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Paulina Zelviene, Evaldas Kazlauskas Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania Abstract: Adjustment disorder (AjD) is among the most often diagnosed mental disorders in clinical practice. This paper reviews current status of AjD research and discusses scientific and clinical issues associated with AjD. AjD has been included in diagnostic classifications for over 50 years. Still, the diagnostic criteria for AjD remain vague and cause difficulties to mental health professionals. Controversies in definition resulted in the lack of reliable and valid measures of AjD. Epidemiological data on prevalence of AjD is scarce and not reliable because prevalence data are biased by the diagnostic algorithm, which is usually developed for each study, as no established diagnostic standards for AjD are available. Considerable changes in the field of AjD could follow after the release of the 11th edition of International Classification of Diseases (ICD-11). A new AjD symptom profile was introduced in ICD-11 with 2 main symptoms as follows: 1) preoccupation and 2) failure to adapt. However, differences between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and ICD-11 AjD diagnostic criteria could result in diverse research findings in the future. The best treatment approach for AjD remains unclear, and further treatment studies are needed to provide AjD treatment guidelines to clinicians. Keywords: adjustment disorder, review, diagnosis, prevalence, treatment, DSM, ICD

The COVID-19 outbreak and subsequent public health interventions have depressed demand and disrupted supply chains for many fishing businesses. This paper provides an analysis of the COVID-19 impacts on the profitability of the EU fishing fleets. Nowcasting techniques were used to estimate the impact of the COVID-19 pandemic on the economic performance for the EU fishing fleet in 2020 and 2021. Our results show that the economic impact of COVID-19 on this sector was smaller than initially expected and overall profits remained positive. This was in part due to low fuel prices that reduced operating costs of fishing, and the early response from governments to support the sector. The results vary by fishing fleet, revealing that small-scale fleets and the fleets in the Mediterranean and Black seas have been more impacted than large-scale fleets and the fleets in the Northeast Atlantic.

Introduction: Prolonged grief disorder is for the first time included in the International Classification of Diseases, 11th Revision. There is a need to establish risk factors that would help clinicians identify people at risk for prolonged grief. It is especially important to understand how the circumstances of the death of a loved one might affect the risk for prolonged grief. Objectives: The aim of the study was to explore which factors related to the loss of a loved one were associated with prolonged grief symptoms severity. Methods: A total of 216 bereaved adults, 186 (86.1%) women, participated in the study. The participants' average age was 39.46 years, ranging from 18 to 92. Time since the loss ranged from 6 to 72months. The Prolonged Grief Disorder-13 questionnaire (PG-13) and questions about the circumstances related to the death of a loved one were used in the study. Results: Regression analysis revealed that female gender, older age, less time since the loss, unexpectedness of the death, and closeness and previous conflicts with the bereaved predicted higher prolonged grief symptoms. The age of the bereaved, illness before the death, being a primary caregiver, living with the deceased, being together during the time of death, and a non-violent death did not predict the severity of prolonged grief symptoms. Conclusions: The results of the study showed that the relationship with the deceased, demographics, unexpectedness of the death and the time since the loss are important predictors of prolonged grief. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to assess the mental health and well-being of Lithuanian healthcare workers by gathering demographic information, identifying common stressors affecting the work environment, evaluating mental health, and exploring directions for psychosocial care. Additionally, the research explored the prevalence of considering a career change among respondents., Material and Methods: The study included 1618 responders who completed an online survey in December 2021 - January 2022. Participants included in this study: physicians, nurses, residents and other healthcare workers. It evaluated their demographics, most common stressors affecting their work environment and mental health on the Depression, Anxiety and Stress Scale - 21 (DASS-21) scale. Lastly, all responders asked if they had considered changing their occupation to a non-medical job. Univariate analysis was performed using χ2 and Student's t test, and binary logistic regression evaluated career change predictors., Results: Career change was considered by 1081 (66.8%) responders. The main career change predictors were poor working conditions (OR 1.91, p < 0.001), direct contact with patients (OR 1.84, p < 0.001), lack of career perspectives (OR 1.95, p < 0.001), mobbing (OR 1.67, p = 0.001) and exhaustion (OR 1.51, p = 0.005). After evaluating DASS-21 scores, it was found that 23% of respondents had severe and extremely severe depression symptoms, 27.4% severe and extremely severe anxiety, and 21.4% had severe and extremely severe stress levels., Conclusions: Lithuanian healthcare workers are in high distress and have poor mental health. They are in need psychosocial assistance to avoid burnout and staff loss. Int J Occup Med Environ Health. 2024;37(3):287-99., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder. Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment. Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression. Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure. Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.

The adverse effects on the health of the Chornobyl nuclear power plant accident clean-up workers have been reported previously. However, there is a lack of studies on the mental health of Chornobyl clean-up workers. The current study explored psychological distress in a sample of Lithuanian clean-up workers 35 years after the accident. In total, 107 Lithuanian Chornobyl clean-up workers (M age  = 62.5) and 107 controls were included in the study. The Hospital Anxiety and Depression Scale (HAD) was used for the assessment of anxiety and depression. The depression symptoms were significantly higher in the clean-up workers compared to the control group. The prevalence of severe depression symptoms was 23.4% and 4.7% in the Chornobyl clean-up workers and control groups, respectively. The risk for severe depression was associated with Chornobyl clean-up work (adjusted OR = 5.9). No differences in the anxiety symptoms were found between clean-up workers and controls. The study revealed the deteriorated mental health of the Lithuanian Chornobyl clean-up workers 35 years after the disaster - in particular, high levels of depression. Psychosocial support programmes for clean-up workers should be provided to mitigate the adverse effects of the disaster.

Internet-delivered cognitive behavioral therapy (ICBT) interventions can be as effective as traditional face-to-face therapy for various mental health conditions. However, a significant challenge these online interventions face is the high rate of people who start but then stop using the program. This early discontinuation can be seen as incomplete treatment and can reduce the potential benefits for users. By exploring why people stop using ICBT programs, we can better understand how to address this problem. This study aimed to examine the experiences of healthcare workers who had stopped using a therapist-guided internet-delivered stress recovery program to gain deeper insights into usage attrition. We conducted semi-structured interviews with twelve participants who were female healthcare workers ranging in age from 24 to 68 years ( M  = 44.67, SD  = 11.80). Telephone interviews were conducted and the data were transcribed and analyzed using thematic analysis. Qualitative data analysis revealed that most participants had multiple reasons for discontinuing the program. They identified both barriers and facilitators to using the program, which could be categorized as either personal or program related. Personal aspects included life circumstances, personal characteristics, and psychological responses to the program. Program-related aspects encompassed technical factors, program content, and the level of support provided. The findings of this study can enhance our understanding of why people stop using guided internet-delivered programs. We discuss the practical and research implications, with the ultimate aim of improving the design and efficacy of internet interventions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

We introduce a protein-ligand binding database (PLBD) that presents thermodynamic and kinetic data of reversible protein interactions with small molecule compounds. The manually curated binding data are linked to protein-ligand crystal structures, enabling structure-thermodynamics correlations to be determined. The database contains over 5500 binding datasets of 556 sulfonamide compound interactions with the 12 catalytically active human carbonic anhydrase isozymes defined by fluorescent thermal shift assay, isothermal titration calorimetry, inhibition of enzymatic activity and surface plasmon resonance. In the PLBD, the intrinsic thermodynamic parameters of interactions are provided, which account for the binding-linked protonation reactions. In addition to the protein-ligand binding affinities, the database provides calorimetrically measured binding enthalpies, providing additional mechanistic understanding. The PLBD can be applied to investigations of protein-ligand recognition and could be integrated into small molecule drug design. Database URL https://plbd.org/., (© The Author(s) 2023. Published by Oxford University Press.)

Background: Research reveals a high prevalence of stressors in adolescence. Mental health in adolescence is highly related to life-stressors exposure and difficulties in adjusting to stressors. Therefore, interventions for recovery from stress are in high demand. The study aims to evaluate the efficacy of the Internet-based stress recovery intervention for adolescents., Methods: A two-arm randomized controlled trial (RCT) on the efficacy of the FOREST-A-an Internet-based stress recovery intervention for adolescents-will be conducted. The FOREST-A is an adapted version of stress recovery intervention initially developed for healthcare workers. FOREST-A is a third-wave cognitive behavioral therapy and mindfulness-based Internet-delivered 4-week psychosocial intervention, which comprises six modules: Introduction, Relaxation, Psychological detachment, Mastery, Control, and Summary. The intervention will be evaluated using the two-arm RCT with intervention and care as usual (CAU) condition at pre-test, post-test, and 3-month follow-up. The measured outcomes will be stress recovery, adjustment disorder, generalized anxiety and depression symptoms, psychological well-being, and perceived positive social support., Discussion: The study will contribute to the development of Internet interventions-easily and broadly accessible tools-for the enhancement of adolescents' stress recovery skills. Based on the study's findings, further development of the FOREST-A, including upscaling and implementation, is foreseen., Trial Registration: ClinicalTrials.gov NCT05688254. Registered on January 6, 2023., (© 2023. The Author(s).)

Healthcare workers (HCWs) often experience high levels of stress, anxiety, and depression due to high workloads and responsibilities in their professional activities. Therefore, recovery from work-related stress is highly important in HCWs. The Recovery Experience Questionnaire (REQ) is a 16-item self-reported measure covering four stress recovery domains: psychological detachment from work, relaxation, mastery, and control. The current study aimed to test the REQ's psychometric properties in a sample of Lithuanian HCWs. In total, 471 HCWs from various healthcare institutions participated in this study. Confirmatory factor analysis (CFA) was used to test the structure of the REQ. We also used the Brief Patient Health Questionnaire (PHQ-4) and the World Health Organization Psychological Well-Being Index (WHO-5) to assess the mental health of the study participants. The CFA analysis supported the correlated four-factor structure of the REQ. Furthermore, we found significant correlations between the levels of REQ and anxiety, depression, and well-being. We conclude that the REQ is a valid measure that could be a useful tool in research on HCWs' mental health. It could also be used in healthcare settings for the evaluation of well-being among healthcare staff.

Background: Further developments in trauma care training for mental health staff are needed to ensure that trauma survivors are recognised and get the most effective care. The evaluation of the effects of trauma care training programs would enable the untangling of the most efficient ways of building the competence of clinicians who encounter trauma-exposed patients in their routine clinical practice., Objective: We aimed to analyse longitudinal changes in mental health professionals' perceived trauma care competencies after a brief online trauma care training, and to examine associations between these changes and specific work-related characteristics., Method: In total, 223 mental health professionals, 96.4% women, 42 years on average, and 51.6% with more than 10 years of clinical practice, participated in a brief online trauma care training programme. The Readiness to Work with Trauma-Exposed Patients Scale (RTEPS) was used to measure perceived trauma care competencies at the pre-training, post-training, and at a 3-month follow-up., Results: Training had a significant effect on all measured perceived trauma care competencies of assessment, treatment and affect tolerance at post-training and 3-month follow-up. We also found that many years of unspecific clinical practice did not contribute to perceived trauma care competencies, and the training was perceived equally beneficial by professionals with more or less clinical practice., Conclusions: Our study indicates that brief training can have lasting effects on clinicians' self-confidence in trauma care. Further investigation of factors associated with the effects of training might help to increase the effectiveness of the training programs.

Highlights: N  =  4,607 trauma-exposed adult participants were recruited from the general population during the first year of the COVID-19 pandemic.The prevalence for probable posttraumatic stress disorder was 17.7%.We identified risk factors (e.g. poor health condition) and protective factors (e.g. social contact) associated with posttraumatic stress disorder.

The paper presents professional activities and the major works of an ambassador of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT), Prof. Danutė Gailienė. Prof. Gailienė is among the most influential European clinical psychologists who contributed to clinical psychology training, research, and practice in former post-communist East European countries. Her entire career was dedicated to the development of clinical psychology, and through her work, Prof. Gailienė demonstrated how even in an oppressive and politically difficult environment, it is possible to keep the integrity and work up to higher standards., Competing Interests: The authors have declared that no competing interests exist.

Background: The 11th revision of the International Classification of Diseases (ICD-11) included two distinct trauma-related diagnoses-Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD). The initial diagnostic factor for both disorders is exposure to a traumatic event. This study aimed to explore whether exposure to different traumatic experiences distinguish risk for PTSD and CPTSD., Methods: The study sample comprised 158 trauma-exposed participants, M (SD) age  = 33.61(9.73). The Life Events Checklist-Revised (LEC-R) was used to evaluate trauma exposure, and the International Trauma Questionnaire (ITQ) was used to assess risk for ICD-11 PTSD and CPTSD. Multinomial logistic regression was used to determine traumatic events as predictors of risk for PTSD and CPTSD., Results: Analysis revealed that sexual abuse experienced in childhood or adulthood was associated with both PTSD and CPTSD. History of other unwanted sexual experiences and childhood physical abuse predicted CPTSD compared to PTSD, whereas exposure to natural disasters predicted PTSD compared to CPTSD., Conclusions: The results showed that experiences of certain traumatic events, such as sexual trauma, childhood physical abuse or natural disasters, might help distinguish risk for PTSD and CPTSD. Nevertheless, future studies on specific aspects of trauma exposure are necessary., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kairyte, Kvedaraite, Kazlauskas and Gelezelyte.)

Background: Although there is increasing knowledge about adjustment disorder (AjD) based on the new diagnostic criteria of the International Classification of Diseases (ICD-11), less is known on AjD in adolescents. This study aimed to examine the prevalence of AjD and its risk factors in Japanese and Lithuanian adolescents., Methods: The cross-sectional study sample comprised 1745 adolescents from Japan ( n = 913) and Lithuania ( n = 832). AjD was assessed using the Adjustment Disorder New Module-8 (ADNM-8). We compared the prevalence of AjD in Japanese and Lithuanian adolescents. Using multinominal logistic regression analysis, we examined the effects of age, gender, socioeconomic status, and cumulative stressors as societal and cultural factors, resilience as an intrapersonal factor, and loneliness and perceived support as interpersonal factors on adolescent AjD., Results: The prevalence of probable AjD was 11.7% in Lithuanian adolescents and 6.9% in Japanese adolescents. Gender, socioeconomic status, cumulative stressors, resilience, loneliness, and perceived positive social support were each significantly associated with AjD risk., Conclusions: This cross-cultural comparative study revealed characteristics of the stressors and prevalence of AjD among Japanese and Lithuanian adolescents. In terms of the socio-interpersonal framework model for the stress-response syndrome, sociocultural, intrapersonal, and interpersonal factors were found to be risk factors associated with AjD in adolescents.

The death of a loved one has physical, psychological, and social consequences. Between 9.8 and 21.5 % of people who lose a loved one develop Prolonged Grief Disorder (PGD). Internet- and computer-based interventions (i.e., Internet-delivered Cognitive-Behavioral Therapy, iCBT) are cost-effective and scalable alternatives that make it possible to reach more people with PGD. The main goal of the present investigation was to examine the effect and feasibility (usability and satisfaction) of an iCBT ( GROw program ) for adults with PGD. A secondary objective was to detect adherence to the app ( Emotional Monitor ) used to measure daily grief symptoms. The study had a single-case multiple-baseline AB design with six participants. The GROw program is organized sequentially in eight modules, and it is based on the dual-process model of coping with bereavement. Evaluations included a pre-to-post treatment assessment of depression, grief symptoms, and typical grief beliefs, along with daily measures of symptom frequency and intensity on the Emotional Monitor App. Treatment opinions and adherence to the App were also collected. Efficacy data were calculated using a Nonoverlap of All Pairs (NAP) analysis and Reliable Change Index (RCI). The mean age of the sample was 29.5 years (SD = 8.19). Two participants dropped out of the study. Adherence to the App varied across patients (4.8 % -77.8 %). Most participants (75 %) showed a clinically significant change (recovered) in depression, and 50 % obtained a clinically significant improvement (recovered) in symptoms of loss and typical beliefs in complicated grief. The participants reported high usability and satisfaction with the treatment content and format. In sum, the GROw program was very well accepted and generally feasible, and it has strong potential for treating PGD. The results support scaling up the treatment by using more complex designs with larger samples (i.e., randomized controlled trials comparing GROw with active conditions)., Competing Interests: The authors declare that they have no competing interests., (© 2022 The Authors.)

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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The paper provides insights into the mental health consequences of the coronavirus disease 2019 (COVID-19) pandemic from the Central, Eastern, Nordic, Southern, and Western subregions of Europe, represented by five member countries of the European Society for Traumatic Stress Studies (ESTSS). On the basis of the existing national research and experiences in these countries, we propose five lessons learned. (1) There is no evidence of a mental health pandemic so far in the countries in focus. No increase in severe mental disorders but some increase in the symptoms of common mental health disorders are observable. More high-quality longitudinal studies are needed to understand the mental health burden of the pandemic. (2) The pandemic affects countries (including the mental health situation) differently, depending on the level of the exposure, management policies, pre-pandemic structural characteristics, and healthcare resources. (3) The pandemic affects people differently: the exposure severity to pandemic-related stressors differs between individuals, as well as individual resources to cope with these stressors. There are winners and losers as well as identifiable at-risk groups that need particular attention. (4) Besides the negative consequences, the pandemic has had a positive impact. The rapidly applied innovations within the system of healthcare responses provide a window of opportunity for positive changes in mental healthcare policies, strategies, and practices. The increased focus on mental health during the pandemic may contribute to the prioritization of mental health issues at policy-making and organizational levels and may reduce stigma. (5) A stress- and trauma-informed response to COVID-19 is required. The European community of psychotraumatologists under the leadership of ESTSS plays an important role in promoting stress- and trauma-informed healthcare and policies of pandemic management. Based on the lessons learned, we propose a stepped-care public mental health model for the prevention of adverse mental health outcomes during pandemics., Highlights: Population mental health is affected differently in the COVID-19 pandemic: there are winners and losers, as well as identifiable at-risk groups that need particular attention.A stress- and trauma-informed public mental health stepped-care model can address pandemic-related mental health burden in a systematic way., Competing Interests: No potential conflict of interest was reported by the authors., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: The 11th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). There has been very little research investigating associations between CPTSD symptoms and suicide risk following sexual abuse. This and questions concerning similarities and differences between CPTSD and borderline personality disorder (BPD), led to the current study that aimed to explore indirect associations between sexual abuse and suicide risk through the symptoms of CPTSD and borderline traits., Methods: The study sample comprised 103 adults with a history of traumatic experiences (M age = 32.64, SD age = 9.36; 83.5% female). In total, 26.3% of the participants reported experiencing sexual abuse during their lifetime. The clinician-administered International Trauma Interview (ITI) was used for the assessment of ICD-11 CPTSD symptoms. Self-report measures were used for the evaluation of borderline pattern (BP) symptoms and suicide risk. Mediation analyses were performed to evaluate the mediating effects of CPTSD and BP symptoms for the association between sexual trauma and suicide risk., Results: In a parallel mediation model, CPTSD and BP symptoms mediated the association between sexual abuse and suicide risk, following adjustment for the covariates of age, gender, and whether the traumatic experience occurred in childhood or adulthood. Around 73% of participants who met diagnostic criteria for CPTSD reported previous suicide attempt(s)., Conclusions: Suicide risk assessment and intervention should be an important part of the management of victims of sexual abuse with CPTSD and BP symptoms., (© 2022. The Author(s).)

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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Dumarkaite, Truskauskaite-Kuneviciene, Andersson and Kazlauskas.)

Background: The 11 th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). The International Trauma Interview (ITI) is a novel clinician-administered diagnostic interview for the assessment of ICD-11 PTSD and CPTSD., Objective: The aim of this study was to evaluate the psychometric properties of the ITI in a Lithuanian sample in relation to interrater agreement, latent structure, internal reliability, as well as convergent and discriminant validity., Method: In total, 103 adults with a history of various traumatic experiences participated in the study. The sample was predominantly female (83.5%), with a mean age of 32.64 years ( SD  = 9.36). For the assessment of ICD-11 PTSD and CPTSD, the ITI and the self-report International Trauma Questionnaire (ITQ) were used. Mental health indicators, such as depression, anxiety, and dissociation, were measured using self-report questionnaires. The latent structure of the ITI was evaluated using confirmatory factor analysis (CFA). In order to test the convergent and discriminant validity of the ITI we conducted a structural equation model (SEM)., Results: Overall, based on the ITI, 18.4% of participants fulfilled diagnostic criteria for PTSD and 21.4% for CPTSD. A second-order two-factor CFA model of the ITI PTSD and disturbances in self-organization (DSO) symptoms demonstrated a good fit. The associations with various mental health indicators supported the convergent and discriminant validity of the ITI. The clinician-administered ITI and self-report ITQ had poor to moderate diagnostic agreement across different symptom clusters., Conclusion: The ITI is a reliable and valid tool for assessing and diagnosing ICD-11 PTSD and CPTSD., Competing Interests: Neil Roberts, Marylene Cloitre, Jonathan Bisson and Chris Brewin are co-authors of the ITI. The remaining co-authors of the current publication have no conflict of interest to disclose., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Introduction: A demand for informal care exists worldwide. Lithuania presents an interesting case example where the need for the informal care is increasing, but relatively little research has been conducted documenting caregivers' experiences and needs., Objectives: The main objective of this study was to investigate Lithuanian informal caregiver characteristics, support needs and burden. In addition, the impact of the COVID-19 on the caregiver's and care receiver's well-being was investigated., Methods: The study was conducted online between May and September 2020. Informal caregivers and individuals with informal caregiving experiences were invited to participate in the survey. The survey questionnaire comprised 38 multiple-choice items including participant demographic characteristics, availability of the support, support needs, well-being and the impact of the COVID-19 pandemic. In addition, caregiver burden was assessed with the 24-item Caregiver Burden Inventory (CBI)., Results: A total of 226 individuals completed the survey. Most of the participants were women (87.6%). Almost half of the participants (48.7%) were not receiving any support, and a total of 73.9% expressed a need to receive more professional support. Participants were found to experience high burden on the CBI (M=50.21, SD=15.63). Women were found to be significantly more burdened than men (p=0.011). Even though many participants experienced psychological problems (55.8%), only 2.2% were receiving any psychological support. Finally, majority of the participants did not experience any changes in their own (63.7%) or the well-being of their care receiver (68.1%) due to the COVID-19 pandemic., Conclusion: Most of the participants were identified as intensive caregivers experiencing a high burden. A majority did not experience changes in their well-being due to COVID-19. We propose several recommendations for increasing accessibility and availability of support for informal caregivers in Lithuania based on the study findings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Background: Informal caregivers are individuals who provide care for ill, frail, or otherwise dependent family members, siblings, or friends. Due to the caregiving demands, informal caregivers are known to experience negative mental health symptoms, such as stress or anxiety. Interventions based on Internet-based Cognitive Behavioral Therapy (ICBT) principles have been previously found to be effective for different populations and could also be considered as a plausible support option for informal caregivers. However, findings regarding effectiveness alone might not be sufficient for informing about the overall feasibility of the intervention. Objective: The aim of this process evaluation study was to evaluate the feasibility of a previously developed ICBT intervention for informal caregivers in Lithuania. More specifically, we evaluated the suitability of the intervention in relation to its content and delivery mode. Methods: Two studies were conducted. Study 1 consisted of participant evaluations of an 8-week, 8-module long therapist supported ICBT intervention. Evaluations for the Study 1 were retrieved from previously unused data, obtained from pilot testing of the intervention in which 63 informal caregivers took part. The evaluations contained of qualitative data (participant comments), as well as quantitative data (evaluations of each of the sessions). The Study 2 was an online stakeholder focus-group discussion conducted via Zoom. Eight stakeholders took part in the discussion, among whom there were social workers, medical professionals as well as individuals with caregiving experience themselves. Data were analyzed using descriptive statistics, thematic analysis, and data coding. Results: Results of the Study 1 showed that most of the pilot randomized controlled trial participants evaluated content and format of the intervention positively. These results were complemented by the findings in the Study 2, in which stakeholders evaluated the intervention as suitable and promising. In addition, stakeholders made certain suggestions for improving the intervention's usability for the informal caregivers. This included improving the instructions, providing with more guidance, and considering personalization options. Conclusion: The process evaluation helped to evaluate the feasibility of the ICBT intervention for informal caregivers in Lithuania from the two perspectives: users and stakeholders. Our findings suggest that the intervention is suitable for the target population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Biliunaite, Kazlauskas, Sanderman and Andersson.)

Multiple empirical studies have revealed significant pandemic effects of COVID-19 on mental health in various populations. This study aimed to analyze the incidences of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) in national healthcare in 2018-2020 in one of the European countries-Lithuania-and estimate the effect of the COVID-19 pandemic on PTSD and AjD incidences in 2020. The national healthcare registry was used for estimations of diagnosis of PTSD, AjD, and major depressive disorder (MD). The study revealed that stress-related disorders PTSD and AjD are diagnosed rarely, resulting in a considerable gap between the expected prevalence and incidences of these diagnoses in healthcare in Lithuania. Moreover, a significant decline in mental disorders incidence in healthcare in 2020, in comparison to 2018 and 2019, was found, revealing that the COVID-19 pandemic had a negative impact on access to healthcare services and increased barriers for mental disorders treatment. The study indicates that major developments in building up knowledge about the effects of trauma and life stressors on mental health are needed in Lithuania and other countries to increase awareness about stress-related disorders and improve care for trauma survivors, in particular in the context of the pandemics or other large-scale disasters.

Background: The COVID-19 pandemic exposes individuals to multiple stressors, such as quarantine, physical distancing, job loss, risk of infection, and loss of loved ones. Such a complex array of stressors potentially lead to symptoms of adjustment disorder., Objective: This cross-sectional exploratory study examined relationships between risk and protective factors, stressors, and symptoms of adjustment disorder during the first year of the COVID-19 pandemic., Methods: Data from the first wave of the European Society of Traumatic Stress Studies (ESTSS) longitudinal ADJUST Study were used. N =  15,563 participants aged 18 years and above were recruited in eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. Associations between risk and protective factors (e.g. gender, diagnosis of a mental health disorder), stressors (e.g. fear of infection, restricted face-to-face contact), and symptoms of adjustment disorder (ADNM-8) were examined using multivariate linear regression., Results: The prevalence of self-reported probable adjustment disorder was 18.2%. Risk factors associated with higher levels of symptoms of adjustment disorder were female gender, older age, being at risk for severe COVID-19 illness, poorer general health status, current or previous trauma exposure, a current or previous mental health disorder, and longer exposure to COVID-19 news. Protective factors related to lower levels of symptoms of adjustment disorder were higher income, being retired, and having more face-to-face contact with loved ones or friends. Pandemic-related stressors associated with higher levels of symptoms of adjustment disorder included fear of infection, governmental crisis management, restricted social contact, work-related problems, restricted activity, and difficult housing conditions., Conclusions: We identified stressors, risk, and protective factors that may help identify individuals at higher risk for adjustment disorder., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial interests that could be perceived as a potential conflict of interest., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

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., (© 2021. The Author(s).)

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., (© 2021. The Author(s).)

Background: The study aimed to evaluate the long-term change of health-related quality of life (HRQOL) and to identify predictors of HRQOL 5 years after cardiac surgery., Methods: Consecutive adult patients, undergoing elective cardiac surgery were enrolled in the study. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire before and 5-years after cardiac surgery. A multivariate latent change modeling approach was used for data analysis., Results: 210 participants (30.5% female) were reached at 5-year follow-up and included in final data analysis. The study revealed, after controlling for gender effects, a significant long-term positive change, in physical functioning (PF, M slope  = 19.79, p < 0.001), social functioning (SF, M slope  = 17.27, p < 0.001), vitality (VT, M slope  = 6.309, p < 0.001) and mental health (MH, M slope  = 8.40, p < .001) in the total sample. Lower education was associated with an increase in PF (M slope  = 24.09, p < 0.001) and VT (M slope  = 8.39, p < 0.001), more complicated surgery (other than the coronary artery bypass graft (CABG) predicted increase in general health (GH, M slope  = 6.76, p = 0.005). Arrhythmia was a significant predictor for lower pre- and post-operative VT and SF., Conclusions: Overall HRQOL in our sample improved from baseline to five years postoperatively. Further studies including larger patient groups are needed to confirm these findings., (© 2021. The Author(s).)

Background: To slow down the spread of the COVID-19 pandemic, governments of many countries introduced various behavioral measures starting March 2020. The measures included domestic quarantine (not leaving home) for infected or potentially infected people. Due to the need for social distancing, online activity increased in spring 2020. This could foster the risk for addictive social media use (SMU). The present study investigated tendencies of addictive SMU and their relationship with depression, anxiety and stress symptoms specifically among individuals who stayed in domestic quarantine due to COVID-19 in Germany and Lithuania., Methods: In Germany ( N  = 529; quarantine group: n  = 157, non-quarantine group: n  = 372) and in Lithuania ( N  = 325; quarantine group: n  = 54, non-quarantine group: n  = 271), data were assessed via online surveys in spring 2020., Results: In both countries, persons in quarantine had higher levels of addictive SMU, depression, anxiety and stress symptoms than individuals who were not in quarantine. The difference was significant only for addictive SMU in the German sample. The significant positive correlations between addictive SMU and symptoms of depression, anxiety and stress were stronger in both quarantine groups than in the non-quarantine groups., Limitations: The mostly female, young and well-educated composition of both investigated samples limits generalizability of the current findings., Conclusions: Results reveal first evidence that the use of social media during domestic COVID-19 quarantine might contribute to the increase of addictive tendencies and negatively impact well-being. Alternative ways of daily routine during the quarantine are discussed., Competing Interests: None., (© 2021 The Author(s). Published by Elsevier B.V.)

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., (©Ieva Biliunaite, Evaldas Kazlauskas, Robbert Sanderman, Inga Truskauskaite-Kuneviciene, Austeja Dumarkaite, Gerhard Andersson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.04.2021.)

Background : Chronic and repeated trauma are well-established risk factors for complex posttraumatic stress disorder (CPTSD) in adult samples. Less is known about how trauma history and other factors contribute to the development of CPTSD in adolescence. Objective : The aim of this study was to assess the potential contribution of trauma history and social factors to CPTSD in adolescents. Method : In a cross-sectional community study of 1299 adolescents aged 12-16 years, PTSD ( n = 97) and CPTSD ( n = 108) was assessed with the Child and Adolescent version of the International Trauma Questionnaire (ITQ-CA). Trauma exposure, family functioning, school problems, and social support as potential discriminating factors between the PTSD and CPTSD groups were investigated. Results : Cumulative trauma exposure did not discriminate between PTSD and CPTSD in this sample. CPTSD was associated with family problems (such as financial difficulties and conflicts in the home), school problems (bullying and learning difficulties), and lack of social support. Conclusions : Our study indicates that factors other than cumulative trauma are important for the development of CPTSD in adolescence. Interventions targeting adolescent's social environment both at home and at school may be beneficial., Competing Interests: No potential conflict of interest was reported by the authors., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

The COVID-19 pandemic had a significant effect on healthcare globally. Additional pressure created by coronavirus adversely affected the mental health and psychological well-being of healthcare workers, leading many to question their desire and willingness to continue working in healthcare. This study aimed to identify predictors for career change ideation among healthcare professionals in two countries; Lithuania and the United Kingdom amid the coronavirus pandemic. In total, 610 healthcare professionals from Lithuania and the UK (285 and 325, respectively) participated in a survey from May to August 2020. Psychological distress and psychological well-being were measured using the self-report scales "DASS-21" and "WHO-5". Almost half of the sample (49.2%), 59.6% and 40.0% in Lithuanian and the UK, respectively, exhibited career change ideation, the country effect was significant ( AOR = 2.21, p < 0.001). Stronger ideation to leave healthcare was predicted by higher levels of depression ( AOR = 1.10, p = 0.005), stress ( AOR = 1.10, p = 0.007), anxiety surrounding inadequate personal protective equipment ( AOR = 2.27, p = 0.009), and lower psychological well-being scores ( AOR = 1.10, p = 0.007). We conclude that psychosocial support must be provided for healthcare professionals to prevent burnout and loss of staff amid the pandemic.

Background: Informal caregivers represent an important and vulnerable part of the society. They can experience negative psychological symptoms, such as depression and anxiety. Internet-based cognitive behavioural therapy (ICBT) is a promising psychological support option that could be effective in reducing informal caregiver burden as well as improving psychological well-being. Qualitative studies are valuable for gaining insights into participant experiences of using ICBT., Objective: The main aim of this study was to explore informal caregiver experiences and hence acceptability and feasibility of the transdiagnostic ICBT program aimed at reducing informal caregiver burden and increasing the quality of life., Methods: Following a strategic sampling procedure, 23 informal caregivers were recruited from previous randomized controlled trial for informal caregivers in Lithuania. Participants were interviewed over phone, using semi-structured interview questions. Interviews were analysed using a thematic analysis approach., Results: Four themes and a total of 10 sub-themes were generated: I A program as a means of change ( Convenience and applicability of the format and materials; Ability to focus on own needs; Opportunity for communication ), II Suggestions for the program ( Including live support; Tailoring materials and format; Providing with more time and resources), III Driving personal and situational forces (Developing acceptance and adjustment over time; Being proactive and/or receiving support ) and Hindering situational factors (Deterioration and unpredictability of the care-receivers health; Lacking external support and opportunities for respite)., Conclusions: Most of the informal caregivers were found to be satisfied with the program's format and materials as well as the communication with the therapist via a message function in the program. Some suggestions were made regarding implementation of the live support option. Also, suggestions regarding possibility for tailoring the program's content. Lastly, several personal and situational factors were identified as important in affecting informal caregiver well-being. We conclude that ICBT has potential in reducing informal caregiver burden and improving psychological health. Further research trials are warranted for evaluating both, the effectiveness and the feasibility of the program., Competing Interests: None., (© 2021 The Authors.)

In most disasters that have been studied, the underlying dangerous cause does not persist for very long. However, during the COVID-19 pandemic a progressively emerging life threat remains, exposing everyone to varying levels of risk of contracting the illness, dying, or infecting others. Distancing and avoiding company have a great impact on social life. Moreover, the COVID-19 pandemic has an enormous economic impact for many losing work and income, which is even affecting basic needs such as access to food and housing. In addition, loss of loved ones may compound the effects of fear and loss of resources. The aim of this paper is to distil, from a range of published literature, lessons from past disasters to assist in mitigating adverse psychosocial reactions to the COVID-19 pandemic. European, American, and Asian studies of disasters show that long-term social and psychological consequences of disasters may compromise initial solidarity. Psychosocial disruptions, practical and financial problems, and complex community and political issues may then result in a 'second disaster'. Lessons from past disasters suggest that communities and their leaders, as well as mental healthcare providers, need to pay attention to fear regarding the ongoing threat, as well as sadness and grief, and to provide hope to mitigate social disruption., Competing Interests: We have no commercial interest to disclose., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

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., (Copyright © 2020 Truskauskaite-Kuneviciene, Brailovskaia, Kamite, Petrauskaite, Margraf and Kazlauskas.)

Background: During the current COVID-19 pandemic, the people in Europe are exposed to self-isolation, quarantine, job loss, risk of contracting COVID-19, or grief of loved ones. Such a complex array of stressors may lead to symptoms of adjustment disorder or posttraumatic stress disorder. This research protocol describes a study launched by the European Society of Traumatic Stress Studies (ESTSS) to investigate the impact of the COVID-19 pandemic on symptoms of adjustment disorder across European countries., Objective: The longitudinal online cohort study aims (1) to explore psychosocial reactions to the COVID-19 pandemic across ten European countries; (2) to examine the relationships between risk and resilience factors, stressors and symptoms of adjustment disorder during the pandemic; and (3) to investigate whether these relationships are moderated by coping behaviours., Method: In ten countries (Austria, Croatia, Georgia, Germany, Italy, Lithuania, Netherlands, Poland, Portugal, and Sweden), between 1,000 and 2,000 participants will be recruited, depending on the size of the country. Participants will be assessed at two timepoints with a six-month interval. Following a conceptual framework based on the WHO's social framework of health, an assessment of risk and resilience factors, COVID-19 related stressors and pandemic-specific coping behaviours will be measured to estimate their contribution to symptoms of adjustment disorder. The Adjustment Disorder New Module 8 (ADNM-8) will be used to assess symptoms of adjustment disorder. As a secondary measure, symptoms of posttraumatic stress disorder will be measure using the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)., Data Analysis: The relative contribution of risk factors, resilience factors, and stressors on symptoms of adjustment disorder or symptoms of posttraumatic stress disorder will be estimated using multilevel analysis. To determine the moderating effects of different types of coping behaviours on these relationships, a multilevel mediation analysis will be carried out., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial interests that could be perceived as a potential conflict of interest., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

The COVID-19 pandemic has changed life in Europe and globally. The pandemic affects both individuals and the broader society across many domains, including physical and psychological health, the economy and general welfare. The measures taken to counteract the pandemic have significantly altered daily life and, along with the threat of contracting the coronavirus and uncertainties surrounding future developments, created a complex system of stressors with a negative impact on public mental health. This paper aims to outline the ESTSS strategy to address mental health issues related to COVID-19 and focuses on (1) trauma-informed policies, (2) capacity building, (3) collaborative research and (4) knowledge-exchange. To facilitate implementation of a trauma-informed approach and appropriate measures, ESTSS has developed a toolkit of recommendations on mental health and psychosocial assistance to be provided during the different phases of crisis and its aftermath. To promote capacity building, ESTSS offers a certification programme based on a curriculum in psychotraumatology and corresponding on-line training to the European community of mental health professionals. To assure evidence-based approaches and methods tailored to current circumstances, ESTSS has initiated a pan-European research project with international cooperation aimed at studying the mental health consequences of the pandemic, with a focus on psychological trauma and other stress-related reactions. To foster knowledge-exchange, the European Journal of Psychotraumatology (EJPT), the official journal of ESTSS, is publishing a special issue on COVID-19., Competing Interests: No potential conflict of interest was reported by the authors., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

This paper presents an overview of the current status in training and legislation of clinical psychology in Lithuania. Clinical psychology training at the university level in Lithuania started soon after the collapse of the Soviet Union in the 1990s and was influenced by the social context and historical-political situation in the country. Currently, legislation for clinical psychology in Lithuania is in progress, and several promising regulations for psychology in health care were introduced in the last decade. However, psychologists, including clinical psychologists, are not licensed in Lithuania. The lack of legislation for psychology is the main obstacle for the recognition and establishment of clinical psychology in the country. In health care, the title 'clinical psychologist' is not common; 'medical psychologist' is the title used instead to refer to both clinical psychologists and health psychologists. We conclude that while the development of clinical psychology in Lithuania is promising, there is still a long way to go to establish clinical psychology as an important profession in Lithuania., Competing Interests: The authors have declared that no competing interests exist.

Background: There is a growing body of evidence to show that low-intensity self-help internet-delivered interventions are effective in the treatment of mental disorders. Despite the promising effectiveness of internet-delivered interventions, there is still a challenge for mental health services to implement internet-delivered interventions in routine health care. The aim of this study was to analyze the predictors of adherence to a self-help internet-delivered intervention for adjustment disorder. Methods: This was a secondary report of data, including unpublished data, from a randomized controlled trial of an internet-delivered self-help intervention for adjustment disorder. The study included 1,077 participants who had completed online baseline assessments. All participants had experienced significant life stressors over the last 2 years and had high levels of adjustment disorder symptoms. We analyzed the role of sociodemographic variables, pre-treatment adjustment disorder symptoms, outcome expectations, and perceived barriers to mental health services on the use of the intervention. Results: We found that usage of internet-delivered self-help intervention and higher adherence was associated with female gender, greater age, higher pre-intervention outcome expectations, exposure to other forms of psychological therapy in addition to the internet-intervention at the time of the study, and reported perceived barriers to mental health services by the study participants. Conclusions: The findings of the study indicated the importance of non-specific therapeutic factors on adherence during internet-delivered intervention. Perceived barriers to mental health services were associated with higher adherence to self-help intervention, which indicated that communities with restricted access to mental health services could benefit from low-intensity internet-delivered interventions., (Copyright © 2020 Kazlauskas, Eimontas, Olff, Zelviene and Andersson.)

Background : A new definition of adjustment disorder symptoms has been included in the 11th edition of the International Classification of Diseases (ICD-11). However, little is known about risk factors of ICD-11 adjustment disorder. Objective : The study aimed to analyse risk factors of adjustment disorder in a sample of the Lithuanian general population exposed to life-stressors. Method : In total, the study included 649 adult participants from the general population with various recent significant life-stressor experiences. ICD-11 adjustment disorder symptoms were measured using the Adjustment Disorder New Module-8 (ADNM-8) scale. Results : The prevalence of the ICD-11 adjustment disorder diagnosis in the sample was 16.5%. Job-related stressors and health-related stressors were significantly associated with adjustment disorder. Other risk factors for adjustment disorder in this study were female gender, greater age, and university education. Conclusions : We conclude that stressor type and demographic characteristics are associated with the risk of developing an adjustment disorder., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: Heart surgery is a major stressful event that can have a significant negative effect on patients' quality of life (QoL) and may cause long-term posttraumatic stress reactions. The aim of this pilot study was to estimate the longitudinal change and predictors of health-related quality of life (HRQOL) dynamics and identify factors associated with PTS at 5-year follow-up (T2) after elective cardiac surgery and associations with pre-surgery (T1) QoL., Materials and Methods: Single-centre prospective study was conducted after Regional Bioethics Committee approval. Adult consecutive patients undergoing elective cardiac surgery were included. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire before (T1) and 5-years after (T2) cardiac surgery. Posttraumatic stress was assessed using the International Trauma Questionnaire., Results: The pilot study revealed a significant positive change at 5-year follow-up in several domains of SF-36: physical functioning (PF), energy/fatigue (E/F), and social functioning (SF). Prolonged postoperative hospital stay was associated with change in SF ( p < 0.01), E/F ( p < 0.05) and emotional well-being ( p < 0.05). The percentage of patients that had the posttraumatic stress disorder (PTSD) at T2 was 12.2%. Posttraumatic stress symptoms were associated with longer hospitalization after surgery ( p < 0.01)., Conclusions: HRQOL improved from baseline to five years postoperatively. Patients with lower preoperative HRQOL scores tended to have a more significant improvement of HRQOL five years after surgery. A prolonged postoperative hospital stay had a negative impact on postoperative social functioning, energy/fatigue, and emotional well-being. Increased levels of PTSD were found in cardiac surgery patients following five years after the surgery.

The European countries have a long history of exposure to large-scale trauma. In the early 1990s the increasing awareness of the consequences of trauma within the mental health community led to the foundation of local societies for psychotraumatology across Europe and the European Society of Traumatic Stress Studies (ESTSS), which celebrated its 25th anniversary in 2018. The focus of this article is to describe the current state of care for survivors of trauma in the 15 European countries where ESTSS member societies have been established. Brief descriptions on the historical burden of trauma in each country are followed by an overview of the care system for trauma survivors in the countries, the state-of-the-art of interventions, current challenges in caring for survivors and the topics that need to be most urgently addressed in the future. The reports from the different countries demonstrate how important steps towards a better provision of care for survivors of trauma have been made in Europe. Given the cultural and economic diversity of the continent, there are also differences between the European countries, for instance with regard to the use of evidence-based treatments. Strategies to overcome these differences, like the new ESTSS training curricula for care-providers across Europe, are briefly discussed.