Criterion A and Non-Criterion A Racial Discrimination Experiences, Posttraumatic Stress Symptoms, and Posttraumatic Cognitions Among Black or African Americans

Racial discrimination is an unfortunately common experience for Black Americans with detrimental physical and mental health consequences. Prior research has established an association between discrimination and posttraumatic stress symptoms (PTSS); yet, trauma-related cognitions have not been studied. The majority of the existing empirical work in this area has not examined specific forms of discrimination experiences, despite potential key differences in these adversities. Relatedly, some forms of discrimination constitute "traumatic" events as defined by Criterion A for PTSD in the DSM-5 while others do not, and these distinctions have also been overlooked. Thus, the present study aimed to (a) examine discrimination, including specific types, in relation to PTSS and posttraumatic cognitions and (b) investigate whether Criterion A and non-Criterion A discrimination experiences were tied to PTSS and trauma-related thoughts. Participants were 172 undergraduate students who identified as Black or African American (Mage = 25.11, SD = 8.25, range = 18-56; 84.9% female). Results indicated that while cumulative trauma was unrelated to PTSS, discrimination experiences were linked with higher PTSS and negative posttraumatic cognitions. Specifically, avoidance discrimination experiences were associated with both outcomes. Criterion A discrimination events were not tied to PTSS. These findings support previous research showing a link between racial discrimination and trauma-related outcomes. In addition, the results suggest that avoidance discrimination, while not classified as "traumatic," may have an important contribution to PTSS and posttraumatic cognitions among Black individuals. The study underscores the need to address racial discrimination experiences, including microaggressions, within a traumatic stress context.

Tobacco use, trauma exposure and PTSD: a systematic review

Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.

Service utilization among adolescents seeking trauma-related care: Differences by risk for suicide and ethnoracial background

Adolescents from ethnoracially minoritized backgrounds increasingly report high rates of attempted suicide, trauma exposure, and limited access to mental healthcare services. However, less is known regarding their use of services across different youth-serving systems. This study examines the associations and interactions between self-injurious thoughts and behaviors (SITBs), race/ethnicity, and service sector utilization (mental healthcare, general healthcare, school, and social services) among a sample of trauma-exposed and treatment-seeking adolescents. Participants were treatment-seeking adolescents (N = 4406) ages 12-17 from the National Child Traumatic Stress Network Core Data Set who had available data for SITBs, race/ethnicity, services utilized, and other key variables. Mixed effects logistic regression was used to examine main and interactive effects for whether adolescents' race/ethnicity and SITBs were associated with service utilization in each of the identified service sectors. SITBs were associated with adolescents' utilization of mental healthcare (OR = 1.38 p < 0.001), general healthcare (OR = 2.30; p < 0.001), and school services (OR = 1.38 p < 0.001). NH Black adolescents reporting SITBs were less likely to use mental health services than other NH Black youths (OR = 0.53; p = 0.004). Hispanic adolescents reporting SITBs were more likely to utilize healthcare services than other Hispanic youths (OR = 1.51; p = 0.039). Trauma-exposed adolescents reporting SITBs are more likely to utilize mental healthcare, general healthcare, and school-based services than other trauma-exposed adolescents. However, NH Black adolescents experiencing SITBs may face additional barriers to utilizing mental healthcare services. Findings can be used to develop nursing practices and policies to address barriers faced by adolescents reporting SITBs.

Disorganized Functional Connectivity of Anterior Insular Subnetworks in Adults with Executive Dysfunction after Trauma Exposure

There is increasing evidence that major trauma can adversely affect the brain and cognition. In some cases, trauma may lead to deficits in executive function (EF). The anterior insula may be a causal outflow hub acting to coordinate EF-related brain networks. To clarify the neural underpinnings of EF deficits (EFD) after trauma, we performed a resting-state functional magnetic resonance imaging (rs-fMRI) study of anterior insular subnetworks in adults who have lost their only child. A total of 167 participants completed various psychological and cognitive assessments to assess EF-related deficits. Correlations were computed between abnormal connectivity and cognitive/post-traumatic stress symptoms. The results showed abnormal anterior insular subregion connectivity in the default mode network (DMN), prefrontal lobe, and cerebellum lobe in participants with EFD. No correlation was found between abnormal connectivity and cognitive/post-traumatic stress symptoms in participants with EFD. These results suggest that excessive connections between the insula and DMN could contribute to EFD after trauma. Overall, this study provides novel references into the neural mechanisms of EF status after trauma exposure.

Physical Health Outcomes of Trauma Exposure Across the Lifespan

Trauma exposure and posttraumatic stress symptoms (PTSS) are established risk factors for poorer physical health. Prior work has focused on childhood adversities and PTSS in relation to physical health conditions, but trauma exposure over the lifespan has been overlooked. Further, the associations between trauma and PTSS and other physical health markers, such as diet and exercise, are less clear. Very little is known regarding how different trauma types (i.e., interpersonal, non-interpersonal), may be tied to aspects of physical health. To expand this area of research, this study aimed to: (a) examine the links between cumulative trauma and PTSS, and body mass index (BMI), diet, and exercise; and (b) investigate the relations between interpersonal and non-interpersonal trauma and these three health indices, while controlling for PTSS. Participants were 493 Midwestern University students (Mage = 23.87, standard deviation [SD] = 6.90, range = 18-63; 79.3% female; 57.4% White). Cumulative trauma corresponded with higher BMIs and less exercise use (B = 0.10; B = -0.09), while PTSS were unrelated. Conversely, PTSS were tied to greater consumption of added sugars (B = 0.11), and cumulative trauma was not linked with diet. Interpersonal and non-interpersonal traumas were not tied to BMI or exercise, although interpersonal trauma and PTSS were linked with greater sugar intake and non-interpersonal trauma was associated with fruit and vegetable consumption. Trauma exposure and PTSS may have complicated and distinct associations with physical health indices, such as BMI, diet, and exercise, and additional research is needed to further parse out these relations.

Inhibitory control as possible risk and/or resilience factor for the development of trauma related symptoms-a study of the Utøya terror attack survivors

PTSD symptomatology is known to be associated with executive dysfunction. Inhibitory control is a core component of executive functioning, and inhibitory skills are essential both for adequate functioning in everyday life and important in situations following trauma. The aim of the present study was to examine the relationship between trauma exposure, inhibitory control and PTSD symptomatology in adolescent survivors of the terror attack at Utøya, Norway on the 22nd of July, 2011. In this cross-sectional case-control study, 20 trauma exposed adolescents and 20 healthy controls matched in age and gender were compared on a neuropsychological test of cognitive inhibition (Color-Word Interference Test) and a self-report measure of inhibition ability (BRIEF-A). Our analyses revealed that the trauma exposed group differed significantly on the self-reported measure of inhibitory control compared to the control group, but there were no differences between groups on the objective measures of cognitive inhibition. Follow-up analyses with subgroups in the trauma exposed group based on PTSD symptomatology (PTSD + and PTSD-) and the control group revealed that the PTSD- group showed significantly better results than both the PTSD + and the control group on the measures of inhibitory control. Moreover, the follow-up analyses showed that the PTSD + group showed significantly poorer results from the other two groups on the measures of inhibitory control and self-reported inhibition. We conclude that impaired inhibitory control, measured both objectively and by self-reported questionnaire, is related to PTSD symptomatology. Findings suggest that inhibitory dysfunctions may be a vulnerability factor for the development of PTSD symptomatology in trauma exposed adolescents, and thus it seems that the ability to exhibit inhibitory control could be a possible resilience factor to prevent the development of PTSD symptoms.

Factors associated with ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder among older adults during the COVID-19 pandemic

ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD have been understudied in the older population. The study focused on the associations between traumatic exposure before the pandemic, COVID-19 worries, depression, and loneliness with current PTSD and CPTSD among older adults. A random sample of five hundred and twelve Israeli older adults (Mage = 72.67 ± 3.81, range 68-87) was recruited using a Web-based survey company (Ipanel, Israel). Participants completed questionnaires of demographic details, self-rated health, COVID-19 worries, trauma exposure, depressive symptoms, level of loneliness, PTSD, and CPTSD. Univariate logistic regression revealed that trauma exposure, COVID-19 worries, depression, and loneliness were associated with PTSD. Multinomial regression revealed that only trauma exposure was associated with PTSD among older adults with PTSD compared with those not reaching the PTSD cutoff level. In the comparison between older adults suffering from CPTSD with those not reaching the PTSD cutoff level, being married, higher levels of trauma exposure, COVID-19 worries, depression, and loneliness were associated with a higher risk of CPTSD. Results suggest that specific factors may be significant psychological correlates of CPTSD symptoms among older adults during the COVID-19 pandemic. Identifying these factors could assist practitioners in tailoring more effective interventions.

Civilian moral injury: associations with trauma type and high-frequency heart rate variability in two trauma-exposed community-based samples

BACKGROUND

Moral injury exposure (MIE) and distress (MID) may indirectly affect the relationship between trauma exposure and alterations in autonomic regulation [assessed via high-frequency heart rate variability (hfHRV)] in civilians, but this has not been tested in prior research. We conducted two exploratory studies to examine trauma types' associations with MIE and MID among civilian medical patients (Study 1) and explore how these facets may indirectly affect the relationship between trauma type and hfHRV among civilians seeking mental health services (Study 2).

METHODS

Participants recruited from a public hospital and/or community advertisements (Study 1, n = 72, 87.5% Black, 83.3% women; Study 2, n = 46, 71.7% Black, 97.8% women) completed measures assessing trauma type, MIE, and MID. In Study 1, trauma types that emerged as significant correlates of MIE and MID were entered into separate linear regression analyses. Trauma types identified were included as predictors in indirect effects models with MIE or MID as the mediator and resting hfHRV (assayed via electrocardiography) as the outcome.

RESULTS

Childhood sexual abuse emerged as the only significant predictor of MIE, b = 0.38, p < 0.001; childhood sexual abuse, b = 0.26, p < 0.05, and adulthood sexual assault, b = 0.23, p < 0.05 were significant predictors of MID. Participants with greater MIE and MID demonstrated lower hfHRV. Adulthood sexual assault showed an indirect effect on hfHRV through MID, B = -0.10, s.e. = 0.06, 95%CI (-0.232 to -0.005).

CONCLUSIONS

Moral injury was uniquely associated with sexual violence and lower hfHRV in civilians. Data highlight moral injury as a pathway through which autonomic dysregulation may emerge and its salience for trauma treatment selection.

Youth Dually-Involved in the Child Welfare and Juvenile Justice Systems: Varying Definitions and Their Associations with Trauma Exposure, Posttraumatic Stress, & Offending

Recently, scholars have placed increasing effort on better understanding the unique needs of youth involved in both the child welfare and juvenile justice systems. This study drew from the Developmental Cascade of Multisystem Involvement Framework to examine group differences in trauma exposure, posttraumatic stress symptoms, and offending among youth solely involved in the juvenile justice system and youth with varying degrees of dual-system involvement, including crossover youth (i.e., youth with a history of maltreatment and offending regardless of system involvement), dual-contact youth (i.e., youth who had a history of a substantiated CW maltreatment petition prior to their involvement in the current study), and dually-involved youth (i.e., youth under the care and custody of the state's child welfare system at the time of study participation). Four-hundred adolescents (25% girls, Mage = 15.97) who were recruited from a detention center and completed self-report measures assessing trauma exposure, posttraumatic stress, and offending. Juvenile justice and child welfare records also were collected. Results indicated that, compared to youth solely involved in the juvenile justice system, crossover youth reported significantly more exposure to traumatic events, more severe posttraumatic stress symptoms, and more self-reported offending. In contrast, results indicated few differences between dual-contact youth and youth solely involved in the juvenile justice system; these groups only differed in age and in recidivism charges. There also were few differences between dually-involved youth and youth solely involved in the juvenile justice system; these groups only differed in age and exposure to non-Criterion A traumatic events. The current results suggest that categorizing youth as crossover youth based on their own self-reported history of child maltreatment exposure resulted in more observed differences between dual-system youth and youth solely involved in juvenile justice. The present results have valuable implications for how we operationalize youth's system involvement and highlight the importance of examining child maltreatment as a point of prevention and intervention efforts for these youth.

Associations Between Latent Classes of Trauma Exposure and Minority Stressors and Substance Use Among Cisgender Sexual Minority Women

Psychosocial stressors (e.g., minority stressors, trauma exposure) profoundly impact sexual minority women's (SMW's) risk of alcohol and other drug (AOD) use. However, research has not examined whether there are distinct typologies (i.e., patterns) of psychosocial stressors and whether these vary based on sociodemographic characteristics or are differentially associated with AOD outcomes (e.g., alcohol dependence) among SMW. This study aimed to identify latent classes of SMW reporting distinct typologies of psychosocial stressors and examine predictors and outcomes of latent classes of psychosocial stressors among SMW. Participants included a community sample of 602 SMW (M_age = 39.9, SD = 14.0; 74.0% lesbian; 37.4% White, 36.6% Black, 22.3% Latinx; 26.6% annual income ≤$14,999). Latent class analysis was used to identify typologies of psychosocial stressors. Regression analyses were employed to examine sociodemographic predictors and AOD outcomes of class membership. Three classes of psychosocial stressors emerged. Participants in Class 1 were likely to report relatively low adversity. SMW in Class 2, who reported childhood physical abuse (CPA), severe childhood sexual abuse, and adult physical assault, were vulnerable to discrimination and stigma consciousness. A distinct subgroup of SMW (Class 3) was at heightened risk of CPA, adult sexual assault (ASA), and stigma consciousness. Older SMW, Black SMW, and SMW with lower social support were more likely to be in classes characterized by higher adversity. Older SMW were at disproportionate risk of CPA and ASA. Different combinations of psychosocial stressors were uniquely associated with AOD outcomes. Findings underscore the importance of considering within-group heterogeneity in SMW's differential risk of psychosocial stressors and AOD outcomes. Routine screening of psychosocial stressors across several dimensions, brief interventions targeting AOD outcomes, and policies mitigating structural drivers of SMW's increased risk of trauma and minority stressors may be especially important for older SMW, Black SMW, and SMW who lack social support.

Functional neuroimaging of resilience to trauma: convergent evidence and challenges for future research

Resilience is broadly defined as the ability to adapt successfully following stressful life events. Here, we review functional MRI studies that investigated key psychological factors that have been consistently linked to resilience to severe adversity and trauma exposure. These domains include emotion regulation (including cognitive reappraisal), reward responsivity, and cognitive control. Further, we briefly review functional imaging evidence related to emerging areas of study that may potentially facilitate resilience: namely social cognition, active coping, and successful fear extinction. Finally, we also touch upon ongoing issues in neuroimaging study design that will need to be addressed to enable us to harness insight from such studies to improve treatments for - or, ideally, guard against the development of - debilitating post-traumatic stress syndromes.

Trauma Exposure, Social Networks, and Suicide Risk Among North Korean Refugee Women in South Korea

Exposure to adverse life events renders North Korean (NK) refugee women vulnerable to mental health problems, suicide risk being one of the most concerning. We examined bonding and bridging social networks as potential moderators of suicide risk among NK refugee women (N = 212). We found that exposure to traumatic events significantly increased suicidal behavior, but its impact was alleviated if they had a stronger bonding social network. The findings suggest that the negative impact of trauma on suicide can be reduced by strengthening bonding between people with similarities (i.e., family, individuals with the same country of origin).

Trauma Exposure and Suicidal Ideation among Korean Male Firefighters: Examining the Moderating Roles of Organizational Climate

Background

This study investigated the relationship between trauma exposure and suicidal ideation. Moreover, this study examines the moderating roles of organizational climate on the association between trauma exposure and suicidal ideation in Korean male firefighters.

Methods

A total of 15,104 male firefighters who completed a questionnaire were analyzed. The data were obtained using an online self-administered questionnaire from the Firefighter Research on Enhancement of Safety and Health Study. Poisson regression analysis was performed to determine the effects of trauma exposure on suicidal ideation and the moderating effect of organizational climate.

Results

The results showed that 389 firefighters (2.6%) responded that they had experienced suicidal ideation. In the final model, trauma exposure was positively related to suicidal ideation (adjusted risk ratio [aRR], 1.076; 95% confidence interval [CI]: 1.051-1.103), and organizational climate was negatively associated with suicidal ideation (aRR, 0.772; 95% CI: 0.739-0.806). Additionally, the interaction term (trauma exposure × organizational climate) was related to suicidal ideation (aRR, 1.016; 95% CI: 1.009-1.023).

Conclusions

This study suggests that trauma exposure might play a significant role in developing suicidal ideation and that positive organizational climate moderates the negative effects of trauma exposure on suicidal ideation among firefighters. It is necessary to perform a follow-up study of various intervention strategies to maintain a healthy organizational climate or work environment. Such interventions should promote lasting trust within teams, provide social support and belonging, and nurture job value.

Co-Occurring Mental Health Symptoms in Urban Adolescents: Comorbidity Profiles and Correlates

OBJECTIVE

To identify subgroups of urban youth based on their self- and teacher-reported mental health symptoms, and to explore characteristics of these subgroups.

METHODS

Cross-sectional data from 426 eighth-grade students (Mage = 13.22 years; 70.1% Black/African American; 58.7% female) across 20 Baltimore City public schools were analyzed using latent profile analysis and latent regressions. Variables for latent profile analysis included self-reported symptoms (i.e., anxiety, depression, trauma, interpersonal issues, social problems, and behavioral dysfunction) and teacher-reported symptoms (i.e., externalizing, internalizing, and problems in social and emotional competence). Regressions used profile membership to predict trauma exposure, coping mechanisms, and substance use.

RESULTS

A 3-profile solution was found from the latent profile analysis. The profile with high student- and teacher-reported symptoms had more trauma exposures, greater use of maladaptive coping mechanisms, and higher substance use.

CONCLUSIONS

The current study may help in the identification of urban youth who are at risk of developing multiple co-occurring psychological disorders to target for prevention efforts.

The Posttraumatic Cognitions Inventory (PTCI): Psychometric evaluation in veteran men and women with trauma exposure

The Posttraumatic Cognitions Inventory (PTCI) is a self-report measure of negative posttraumatic cognitions, which is an important construct in the development and maintenance of posttraumatic stress disorder (PTSD). Evidence for the most appropriate PTCI item and factor structure is mixed, and this measure has not been extensively studied in veterans. The present study examined the psychometric properties of the PTCI in two national samples of veteran men and women. Participants in Sample 1 (veterans from all service eras) and Sample 2 (recently separated veterans) completed the PTCI and additional measures of mental health symptoms. Confirmatory factor analyses indicated that a brief version of the PTCI (PTCI-9; 3-factor, nine-item) was a superior fit relative to other examined factor structures. Consistent with the original conceptualization of the measure, these factors were labeled: Negative cognitions about self, negative cognitions about the world, and self-blame. Scores on the PTCI-9 were differentially associated with the PTSD symptom clusters and with scores on self-report measures of external comorbidities. PTCI-9 scores were higher among individuals with trauma exposure and with a probable PTSD diagnosis. There was evidence of full (Sample 1) and partial (Sample 2) scalar invariance across men and women. Overall, the present study supports the use of the PTCI-9 as a measure of negative cognitions; however, scores may not be specific to PTSD and may represent a global negative thinking style. Even so, the PTCI-9 appears to be a suitable and abbreviated measure that could be used with veterans in research and clinical practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotion dysregulation mediates the association between acute sleep disturbance and later posttraumatic stress symptoms in trauma exposed adults

Background: Sleep disturbance is common within days to weeks following a traumatic event and has been associated with emotion dysregulation, a strong risk factor for PTSD development. This study aims to examine if emotion dysregulation mediates the relationship between early post-trauma sleep disturbance and subsequent PTSD symptom severity.Methods: Adult participants (n = 125) completed questionnaires regarding sleep disturbance (via Pittsburgh Sleep Quality Index Addendum; PSQI-A) and emotion dysregulation (via Difficulties in Emotion Regulation Scale; DERS) within 2 weeks after exposure to traumatic events.Results: PTSD symptom severity was assessed with PTSD Checklist for DSM-5 (PCL-5) at 3-month follow-up. There were strong correlations between PSQI-A, DERS, and PCL-5 (r ranges between .38 and .45). Mediation analysis further revealed significant indirect effects of overall emotion regulation difficulties in the relationship between sleep disturbance at 2 weeks and PTSD symptom severity at 3 months (B = .372, SE = .136, 95% CI: [.128, .655]). Importantly, limited access to emotion regulation strategies emerged as the single, significant indirect effect in this relationship (B = .465, SE = .204, 95% CI [.127, .910]) while modelling DERS subscales as multiple parallel mediators.Conclusions: Early post-trauma sleep disturbance is associated with PTSD symptoms over months, and acute emotion dysregulation explains part of this association. Those with limited emotion regulation strategies are at particular risk of developing PTSD symptoms. Early interventions focusing on the appropriate strategies for emotion regulation may be crucial for trauma-exposed individuals.

Everyday life experiences for evaluating post-traumatic stress disorder symptoms

Background: Previous research has highlighted the importance of regularizing daily routines for maintaining mental health. Little is known about whether and how regularity of daily routines is associated with reduced post-traumatic stress disorder (PTSD) symptoms.Objective: We aimed to examine the associations between regularity of daily routines and PTSD symptoms in two studies (N = 796).Method: In Study 1, prospective data were analysed with the latent change score model to investigate the association between sustainment of regular daily routines and change in PTSD symptoms over time amid massive civil unrest in Hong Kong in 2019. Study 2 used vignette as a quasi-experimental method to assess the ability of maintaining regular daily routines in face of a major stressor, and tested its associations with PTSD symptoms.Results: In Study 1, increased regularity of diverse daily routines was inversely associated with increased PTSD symptoms amid the civil unrest in Hong Kong (β = -.427 to -.224, 95% confidence intervals [-.543 to -.359, -.310 to -.090], p values < .01). In Study 2, a greater ability to maintain regular daily routines during stress was associated with lower levels of PTSD symptoms (β = -.285 to -.096, 95% confidence intervals [-.379 to -.189, -.190 to -.003], p values < .05).Conclusions: Our findings suggest the benefit of considering diverse everyday activities in evaluating PTSD symptoms in both clinical and subclinical populations. Interventions with the direct focus on the role of daily living could promote psychological resilience during and after potentially traumatic events.

Journalists and Depressive Symptoms: A Systematic Literature Review

Mental health research focusing on journalists has largely tended to give precedence to trauma exposure and subsequent symptoms of posttraumatic stress disorder. However, there are several occupational factors that may be associated with the development of depressive symptoms in journalists. This systematic literature review aims to provide a concise, comprehensive, and systematic review of the quantitative literature relating to journalists' experiences of depressive symptoms. The systematic literature review method adopted was based on that prescribed by Fink and contains three main elements: sampling the literature, screening the literature, and extracting data. Key terms were developed and used to source appropriate studies from several electronic databases, a hand search of reference lists was conducted, and authors were contacted to suggest examples of their own work not yet sampled. The sample included 13 quantitative studies reported in English language. Journalists most at risk of experiencing depressive symptoms had (1) greater exposure to work-related and personal trauma, (2) experienced threats to themselves or their family, and (3) reduced levels of family and peer support, social acknowledgment, and education. An area for further investigation is the prevalence and experiences of specific depressive disorders within the journalist population. There are a number of theoretical and methodological issues that can be addressed in future research.

Do levels of posttraumatic growth vary by type of traumatic event experienced? An analysis of the Nurses' Health Study II

OBJECTIVE

Posttraumatic growth (PTG) has been documented in the aftermath of a range of traumatic events, including bereavement, physical assault, and rape. However, only a handful of studies have examined whether levels of total PTG, as well as the 5 domains of PTG (Appreciation of Life, New Possibilities, Relating to Others, Personal Strength, and Spiritual Change), vary by the type of potentially traumatic event. The current study examined variation in total PTG and PTG domains, as well as posttraumatic stress (PTS), by event type using data from a large epidemiological study.

METHOD

Participants were from a substudy of the Nurses' Health Study 2, an epidemiologic study of female nurses in the United States (N = 1,574).

RESULTS

Controlling for demographic covariates, we found that rape was consistently associated with lower PTG, both total PTG and all five PTG domains, relative to other event types. Other findings were limited to specific PTG domains; for example, intimate partner violence (IPV) was associated with higher Personal Strength and New Possibilities. In contrast, rape and IPV were associated with higher PTS, and the serious illness or injury of someone close with lower PTS, relative to other event types.

CONCLUSION

These results add to the growing literature exploring variation in PTG by event type and suggest that different events could yield markedly different patterns of PTG domains and PTS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Public Safety Personnel Family Resilience: A Narrative Review

The families of public safety personnel (PSP) face demands that are unique to these occupations. Nonstandard work, trauma exposure, and dangerous work environments affect both workers and the families who support them. This narrative review aims to identify the stressors that PSP families experience and the support and resources needed to enhance family resilience. Due to a lack of research on PSP families, this review is a necessary first step to summarizing and interpreting a diverse body of research. The studies included addressed structural and emotional work-family conflict with reference to PSP sectors. A framework from the military family resiliency literature interprets the findings. Factors influencing family functioning and the availability and accessibility of resources provide clues about the type of skills and supports that PSP families rely on. Meaning-making, collaboration, a sense of coherence, and communication were identified as themes associated with intrafamilial processes. Extrafamilial themes included public perceptions, a lack of recognition for the roles families fulfill, and the need for information and education. The results suggest that the vulnerability of PSP families is variable and extrafamilial resources in the form of formal and informal supports are necessary to enhance family resiliency.

Professional Mental Health Help-Seeking Amongst Afghan and Iraqi Refugees in Australia: Understanding Predictors Five Years Post Resettlement

The current longitudinal study sought to identify predictors of professional help seeking for mental health problems amongst Afghan and Iraqi refugees five years post-settlement utilising the Building a New Life in Australia dataset (BNLA). Data were collected via face-to-face or phone interviews across five waves from October 2013 to March 2018. Afghan and Iraqi born refugees numbering 1180 and over 18 years of age with a permanent humanitarian visa were included in this study. The results suggest differences in help-seeking behaviors amongst the two ethnic groups. Amongst the Afghan sample, older adults with high psychological distress were more likely to seek help, while living in regional Australia, not requiring interpreters, and knowing how to find out information about government services were related to lower likelihood of help-seeking. Within the Iraqi sample, poor overall health and knowing how to find out about services were related to a greater likelihood of help-seeking, while fewer financial hardships decreased the likelihood of help-seeking. Amongst those with probable PTSD, disability was associated with an increased likelihood of help-seeking while experiencing fewer financial hardships and living in regional Australia resulted in a lower likelihood of help-seeking in this group. These results have implications for promotional material and mental health interventions, suggesting that more integrated services tailored to specific characteristics of ethnic groups are needed.

Beyond Trauma Exposure: Discrimination and Posttraumatic Stress, Internalizing, and Externalizing Problems Among Detained Youth

According to the race-based traumatic stress model, racial discrimination is proposed to comprise a traumatic experience that results in posttraumatic stress symptoms, as well as internalizing and externalizing problems among youth. Accordingly, a significant body of research has emerged that supports the associations among these constructs. However, the majority of these empirical studies have not accounted for the potential role of traditionally defined traumatic events in these associations. This study investigated whether self-reported racial discrimination was related to posttraumatic stress symptoms, internalizing, and externalizing symptoms above and beyond the impact of other trauma exposures in a sample of 266 detained youth (79% boys, 60% identified as an ethnic minority). Results of hierarchical linear regressions demonstrated that, after accounting for youths' other trauma exposures, racial discrimination accounted for significant variance in the models predicting delinquency and risk-taking but no other externalizing and internalizing problems, or posttraumatic stress symptoms. These findings indicate that racial discrimination may be particularly important for understanding offending behavior among detained youth.

A Positive Legacy of Trauma? The Role of Perceived Social Support on Mental Health Among Earthquake Survivors During the COVID-19 Outbreak

BACKGROUND

People with prior experience of severe trauma may be particularly vulnerable in the face of the COVID-19 pandemic. However, little is known about mental health problems among prior trauma survivors during the pandemic outbreak.

METHODS

A total of 362 Wenchuan earthquake survivors were assessed using Patient Health Questionnaire, Generalized Anxiety Disorder Scale, as well as Multidimensional Scale of Perceived Social Support, as part of an online survey between February 3 and 10, 2020.

RESULTS

Our results showed that 6.6 and 4.7% of the participants experienced depression and anxiety during the COVID-19 outbreak, respectively. Perceived social support was negatively associated with depressive and anxiety symptoms. Earthquake exposure has no direct effect on current depressive and anxiety symptoms, but it would moderate the direct relationship between perceived social support and psychological symptoms.

CONCLUSIONS

Our findings suggested that trauma exposure may lead to salutogenic outcomes. The protective effect of perceived social support on psychological symptoms was greater in people with a higher level of trauma exposure than in a lower one.

Exploring complex-PTSD comorbidity in trauma-exposed Northern Ireland veterans

BACKGROUND

Complex posttraumatic stress disorder (CPTSD) describes the results of complex, prolonged, and/or inescapable trauma, and is typified by avoidance, re-experiencing, sense of threat, affect dysregulation, negative self-concept, and interpersonal disturbances. Additionally, CPTSD is highly comorbid with other common psychopathologies.

OBJECTIVES

A study was conducted in a trauma-exposed UK Armed Forces Veteran population resident in Northern Ireland (N = 638, NI) to determine the prevalence of CPTSD and comorbid associations.

METHODS

Data from the Northern Ireland Veterans Health and Wellbeing Study (NIVHWS), including self-report data describing traumatic stress, depression, anxiety, and suicidality, were used in a latent class analysis to identify distinct profiles of symptomology in the sample, and in a multinomial logistic regression to identify comorbidities associated with class membership.

RESULTS

Three distinct classes emerged: a low endorsement 'baseline' class (36%), a 'Moderate Symptomatic' class (27%), and a high endorsement 'Probable CPTSD' class (37%). Both the Moderate Symptomatic and CPTSD classes were predicted by cumulative trauma exposure. Depression was highly comorbid (OR = 23.06 in CPTSD), as was anxiety (OR = 22.05 in CPTSD) and suicidal ideation (OR = 4.32 in CPTSD), with suicidal attempt associated with the CPTSD class (OR = 2.51).

CONCLUSIONS

Cases of probable CPTSD were more prevalent than cases of probable posttraumatic stress disorder (PTSD) without Difficulties in Self-Organisation (DSO) symptoms in a UK Armed Forces veteran sample, were associated with repeated/cumulative trauma, and were highly comorbid across a range of psychopathologies. Findings validate previous literature on CPTSD and indicate considerable distress and thus need for support in UK Armed Forces veterans resident in NI.

Systemic interventions for traumatic event exposure: A 2010-2019 decade review

Trauma exposure is a pervasive issue worldwide. People exposed to traumatic events may develop PTSD, depression, anxiety, and other mental health symptoms. Family and intimate partner relationship problems also are frequently associated with trauma exposure. The purpose of this study was to conduct a systematic research synthesis of the empirical evidence on systemic interventions for traumatic event exposure from 2010 to 2019. A search of peer-reviewed research resulted in 31 articles that met inclusion criteria and were included in this review. Systemic interventions were grouped by modality (e.g., parent-child, couple, group). The collective evidence was strongest for systemic youth-caregiver interventions, group, and couple treatment categories for traumatic event exposure. Youth-centered interventions that included various combinations of family member participation can be considered probably efficacious. Overall, results indicated that systemic interventions for traumatic event exposure were successful in reducing posttraumatic stress symptoms including PTSD, depression, and anxiety, and improving relational outcomes.

Factors associated with posttraumatic growth among healthcare workers at an academic-medical center: A correlational study

PURPOSE

Posttraumatic growth (PTG) can occur after experiencing traumatic events. Our purpose was to examine factors associated with PTG experiences of healthcare workers within an academic-medical center.

DESIGN AND METHODS

A correlational study was conducted using a convenience sample of 479 healthcare workers at a large academic-medical center.

FINDINGS

Having children living at home, serving the pediatric population, longer duration of alcohol abstinence, and having received treatment for trauma were significantly associated with greater PTG scores. Compared to nondirect care staff, advance practice providers, nursing staff, social work/psychologists, and pharmacy staff had significantly lower PTG scores.

PRACTICE IMPLICATIONS

Understanding the positive psychological changes that occur in workers after trauma experiences may provide insight to guide interventions that promote healthcare worker wellbeing.

Trauma exposure and the PTSD symptoms of college teachers during the peak of the COVID‐19 outbreak

This study aimed to explore influencing factors for the psychological impact of coronavirus disease 2019 (COVID-19) on Wuhan college teachers, posttraumatic stress symptoms in particular, so as to inform evidence-based strategy development to ameliorate such adverse impacts. An online survey was conducted from 26 to 29 April 2020, and 1650 teachers (47.54% male; M = 40.28 years, SD = 8.3 years) enrolled in Wuhan universities and colleges participated. The results showed that the overall incidence of posttraumatic stress disorder (PTSD) among college teachers was as high as 24.55%, but the average level of PTSD score was low (M = 1.06, SD = 0.72). Logistic regression analysis showed that for those with confirmed COVID-19, the ratio was much higher, up to 2.814 (95% confidence interval [CI]: [1.542, 5.136], p < 0.001); that is, compared with those without symptoms, the ratio of PTSD increased by 181%. For those who had family members or relatives who died of COVID-19, the ratio was 5.592 (95% CI: [2.271, 13.766], p < 0.001), 459% higher than those who had no one who died. But the living places during the pandemic had no significant effect on PTSD. The findings suggest that mental health services reducing PTSD should be provided. Teachers who confirmed COVID-19 or lost loved ones to COVID-19 should be given particular care.

Perceived social stigma, self-concealment, and suicide risk among North Korean refugee women exposed to traumatic events

INTRODUCTION

Suicide among North Korean (NK) refugee women is one of the most concerning public health problems in South Korea. Pre-resettlement trauma exposure and post-resettlement factors can contribute to suicide risk among NK refugee women; however, few studies have explored these associations.

METHODS

This study aimed to assess suicidal ideation and suicide attempts among NK refugee women in South Korea (N = 212) and to examine the impact of pre-resettlement trauma exposure on suicide risk. Perceived social stigma and self-concealment in the post-resettlement phases were investigated as moderating factors for suicide risk related to trauma exposure using multiple regression analyses.

RESULTS

Trauma exposure significantly increased suicidal ideation severity and the risk of suicide attempt. Furthermore, perceived social stigma significantly moderated this relationship such that the impact of trauma exposure in the pre-resettlement phases was amplified as perceived social stigma increased.

CONCLUSION

Based on our study findings, professionals working with refugee populations should assess for perceived social stigma and exposure to traumatic events to reduce and prevent suicidal ideation and attempts.

The effect of nicotine dependence on the risk of developing post-traumatic stress disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND

It is evident that an association between smoking and post-traumatic stress disorder (PTSD) exists, but research is lacking in establishing the directionality of the relationship.

METHODS

We used longitudinal data from wave I (2001-2002) and II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Individuals with nicotine dependence (ND) were matched to individuals without ND using propensity score matching to estimate the risk of developing PTSD after trauma. We also matched smokers (with or without ND) to lifetime non-smokers to estimate their risk of developing PTSD after trauma. Lastly, we conducted a mediation analysis on the effect of ND severity on PTSD symptoms.

RESULTS

Individuals with ND (n = 1,514) were more likely to develop PTSD (OR: 1.59; 95%CI: 1.09-2.32; p = 0.017) compared to individuals without ND (n = 6,047). Smokers (regardless of ND status) (n = 2,335) compared to non-smokers (n = 5,226) had no significant effect on risk of PTSD (p = 0.26). Withdrawal was found to be a mediator of the effect of ND severity on PTSD symptoms.

CONCLUSION

ND, but not smoking status, increases a smoker's risk of developing PTSD. This provides information that could aid in preventive strategies for individuals with ND who are exposed to trauma.

IMPLICATIONS

This study provides evidence in a national representative sample of adults in the U.S. that nicotine dependence may increase one's risk of developing PTSD after exposure to trauma. It also shows the directionality of the association between smoking and PTSD. Lastly, it demonstrates that withdrawal may be the link to the association between nicotine dependence and PTSD. We hope that with these findings, preventative strategies are put in place for smokers who are dependent and are exposed to trauma, such that they do not develop PTSD.

Trauma Exposure, Posttraumatic Stress Disorder, and Aggression Among Civilian Females

Trauma exposure and posttraumatic stress disorder (PTSD) have evinced ties to increased risk for aggressive behavior. However, very little information is known regarding the relations between trauma exposure, PTSD, and aggression among non-veteran women. Furthermore, research has not examined the associations between trauma exposure, PTSD symptoms, and aggression using the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) PTSD criteria. The primary aim of the current study was to investigate the relationships between trauma exposure, PTSD symptoms, and aggression among women. The secondary aim was to examine the specific PTSD symptom clusters in relation to indices of aggression. A total of 217 civilian, trauma-exposed female undergraduate students participated in the study (M_age = 24.30, SD = 6.83, 63.2% White). Higher levels of trauma exposure and PTSD symptoms corresponded with anger (b = .47, 95% CI = [0.11-0.83]; b = .11, 95% CI = [0.05-0.16], respectively) and verbal aggression (b = .50, 95% CI = [0.21-0.78]; b = .06, 95% CI = [0.01-0.10], respectively). PTSD symptoms, but not cumulative trauma exposure, was associated with hostility (b = .23, 95% CI = [0.14-0.59]), whereas physical aggression was only related to trauma exposure (b = .69, 95% CI = [0.31-1.06]). Furthermore, there was a significant indirect effect of cumulative trauma through PTSD symptoms on anger and verbal aggression (b = .15, 95% CI = [0.05-0.32]; b = .09, 95% CI = [0.02-0.20], respectively). Trauma-exposed civilian females with higher levels of PTSD symptoms may be at increased risk for several indices of aggressive behavior. Furthermore, PTSD symptoms may better account for some, but not all, aspects of aggression in trauma-exposed women.

Trauma Exposure and PTSD Among Women Receiving Treatment for Intimate Partner Violence Perpetration

Trauma exposure and posttraumatic stress disorder (PTSD) symptoms have been associated with men's perpetration of intimate partner violence (IPV), but relatively little research has examined these associations among women who perpetrate IPV. This exploratory investigation evaluated the associations among trauma, PTSD symptoms, and IPV perpetration for women and a comparison sample of men. During intake at a community-based Abuse Intervention Program (AIP), women (n = 32) and a demographically similar comparison sample of men (n = 64) completed measures of trauma exposure, PTSD symptoms, physical aggression and emotional abuse perpetration, and use of alcohol and other drugs. The vast majority of women (93.5%) reported traumatic event exposure, and close to half (43.8%) screened positive for a probable PTSD diagnosis. Women's level of PTSD symptoms correlated positively with emotional abuse perpetration, with medium-to-large effect sizes. After controlling for substance use, women's PTSD symptoms were significantly and positively correlated with physical assault and emotional abuse perpetration. Women reported significantly higher rates of exposure to IPV victimization and had significantly higher rates of probable PTSD and PTSD symptoms than did men from the same AIP. Gender did not significantly moderate the associations between PTSD symptoms and IPV perpetration. Overall, findings indicate that trauma exposure and PTSD symptoms are important correlates of women's IPV perpetration. Women in treatment for IPV perpetration may benefit from additional assessment and treatment of trauma and trauma-related symptoms.

Impulse Control Difficulties and Hostility Toward Women as Predictors of Relationship Violence Perpetration in an Undergraduate Male Sample

Relationship violence in college students continues to be an important social problem. Prior research has identified several risk factors for relationship violence including trauma exposure, impulse control difficulties, and hostility toward women; however, previous research assessing these variables has mainly focused on bivariate relationships, with little work attempting to connect multiple correlates to relationship violence while utilizing a theoretical, interactive approach. The purpose of this study was to simultaneously examine several correlates of relationship violence (i.e., hostility toward women, trauma exposure, and impulse control difficulties), and to examine male perpetration of relationship violence among a sample of male college students using a cross-sectional design. It was hypothesized that among men in this sample, hostility toward women and trauma exposure would moderate the relationship between impulse control difficulties and relationship violence. The findings suggested that college-aged men, who have high impulse control difficulties, high hostility toward women, and who have multiple trauma exposures, may be more likely to perpetrate relationship violence against a female intimate partner than those who are low in impulse control difficulties, report low levels of hostility toward women, or report fewer or no trauma exposures. Thus, the current study suggests that exposure to trauma predisposes men with specific attributes to relationship violence, which may provide a treatment target for future intervention programs.

Gene Expression Differences Between Young Adults Based on Trauma History and Post-traumatic Stress Disorder

Background: The purpose of this study was to identify gene expression differences associated with post-traumatic stress disorder (PTSD) and trauma exposure (TE) in a three-group study design comprised of those with and without trauma exposure and PTSD. Methods: We conducted gene expression and gene network analyses in a sample (n = 45) composed of female subjects of European Ancestry (EA) with PTSD, TE without PTSD, and controls. Results: We identified 283 genes differentially expressed between PTSD-TE groups. In an independent sample of Veterans (n = 78) a small minority of these genes were also differentially expressed. We identified 7 gene network modules significantly associated with PTSD and TE (Bonferroni corrected p ≤ 0.05), which at a false discovery rate (FDR) of q ≤ 0.2, were significantly enriched for biological pathways involved in focal adhesion, neuroactive ligand receptor interaction, and immune related processes among others. Conclusions: This study uses gene network analyses to identify significant gene modules associated with PTSD, TE, and controls. On an individual gene level, we identified a large number of differentially expressed genes between PTSD-TE groups, a minority of which were also differentially expressed in the independent sample. We also demonstrate a lack of network module preservation between PTSD and TE, suggesting that the molecular signature of PTSD and trauma are likely independent of each other. Our results provide a basis for the identification of likely disease pathways and biomarkers involved in the etiology of PTSD.

Multimorbidity, Trauma Exposure, and Frailty of Older Adults in the Community

The aim of this study is to investigate the relation between multimorbidity, traumatic events and frailty among older adults in the community. The studied population consisted of 257 older people who were recipients of the services and active members of Open Care Centers for the Elderly (OCCE) of the Municipality of Grevena and meet a set of selection criteria. The collection of the data was carried out using a fully structured questionnaire, which consisted of two sections: a form of individual features and the Tilburg Frailty Indicator (TFI). The sample consisted of 114 men (44.4%) and 143 women (55.6%) aged between 61 and 96 years with an average of 75.12 years. The results showed that the mean scores were 2.70 for the Physical Frailty (standard deviation = 2.16), 1.43 for the Psychological Frailty (standard deviation = 1.21), 1.32 for the Social Frailty (standard deviation = 0.64) and 5.44 for the total Frailty (standard deviation = 3.02). We took into account the cut-off point five of 54.1% (n = 139) in terms of the participants' frailty. Physical, Psychological, and Total Frailty are related to (a) the presence of two or more chronic diseases or disorders, (b) the experience of a serious illness in the previous year, and (c) the experience of a serious illness of a loved one during the previous year. The outcomes helped to identify frailty syndrome in older people and the factors associated with it.

Associations between News Media Coverage of the 11 September Attacks and Depression in Employees of New York City Area Businesses

Research has examined the association between contact with media coverage of mass trauma events and various psychological outcomes, including depression. Disaster-related depression research is complicated by the relatively high prevalence of the major depressive disorder in general populations even without trauma exposure. The extant research is inconclusive regarding associations between disaster media contact and depression outcomes, in part, because most studies have not distinguished diagnostic and symptomatic outcomes, differentiated postdisaster incidence from prevalence, or considered disaster trauma exposures. This study examined these associations in a volunteer sample of 254 employees of New York City businesses after the 11 September 2001, terrorist attacks. Structured interviews and questionnaires were administered 35 months after the attacks. Poisson and logistic regression analyses revealed that post-9/11 news contact significantly predicted the number of postdisaster persistent/recurrent and incident depressive symptoms in the full sample and in the indirect and unexposed groups. The findings suggest that clinical and public health approaches should be particularly alert to potential adverse postdisaster depression outcomes related to media consumption in disaster trauma-unexposed or indirectly-exposed groups.

The Tension Between Cognitive and Regulatory Flexibility and Their Associations With Current and Lifetime PTSD Symptoms

In recent years, researchers have tried to unpack the meaning of the term flexibility and test how different constructs of flexibility are associated with various psychopathologies. For example, it is apparent that high levels of flexibility allow individuals to adaptively cope and avoid psychopathology following traumatic events, but the precise nature of this flexibility is ambiguous. In this study we focus on two central constructs: cognitive flexibility - the ability to recognize and implement possible responses to a situation- and regulatory flexibility - the ability to modulate emotional expression and experience across situations. We aim to explore the connection between cognitive and regulatory flexibility and evaluate their relative effect on PTSD symptoms. Trauma-exposed college students (N = 109, M age = 25.31, SD = 4.59) were assessed for cognitive and regulatory flexibility and current and lifetime PTSD symptoms. We predicted and found a relatively weak, yet significant, overlap between participants' cognitive and regulatory flexibility. Importantly, while both cognitive and regulatory flexibility were associated with lifetime PTSD symptoms, only cognitive flexibility was associated with current PTSD symptoms. The findings illuminate the possible value of differentiating between constructs of flexibility in predicting short and long-term effects of traumatic exposure and may pave the ground for developing personalized intervention methods.

Celebrating 10 years of the European Journal of Psychotraumatology

It is 10 years ago that the European Journal of Psychotraumatology (EJPT) was launched. This was celebrated with a one day symposium on 1 February 2021 with all EJPT's editors presenting on the state of the art developments in the field of psychotraumatology. The European Society for Traumatic Stress Studies (ESTSS) is proud to have all these speakers together sharing their knowledge on a range of topics within the field of psychotraumatology, from genetics to clinical practice. In this editorial the programme with the presentations is presented, including links to both to short summaries of the lectures and to the online session itself. In line with the Open Access format of the journal, access to the symposium content is free of charge and thus available to all around the world without barriers.

Trauma, Sleep and Mental Health Problems in Low-Income Young Adults

Low-income young adults are more likely to have exposure to trauma, which increases risk for mental health problems. Although adequate sleep promotes good health, people with histories of trauma are more likely to have sleep problems. The current study explored whether poor sleep mediated the relationship between trauma exposure and mental health. A sample of 143 low-income 18-24-year-old young adults completed depression, anxiety, and trauma exposure measures and wore sleep monitors for four nights. Structural equation modeling (SEM) was used to examine both direct and indirect effects of variables. Results showed that higher trauma exposure was associated with depression and anxiety. Mean sleep hours per night was fewer than six, far below recommended guidelines for optimal health and functioning. Fewer sleep hours partially mediated the relationship between both trauma exposure and depression and anxiety, and the direct effect from trauma remained significant after adjusting for the partial mediation from sleep.

Latent Profiles of Alcohol Consumption Among College Students Exposed to Trauma

BACKGROUND

Alcohol use/misuse is a costly public health problem, particularly among college students in the United States. Alcohol use tends to increase during adolescence and peaks in the early/mid-20s; however, there is significant heterogeneity among alcohol use during the college years. Several studies applying a mixture modeling framework to extract latent profiles of alcohol consumption have been conducted. However, none to our knowledge has included only those exposed to trauma, a group known to be at risk for alcohol misuse. The aim of this longitudinal study (n = 1,186) was to identify profiles of alcohol consumption and their associations with demographic and trauma-related constructs.

METHOD

Data were collected from a larger study of college students attending a large public university. Participants in the current study were, on average, 18.46 years old at study entry, primarily female (69.6%), and of diverse racial/ethnic backgrounds (e.g., 48.8% White, 20.4% Black, 16.8% Asian).

RESULTS

Results suggest evidence for four latent profiles. These classes include an initially high increasing, an initially high decreasing, an initially low decreasing, and an initially low increasing, the last of which had not been found. Using analyses of variance, profile membership was associated with number of traumas, probable posttraumatic stress disorder, broad drinking motives, and trauma-specific drinking-to-cope motives.

CONCLUSIONS

Results suggest that drinking motives and trauma-related factors are important correlates of these latent alcohol profiles. Work clarifying the longitudinal interrelations between profile membership and these factors is needed to help inform more effective prevention and intervention efforts.

Prevalence and correlates of depression among rural and urban Rwandan mothers and their daughters 26 years after the 1994 genocide against the Tutsi

BACKGROUND

In the past 26 years since the genocide against the Tutsi, mental illness continues to be the greatest challenges facing the Rwandan population. In the context of the 1994 genocide against Tutsi, there are three different survival status within Rwandan women. Those who were targeted by the genocide referred to as 'survivors', those who were in the country during the genocide but were not targeted referred to as 'non-targeted', and those who were outside the country referred to as '1959 returnees'. All these groups experienced the traumatic events differently. The literature shows that traumatic stress exposure is associated with depression.

OBJECTIVES

To demonstrate differences in trauma exposure in a sample of mothers and daughters according to their genocide survival status. To examine differences in depression prevalence between these three groups of mothers and daughters as a function of their genocide survival status and place of residence. To examine the relationship between major depression, survival status, place of residence, and trauma exposure in sample of mothers and daughters, including the relationship between mothers' depression and daughters' depression.

METHODS

A sample of 309 dyads of mothers and daughters was recruited. Data were collected using the Mini International Neuropsychiatric Interview, Life Events Questionnaire and the Social Demographics Questionnaire. Data were analysed using descriptive statistics, chi-square test, logistic regression, and one-way ANOVA.

RESULTS

There is a significant difference in trauma exposure in three survival categories of mothers and daughters. A 23% of mothers and 18.4% of daughters met criteria for major depression, with urban participants twice as likely to meet criteria as participants from rural areas. Depression was associated with trauma exposure and place of residence in mothers' and daughters' samples. Maternal depression was associated with depression in daughters.

CONCLUSIONS

Family support counselling services and research to identify factors of intergenerational depression are needed.

War-related trauma and post-traumatic stress disorder prevalence among Syrian university students

BACKGROUND

Posttraumatic stress disorder (PTSD) is one of the most prevalent mental disorders in war-affected regions. Syria has endured 9 years of war and yet little is known about the impact of the conflict on the well-being of Syrians who remain. In this study, we investigated trauma and estimated PTSD prevalence among university students in Deir-ez-Zor, a Syrian governorate that was under the siege by ISIS for over 3 years.

METHODS

A descriptive cross-sectional study design was used on a sample of Al-Furat university students in Deir-ez-Zor. We collected data on socio-demographics, trauma exposure, and stress levels. PTSD Checklist for DSM-5 was used to provide prevalence rate estimates, and determine the symptom severity among Syrian university students. Binary logistic regression was used to identify factors associated with the development of PTSD symptoms.

RESULTS

A total of 833 students were recruited into the study, 86.4% of the participants were exposed to at least one traumatic event. The estimated PTSD prevalence was 28.2%, and the highest PTSD rates were found among students who were forced into sexual act (46.3%). A significant association was found between PTSD and internal displacement (p = .032), academic year (p = .002), and social economic status (p = .000). Binary logistic regression indicated that PTSD symptoms were predicted by smoking and third-year university students.

CONCLUSIONS

The results presented in this research revealed a high prevalence of trauma exposure and PTSD symptoms among a sample of university students in Deir-ez-Zor. These findings call for immediate actions to help the affected population in restoring their mental health, so they can be prepared to face the challenges and demands of the post-conflict period.

Intervention Response to the Trauma-Exposed, Justice-Involved Female Youth: A Narrative Review of Effectiveness in Reducing Recidivism

This study aims to examine current research about trauma-exposed, justice-involved (TEJI) female youth, and evaluate the current literature regarding the effectiveness of gender-specific interventions aimed at reducing their recidivism. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology was utilized to examine quantitative and qualitative literature, published from 2000 through March 2020, about interventions for female justice-involved youth with trauma exposure. Analysis of selected studies utilized an integrated framework based on Andrew’s Risk-Need-Responsivity (RNR) model and Lipsey’s factors of effectiveness, which reviewed studies showing the relationship between female justice-involved youth with mental health symptomologies and trauma. The findings show that effective intervention for this population targets the youth’s negative internal mechanisms related to trauma-subsequent psychosocial problems. These studies suggest that trauma-sensitive modalities have the potential to mitigate the further risk of problematic external behaviors. All studies had limited sample sizes, low follow-up rates, and unknown long-term outcomes. Future research should explore dimensions of sustainability and achieving stability in relation to intervention setting. Selecting the proper venue and facilitator for quality implementation and stability of setting is critical in delivering effective therapies. Modifications in public expectations of juvenile justice policy and practice, from disciplinary to therapeutic approaches, is needed.

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.

Associations between Trauma Exposure and Physical Conditions among Public Safety Personnel: Associations entre l'exposition à un traumatisme et les problèmes physiques chez le personnel de la santé publique

BACKGROUND

Trauma exposure is associated with adverse health-related correlates, including physical comorbidities, and is highly prevalent among public safety personnel (PSP). The current study (1) examined the association between context of index trauma exposure (part of job vs. other) and physical conditions and (2) established the prevalence of physical conditions according to PSP category (e.g., police, paramedic) and index trauma type (e.g., serious accident, physical assault) in a large Canadian sample of PSP.

METHODS

PSP completed an online survey between September 2016 and January 2017. Multivariable logistic regressions examined associations between context of index trauma exposure (i.e., part of job vs. other) and physical condition categories. Cross-tabulations with chi-square analyses examined whether the prevalence of physical conditions significantly differed according to PSP category and index trauma type.

RESULTS

There were 5,267 PSP included in the current study. Results from the most stringent model of logistic regressions demonstrated that, compared to PSP who experienced their index trauma in any other context, PSP who experienced it as part of their job had reduced odds of "other" physical conditions (adjusted odds ratio = 0.73, 95% confidence interval, 0.57 to 0.94, P < 0.05). Results also revealed significant differences in the prevalence of physical conditions across all PSP categories and select index trauma types.

CONCLUSION

Results highlight the relevance of trauma exposure outside of an occupational context among PSP and may have implications for the positive impact of stress inoculation and resiliency training programs for PSP.

Ethnic Disparities in Trauma-Related Mental Illness: Is Ethnic Identity a Buffer?

Despite evidence that racial and ethnic characteristics influence the impact of traumatic exposure on psychological health, little is known about how race and ethnic identity can alter, and possibly protect against, the effects of trauma on the psychiatric diagnoses of women. Therefore, the present study examined the moderating role of race/ethnicity and ethnic identity in the link between trauma exposure and psychiatric diagnosis for African American and Caucasian college women. Participants were a sample of 242 women from the Mid-Atlantic region of the United States who self-identified as African American or Black (31%) and European American or Caucasian (69%; M age = 19.5 years). Interviews were conducted over the phone to screen for trauma, followed by longer in-person interviews. Each of the interviewers was supervised, and interviews were reviewed to control for quality. Regression analyses revealed that the number of traumatic events was a stronger predictor of lifetime psychiatric diagnoses for Caucasian women. In addition, ethnic identity served as a protective factor against trauma exposure among participants. The findings suggest that ethnic identity is a relevant buffer against potential psychiatric diagnoses as result of exposure to traumatic events for both Caucasian and African American women.

Validation of the Suicidal Behavior Exposure Scale in First Responders

Background: First responders (e.g., emergency medical technicians, firefighters) may be at higher suicide risk than the general population due to frequent exposure to suicidal behaviors of others. Aims: We aimed to confirm the factor structure, scale reliability, and convergent validity of a new measure of suicidal exposure, the Suicidal Behaviors Exposure Scale, in first responders. Method: Using a cross-sectional web-based survey, we recruited 862 participants (81.3% male, mean age = 40.23, SD = 11.88) from a national database and southeastern state-based organization of first responders. Results: Confirmatory factor analysis resulted in a generally poor fit for the three-factor structure (exposure to suicidal communication, indirect exposure to suicide attempts/deaths, direct exposure to suicide attempts/deaths). However, good scale reliability and convergent validity were demonstrated. Limitations: The cross-sectional design, a convenience sample, and the low percentage of women comprise the limitations of this study. Conclusion: The Suicidal Behavior Exposure Scale requires additional development and validation before use in a first-responder sample. Future work should also examine other aspects of reliability and validity, namely, measurement invariance across groups and time.

Trauma exposure and stress-related disorders in African-American women with diabetes mellitus

OBJECTIVE

The purpose of the study was to assess demographic features, rates of trauma exposure, prevalence of post-traumatic stress and depressive symptoms in a group of urban, low-income, African-American women with type 1 or type 2 diabetes mellitus.

RESEARCH DESIGN AND METHODS

We conducted a survey of (n = 290) low-income, African-American women seeking care in the diabetes clinic of an urban hospital and collected data on the demographic characteristics, childhood and nonchildhood abuse trauma exposure, and the severity of post-traumatic stress and depressive symptoms using the Post-traumatic Stress Disorder (PTSD) Symptom Scale (PSS) and the Beck Depression Inventory (BDI). In a subset of women with type 2 diabetes (n = 96), we assessed haemoglobin A1c to examine the relationship between psychopathology and glycaemic control.

RESULTS

Of the overall sample, 61.7% reported exposure to trauma in their lifetime, and 30.4% and 29.3% had current PTSD and MDD, respectively. Exposure to both childhood and nonchildhood abuse trauma was associated with an increased PTSD and depressive symptom severity (P's < .05). PTSD diagnosis, but not depression, was associated with increased haemoglobin A1c (P = .002).

CONCLUSIONS

These data document high levels of trauma exposure, PTSD and depressive symptoms in diabetic African-American women treated in a specialty clinic of an urban hospital setting. Furthermore, these data indicate that the presence of PTSD is negatively associated with glycaemic control.

Cumulative Risk on Oxytocin-Pathway Genes Impairs Default Mode Network Connectivity in Trauma-Exposed Youth

Background: Although the default mode network (DMN) is a core network essential for brain functioning, little is known about its developmental trajectory, particularly on factors associated with its coherence into a functional network. In light of adult studies indicating DMN's susceptibility to stress-related conditions, we examined links between variability on oxytocin-pathway genes and DMN connectivity in youth exposed to chronic war-related trauma Methods: Following a cohort of war-exposed children from early childhood, we imaged the brains of 74 preadolescents (age 11-13 years; 39 war-exposed) during rest using magnetoencephalography (MEG). A cumulative risk index on oxytocin-pathway genes was constructed by combining single nucleotide polymorphisms on five genes previously linked with social deficits and psychopathology; OXTR rs1042778, OXTR rs2254298, OXTRrs53576, CD38 rs3796863, and AVPR1A RS3. Avoidant response to trauma reminders in early childhood and anxiety disorders in late childhood were assessed as predictors of disruptions to DMN theta connectivity. Results: Higher vulnerability on oxytocin-pathway genes predicted greater disruptions to DMN theta connectivity. Avoidant symptoms in early childhood and generalized anxiety disorder in later childhood were related to impaired DMN connectivity. In combination, stress exposure, oxytocin-pathway genes, and stress-related symptoms explained 24.6% of the variance in DMN connectivity, highlighting the significant effect of stress on the maturing brain. Conclusions: Findings are the first to link the oxytocin system and maturation of the DMN, a core system sustaining autobiographical memories, alteration of intrinsic and extrinsic attention, mentalization, and sense of self. Results suggest that oxytocin may buffer the effects of chronic early stress on the DMN, particularly theta rhythms that typify the developing brain.

The effect of pre-existing alcohol use disorder on the risk of developing posttraumatic stress disorder: results from a longitudinal national representative sample

Background: There is inconsistent evidence in the literature as to whether or not Alcohol Use Disorder (AUD) is a risk factor for Post-Traumatic Stress Disorder (PTSD).Objectives: We evaluated the risk of developing PTSD after trauma exposure in individuals with AUD. As a secondary analysis, we also tested if alcohol dependence or alcohol abuse separately increased the risk of PTSD development. We also explored the effect of AUD on exposure to various traumas.Methods: Longitudinal data was obtained from 30,180 individuals with and without AUD from National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) waves I and II. Using propensity score methods, we matched individuals with AUD (alcohol abuse and/or dependence using DSM-IV criteria) to those without AUD at baseline on demographic, familial, and clinical factors to estimate the risk of PTSD development after trauma exposure. Data were adjusted for complex survey methods.Results: Individuals with AUD had an increased risk of being exposed to various traumas between wave I and II (60.6% vs. 48.3% of controls). Among individuals exposed to trauma between the two waves (N = 14,107), AUD had no effect on subsequent PTSD development after matching and controlling for covariates (OR: 1.00; 95%CI: 0.72-1.39; p = .99). However, those with alcohol dependence only did have an effect on subsequent PTSD development (OR: 1.76; 95%CI: 1.05-2.95; p = .03).Conclusion: In individuals with alcohol dependence the experience of trauma increases the risk of developing PTSD. These findings suggest that prevention methods from PTSD after trauma exposure for individuals with alcohol dependence are needed.

Traumatic imagery following glucocorticoid administration in earthquake-related post-traumatic stress disorder: A preliminary functional magnetic resonance imaging study

OBJECTIVE

Post-traumatic stress disorder involves excessive retrieval of traumatic memories. Glucocorticoids impair declarative memory retrieval. This preliminary study examined the effect of acute hydrocortisone administration on brain activation in individuals with earthquake-related post-traumatic stress disorder compared with earthquake-exposed healthy individuals, during retrieval of traumatic memories.

METHOD

Participants exposed to earthquakes with (n = 11) and without post-traumatic stress disorder (n = 11) underwent two functional magnetic resonance imaging scans, 1-week apart, in a double-blind, placebo-controlled, counter-balanced design. On one occasion, they received oral hydrocortisone (20 mg), and on the other, placebo, 1 hour before scanning. Symptom provocation involved script-driven imagery (traumatic and neutral scripts) and measures of self-reported anxiety.

RESULTS

Arterial spin labelling showed that both post-traumatic stress disorder and trauma-exposed controls had significantly reduced cerebral blood flow in response to retrieval of traumatic versus neutral memories in the right hippocampus, parahippocampal gyrus, calcarine sulcus, middle and superior temporal gyrus, posterior cingulate, Heschl's gyrus, inferior parietal lobule, angular gyrus, middle occipital gyrus, supramarginal gyrus, lingual gyrus and cuneus, and the left prefrontal cortex. Hydrocortisone resulted in non-significant trends of increasing subjective distress and reduced regional cerebral blood flow in the left inferior frontal gyrus, left anterior cingulate gyrus, middle temporal gyrus, cerebellum, postcentral gyrus and right frontal pole, during the trauma script.

CONCLUSION

Findings do not fit with some aspects of the accepted neurocircuitry model of post-traumatic stress disorder, i.e., failure of the medial prefrontal cortex to quieten hyperresponsive amygdala activity, and the potential therapeutic benefits of hydrocortisone. They do, however, provide further evidence that exposure to earthquake trauma, regardless of whether post-traumatic stress disorder eventuates, impacts brain activity and highlights the importance of inclusion of trauma-exposed comparisons in studies of post-traumatic stress disorder.