study across three SACs in Norway, from the perspective of nurses and social workers.Method: We conducted semi-structured interviews with fifteen nurses and social workers, ten of whom received training in prolonged exposure therapy (mPE). We used Thematic Analysis to identify themes and subthemes.Results: Thematic analysis yielded four significant themes for process evaluation: (1) The quality of the new intervention modified prolonged exposure was considered satisfactory through training and supervision and delivered with good adherence to the manual, although some therapists perceived the manual as too rigid; (2) Adoption dynamics within the SACs are complex and include both enthusiasm for clinical research as well as resistance to change; (3) Narrow inclusion criteria and burden with participation for patients may limit reach and representativeness of the RCT; (4) Unintended consequences were identified, such as delayed start, conflicting advices and cross-contamination, underscoring the ongoing necessity for process evaluation alongside RCTs.Conclusion: This qualitative process evaluation offers insight into real-world clinical challenges with implementing a new intervention and conducting a multisite RCT within SACs in Norway. This study may inform opportunities to advance evidence-based practices for rape survivors seeking help.Trial registration: ClinicalTrials.gov identifier: NCT05489133..

Anhedonia and PTSD symptom severity profiles differentially influence physical activity volume in trauma-exposed adults

Background: It is well-established that adults with elevated psychiatric symptoms or a psychiatric disorder (e.g. depression) engage in lower amounts of physical activity (PA) compared to adults with fewer symptoms/no diagnosis. However, less is known about the association between psychiatric symptoms and PA behaviour in trauma-exposed adults. Most prior investigations have focused on independent associations between overall depression or posttraumatic stress disorder (PTSD) symptoms in relation to PA and have neglected specific symptom domains (e.g. anhedonia). Therefore, we conducted secondary analyses on a parent dataset to examine whether PTSD symptom severity moderates the association between anhedonia and PA volume.Methods: Trauma-exposed adults (N = 107, 61% women, M ± SD age = 28 ± 9 y 54% White) completed questionnaires assessing demographic information, anhedonia, PTSD symptom severity (overall and symptom clusters), and PA volume (total MET-min/week). Main effects and interactions between anhedonia and PTSD symptom severity in relation to PA volume were examined with robust linear regression models.Results: We observed a significant anhedonia × PTSD symptom severity interaction. An inverse association between anhedonia and PA volume was observed among adults with lower-to-moderate PTSD symptom severity, and a positive association between anhedonia and PA volume was observed among adults with higher PTSD symptom severity. Significant anhedonia × PTSD symptom severity interactions for avoidance (Cluster C) and negative alterations in arousal/reactivity (Cluster E) symptoms were also observed, with associations in the same direction as the overall PTSD symptom severity model.Conclusion: These preliminary findings suggest that co-occurring anhedonia and PTSD symptom severity profiles interact to influence PA volume in trauma-exposed adults. Future research is needed to understand why trauma-exposed adults with greater co-occurring anhedonia and PTSD symptom severity profiles reported engaging in higher levels of PA compared to those with lower symptom severity profiles. Such knowledge could help healthcare practitioners tailor treatment plans to incorporate or adjust PA prescriptions.

Experts in traumatic stress are concerned about global impact of what is happening in U.S

Trauma is a global issue and public health concern. Political decisions may directly impact rates of trauma exposure, be it individual trauma or mass disaster, and guide how we deal with the consequences of trauma. In this editorial, we warn that the current U.S. administration's decisions are impacting exposure to and consequences of trauma worldwide as well as disrupting the field of traumatic stress in research and practice.

The diagnostic accuracy of PTSD assessment instruments used in older adults: a systematic review

Background: As the number of older adults increases worldwide, understanding their mental health is crucial, including the impact of traumatic experiences that can lead to posttraumatic stress disorder (PTSD). However, validated screening and diagnostic instruments for PTSD in older adults are limited.Objective: We sought to provide a comprehensive summary of the diagnostic accuracy of PTSD screening and diagnostic instruments used in older adults (Mage ≥ 60 years).Method: A systematic search of MEDLINE, EMBASE, PsycINFO and Web of Science databases was conducted for January 1980 through 10 January 2025. Studies that focused on the psychometric properties of PTSD instruments in older adults were included.Results: Out of 21,197 publications screened, only 40 studies including 24 instruments met the eligibility criteria. Only seven were conducted with participants from the general population or primary care patient samples. There were 14 relevant studies in the last ten years, with only six based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria. Validation studies conducted in non-Western and/or non-English speaking older adult samples are rare.Conclusions: There is a shortage of validation studies of PTSD screening and diagnostic tools in the general older adult population. We recommend using the Clinician-Administered PTSD Scale for DSM-5 in clinical practice. It is the gold standard for assessing current and lifetime PTSD in the general population. Further research is required to establish evidence-based clinical cut-off scores and cross-cultural validity for PTSD screening in different populations of older adults. Future studies should also assess measures that consider the multimorbidity in this population (e.g. cognitive impairment and other psychiatric or medical disorders) and are easy to administer in clinical practice.

Implementation of evidence-based psychotherapies for posttraumatic stress disorder in Azerbaijan

Background: Following the second Karabakh War, mental health services in Azerbaijan encountered significant challenges due to an increased number of traumatised individuals. To address the needs of people with post-traumatic stress disorder (PTSD), two evidence-based treatments, Cognitive Processing Therapy (CPT) and Written Exposure Therapy (WET), have been selected for future implementation in the country.Objective: This study aims to present preliminary findings on the training and implementation of CPT and WET.Method: Forty-two clinicians participated in the training programme, with 24 enrolled in CPT training and 18 in WET training. The programme included a self-administered online course, workshops, and consultations. Following each phase of training, clinicians completed the Perceived Characteristics of Intervention Scale (PICS) to assess the effectiveness and legitimacy of trauma-focused therapies.Results: Our results indicated a positive trend in perception from one assessment to another (F(2, 82) = 20.2, p < .001, η2p = .330), along with a decrease in perceived risk associated with treatment (F(2, 82) = 5.3, p < .007, η2p = .114). Additionally, the study found that belonging to either the CPT or WET training group did not significantly influence positive perception.Conclusions: These findings confirm the feasibility of utilising CPT and WET by clinicians providing services for PTSD patients in Azerbaijan.

Attention bias variability as a cognitive marker of PTSD: A comparison of eye-tracking and reaction time methodologies

Identification of reliable behavioral markers for posttraumatic stress disorder (PTSD) can offer objective measures beyond self-reports to aid in diagnosis, treatment, and prevention. Attention bias variability (ABV), defined as fluctuations in attention toward or away from threat-related stimuli, has been associated with PTSD. Reaction time-based ABV (RT-ABV) has been extensively studied and shown to be linked with PTSD symptomatology. An eye-tracking-based ABV index (ET-ABV) was only recently introduced, and results show that it may be associated with trauma exposure rather than with PTSD symptoms. However, these two ABV types have yet to be studied within the same sample. The current study explored the association between trauma exposure, PTSD symptom severity, and ABV measures, applying both the classic RT-ABV and the new ET-ABV in the same sample. Participants with PTSD (n = 41), trauma-exposed healthy controls (TEHC; n = 71), and non-trauma-exposed healthy controls (HC; n = 38) completed an eye-tracking free-viewing matrix task and a response-based dot-probe task using the same threat-related stimuli (angry faces) across tasks. Results indicate that both RT-ABV and ET-ABV were significantly higher in participants with PTSD compared to participants in the TEHC and HC groups, with no significant difference between the latter groups. Additional analyses indicate that although moderately correlated, each of the ABV measures explains unique portions of the variance in PTSD severity. This study replicates and extends prior findings on the association between ABV and PTSD and highlights the potential of ET-ABV as a novel and reliable marker for PTSD severity.

Trauma-informed practice for genetic counselors: Insights from a workshop evaluation

Trauma-informed practice (TIP) is an emerging model of care that acknowledges the widespread impact of trauma and emphasizes both physical and psychological safety for consumer and provider. It is being increasingly integrated into models of healthcare delivery, organizational policies, and practices, and has been shown to improve clinical interactions, increase treatment adherence, and improve healthcare outcomes. However, to date, TIP has not yet been systematically integrated into genetic counseling training and practice. In this study, using the RISE2 Genomics reporting standard, we present the outcomes of developing and evaluating a TIP workshop designed and delivered for genetic counselors in New South Wales, Australia. This workshop was the first of its kind and addressed the unique clinical and psychosocial challenges that genetic counselors face, including the risk of vicarious trauma and the high rates of burnout in the profession. The workshop aimed to enhance genetic counselors' understanding of trauma and its effects, provide practical strategies for communication and engagement with trauma-affected individuals, and offer guidance on incorporating TIP into clinical practice. Genetic counselors who participated in the TIP training expressed strong appreciation for the workshop and reported increased awareness of the ubiquity of trauma and the presentation of traumatic responses, and increased self-perceived knowledge and confidence in providing trauma-informed care. Additionally, participants were interested in ongoing TIP professional development and the integration of TIP into models of genetic counseling and professional practice. As the field of genetic counseling continues to evolve, we suggest that integrating TIP into training, professional development, and practice will not only improve client outcomes but also reduce rates of vicarious trauma and burnout among genetic counselors. This study is the first to consider the educational needs and the incorporation of TIP into genetic counseling practice, and in doing so, it paves the way for future research and policy development that integrates TIP into models of genetic counseling.

Traumatic Exposure and PTSD Symptoms in a Sample From a Tertiary Pain Clinic

BACKGROUND

Post-traumatic stress disorder (PTSD) is a significant psychiatric comorbidity in individuals with chronic pain. To date, the link between PTSD and chronic pain has mostly been described using the outdated DSM-IV PTSD criteria. Stronger evidence utilizing the updated DSM-5 criteria is needed to ensure comparability with earlier prevalence rates.

METHODS

This observational study reported the percentage of individuals who had experienced at least one traumatic event and fulfilled the DSM-5 PTSD criteria, based on self-report, at a tertiary pain clinic in Sweden. The study also investigated the associations between PTSD symptom severity and sociodemographic characteristics, trauma-related factors, and pain-related factors, using regression analysis in the trauma-affected subsample.

RESULTS

A large proportion of the sample (76.8%) reported having experienced at least one traumatic event, with the prevalence of self-reported PTSD being 23.0% for the sample. Female sex, being born outside of Sweden, anxiety, and multiple traumatic events were identified as significant predictors of more severe PTSD symptoms. The most common trauma types were accidents, life-threatening illness or injury, sudden accidental or violent death, and multiple traumas.

CONCLUSIONS

Based on the results from this study, it seems important to integrate PTSD assessment in clinical settings focused on chronic pain. The findings align with the broader literature on the impact of sex, migration, and cumulative traumas as predictors of PTSD symptomatology. Furthermore, the results highlight the complex interconnection between PTSD and chronic pain, underscoring the importance of considering sociodemographic and trauma-related factors in the clinical assessment and treatment of chronic pain populations.

Risk and Protective Factors in Dancers Exposed to Trauma

PURPOSE

This study examined risk and protective factors in dancers with/without posttraumatic stress disorder (PTSD) and with/without trauma exposure.

LITERATURE REVIEW

Exposure to traumatic events and developing PTSD can compromise daily functioning and performance ability. Despite exposure many dancers adapt, whereas others suffer psychopathology such as depression, anxiety, PTSD, and difficulties regulating emotions.

METHODS

Two hundred ninety two pre-professional/professional dancers provided informed consent (IRB approved) and completed 8 self-report measures. A subsample (66%) exposed to a significant traumatic event was evaluated for PTSD. Multivariate analyses of covariance (MANCOVA) were conducted to compare dancers with/without PTSD and with/without trauma exposure. A logistic regression analysis determined predictors of PTSD.

RESULTS

The MANCOVAs indicated that dancers exposed to trauma (66%) and who had PTSD (32%) had significantly more difficulty regulating emotions, engaged more emotion-oriented coping under stress, and had increased depression, trait anxiety, and cumulative trauma. In these group comparison analyses there were non-significant differences regarding flow experiences and task- and avoidance-oriented coping strategies. In the logistic regression analysis childhood physical and sexual abuse, childhood emotional neglect, mental illness within the family, and difficulty disclosing abuse experiences were predictors of PTSD. In the total sample 21% had PTSD.

DISCUSSION AND CONCLUSIONS

This study identified types of abuse/trauma, emotion regulation/coping, and psychopathology associated with PTSD in dancers exposed to trauma (66%) and with PTSD (32%). In the total sample 21% had PTSD. Regardless of exposure to trauma or PTSD, the non-significant findings indicated similarities for dancers for global and autotelic flow experiences and task- and avoidance-oriented coping strategies. These positive factors may mitigate trauma-related symptoms. It is recommended that dancers, educators, and clinicians understand the effects of trauma exposure and promote the development of effective coping strategies, emotion regulation, and flow states which may diminish the negative effects of PTSD.

Sexual Trauma and Mental Distress among Former Ultra-Orthodox Jewish Individuals

BACKGROUND

Disaffiliating from an ultra-Orthodox society is a risk factor for psychological distress, depression, and suicide ideation because the process involves encountering culture shock, education gaps, and disconnection from familiar surroundings. Traumatic experiences such as sexual abuse may augment distress among ex-ultra-Orthodox individuals (ex-ULTOIs).

OBJECTIVE

This study examined the prevalence of past sexual trauma among ex-ULTOIs, and assessed the contribution of experiences of sexual trauma to psychopathology among this population.

METHODS

In an online cross-sectional survey among ex-ULTOIs (N = 724, aged 19-54, 47.9% women), anonymously completed questionnaires concerning prior sexual trauma, psychopathology, depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, and suicide ideation and behavior.

RESULTS

Sexual trauma was reported by 252 (34.8%) of the respondents, of whom 150 (20.7%) reported being sexually assaulted by a family member. Sexual trauma was associated with increased levels of emotional distress, including a higher probability of depression, anxiety, PTSD, and suicide risk.

CONCLUSIONS

Sexually traumatic experiences are prevalent among ex-ULTOIs. Sexual trauma was found to be associated with an increased risk of emotional distress and psychopathology. Bearing in mind that this population is, by definition, vulnerable to high levels of emotional distress, the study results highlight the importance of screening for sexual trauma in order to identify and treat ex-ULTOIs who have experienced sexual abuse. Moreover, therapeutic programs specifically focusing on this vulnerable population are warranted.

The efficacy of elevating anandamide via inhibition of fatty acid amide hydrolase (FAAH) combined with internet-delivered cognitive behavioral therapy in the treatment of post-traumatic stress disorder: a randomized, placebo-controlled clinical trial

Post-traumatic stress disorder (PTSD) is a severe mental health disorder with limited treatment options. Gold standard treatment includes cognitive behavioral therapies (CBT) that incorporate exposure to traumatic memories to facilitate extinction. CBT can be effective in PTSD, but effects are incomplete and symptoms are prone to spontaneous return. Pharmacologically facilitating fear extinction could potentiate the effects of exposure-based therapy. Here, we explored whether targeting the endocannabinoid (eCB) system, a neuromodulatory system critically involved in fear extinction, would promote the efficacy of exposure-based CBT. Specifically, we tested the effects of elevating the eCB ligand anandamide (AEA) via inhibition of its main degradative enzyme, fatty acid amide hydrolase (FAAH). In this double-blind, placebo-controlled study, patients with PTSD (N = 100; 85 women) were randomized to the FAAH inhibitor (FAAHi) JNJ-42165279 (25 mg b.i.d.) or placebo for 12 weeks. In weeks 5-12, all participants completed an internet-delivered CBT that included exposure-based modules. The primary outcome was clinician-assessed PTSD symptom severity (CAPS-5). Secondary outcomes included self-reported symptoms of PTSD, depression, anxiety, and sleep quality. Blood samples were taken to measure levels of drug and eCBs. Overall, PTSD symptoms improved over time. While FAAHi increased AEA levels, there was no effect of FAAHi on PTSD symptoms or any secondary measure. FAAHi combined with internet-delivered CBT did not improve PTSD symptoms to a greater extent than internet-delivered CBT alone. Thus, FAAH inhibition does not appear to be a suitable adjunct treatment for enhancing CBT in PTSD. This study was registered as Eudra-CT 2020-001965-36.

Incorporating AI Into Military Behavioral Health: A Narrative Review

INTRODUCTION

Concerns regarding suicide rates and declining mental health among service members highlight the need for impactful approaches to address behavioral health needs of U.S. military populations and to improve force readiness. Research in civilian populations has revealed that artificial intelligence and machine learning (AI/ML) have the promise to advance behavioral health care in the following 6 domains: Education and Training, Screening and Assessment, Diagnosis, Treatment, Prognosis, and Clinical Documentation and Administrative Tasks.

MATERIALS AND METHODS

We conducted a narrative review of research conducted in U.S. military populations, published between 2019 and 2024, that involved AI/ML in behavioral health. Studies were extracted from Embase, PubMed, PsycInfo, and Defense Technical Information Center. Nine studies were considered appropriate for the review.

RESULTS

Compared to research in civilian populations, there has been much less research in U.S. military populations regarding the use of AI/ML in behavioral health. The studies selected using ML have shown promise for screening and assessment, such as predicting negative mental health outcomes in military populations. ML has also been applied to diagnosis as well as prognosis, with initial positive results. More research is needed to validate the results of the studies reviewed.

CONCLUSIONS

There is potential for AI/ML to be applied more extensively to military behavioral health, including education/training, treatment, and clinical documentation/administrative tasks. The article describes challenges for further integration of AI into military behavioral health, considering perspectives of service members, providers, and system-level infrastructure.

Psychological therapies for post-traumatic stress disorder in children and adolescents

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects (i.e. benefits and harms) of psychological therapies for post-traumatic stress disorder and complex post-traumatic stress disorder in children and adolescents.

Validation of an electronic self-administered version of the Dimensional Inventory of Stress and Trauma Across the Lifespan in a large sample of young adults

Recent advances in the dimensional assessment of traumatic stress have initiated research examining correlates of exposure to specific features of stress. However, existing tools require intensive, in-person, clinician administration to generate the rich phenotypic data required for such analyses. These approaches are time consuming, costly, and substantially restrict the degree to which assessment tools can be disseminated in large-scale studies, constraining the refinement of existing dimensional models of early adversity. Here, we present an electronic adaptation of the Dimensional Inventory of Stress and Trauma Across the Lifespan (DISTAL), called the DISTAL-Electronic (DISTAL-E), present descriptive statistics drawn from a large sample of N = 500 young adult participants who completed the novel measure, and provide information about its psychometric properties. Results suggest that the DISTAL-E adequately assesses the following dimensional indices of traumatic stress exposure: type, chronicity, age of onset, severity, proximity, caregiver involvement, controllability, predictability, betrayal, threat, and deprivation and that it has excellent content and convergent validity and good test-retest reliability over a 7-11 day period. Although the development of the DISTAL-E facilitates the broad assessment of dimensions of stress exposure in large-scale datasets and has the potential to increase access to stress-related research to a wider group of participants who may not be able to access clinical research in traditional, in-person, clinic-based settings, the generalizability of results of the present study may be constrained by the fact that study participants were primarily White, educated, and with middle-to-high income. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Misconceptions Among Mental Health Treatment Providers About OCD and PTSD

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) share overlapping features for which similar cognitive behavioral treatment (CBT) strategies can be employed. However, the comorbid presence of these conditions poses unique clinical considerations, and a nuanced approach to assessment, conceptualization, and treatment is needed when working with individuals with co-occurring OCD and PTSD. Treatment providers may not be aware of these nuances and may hold misconceptions about co-occurring OCD and PTSD, impacting their approach to assessment, conceptualization, and treatment. The current study sought to examine possible misconceptions among mental health treatment providers of differing specializations. Among 146 primarily CBT-oriented treatment providers (20.3% generalist, 13.0% PTSD specialist, 32.6% OCD specialist, and 34.1% OCD/PTSD specialist), exploratory factor analysis categorized misconceptions relating to Trepidation, Differential Diagnosis, Flexibility, OCD is Trauma, Trauma Misconceptions, and Compartmentalization. Overall, OCD specialists endorsed misconceptions most frequently, including those of Trepidation and underestimating the prevalence of trauma and PTSD in individuals with OCD. In contrast, PTSD specialists were more likely to endorse providing patients reassurance for their OCD-related fears, and OCD/PTSD providers were more likely to apply rigid Differential Diagnosis criteria not supported by research or diagnostic criteria to intrusive thoughts and safety behaviors. Misconceptions are explained through the lens of differing conceptualization and treatment approaches between areas of specialization.

Effects of ketamine on fear memory extinction: a review of preclinical literature

Introduction

Ketamine, a multimodal dissociative anesthetic, is widely used as a trauma analgesic in emergency situations. Ketamine is also used to treat psychiatric disorders due to its broad application potential, including treatment-resistant major depression. However, its impacts on the development of post-traumatic stress disorder (PTSD) and its potential as a treatment for PTSD are controversial. PTSD is marked by persistent and intrusive memories of traumatic event(s) and re-experiencing of the traumatic memories when exposed to trauma-related stimuli. Individuals with PTSD are often treated with prolonged exposure therapy (PE), in which they are gradually exposed to stimuli that remind them of the previous traumatic memory. If successful, they may learn that the previously traumatic stimuli are no longer threatening, a process known as fear extinction. Although fear extinction can be studied in laboratory animals, previous preclinical literature on the effects of ketamine on fear extinction has been inconsistent.

Methods

Thus, we summarized the existing preclinical literature examining effects of ketamine on fear extinction and its potential molecular mechanisms.

Results

Studies found that ketamine may enhance, impair, have no effect, or have mixed effects on fear extinction. These discrepancies may be attributed to differences in dosage, route, and timing of ketamine administration.

Discussion

We conclude the review with recommendations for future research on ketamine and PTSD such as the inclusion of more female subjects, clinically relevant doses and routes of ketamine administration, and more comprehensive behavioral assays that are relevant to PTSD in humans to enhance translation between preclinical and clinical research.

Traumatic Psychedelic Experiences

Psychedelic experiences involving extreme feelings of horror, helplessness, and perceived threats can be traumatizing. Traumatic psychedelic experiences are a rare, extreme, and largely preventable form of challenging experience which can arise due to frightening psychedelic drug effects, unsafe settings, and emergence of pre-existing trauma. Some people recover quickly, but others develop prolonged anxiety, sleep disturbances, derealization, or other potentially trauma-related symptoms. This chapter discusses the causes, phenomenology, and potential outcomes of traumatic psychedelic experiences, as well as how to prevent them and minimize their negative impact.

Trade-offs between machine learning and deep learning for mental illness detection on social media

Social media platforms provide valuable insights into mental health trends by capturing user-generated discussions on conditions such as depression, anxiety, and suicidal ideation. Machine learning (ML) and deep learning (DL) models have been increasingly applied to classify mental health conditions from textual data, but selecting the most effective model involves trade-offs in accuracy, interpretability, and computational efficiency. This study evaluates multiple ML models, including logistic regression, random forest, and LightGBM, alongside DL architectures such as ALBERT and Gated Recurrent Units (GRUs), for both binary and multi-class classification of mental health conditions. Our findings indicate that ML and DL models achieve comparable classification performance on medium-sized datasets, with ML models offering greater interpretability through variable importance scores, while DL models are more robust to complex linguistic patterns. Additionally, ML models require explicit feature engineering, whereas DL models learn hierarchical representations directly from text. Logistic regression provides the advantage of capturing both positive and negative associations between features and mental health conditions, whereas tree-based models prioritize decision-making power through split-based feature selection. This study offers empirical insights into the advantages and limitations of different modeling approaches and provides recommendations for selecting appropriate methods based on dataset size, interpretability needs, and computational constraints.

Changes in the prevalence of forcible rape, physical violence, and physical partner violence among men and women in Norway: a population-based repeated cross-sectional study in 2013 and 2022

BACKGROUND

Repeated prevalence studies are necessary to monitor the government's progress toward preventing community violence over time. This study aims to identify possible changes in self-reported physical violence, forcible rape, and physical partner violence in the Norwegian general population between 2013 and 2022.

METHODS

The 2022 and 2013 studies employed a cross-sectional design, utilizing identical sampling procedures and measures in 2022. Participants aged 18-74, including males and females, were randomly selected from the Norwegian National Population Registry. Data were collected through phone interviews. The response rate in 2022 was 25.3% of those who answered the phone and 42.9% in 2013. The total number of respondents was 4,295 in 2022 and 4,527 in 2013.

RESULTS

Confidence intervals from bootstrapped analyses were used to evaluate crude differences in prevalence estimates between 2013 and 2022 for women and men separately. Among women, the lifetime prevalence of self-reported forcible rape increased from 9.4% in 2013 to 14.4% in 2022 (∆prevalence = 5.0%, 95% CI 3.1-6.8); severe physical violence in adulthood increased from 22.5% to 29.4% (∆prevalence = 6.9%, 95% CI 4.4-9.5); and physical partner violence in adulthood increased from 9.2% to 11.2% (∆prevalence = 2.0%, 95% CI 0.7-3.4). There were no statistically significant changes in self-reported forcible rape, physical violence, and physical partner violence among men between 2013 and 2022. Logistic regression analyses (adjusted for gender, age, education, financial situation, and marital status) corroborated these findings showing overall increased odds of self-reported forcible rape (adjusted odds ratio [aOR] = 1.70, 95% CI = 1.42-2.04), severe physical partner violence (aOR = 1.32, 95% CI = 1.09-1.58) and severe physical violence (aOR = 1.25, 95% CI = 1.14-1.37) in the 2022 survey compared to the 2013 survey.

CONCLUSIONS

Forcible rape, physical violence, and physical partner violence were highly prevalent in 2022 and remain significant challenges in Norway. The reported exposure to all three severe violence forms increased among females between 2013 and 2022. These findings call for immediate action and underscore the need for continued governmental efforts toward preventing violence. Given the high prevalence, these efforts should be targeted towards the general population.

Integrating a trauma recovery center into an urban hospital setting serving multiply marginalized patients in the Southeastern United States

BACKGROUND

Few interpersonal violence survivors receive psychosocial services, and those who are multiply marginalized are among the least likely to receive needed care. Trauma recovery centers (TRCs) aim to reduce health disparities by increasing access to trauma-focused care. This study describes the initial adoption, implementation, and reach of the first TRC in the southeastern USA.

METHODS

Funding was awarded to support the adoption of the Grady TRC within an urban safety net hospital in Atlanta, Georgia, and interdisciplinary collaboration was leveraged to support implementation. The electronic health records of 3,238 adult patients seeking medical care were screened for TRC eligibility to determine the program's reach (2020-2023).

RESULTS

53% (n = 1,712) of patients were eligible for TRC services; of these, 16.8% completed TRC intake assessments (n = 288; 84.4% Black, 58.3% female, 47.1% referred for gunshot wounds). Most TRC patients (68.1%; n = 196) screened positive for probable posttraumatic stress disorder (PTSD); many endorsed severe anxiety (44.8%, n = 129) or depressive (23.6%, n = 68) symptoms. Most reported no/low alcohol and drug use.

CONCLUSIONS

A demonstrable need for trauma-focused services was found among violence-exposed patients seeking public healthcare. Integrating the TRC model into institutions serving multiply marginalized patients may help increase access to trauma-focused care for those who may not otherwise receive it.

Trauma Burden Affected People with Multiple Sclerosis During SARS-CoV-2 Pandemic

Background/Objectives: Trauma is a psychological injury resulting from a distressing or overwhelming event. The SARS-CoV-2 pandemic has been disruptive and traumatic for many people with multiple sclerosis (pwMS). The relationship between patient characteristics and trauma in pwMS during the pandemic has not yet been thoroughly explored. The aim of this bicentric prospective cohort study was to analyze the prevalence and development of probable post-traumatic stress disorder (PTSD) among pwMS during the SARS-CoV-2 pandemic and to identify patient parameters associated with this condition. Methods: We have assessed pwMS for probable PTSD before and after the approval of the first SARS-CoV-2 vaccines in Germany using an adapted version of the Trauma Screening Questionnaire (TSQ). We compared pwMS with probable PTSD (TSQ sum score ≥ 6) with those without probable PTSD (TSQ sum score < 6) regarding sociodemographic and MS-specific clinical characteristics, polypharmacy status, comorbidities, anxiety/depression levels, personality traits, mental/physical/social burden, and general vaccination willingness. Results: Out of the 149 pwMS included, 8.1% were identified as having probable PTSD. These patients had significantly higher rates of pre-pandemic abnormal anxiety (66.7% vs. 18.5%, p < 0.001) and depression scores (45.5% vs. 12.6%, p = 0.013). The patients with probable PTSD exhibited a distinct personality profile, with significantly higher neuroticism and harm avoidance scores and lower conscientiousness, cooperativeness, and self-directedness scores. They were also significantly more likely to report severe or very severe mental/physical/social burdens during the pandemic compared to those without probable PTSD (p ≤ 0.045). Conclusions: Medical and social services should be provided to support patients who experienced serious stress or trauma. The development of concepts for education and vaccination procedures should be accompanied by comprehensive and clear communication that recognizes individual risk factors and addresses possible concerns with evidence-based and convincing arguments.

Memory Boost for Recurring Emotional Events Is Driven by Initial Amygdala Response Promoting Stable Neocortical Patterns across Repetitions

Emotionally arousing events are typically vividly remembered, which is generally adaptive but may contribute to mental disorders such as post-traumatic stress disorder. Previous research on emotional memory focused primarily on events that were experienced only once, leaving the memory mechanisms underlying repeatedly encountered emotional events largely unexplored. Here, we aimed to elucidate the brain mechanisms associated with memory for recurring emotional events. Specifically, we sought to determine whether the memory enhancement for recurring emotional events is linked to more variable neural representations, as predicted by the encoding-variability hypothesis, or to more stable representations across repetitions, as suggested by a memory reinstatement account. To investigate this, we repeatedly presented healthy men and women with images of emotionally negative or neutral scenes during three consecutive runs in an MRI scanner. Subsequent free recall was, as expected, enhanced for emotional compared with neutral images. Neural data showed that this emotional enhancement of memory was linked to (1) activation of the amygdala and anterior hippocampus during the initial encounter of the emotional event and (2) increased neural pattern similarity in frontoparietal cortices across event repetitions. Most importantly, a multilevel-moderated mediation analysis revealed that the impact of neocortical pattern stability across repetitions on emotional memory enhancement was moderated by amygdala activity during the initial exposure to the emotional event. Together, our findings show that the amygdala response during the initial encounter of an emotional event boosts subsequent remembering through a more precise reinstatement of the event representation during subsequent encounters of the same event.

Reprint of Children Fleeing War-Exploring the Mental Health of Refugee Children Arriving in Israel after the Ukraine 2022 Conflict

BACKGROUND

In February 2022, Ukraine suffered a devastating assault by Russia, leading to destruction, casualties, and mass displacement. Among those displaced were over 1.5 million children. Forced displacement exposes children to a heightened risk of mental health issues.

OBJECTIVE

This study investigated the prevalence of Post-traumatic stress disorder (PTSD) and other mental health issues among child refugees shortly after their displacement from Ukraine to Israel. It aimed to identify factors influencing PTSD development and explore their associations.

METHODS

The study included 59 child refugees who had arrived in Israel after fleeing the war in Ukraine. Parents completed self-report questionnaires to assess their children's mental health.

RESULTS

Only three children met the DSM diagnostic criteria for PTSD, with higher scores in the negative cognition and re-experiencing clusters. Over half of the children exhibited general mental health problems, with approximately 40 % showing internalizing problems, and 30 % showing externalizing problems. The study also found a significant comorbidity between PTSD symptoms and internalizing problems. Additionally, internalizing problems emerged as the sole significant predictor of PTSD levels when considering factors such as age, gender, economic status, parents' work status, internalizing problems, and externalizing problems.

CONCLUSIONS

Child refugees frequently experience psychological distress, even if they do not meet the formal diagnostic criteria for PTSD. They often exhibit other distress symptoms, primarily internalizing problems, which can be challenging to detect. A deeper understanding of the challenges faced by refugee children can inform the development of targeted assistance programs and the recruitment and training of personnel in host countries.

Emotions, coping and psychological flexibility in earthquake survivors: a cross-sectional study

Earthquakes may play a role in the development of several psychological distresses or psychopathologies. Nevertheless, protective factors such as positive emotions, psychological flexibility, and coping mechanisms may be helpful for earthquake survivors in coping. On the other hand, the role of both positive and negative emotions of earthquake survivors in psychological flexibility and coping remains elusive. Accordingly, this study aimed to examine the relationship between emotions, coping, and psychological flexibility levels of earthquake survivors considering positive and negative emotions together. A total of 330 adult participants of the cross-sectional study completed the Participant Information Form, Perceived Ability to Cope with Trauma (PACT), Psychological Flexibility (PF), and Positive-Negative Affect Schedule (PANAS) scales. Participants were aged between 20 and 68 years (Mean ± SD = 42.42 + 12.88). It was determined that as the PACT levels increased, the PF and negative emotion levels increased yet positive emotion levels decreased. As the PF levels increased, the negative emotion levels increased yet the positive emotion levels decreased (p < 0.01). According to the established model, it was concluded that the PACT was related to positive-negative emotion levels and values, being in the moment, and dissociation sub-dimensions of PF were unrelated to contextual self and acceptance (p > 0.05). In conclusion, positive-negative emotions and PF were found to have a mediating role in the coping of earthquake survivors. Mental health professionals may contribute to increasing PACT in earthquake survivors through interventions aimed at maintaining positive emotions, recognizing negative emotions, and increasing PF.

Chronic pain and comorbid posttraumatic stress disorder: Potential mechanisms, conceptualizations, and interventions

Posttraumatic stress disorder (PTSD) is a common comorbidity to chronic pain, among others due to potentially shared posttraumatic origin. There has been growing interest in this field in the past decades, also providing some important studies to support our understanding of this comorbidity and how to address it in clinical practice. However, there are still important questions, particularly regarding the potentially shared vulnerabilities, mutually maintaining mechanisms, and how to best treat this comorbidity. This article provides a brief and up-to-date review of what we argue to be some of the most important studies within the field of chronic pain and comorbid PTSD and will discuss some of the current challenges and ways forward.

Beneath the Surface: Mental Health in Commercial Fisheries

Commercial fishing is a dangerous occupation where injuries, stress, and traumatic events are common. This study determined probable Post-Traumatic Stress Disorder (PTSD) rates in a cohort of 142 commercial fishermen in the United States and assessed factors that influence PTSD outcomes and severity. Fishermen representing four fisheries were sampled: salmon gillnetters (Alaska), Dungeness crab (Oregon), scallopers and lobstermen (Massachusetts). Participants self-reported information on health, sleep, activity, and substance use through surveys, and responded to a brief PTSD screener (PC-PTSD-5) that assesses probable PTSD under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Positive PTSD screening rates in male fishermen were 12% (as compared to 10% for female fishermen), roughly three times the national average for US men (4%). Fishermen with self-reported depression, financial struggles, inability to control important things in their lives, difficulty going to (p = .0278) or staying (p = .038) asleep were significantly more likely to screen positive for PTSD. Factors influencing the severity of PTSD symptoms in those that have experienced a traumatic event included: financial insecurity, interpersonal concerns (family, crew), stress, and concern for safety on the vessel. Interestingly, sleep variables did not impact the severity of PTSD symptoms, only the outcome of probable PTSD. These results suggest the need to better understand the nature of traumatic events in fishing communities and to validate existing PTSD screening tools with fishermen to determine their accuracy in diagnosing PTSD in this population. Additionally, tailored behavioral health care for fishermen is essential to effective treatment and recovery from trauma.

The relationship between language features and PTSD symptoms: a systematic review and meta-analysis

Objective

The aim of this study is to investigate the relationship between language features and symptoms of Post-Traumatic Stress Disorder (PTSD) to determine if language features can serve as a reliable index for rapid screening and assessing PTSD.

Methods

A comprehensive literature search was performed using Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Ovid databases, augmented by backward reference tracking, to gather pertinent literature concerning language features and traumatic stress disorders published until August 2024.

Results

Twelve observational studies were included, comprising a cumulative sample size of 5,706 cases. Various language analysis tools, such as Linguistic Inquiry and Word Count (LIWC), manual coding, and machine learning techniques, were employed in the studies. Meta-analysis findings revealed a positive correlation between death-related words and PTSD symptoms (OR 1.32, 95%CI 1.10 to 1.59, I² 79.4%, p = 0.004), as well as significant positive correlations between negative emotion words and PTSD symptoms (OR 1.21, 95%CI 1.11 to 1.32, I² 30.5%, p < 0.001), anger-related words and PTSD symptoms (OR 1.14, 95%CI 1.11 to 1.17, I² 0.0%, p < 0.001), word count and PTSD symptoms (OR 1.20, 95%CI 1.09 to 1.31, I² 11.2%, p < 0.001). Additionally, a positive correlation was observed between body-related words and hyperarousal symptoms of PTSD (OR 1.26, 95%CI 1.15 to 1.37, I² 0.0%, p < 0.001), intrusive symptoms (OR 1.40, 95%CI 1.16 to 1.68, I² 0.0%, p < 0.001), and avoidance symptoms (OR1.29, 95%CI 1.21 to 1.37, I² 0.0%, p < 0.001). Death-related words (OR 1.16, 95% CI 1.08 to 1.25, I² 0.0%, p < 0.001) and word count (OR 1.18, 95% CI 1.10 to 1.27, I² 0.0%, p < 0.001) were observed positive correlations between intrusive symptoms of PTSD. Conversely, no correlation was found between the use of words related to sadness, anxiety, positive emotions, first-person pronouns, sensory, cognitive-related words and PTSD symptoms.

Conclusion

Death-related words, anger-related words, negative emotion words, body-related words and word count in Language features hold promise as a reliable indicator for rapid screening and assessing PTSD; however, further research is warranted to investigate their relationship with PTSD symptoms across various cultural contexts, genders, and types of trauma.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024528621.

Validation of the Childhood Trauma Questionnaire (CTQ) in the Context of Trauma-Focused Treatment

Background: The Childhood Trauma Questionnaire (CTQ) is widely used, but retrospective self-report measures may be susceptible to bias especially in the context of pathology. Therefore, we aimed to validate the CTQ in the context of reduced psychopathology following trauma-focused treatment. Methods: We analyzed 149 outpatients with posttraumatic stress disorder (PTSD) related to childhood abuse. Participants received one of three variants of prolonged exposure. The CTQ was administered at baseline and six months later. The internal consistency of the CTQ was assessed using Cronbach's alpha, inter-item and item-total correlations. Convergent validity was assessed with the clinician administered PTSD Scale for DSM-5 (CAPS-5). The consistency of CTQ scores over time was analyzed using linear mixed models and intra-class correlation coefficients. Results: Most CTQ subscales demonstrated high internal consistency and satisfactory inter-item and item-total correlations except for physical neglect and minimization/denial subscales. CTQ subscales physical and sexual abuse exhibited adequate convergent validity with the CAPS-5. None of the CTQ subscales mean score changed significantly from baseline to follow-up. Agreement between the baseline and follow-up assessment within-persons was moderate at item-level but good at subscale-level except for subscale minimization/denial. Minimization/denial at baseline and change in symptomatology during treatment were not significantly related to change in CTQ subscale scores. Conclusions: These findings support the use of the CTQ subscales to retrospectively assess childhood maltreatment.

The age of trauma: the prevalence and psychological impact of potentially traumatic exposures in South Korea

Background

Exposure to potentially traumatic events (PTE) is associated with a range of negative mental health outcomes, including post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD). Although exposure to PTEs is highly prevalent, and their impact on mental health is pervasive, research is mostly limited to diagnosed populations or specific trauma cohorts in the post-pandemic era.

Methods

We conducted an online survey of 1,000 Seoul residents from October 6-12, 2023, using a stratified sampling method. Participants were asked about their traumatic experiences, mental health outcomes, and experiences with mental health services.

Results

Most participants (98.8%) reported that they had experienced at least one PTE. The average number of PTEs reported was 9.19 (SD=7.908). Ninety participants (9%) were categorized as having probable PTSD (2.8% with PTSD only, and 6.2% with cPTSD). The sum of direct and indirect exposures to PTEs of individuals was associated with mental health outcomes, including PTSD symptom severity. Only 34.4% of patients with probable PTSD reported that they had received appropriate mental health services.

Conclusion

Our results suggest that PTE exposures are highly prevalent, and self-awareness of mental health conditions and utilization of mental health services are low in South Korea. Given the lasting effects of traumatic events and the large number of untreated cases, this study highlights the need for proactive responses to traumatic events and better access to short- and long-term services for traumatized individuals.

Substance use and traumatic events among Afghan general population: findings from the Afghanistan national mental health survey

PURPOSE

Substance use and traumatic events are prevalent in Afghanistan, but their relationship is under-investigated.

METHODS

A nationally-representative, cross-sectional survey was conducted in 8 regions of Afghanistan in 2017 (N = 4474). First, we examined the burden of substance use, and demographic correlates (e.g., gender, age) in the Afghan general population; second, we examined the association between traumatic and stressful experiences, including PTSD, and any substance use, tobacco use and sedative use.

RESULTS

Substance use disorder is prevalent in Afghanistan, with prevalence of any substance use at 5.03%, tobacco use at 21.82%, and sedative use prevalence at 6.71%. Women and people with middle and high economic status were less likely to use any substance and tobacco, however, women were more likely use sedative compared to men. People who had collective violence and experienced any traumatic event more likely to use any substances, tobacco and sedative compared to their counterparts. Finally, individuals with PTSD, depression and generalized anxiety were more likely to use any substances, tobacco and sedative compared to individuals without these psychiatric disorders.

CONCLUSION

Substance use and dependence are prevalent in Afghanistan, an area with exposure to conflict and trauma for a majority of the population, underscoring the pervasive impact of trauma exposure on population health in this area. As resources are deployed to assist the Afghan population through conflict, attention to substance use and psychiatric disorders is needed to fully address population health.

Combat exposure, social support, and posttraumatic stress: a longitudinal test of the stress-buffering hypothesis among veterans of the wars in Afghanistan and Iraq

PURPOSE

While social support is widely viewed as a protective factor against posttraumatic stress disorder (PTSD), few studies have directly tested whether social support buffers the long-term effects of pre-existing PTSD symptoms or baseline combat exposure among Veterans (i.e., the stress-buffering hypothesis).

METHODS

To address this gap, the current study tested perceived social support as a moderator of the effects of baseline PTSD symptoms and combat exposure on PTSD symptoms at 10-year follow up in a sample of post-911 Veterans (N = 783).

RESULTS

Higher levels of combat exposure and baseline PTSD symptoms predicted elevated PTSD symptoms at 10-year follow-up. Perceived social support moderated these effects, such that the impacts of baseline symptoms and combat exposure were attenuated for Veterans with high levels of perceived support. However, buffering effects were less evident at higher levels of combat exposure and were not significant at very high levels of baseline PTSD symptoms.

CONCLUSION

While findings are broadly consistent with the stress-buffering hypothesis, results of the present study suggest that the benefits of perceived social support may be less evident at higher levels of combat exposure. Results also offer preliminary evidence that perceived social support is less protective for Veterans with severe pre-existing symptoms.

Gender Differences in the Relationship Between Interpersonal Childhood Adversities and Later Life Depressive Symptoms

There is very little research on the relationship between interpersonal adverse childhood experiences and depressive symptoms in later adulthood in China. This study examines gender differences in the relationships between childhood physical abuse, bullying victimization, witnessing domestic violence, and depressive symptoms in Chinese middle-aged and older adults, controlling for self-rated physical health and sociodemographic characteristics.The study was based on a nationally representative sample of 4,775 males and 5,596 females aged 45 and older collected through the China Health and Retirement Longitudinal Study (CHARLS). Childhood adversity indicators in the 2014 Life History Survey were merged with the harmonized 2018 CHARLS dataset. Structural equation modeling was conducted for males and females simultaneously.Physical abuse was not significantly associated with depressive symptoms for either males or females. However, bullying victimization was significantly associated with depressive symptoms for both males and females. This association was stronger for males compared to females, but the gender difference was not statistically significant. Additionally, witnessing domestic violence had a significant association with depressive symptoms for both males and females, with a stronger association for females but this gender difference also was not statistically significant.Being bullied and witnessing domestic violence were still influential in middle and late life. To provide more effective prevention and interventions, further investigations are needed regarding the mechanisms behind the significant relationships and to explore why childhood physical abuse was not significantly associated with depressive symptoms among these Chinese participants.

Brain Fog and Cognitive Dysfunction in Posttraumatic Stress Disorder: An Evidence-Based Review

The term "brain fog" has long been used both colloquially and in research literature in reference to various neurocognitive phenomenon that detract from cognitive efficiency. We define "brain fog" as the subjective experience of cognitive difficulties, in keeping with the most common colloquial and research use of the term. While a recent increase in use of this term has largely been in the context of the post-coronavirus-19 condition known as long COVID, "brain fog" has also been discussed in relation to several other conditions including mental health conditions such as post-traumatic stress disorder (PTSD). PTSD is associated with both subjective cognitive complaints and relative deficits on cognitive testing, but the phenomenology and mechanisms contributing to "brain fog" in this population are poorly understood. PTSD psychopathology across cognitive, affective and physiological symptom domains have been tied to "brain fog". Furthermore, dissociative symptoms common in PTSD also contribute to the experience of "brain fog". Comorbid physical and mental health conditions may also increase the risk of experiencing "brain fog" among individuals with PTSD. Considerations for the assessment of "brain fog" in PTSD as part of psychodiagnostic assessment are discussed. While standard psychological intervention for PTSD is associated with a reduction in subjective cognitive deficits, other cognitive interventions may be valuable when "brain fog" persists following PTSD remission or when "brain fog" interferes with treatment. Limitations of current research on "brain fog" in PTSD include a lack of consistent definition and operationalization of "brain fog" in the literature, as well as limited tools for measurement. Future research should address these limitations, as well as further evaluate the use of cognitive remediation as an intervention for "brain fog".

Association between mental health and professional quality of life among advocates for victims of sexual assault: a cross-sectional study

BACKGROUND

Advocates for victims of sexual assault are exposed to the traumatic events of victims, which can lead to occupational stress. Occupational stress specific to advocates who support victims can cause compassion fatigue and burnout, which can worsen their mental health. Furthermore, such exposure could lead to compassion satisfaction, which, in turn, may buffer compassion fatigue and burnout. To improve the mental health of advocates for victims of sexual assault in Japan, this study aimed to evaluate a hypothesized model explaining the effect of occupational stress on their mental health.

METHODS

This cross-sectional study was conducted using a self-administered questionnaire via mail. The sample comprised 560 advocates from one-stop support centers for victims of sexual assault. Questionnaires comprising the components of the hypothesized model, namely, compassion fatigue, burnout, compassion satisfaction, traumatic stress symptoms, and psychological distress, were mailed. After using descriptive statistics, a path analysis was conducted to test the hypotheses and the fitness of the model.

RESULTS

Data from 250 participants were analyzed. The prevalence rates of compassion fatigue, burnout, and compassion satisfaction were 30%, 65%, and 4%, respectively. The hypothesized model demonstrated a good fit. Compassion fatigue exerted a significant positive effect on traumatic stress symptoms and psychological distress. Burnout also demonstrated a significant positive effect on psychological distress. However, its association with traumatic stress symptoms was not significant. Compassion satisfaction exerted a significant negative effect on compassion fatigue and burnout.

CONCLUSIONS

Improving the mental health of advocates, particularly for traumatic stress symptoms, requires not only intervening in burnout but also improving compassion fatigue. Increasing compassion satisfaction contributes to the improvement of compassion fatigue and burnout. Therefore, creating a supportive environment that considered these would help improve the mental health of the advocates.

The prevalence of mental health issues among nursing students: An umbrella review synthesis of meta-analytic evidence

BACKGROUND

The ongoing global student mental health crisis indicates the urgent need for updated research specifically targeting nursing students. Considering their anticipated transition into healthcare professions, their mental well-being is critical, not only for their academic performance but also for the quality of care they will deliver in their professional roles.

OBJECTIVE

To estimate the prevalence of mental health issues among nursing students by synthesizing data from systematic reviews and meta-analyses.

DESIGN

An umbrella review of published prevalence meta-analyses.

REVIEW METHODS

Publication records were retrieved from four databases-PubMed, CINAHL, PsycINFO, and Scopus-up to September 2024. The methodological quality of each meta-analysis was assessed using the A Measurement Tool for the Assessment of Multiple Systematic Reviews (AMSTAR-2). Assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline checklist. A random-effects model was used for the meta-analysis, and the I2 index was employed to assess between-study heterogeneity. Additionally, the Risk of Bias in Systematic Reviews tool was used to assess review quality, including calculation of overlap between primary studies and adherence to GRADE criteria.

RESULTS

Twenty-five meta-analyses, comprising 375 primary studies and a total of 171,828 nursing students, were included, revealing an overall prevalence of mental health issues at 27 % (95 % CI: 25 % - 30 %). Sleep disturbances were the most prevalent at 50 % (95 % CI: 28 % - 72 %), followed by fear at 41 % (95 % CI: 7 % - 75 %), burnout at 32 % (95 % CI: 25 % - 38 %), and depression at 29 % (95 % CI: 21 % - 38 %). Nomophobia/smartphone addiction had a prevalence of 30 % (95 % CI: 12 % - 49 %), anxiety 29 % (95 % CI: 17 % - 40 %), and stress 27 % (95 % CI: 17 % - 37 %). Lower prevalence rates were observed for smoking, eating disorders, post-traumatic stress disorder, and suicidal ideation/attempts. Significant heterogeneity was noted, particularly in the meta-analyses for anxiety, nomophobia/smartphone addiction, and stress.

CONCLUSIONS

Our review identified eleven prevalent mental health issues among nursing students, with sleep disturbances, anxiety, depression, and burnout being the most common. Behavioral issues, such as nomophobia, are also rising concerns. These findings indicate the need for targeted interventions and further research into causal factors (e.g., geographical and cultural contexts), gender disparities (as most studies focused on female students), and resilience-building strategies.

REGISTRATION

The study protocol was uploaded to the Open Science Framework (OSF) at https://doi.org/10.17605/OSF.IO/EN7UX (registered on 28/10/23).

TWEETABLE ABSTRACT

Among nursing students, overall mental health issues are at 27 %. Key concerns include sleep disturbances, burnout, anxiety, and depression. Nomophobia prevalence also warrants further study.

Talking about trauma: A systematic review of young people's reactions to trauma-focused research

Concerns persist about the potential negative impact of asking young people about their trauma experiences in a research context. Previous research on this ethical issue has focused on adult populations, and the limited evidence for young people has limitations. This systematic review synthesised empirical evidence of young people's reactions to trauma-focused research, and associated participant and study characteristics. Eligible studies included young people aged up to 18 years in any setting who were systematically asked about their response to participating in trauma-focused research. Seventeen studies were identified, containing a total of 40,660 participants. Risk of bias was assessed using a bespoke quality assessment tool. Findings revealed higher benefits than costs, suggesting generally positive appraisals of trauma-focused research for young people. Those with a trauma history or symptoms were more vulnerable to costs. Age and gender did not appear to influence costs, but it was unclear how these factors impacted benefits. These findings suggest that young people can safely be asked about their trauma experiences and its impact, but that consideration of trauma history and symptoms is needed. Routinely asking should become part of ethical research design and would contribute to a richer evidence base.

Trauma history and persistent poor objective and subjective sleep quality among midlife women

OBJECTIVES

Whereas some work links trauma exposure to poor subjective sleep quality, studies largely rely upon limited trauma measures and self-reported sleep at one time point. It is unknown whether trauma is related to persistent poor sleep, whether associations differ based on childhood versus adulthood trauma, and whether trauma exposure is related to poorer objectively assessed sleep. We tested whether childhood or adult trauma associated with persistent poor objectively and subjectively measured sleep at two time points in midlife women.

METHODS

One hundred sixty-seven women aged 40-60 at baseline were assessed twice 5 years apart. At baseline, women reported childhood trauma (Child Trauma Questionnaire), adult trauma (Brief Trauma Questionnaire), demographics, depressive symptoms, apnea symptoms, and medical history, and provided physical measures. At both visits, women completed 3 days of actigraphy (total sleep time [TST], wake after sleep onset [WASO]) and reported sleep quality (Pittsburgh Sleep Quality Index). Relations of childhood and adult trauma exposure, respectively, with persistent poor sleep at both baseline and follow-up visits (TST [<6 hours], WASO [>30 minutes], Pittsburgh Sleep Quality Index [>5]) were assessed in logistic regression models, adjusted for age, race/ethnicity, education, body mass index, sleep medications, nightshift work, apnea, depressive symptoms, vasomotor symptoms, and alcohol use.

RESULTS

Childhood trauma was related to persistent high WASO (odds ratio [95% confidence interval] = 2.16 [1.04-4.50], P = 0.039, multivariable). Adult trauma was related to persistent poor sleep quality (odds ratio [95% confidence interval] = 2.29 [1.07-4.93], P = 0.034, multivariable). Trauma was unrelated to persistent short TST.

CONCLUSIONS

Childhood and adult trauma, respectively, were related to persistent poor objective sleep continuity and subjective sleep quality in midlife women, independent of risk factors.

Open Scapulothoracic Dissociation

Scapulothoracic dissociation is a rare and serious type of trauma caused by musculoskeletal, vascular, and brachial plexus injuries owing to lateral displacement of the scapula with a strong blunt external force. Here, we describe the treatment of an open scapulothoracic dissociation patient and summarize the findings.

Brexpiprazole and Sertraline Combination Treatment in Posttraumatic Stress Disorder: A Phase 3 Randomized Clinical Trial

Importance

New pharmacotherapy options are needed for posttraumatic stress disorder (PTSD).

Objective

To investigate the efficacy, safety, and tolerability of brexpiprazole and sertraline combination treatment (brexpiprazole + sertraline) compared with sertraline + placebo for PTSD.

Design, Setting, and Participants

This was a parallel-design, double-blind, randomized clinical trial conducted from October 2019 to August 2023. The study had a 1-week, placebo run-in period followed by an 11-week, double-blind, randomized, active-controlled, parallel-arm period (with 21-day follow-up) and took place at 86 clinical trial sites in the US. Adult outpatients with PTSD were enrolled (volunteer sample).

Interventions

Oral brexpiprazole 2 to 3 mg per day (flexible dose) + sertraline 150 mg per day or sertraline 150 mg per day + placebo (1:1 ratio) for 11 weeks.

Main Outcomes and Measures

The primary end point was change in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total score (which measures the severity of 20 PTSD symptoms) from randomization (week 1) to week 10 for brexpiprazole + sertraline vs sertraline + placebo. Safety assessments included adverse events.

Results

A total of 1327 individuals were assessed for eligibility. After 878 screen failures, 416 participants (mean [SD] age, 37.4 [11.9] years; 310 female [74.5%]) were randomized. Completion rates were 137 of 214 participants (64.0%) for brexpiprazole + sertraline and 113 of 202 participants (55.9%) for sertraline + placebo. At week 10, brexpiprazole + sertraline demonstrated statistically significant greater improvement in CAPS-5 total score (mean [SD] at randomization, 38.4 [7.2]; LS mean [SE] change, -19.2 [1.2]; n = 148) than sertraline + placebo (randomization, 38.7 [7.8]; change, -13.6 [1.2]; n = 134), with LS mean difference, -5.59 (95% CI, -8.79 to -2.38; P < .001). All key secondary and other efficacy end points were also met. Treatment-emergent adverse events with incidence of 5% or greater for brexpiprazole + sertraline (and corresponding incidences for sertraline + placebo) were nausea (25 of 205 [12.2%] and 23 of 196 [11.7%]), fatigue (14 of 205 [6.8%] and 8 of 196 [4.1%]), weight increase (12 of 205 [5.9%] and 3 of 196 [1.5%]), and somnolence (11 of 205 [5.4%] and 5 of 196 [2.6%]). Discontinuation rates due to adverse events were 8 of 205 participants (3.9%) for brexpiprazole + sertraline and 20 of 196 participants (10.2%) for sertraline + placebo.

Conclusions and Relevance

Results of this randomized clinical trial show that brexpiprazole + sertraline combination treatment statistically significantly improved PTSD symptoms vs sertraline + placebo, indicating its potential as a new efficacious treatment for PTSD. Brexpiprazole + sertraline was tolerated by most participants, with a safety profile consistent with that of brexpiprazole in approved indications.

Trial Registration

ClinicalTrials.gov Identifier: NCT04124614.

Epidemiology of DSM-5 PTSD and ICD-11 PTSD and complex PTSD in the Netherlands

INTRODUCTION

Information regarding the prevalence of potentially traumatic events (PTEs), DSM-5 posttraumatic stress disorder (PTSD) and ICD-11 complex PTSD (CPTSD) in the Netherlands is currently lacking, as is data on treatment uptake and treatment barriers. We aimed to provide prevalence estimates for potentially traumatic events, PTSD and CPTSD in the Netherlands, describe treatment seeking behavior and explore associated risk factors.

METHOD

We included a sample of 1690 participants aged 16 years and older across the Netherlands via the Longitudinal Internet studies for the Social Sciences panel, a true probability sample of households drawn from the population register by Statistics Netherlands. We recruited participants between September 1st, 2023, and November 1st 2023. All participants completed online self-report questionnaires, and a subset consented to an interview (n = 204). Instruments included the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5) and the International Trauma Questionnaire (ITQ).

RESULTS

The lifetime prevalence of any PTE was 81.5 %. The estimated lifetime prevalence of DSM-5 PTSD was 11.1 % and current prevalence 1.3 %. The estimated current prevalence of ICD-11 PTSD was 1.0 % and ICD-11 complex PTSD was 1.6 %. Especially females, younger adults, those with a lower education and those with a non-Dutch cultural background were at risk for PTSD. About half of the people with probable lifetime PTSD sought professional help and one-third received first-line PTSD treatment. Common reasons for refraining from seeking professional support included a lack of knowledge, shame and avoidance.

CONCLUSIONS

PTEs, PTSD and CPTSD are common in the Netherlands and disproportionately distributed in society. Although evidence-based treatments for PTSD are available, only about one-third of those with lifetime PTSD receive first-line treatment. Findings underscore the need for targeted screening and preventative interventions, alongside public health campaigns aimed at enhancing knowledge and mitigating stigma about PTSD.

Psychometric Properties of the ITQ for Measuring ICD-11 Complex PTSD in a Spanish Sample of Women Survivors of Intimate Partner Violence

Complex posttraumatic stress disorder (CPTSD) is related to prolonged, multiple, and interpersonal exposure to traumas. Several studies in different populations have focused on implementing the International Trauma Questionnaire (ITQ) to assess PTSD and CPTSD, though not in women survivors of intimate partner violence. The aim was to assess the psychometric properties of this measure in this population. The results obtained for this sample (N = 340) indicated excellent internal ITQ reliability. Moreover, a six-factor CPTSD first-order correlated model was considered, and concurrent validity supported ITQ administration to this population.

Mind-body intervention for post-traumatic stress disorder in adolescents: a systematic review and network meta-analysis

BACKGROUND

Post-traumatic stress disorder (PTSD) is a potentially disabling condition that can lead to long-term impairments, with a significant proportion of adolescents being affected by trauma. Studies have suggested that trauma-focused cognitive behavioral therapy (TF-CBT) is an effective treatment for PTSD in adolescents, however, little is known about the relative advantages of different mind-body interventions. The network meta-analysis aims to evaluate and compare the efficacy of various mind-body interventions in alleviating PTSD symptoms in adolescents.

METHODS

A systematic search was conducted across multiple databases including PubMed, Embase, Web of Science, Scopus, The Cochrane Library, CNKI, WFDSP, and VIP databases. Randomized controlled trials (RCTs) evaluating the effects of mind-body interventions on PTSD in adolescents were included. A network meta-analysis (NMA) was conducted to evaluate the effectiveness of various mind-body intervention therapies using the Surface Under the Cumulative Ranking curve (SUCRA). SUCRA calculates the mean of the cumulative percent area under the curve for each therapy, providing a comprehensive ranking of treatment efficacy. The primary outcomes measured were changes in PTSD symptom scores post-treatment and at follow-ups ranging from 1 to 12 months.

RESULTS

A total of 20 studies involving 5 interventions and 2085 adolescents were included in the analysis. No inconsistencies were found between direct and indirect evidence. TF-CBT consistently demonstrated the most significant effect in reducing PTSD symptoms compared to routine care and no-treatment groups. The ranking of intervention efficacy from highest to lowest was as follows: TF-CBT (SUCRA = 87.3%), meditation, CBT, yoga combined with meditation and mindfulness (SUCRA = 32.3%). Due to limited evidence, the follow-up results for PTSD symptom changes remained inconclusive.

CONCLUSION

Five mind-body interventions were found to be effective in treating PTSD symptoms in adolescents, with TF-CBT emerging as the most effective treatment. Findings suggest that yoga combined with meditation and mindfulness may have promising effects, however, further research is needed to confirm these results due to the limited evidence available.

Examining the Influence of Exposure to Community Violence on Posttraumatic Stress in Community Women Experiencing Intimate Partner Violence

Women who experience intimate partner violence (IPV) report multiple and diverse traumas. Exposure to community violence may be important to consider when examining the development, maintenance, and exacerbation of posttraumatic stress disorder (PTSD) symptoms in this population. The purpose of this study was to examine the relative and unique associations between PTSD symptom clusters and witnessing and experiencing community violence among women experiencing IPV. Participants were 171 community women experiencing IPV (Mage = 40.56; 40.3% white, 31.5% Black, and 17.5% Hispanic or Latina). Experiencing and witnessing community violence were significantly and positively correlated with overall PTSD symptoms and with each PTSD symptom cluster. The PTSD symptom cluster of arousal and reactivity was uniquely associated with experiencing and witnessing community violence above and beyond other PTSD symptom clusters. Findings indicate the relevance of assessing-and intervening-on arousal and reactivity PTSD symptoms in this population.

Early Leaves from Inpatient Care Among Individuals with Traumatic Life Events in Ontario, Canada

Psychological trauma is a prevalent mental health concern, with most individuals experiencing at least one traumatic event in their lifetime. Early leaves from inpatient settings are a pertinent challenge among persons who have experienced trauma and may reflect unmet care needs. This study examined patterns of early leaves among persons with trauma from inpatient care in Ontario, Canada. All records for individuals who have experienced trauma with an index admission of over 72 h between January 1, 2015 and December 31, 2019 were included (N = 11,043). Logistic regression using generalized equation estimation was used to assess the association between demographic and clinical characteristics, substance use, social relationships, staff dynamics, and control interventions with the outcome of early leaves. In the final model, alcohol (OR: 1.83, 95% CI: 1.27-2.64), other substances (OR: 2.15, 95% CI: 1.34-3.46), and poly substance use (OR: 2.46, 95% CI: 1.82-3.31) all increased the odds of early leaves after considering possible facility effects, and after adjusting for other demographic and clinical factors. Being older, employed, and having mood disorders reduced odds of early leaves. Early leaves are important within treatment planning, particularly in relation to addressing complex traumas. While challenges related to substance use may be driving some of the early leaves, there may also be challenges to providing complex care within acute mental health settings. Further exploration of policies and practices to prevent early leaves are necessary, including the potential need for longer-term specialized treatment programs.

Trauma-informed healthcare systems: an evaluation of trauma-informed care training for hospital-based healthcare professionals in the aftermath of the 2023 earthquakes in Türkiye

Disasters are complex global problems with an increasing impact with rising prevalence of associated illness, mortality, and intensifying health inequities. In recent years, there has been an emphasis on integrating trauma-informed care approaches into health policies and protocols. The purpose of the current study was to investigate the benefits of a trauma-informed healthcare training program for hospital-based healthcare providers with a focus on knowledge acquisition, empowerment of professional practice, and personal well-being. The program was implemented in the aftermath of the 2023 earthquakes in southeastern Türkiye. The training consisted of four modules, developed based on psychological trauma theories and behavior change theories, and was evaluated using a mixed-methods approach. Assessments were conducted at the end of the training program, at baseline, and at a 6-month follow-up. A structured questionnaire including items covering the content of the training, trainer effectiveness, and program suitability was administered at the end of the training program. At 6 months, participants completed an 18-item follow-up questionnaire which assessed their understanding of the principles of the trauma-informed care approach. The Maslach Burnout Inventory (MTI) was also administered, and themes regarding the impact of the training program were extracted through in-depth individual qualitative interviews. Data were obtained from 501 program participants. The intervention program was found to improve healthcare workers' understanding of trauma, professional practices, and interpersonal relationships, and significantly reduced symptoms of burnout. These results demonstrate the critical role of trauma-informed training programs in hospitals in disaster-affected regions, especially when assistance to survivors will be enhanced by strengthening healthcare workers' resilience and improving their perceptions of service efficacy and value. The study highlights the need for more widespread adoption of these training initiatives and emphasizes that they may play significant future roles in transforming trauma-informed healthcare systems in disaster-prone countries and regions.

Traumatic life events as predictors for depression in middle-aged men and women: A Finnish twin study

BACKGROUND

We examined exposure to adulthood traumatic life events (TLEs) and their associations with depression in women and men. Then we examined whether those associations are independent of exposure loading and vulnerability including familial confounding.

METHODS

The fourth survey in 2011 of the population-based Finnish Twin Cohort had 8410 participants (45 % men, mean age 60 years). Using the Center for Epidemiologic Studies Depression (CES-D) scale, depression was defined using a cut-off value ≥20. Participants reported exposure to TLEs during adulthood. Logistic regression adjusted for multiple covariates was used as the individual-based analyses. Familial confounding was tested using conditional logistic regression in 399 twin pairs discordant for depression.

RESULTS

More women (15 %) than men (11 %) were depressed. Men reported more traffic accidents (men: 11.8 %, women: 7.4 %), other serious accidents (11.8 %, 5.8 %), and violent crime (3.1 %, 2.0 %) whereas women reported more sexual assault (0.7 %, 10.6 %). Violent crime (Odds Ratio 3.86; 95 % Confidence Intervals 2.59, 5.73), sexual assault (3.49; 2.67, 4.55), physical assault (3.10; 2.45, 3.93), and other serious accidents (1.36; 1.01, 1.85) were associated with depression. These associations, except other serious accidents, remained significant after adjusting for multiple covariates including shared familial factors. The associations did not differ by sex.

LIMITATIONS

A relatively small set of relevant TLEs was reported retrospectively and the order of TLEs was not assessed.

CONCLUSIONS

Women and men differ in exposure to TLEs but, if exposed, they are equally vulnerable for depression. Because traumatic life events are robustly associated with depression, they should be considered in treatment.

Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis

Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.