Trauma exposure, posttraumatic stress, and identity content valences among Japanese adolescents

INTRODUCTION

Theorists and a few empirical studies have suggested that traumatic experiences, posttraumatic stress disorder (PTSD), and complex PTSD (CPTSD) may affect identity development. However, existing studies have overlooked how adolescents' traumas are associated with the alignment of their identity with socio-cultural expectations, which is a crucial component of identity development. To address this gap, this study examined the associations of various types of potentially traumatic experiences and PTSD and CPTSD symptoms with the positive and negative valences of identity affected by desirable and undesirable images within socio-cultural contexts.

METHODS

A cross-sectional survey of 341 adolescents (44.0% girls; M_age  = 14.8, SD = 1.8) was conducted in Japan.

RESULTS

Exposure to certain types of potentially traumatic events (e.g., family violence and physical attack) were related to high levels of negative identity elements, whereas none of the types were related to positive identity elements. The results also indicated that CPTSD-specific symptoms of disturbances in self-organization (DSO) were related to high levels of negative identity elements rather than PTSD.

CONCLUSIONS

The findings expand upon related research by suggesting that adolescents' exposure to some types of traumatic events (e.g., family violence and physical attack) and posttraumatic DSO symptoms have the potential to disturb the alignment of their identities with socio-cultural expectations.

Associations between moral injury and ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD among help-seeking nurses: a cross-sectional study

OBJECTIVES

This study aimed to evaluate how moral injury (MI), traumatic experiences and daily stressors were related to the symptoms of post-traumatic stress disorder (PTSD) and International Classification of Diseases 11th revision specific complex PTSD (CPTSD) symptoms of disturbances in self-organisation (DSO) in a treatment-seeking sample of nurses.

DESIGN

A cross-sectional study.

SETTING

Nurses from all regions of Lithuania participated in the study. The data were collected between April and May 2021.

PARTICIPANTS

A total of 206 nurses, mean age 42.34 years (SD=11.68), 97.1% women and with 65% >10 years of work experience.

RESULTS

The prevalence of PTSD and CPTSD in the treatment-seeking sample of nurses was 9.2% and 10.2%, respectively. The results of structural equation modelling indicated an acceptable model fit for the model regarding the links between trauma exposure, daily stressors, MI, PTSD and DSO symptoms, (χ2 (df)=219.718 (123), p<0.001, Comparative Fit Index/Tucker-Lewis Index=0.937/0.922, root mean square error of approximation (90% CI)=0.062 (0.048 to 0.075), standardised root mean square residual=0.049). MI had a large effect on DSO symptoms, β=0.667, p<0.001, and a medium effect on PTSD symptoms, β=0.394, p<0.001. Daily stress but not trauma exposure was significantly related to MI, β=0.618, p<0.001.

CONCLUSIONS

The prevalence of PTSD and CPTSD in a treatment-seeking sample of nurses inform healthcare administrators, policymakers and medical staff about the demand for psychosocial interventions for healthcare workers focused on stress management to address their daily stressors and mitigate effects on MI or trauma-focused treatments for PTSD/CPTSD.

TRIAL REGISTRATION NUMBER

NCT04817995; Pre-results.

The Effects of Online Mindfulness-Based Intervention on Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder Symptoms: A Randomized Controlled Trial With 3-Month Follow-Up

Objectives

Mindfulness-based interventions have recently been shown to be a promising option for treating posttraumatic stress. The current study aimed to investigate the effects of an online mindfulness-based intervention on ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) symptoms at a 3-month follow-up.

Methods

An RCT design with three measurement points (pre-intervention, post-intervention, and 3-month follow-up) was used to investigate the effects of an 8-week online mindfulness intervention. In total, 53 traumatized young adults (M age = 23.21, SD age = 2.81; 84.9% female) participated in the study: 17 in the intervention group and 36 in the waiting list control group.

Results

Intervention group and waiting list control group comparison revealed that the intervention was effective for reducing CPTSD disturbances in self-organization symptoms (d = -0.84 [-1.44; -0.24]), specifically, negative self-concept (d = -0.66 [-1.25; -0.07]) and disturbances in relationships (d = -0.87 [-1.47; -0.27]), at 3-month follow-up. There were no between-group effects for PTSD symptoms from pre-test to follow-up.

Conclusion

This is one of the first RCT studies to report follow-up effects of an online mindfulness-based intervention for ICD-11 PTSD or CPTSD symptoms. Our study yielded that the effects of mindfulness-based internet intervention on CPTSD symptoms tend to retain over time.

Trial Registration

This study was registered with ClinicalTrials.gov (NCT number: NCT04333667; https://clinicaltrials.gov/ct2/show/NCT04333667). Registered April 3, 2020.

Physical activity, mental and physical health during the Covid-19 outbreak: longitudinal predictors of suicide ideation in Germany

Aim

Suicide ideation has increased since the outbreak of Covid-19 in many countries. The present longitudinal study investigated potential predictors of suicide ideation.

Subject and methods

Data of 406 participants from Germany (age M = 27.69, SD = 6.88) were assessed via online surveys in spring 2020 (baseline, BL) and in spring 2021 (follow-up, FU).

Results

The current results reveal a significant increase in symptoms of depression, anxiety, and stress between 2020 and 2021. Positive mental health (PMH), sense of control, and physical health significantly decreased. Depression symptoms (BL), PMH (BL), and consciously enhanced physical activity since the pandemic outbreak (FU) significantly predicted 12-month suicide ideation (FU). In a moderated mediation analysis, the positive relationship between depression and suicide ideation was significantly mediated by PMH. Consciously enhanced physical activity significantly moderated the negative association between PMH and suicide ideation.

Conclusion

The context of Covid-19 could negatively impact mental health and physical health. This might increase the risk for suicide ideation. However, PMH and physical activity might serve as protective factors. The protective effect of physical activity could be especially important in people with high depression symptoms and low PMH, such as clinical patients. Potential ways of how PMH and physical activity could be enhanced in the Covid-19 context to prevent suicide ideation are discussed.

Effects of Mindfulness-Based Internet Intervention on ICD-11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder Symptoms: a Pilot Randomized Controlled Trial

Objectives

A substantial proportion of trauma survivors with posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) continue to experience symptoms even after trauma-focused therapies. Internet-based interventions could facilitate access to treatment for PTSD and CPTSD. The current pilot study aimed to investigate the effects of mindfulness-based internet intervention on PTSD and CPTSD symptoms.

Methods

A randomized controlled trial (RCT) design with two measurement points (pre-test and post-test) was used to investigate the effects of a structured mindfulness-based internet intervention on PTSD and CPTSD symptoms as well as anxiety, depression, and positive mental health. In total, 70 university students with high levels of PTSD and CPTSD symptoms based on ICD-11 criteria participated in the study: 31 in the intervention group and 39 in the waiting list control group.

Results

We found that the mindfulness-based internet intervention reduced CPTSD disturbances in self-organization (DSO) symptoms (ES = − 0.48 [− 0.96; 0.00]), particularly negative self-concept (ES = − 0.72 [− 1.21; − 0.24]) and disturbances in relationships (ES = − 0.55 [− 1.03; − 0.07]). Moreover, the intervention reduced the symptoms of PTSD sense of threat (ES = − 0.48 [− 0.96; − 0.01]) and promoted positive mental health (ES = 0.51 [0.03; 0.99]). High user satisfaction and good usability of the intervention were reported.

Conclusions

Promising treatment effects were found, indicating that mindfulness-based internet intervention can reduce CPTSD symptoms and have a positive effect on mental health among youth in general. The findings of the current study contribute to the further development of trauma care using internet-delivered interventions.

Trial registration: ClinicalTrials.gov NTC04333667 (3 April 2020)

Adolescents amid the COVID-19 pandemic: a prospective study of psychological functioning

BACKGROUND

The spread of coronavirus disease (COVID-19) and the accompanying countermeasures can significantly impact the wellbeing of adolescents. There is a lack of longitudinal studies that can shed light on potential social, emotional, and behavioral development in adolescents. We aimed to identify potential changes in adolescent psychosocial functioning from pre-pandemic to peri-pandemic assessment, and secondly, to identify specific patterns of change.

METHODS

This longitudinal study was based on a Lithuanian community sample of 331 adolescents aged 12-16 at T1 (M  =  13.87, SD  =  1.59). T1 data collected before the pandemic (March-June, 2019) was compared with T2 data collected during the COVID-19 outbreak (October 2020). Psychosocial functioning was assessed by The Strengths and Difficulties Questionnaire (SDQ). Multivariate latent change modeling and latent class change approaches were used to identify patterns of change.

RESULTS

We found a small but significant increase in hyperactivity/inattention, emotional symptoms, but also prosocial behavior from before to during the pandemic, even adjusting for resilience, lifetime abuse experience, and socio-demographic situation. Three change profiles were identified in the latent change analysis: (1) a majority (70.7%) experienced a significant increase in psychosocial problems; (2) a smaller sub-group (19.6%) with increased peer problems only; (3) a small group (9.7%) showing no negative change and an increase in prosocial behavior.

CONCLUSIONS

The study found a significant negative impact of the COVID-19 pandemic on mental health in the majority of adolescents, as well as indications of positive social development in a small group. These findings highlight the importance of identifying and supporting adolescents in the time of the pandemic more effectively. Accumulating knowledge about human responses to the coronavirus, particularly in young people, is pivotal to societal preparedness for future pandemics.

Internet-based stress recovery intervention FOREST for healthcare staff amid COVID-19 pandemic: study protocol for a randomized controlled trial

BACKGROUND

The demand for care during the COVID-19 pandemic has affected the mental health of healthcare workers (HCWs), thus increasing the need for psychosocial support services. Internet-based interventions have previously been found to reduce occupational stress. The study aims to test the effects of an Internet-based stress recovery intervention-FOREST-among HCWs.

METHODS

A randomized controlled trial (RCT) parallel group design with three measurement points will be conducted to assess the efficacy of an Internet-based stress recovery intervention FOREST for nurses. The FOREST intervention is a 6-week Internet-based CBT and mindfulness-based program which comprises of six modules: (1) Introduction, (2) Detachment (relaxation and sleep), (3) Distancing, (4) Mastery (challenge), (5) Control, and (6) Keeping the change alive. We will compare the intervention against a waiting list group at pre-test, post-test, and follow-up. Stress recovery, PTSD, complex PTSD, moral injury, the level of stress, depression, anxiety, and psychological well-being will be measured.

DISCUSSION

The study will contribute to the development of mental healthcare programs for the HCWs. Based on the outcomes of the study, the FOREST intervention can be further developed or offered to healthcare staff as a tool to cope with occupational stress.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04817995 . Registered on 30 March 2021.

Suicidal ideation in university students in Lithuania amid the COVID-19 pandemic: A prospective study with pre-pandemic measures

We aimed to identify patterns of changes in suicidal ideation among university students six months after the COVID-19 outbreak, in comparison to the pre-pandemic suicidal ideation. Furthermore, we explored the links among these patterns and mental health indicators. 474 university students participated in the study in October-December 2019 and October-December 2020. The latent class change analysis revealed four groups: no-ideation (68.1%), stable low ideation (16.2%), increased ideation (8.9%), and decreased ideation (6.8%). Increased, in comparison to decreased ideation, was positively linked to changes in depression, stress, and anxiety. More loneliness during the pandemic was related to higher suicidal ideation.

The Psychometric Properties of the Resilience Scale (RS-14) in Lithuanian Adolescents

In the current study, we provided the evidence of satisfactory validity of the RS-14 scale in the Lithuanian adolescents' sample (N = 1299; M age = 14.24; SD age = 1.26), based on its internal structure, and relations to other variables. The results of the study indicated an acceptable model fit for a single-factor structure of the scale with a high internal consistency (McDonald's omega = 0.89). We also confirmed the scalar measurement invariance across groups of adolescents in terms of their age (i.e., early and middle adolescence) and mental health profile as well as partial scalar gender invariance. Adolescents characterized by high levels of socio-emotional problems reported lower levels of resilience, in comparison to adolescents that reported low levels of socio-emotional problems. However, the data indicated that adolescents from emotional problems and behavioral problems groups cannot be differentiated with the RS-14 scale.

The patterns of problematic social media use (SMU) and their relationship with online flow, life satisfaction, depression, anxiety and stress symptoms in Lithuania and in Germany

The present study investigated problematic social media use (SMU) in Lithuania and in Germany. In two student samples (Lithuania: N = 1640; Germany: N = 727), problematic SMU, flow experienced during SMU, life satisfaction, depression, anxiety and stress symptoms were assessed by online surveys. Latent Class Analysis resulted in a four-group classification of participants due to their levels of problematic SMU characteristics: low-symptom, low-withdrawal, high-withdrawal, and high-symptom. The proportion of participants in the low-symptom group was significantly higher in Germany than in Lithuania. In contrast, significantly more Lithuanian participants belonged to both withdrawal groups. No significant country differences were found for the composition of the high-symptom group. In both countries, a series of Structural Equation Models showed that the level of flow, depression, anxiety and stress symptoms was the highest in the high-symptom group, and the lowest in the low-symptom group. Life satisfaction revealed the reversed result pattern. The current findings show that students from Lithuania and Germany can be grouped considering their problematic SMU level. Individuals in the four groups differ due to their level of mental health. Especially members of the high-symptom group might benefit from external controlling strategies of their time spent on SM, while members of the withdrawal groups are suggested to train their SMU self-control.

Internet-Based Cognitive Behavioral Therapy for Informal Caregivers: Randomized Controlled Pilot Trial

BACKGROUND

Caregiving for a family member can result in reduced well-being for the caregiver. Internet-delivered cognitive behavioral therapy (ICBT) may be one way to support this population. This is especially the case for caregivers in countries with limited resources, but high demand for psychological services.

OBJECTIVE

In this study we evaluated the effects of a therapist-guided 8-week-long ICBT intervention for informal caregivers.

METHODS

In total, 63 participants were recruited online and randomized either to the intervention or to the wait-list control group. The main study outcome was the Caregiver Burden Inventory (CBI). Secondary outcomes included measures of caregiver depression, anxiety, stress, and quality of life.

RESULTS

Moderate between-group effect sizes were observed for the CBI measure, in favor of the intervention group, with a Cohen d=-0.70 for the intention-to-treat analysis. Analyses of the subscales of the CBI showed significant reductions on the subscales of Development and Physical Health. Moderate reductions were found for depression and anxiety scores as indicated by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. Large between-group effects were observed for reduction in stress and increase in quality of life as indicated by the Perceived Stress Scale-14 (PSS-14), The Brunnsviken Brief Quality of Life Scale (BBQ), and The World Health Organization-Five Well-Being Index (WHO-5). In addition, participants experienced little to no difficulty in using the program and were mostly satisfied with the intervention's platform and the choice of content.

CONCLUSIONS

This is the first internet intervention study for informal caregivers in Lithuania. The results suggest that therapist-guided ICBT can be effective in reducing caregiver burden, anxiety, depression, stress, and improving quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04052724; https://clinicaltrials.gov/ct2/show/NCT04052724.

Patterns of abuse and effects on psychosocial functioning in Lithuanian adolescents: A latent class analysis approach

BACKGROUND

There is considerable evidence that child abuse and neglect has a significant impact on social relationships and mental health across the lifespan.

OBJECTIVE

We aimed to estimate the prevalence of child abuse in Lithuanian adolescents, to identify patterns of abuse experiences using a latent class analysis approach, and to assess psychosocial functioning associated with these patterns of abuse.

PARTICIPANTS AND SETTING

The study was based on a sample of 1299 adolescents from the Lithuanian general population aged 12-16 (M = 14.24, SD = 1.26) years.

METHODS

Lifetime abuse exposure measures included neglect, emotional abuse, physical abuse, online sexual violence, sexual abuse from adult, and sexual abuse from peers. Psychosocial functioning was measured with the Strength and Difficulties Questionnaire (SDQ). Patterns of abuse were identified by a two-step latent class analysis (LCA).

RESULTS

Around two-thirds of adolescents (71 %) reported at least one type of abuse over their lifetime. The results of the LCA indicated that for each type of abuse two different groups of adolescents can be distinguished in terms of the severity of abuse, and four classes 'less-severe', 'peer sexual', 'adult sexual', and 'severe abuse' were identified. Psychosocial functioning varied significantly between the four classes with higher psychosocial functioning problems associated with high severity and sexual abuse.

CONCLUSIONS

The study revealed a high child abuse prevalence in Lithuania. The results show that the psychosocial functioning of adolescents is associated with severity and types of abuse experiences.

Does Trauma Shape Identity? Exploring the Links Between Lifetime Trauma Exposure and Identity Status in Emerging Adulthood

In emerging adulthood, coherent identity plays a protective role against the development of the disturbed psychosocial functioning and is seen as one of the defining characteristics of positive youth development. The factors that shape the identity are still understudied and little quantitative research has addressed, how trauma exposure is linked to emerging adults' identity. Therefore, the current study aimed to investigate how exposure to traumatic experiences over the lifetime is associated with current identity status among emerging adults in an academic environment and to explore links between different types of traumatic experiences as well as the severity of exposure to trauma and identity statuses. The study sample consisted of 1,614 first-year undergraduate students from Lithuania with the age range of 18-29 years (M = 19.09, SD = 1.05, 68.28% female). The three distinct identity profiles were identified using the Latent Class Analysis, representing diffused, undifferentiated, and coherent identity statuses. The results provided no clear evidence of links between traumatic experiences and identity status for overall exposure and most types of traumatic events. However, our study concerns the potential importance of severe traumatic experiences, such as sexual trauma, on identity.