Search

Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD).To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD.Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7-18 years, (A four class solution was optimal (LMR = 398.264,Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms.

Background Understanding how pandemics differentially impact on the socio-protective and psychological outcomes of males and females is important to develop more equitable public health policies. We assessed whether males and females differed on measures of major depression and generalized anxiety during the COVID-19 the pandemic, and if so, which sociodemographic, pandemic, and psychological variables may affect sex differences in depression and anxiety. Methods Participants were a nationally representative sample of Irish adults (N = 1,032) assessed between April 30th to May 19th, 2020, during Ireland’s first COVID-19 nationwide quarantine. Participants completed self-report measures of anxiety (GAD-7) and depression (PHQ-9), as well as 23 sociodemographic pandemic-related, and psychological variables. Sex differences on measures of depression and anxiety were assessed using binary logistic regression analysis and differences in sociodemographic, pandemic, and psychological variables assessed using chi-square tests of independence and independent samples t-tests. Results Females were significantly more likely than males to screen positive for major depressive disorder (30.6% vs. 20.7%; χ2 (1) = 13.26, p χ2 (1) = 13.42, p Conclusion Observed sex-differences in depression and anxiety during the COVID-19 pandemic in the Republic of Ireland are best explained by psychosocial factors of COVID-19 related anxiety, trait neuroticism, lower sleep quality, higher levels of loneliness, greater somatic problems, and, in the case of depression, increases in childcaring responsibilities and lower trait consciousnesses. Implications of these findings for public health policy and interventions are discussed.

Purpose: This study represents the first assessment of the prevalence of trauma exposure, and Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD), ever conducted in the general population of the Republic of Ireland. Additionally, prevalence of past-year mental health service use, comorbidity with major depression and generalized anxiety, and risk factors associated with PTSD and CPTSD were assessed. Methods: A nationally representative sample of non-institutionalized Irish adults (N = 1,020) completed self-report measures of trauma history, trauma-related psychopathology, mental health service use, and concurrent mental health problems. Results: Lifetime exposure to one or more traumatic events was 82.3%, and 67.8% reported experiencing two or more traumatic events. Males and females significantly differed in their frequency of exposure to eight of 16 traumatic events. The past-month prevalence for PTSD was 5.0% (95% CI = 3.7%, 6.3%) and 7.7% (95% CI = 6.1%, 9.4%) for CPTSD. Of those who screened positive for PTSD or CPTSD, 48.6% accessed mental health care in the past year. Comorbidity with major depression and generalized anxiety was high, especially among those with CPTSD. Several unique and shared risk factors for PTSD and CPTSD were identified. Conclusions: Approximately one-in-eight Irish adults met diagnostic requirements for PTSD or CPTSD, and comorbidity with other disorders was high. History of interpersonal trauma and exposure to multiple types of trauma in different developmental periods were associated with CPTSD. Many individuals did not access mental health care revealing a substantial mental health treatment gap.

Objective There is little evidence that posttraumatic stress disorder (PTSD) is more likely to follow traumatic events defined by Criterion A than non-Criterion A stressors. Criterion A events might have greater predictive validity for International Classification of Diseases (ICD)-11 PTSD, which is a condition more narrowly defined by core features. We evaluated the impact of using Criterion A, an expanded trauma definition in line with ICD-11 guidelines, and no exposure criterion on rates of ICD-11 PTSD and Complex PTSD (CPTSD). We also assessed whether 5 psychologically threatening events included in the expanded definition were as strongly associated with PTSD and CPTSD as standard Criterion A events. Method A nationally representative sample from Ireland (N = 1,020) completed self-report measures. Results Most participants were trauma-exposed based on Criterion A (82%) and the expanded (88%) criterion. When no exposure criterion was used, 13.7% met diagnostic requirements for PTSD or CPTSD, 13.2% when the expanded criterion was used, and 13.2% when Criterion A was used. The 5 psychologically threatening events were as strongly associated with PTSD and CPTSD as the Criterion A events. In a multivariate analysis, only the psychologically threatening events were significantly associated with PTSD (stalking) and CPTSD (bullying, emotional abuse, and neglect). Conclusions Certain non-Criterion A events involving extreme fear and horror should be considered traumatic. The ICD-11 approach of providing clinical guidance rather than a formal definition offers a viable solution to some of the problems associated with the current and previous attempts to define traumatic exposure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Purpose: There are multiple studies illustrating how benevolent childhood experiences (BCEs) are associated with more favorable health outcomes across the life-course, even in the context of adverse childhood experiences (ACEs). Despite this, few measures are available to assess BCEs. Existing measures include a narrow spectrum of objective BCEs and are limited by the use of binary response categories while few investigate BCEs specifically related to the family and home environment. Thus, the current study sought to develop and validate a measure which assesses positive recollections of experiences and emotions at home and with family during childhood called the ‘Memories of Home and Family Scale’(MHFS). Methods: Items were generated which captured a diverse range of positive emotions and experiences related to home and family life during childhood. Confirmatory factor analysis (CFA) was employed to test the latent structure of the preliminary MHFS item scores in a sample of university students from the United Kingdom (N=624). Following selection of the best-fitting model and final items for inclusion in the scale, total and subscale scores were correlated with a range of mental health outcomes. Results: The results from the CFA indicated that the latent structure of the MHFS items was best represented by a correlated six-factor first-order model. The final MHFS demonstrated high levels of internal reliability and convergent validity. Conclusion: The MHFS is a 28-item multidimensional measure which assesses positive memories of home and family during childhood across six dimensions including valued, independence, support, security, wellness, growth and meaning.

The mental health consequences of the war in Ukraine will be enormous. Mental health professionals who are providing care for people in Ukraine, or those resettled elsewhere, may require access to standardized and validated assessment tools. We have developed a repository of mental health measures that are available in Ukrainian, Russian and English and can be accessed at www.traumameasuresglobal.com/ukraine .

Current data on the prevalence and psychosocial correlates of sexual violence in the Republic of Ireland is lacking, with the most recent sexual abuse and violence survey dating back to 2001. The current study sought to identify what proportion of Irish adults have experienced sexual violence, if there are sex differences in exposure to different forms of sexual violence, and to what extent different forms of sexual violence are associated with adverse psychosocial outcomes. To achieve these objectives, we carried out a nationally representative sample of Irish adults ( N = 1,020) completed self-report measures of history of sexual violence and mental health. Results suggest that approximately one-in-three (34.4%) Irish adults experienced some form of sexual violence, including 14.8% who were sexually assaulted (raped) and 31.1% who were sexually harassed. Women were significantly more likely than men to have experienced all forms of sexual violence ( ps < .001), with the exception of sexual assault by a parent or guardian. All forms of sexual violence were associated with an increased likelihood of serious mental health problems, with sexual assault by a parent/guardian associated with several other psychosocial outcomes in life, including education achievement, history of being taken into state care, salary, and employment status. Sexual violence is a common experience in the general population and women are disproportionately affected (1-in-2 women versus 1-in-5 men). Additional resources to increase mental health care among survivors of sexual violence is urgently needed. How our findings compare to Ireland’s previous sexual abuse and violence survey and the implications of our findings for policy are discussed.

BackgroundDimensional models of psychopathology are increasingly common and there is evidence for the existence of a general dimension of psychopathology (‘p’). The existing literature presents two ways to model p: as a bifactor or as a higher-order dimension. Bifactor models typically fit sample data better than higher-order models, and are often selected as better fitting alternatives but there are reasons to be cautious of such an approach to model selection. In this study the bifactor and higher-order models of p were compared in relation to associations with established risk variables for mental illness.MethodsA trauma exposed community sample from the United Kingdom (N = 1051) completed self-report measures of 49 symptoms of psychopathology.ResultsA higher-order model with four first-order dimensions (Fear, Distress, Externalising and Thought Disorder) and a higher-order p dimension provided satisfactory model fit, and a bifactor representation provided superior model fit. Bifactor p and higher-order p were highly correlated (r = 0.97) indicating that both parametrisations produce near equivalent general dimensions of psychopathology. Latent variable models including predictor variables showed that the risk variables explained more variance in higher-order p than bifactor p. The higher-order model produced more interpretable associations for the first-order/specific dimensions compared to the bifactor model.ConclusionsThe higher-order representation of p, as described in the Hierarchical Taxonomy of Psychopathology, appears to be a more appropriate way to conceptualise the general dimension of psychopathology than the bifactor approach. The research and clinical implications of these discrepant ways of modelling p are discussed.

This study aimed to examine how UK military veterans with complex post-traumatic stress disorder (CPTSD) engage with psychological services. Qualitative interviews were conducted with eight veteran...

Complex posttraumatic stress disorder (CPTSD) has been included as a diagnostic category in the International Classification of Diseases, 11th Edition, consisting of six symptom clusters: the three PTSD criteria of reexperiencing, avoidance, and hypervigilance, in addition to three disturbances of self-organization (DSO) symptoms defined as emotional dysregulation, interpersonal difficulties, and negative self-concept. As borderline personality disorder (BPD) shares similar features to DSO presentations and is commonly associated with PTSD, there is debate as to whether and how CPTSD is distinct from PTSD comorbid with BPD. This article aimed to identify groups with distinct profiles of self-reported CPTSD and BPD symptoms and associated trauma history characteristics. A latent class analysis (LCA) using CPTSD and BPD symptom variables was conducted on a sample of 195 treatment-seeking adults at a specialist trauma service. The classes were then compared on demographic and clinical characteristics using a series of analysis of variance and χ2 tests. The latent class analysis determined three distinct classes: a CPTSD/High BPD class characterized by high symptom endorsement across both conditions, a CPTSD/Moderate BPD class characterized by high PTSD and DSO symptom endorsement and moderate BPD, and a PTSD/Low BPD class characterized by PTSD symptoms and low DSO and BPD symptom endorsement. The two CPTSD classes were associated with greater exposure to multiple, interpersonal traumas earlier in life and exhibited higher functional impairment. Findings support the construct of a CPTSD diagnosis as a separate entity although BPD features seem to overlap greatly with CPTSD symptoms in this highly traumatized clinical sample. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background The new International Classification of Diseases was published in 2018 (ICD-11; World Health Organization, 2018) and now includes 'Mixed depressive and anxiety disorder' (6A73: MDAD) designated as a mood disorder. This disorder is defined by symptoms of both anxiety and depression occurring more days than not, for a period of two weeks, and neither set of symptoms considered separately reaches a diagnostic threshold for either disorder. However, to date no study has examined the validity of these guidelines in a general population sample. Methods Using Goldberg et al.'s (2017) guidelines regarding measurement of depression and anxiety, this study used factor mixture modelling (FMM) to examine the validity of the ICD-11 criteria of MDAD. Symptom endorsement rates are provided as well as demographic predictors and somatization outcomes. Results Fit indices suggested the two-factor four-class solution was the best balance between model complexity and model fit. The results did not support a class that is subsyndromal to both anxiety and depression. On the contrary, we suggest that there exists a 'Comorbid' class that represents endorsement of both anxiety and depression symptoms at a higher level when compared to both 'anxiety' and 'depression' groups. Demographic predictors, as well as somatization and functional impairment outcomes, provided support for this FMM solution. Conclusions The 'Comorbid' group was the largest symptomatic group and had the highest levels of both anxiety and depression symptoms. Importantly, this group was larger than either the 'anxiety' or 'depression' group and was associated with high levels of functional impairment and somatization.

Background ICD-11 includes a new diagnosis of complex post-traumatic stress disorder (CPTSD), resulting predominantly from reoccurring or prolonged trauma. Previous studies showed that lack of social support is among the strongest predictors of PTSD, but social factors have been sparsely studied in the context of the ICD-11 definition of PTSD and CPTSD. Aims To analyse the factor structure of the International Trauma Questionnaire (ITQ) in a Lithuanian clinical sample and to evaluate the mediating role of social and interpersonal factors in the relationship between trauma exposure and ICD-11 PTSD and CPTSD. Method The sample comprised 280 adults from out-patient mental health centres (age, years: mean 39.48 (s.d. = 13.35); 77.5% female). Trauma-related stress symptoms were measured with the ITQ. Social disapproval was measured with the Social Acknowledgment Questionnaire (SAQ) and trauma disclosure using the Disclosure of Trauma Questionnaire (DTQ). Results ICD-11 PTSD and CPTSD prevalence among the participants in this study was 13.9% and 10.0% respectively. Results indicated that avoidance of trauma disclosure mediated the relationship between trauma exposure and PTSD as well as CPTSD, whereas social disapproval mediated only the relationship between trauma exposure and CPTSD. Conclusions The findings suggest that disclosure of traumatic experiences and support from closest friends and family members might mitigate the effects of traumatic experiences, potentially reducing the risk of developing CPTSD.

Objectives\ud \ud This paper outlines fieldwork procedures for Wave 4 of the COVID-19 Psychological Research Consortium (C19PRC) Study in the UK during November–December 2020.\ud \ud \ud Methods\ud \ud Respondents provided data on socio-political attitudes, beliefs, and behaviours, and mental health disorders (anxiety, depression, and posttraumatic stress). In Phase 1, adults (N = 2878) were reinvited to participate. At Phase 2, new recruitment: (i) replenished the longitudinal strand to account for attrition; and (ii) oversampled from the devolved UK nations to facilitate robust between-country analyses for core study outcomes. Weights were calculated using a survey raking algorithm to ensure the longitudinal panel was representative of the baseline sample characteristics.\ud \ud \ud Results\ud \ud In Phase 1, 1796 adults were successfully recontacted and provided full interviews at Wave 4 (62.4% retention rate). In Phase 2, 292 new respondents were recruited to replenish the panel, as well as 1779 adults from Wales, Scotland, and Northern Ireland, who were representative of the socio-political composition of the adult populations in these nations. The raking procedure successfully re-balanced the longitudinal panel to within 1% of population estimates for selected socio-demographic characteristics.\ud \ud \ud Conclusion\ud \ud The C19PRC Study offers a unique opportunity to facilitate and stimulate interdisciplinary research addressing important public health questions relating to the COVID-19 pandemic.

Objective: Emerging evidence indicates that the mental health consequences of COVID-19 may not be as deleterious as initially feared. We analyzed the levels of symptom expression and rates of Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and COVID-19 related Posttraumatic Stress Disorder (C19-PTSD) in the adult population of Ireland at different points during the first year of the pandemic.Methods: Data were collected from a nationally representative sample of 1041 adults across five waves from March/April 2020 to March/April 2021. New participants were recruited at follow-up waves to maintain nationally representative cross-sectional estimates. Cross-sectional estimates of each and any disorder were calculated, and longitudinal changes in means and prevalence estimates of MDD, GAD, and C19-PTSD were assessed using structural equation modelling.Results: Cross-sectional estimates of meeting criteria for MDD, GAD, or C19-PTSD were 34.7% in March/April 2020 (Wave 1) and 33.7% in March/April 2021 (Wave 5). Longitudinal analyses revealed no significant change in symptoms of MDD, a significant decrease in GAD symptoms, and a significant increase in C19-PTSD symptoms. There were significant decreases in prevalence estimates of MDD (by 4.9%) and GAD (by 6.3%), and no significant change in C19-PTSD. Overall, 4.7% fewer people met criteria for any disorder at Wave 5 than at Wave 1. Conclusion: There was no evidence of an increase in mental health problems in the adult population during the first year of the pandemic in Ireland. Analyses of longitudinal data indicated a small but significant decrease in the proportion of people suffering from a mental health disorder.

Introduction Suicide is a tragic outcome with devastating consequences. In 2018, Scotland experienced a 15% increase in suicide from 680 to 784 deaths. This was marked among young people, with an increase of 53% in those aged 15-24, the highest since 2007. Early intervention in those most at risk is key, but identification of individuals at risk is complex, and efforts remain largely targeted towards universal suicide prevention strategies with little evidence of effectiveness. Recent evidence suggests childhood adversity is a predictor of subsequent poor social and health outcomes, including suicide. This protocol reports on methodology for harmonising lifespan hospital contacts for childhood adversity, mental health, and suicidal behaviour. This will inform where to 1) focus interventions, 2) prioritise trauma-informed approaches, and 3) adapt support avenues earlier in life for those most at risk. Methods This study will follow a case-control design. Scottish hospital data (physical health SMR01; mental health SMR04; maternity/birth record SMR02; mother’s linked data SMR01, SMR04, death records) from 1981 to as recent as available will be extracted for people who died by suicide aged 10-34, and linked on Community Health Index unique identifier. A randomly selected control population matched on age and geography at death will be extracted in a 1:10 ratio. International Classification of Disease (ICD) codes will be harmonised between ICD9-CM, ICD9, ICD10-CM and ICD10 for childhood adversity, mental health, and suicidal behaviour. Results ICD codes for childhood adversity from four key studies are reported in two categories, 1) Maltreatment or violence-related codes, and 2) Codes suggestive of maltreatment. ‘Clinical Classifications Software’ ICD codes to operationalise mental health codes are also reported. Harmonised lifespan ICD categories were achieved semi-automatically, but required labour-intensive supplementary manual coding. Cross-mapped codes are reported. Conclusion There is a dearth of evidence about touchpoints prior to suicide. This study reports methods and harmonised ICD codes along the lifespan to understand hospital contact patterns for childhood adversity, which come to the attention of hospital practitioners. Key words Childhood Adversity, Adverse Childhood Experiences, Mental Health, Self-harm, Suicide, Suicidality, Violence, Hospital episodes, Routine Data, Data Linkage, Study Protocol

Individual Recovery Outcomes Counter (I.ROC) is a brief tool measuring personal recovery designed for collaborative use within support. This study aimed to investigate the psychometric properties of a self-report version of the I.ROC within a trauma population. A total of 107 adults attending trauma interventions in an NHS service in Scotland completed I.ROC alongside measures of self-esteem, mental illness symptoms, and functional impairment. Scores on each measure were compared to evaluate the convergent validity of I.ROC. Internal consistency and factor analytical techniques were also used to assess the structural validity and reliability of the measure. Results of internal consistency, convergent validity, and factor analysis provide preliminary support for I.ROC's validity within a trauma population. Previously proposed models were a poor fit for the current sample; principal components analysis suggested a three-factor structure with acceptable internal consistency, comprising ten of the original twelve items (I.ROC-10). Correlations with all measures reached significance for the original and modified I.ROC and its subscales. I.ROC appears to be a valid and reliable tool for use in measuring recovery within a trauma population, but further research is needed to examine the structural validity of I.ROC.

Debate exists in the trauma literature regarding the role of dissociation in traumatic stress disorders. With the release of the new ICD-11 diagnostic guideline for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD), this issue warrants further attention. In the current study, we provide a preliminary assessment of the associations between ICD-11 CPTSD and dissociative experiences. This study is based on a sample (N = 106) of highly traumatised clinical patients from the United Kingdom who completed measures of traumatic stress and dissociative experiences. The majority of participants met the diagnostic criteria for CPTSD (69.1%, n = 67), with few patients qualifying for a diagnosis of PTSD (9.3%, n = 9). Those with CPTSD had significantly higher levels of dissociative experiences compared to those with PTSD (Cohen’s d = 1.04) and those with no diagnosis (Cohen’s d = 1.44). Three CPTSD symptom clusters were multivariately associated with dissociation: Affective Dysregulation (β = .33), Re-experiencing in the here and now (β = .24), and Disturbed Relationships (β = .22). These findings indicate that dissociative experiences are particularly relevant for clinical patients with CPTSD. Future longitudinal work will be needed to determine if dissociation is a risk factor for, or outcome of, CPTSD.

Resilience is a key health protective factor for those with adverse childhood experiences (ACEs), but little research has explored how it manifests in early adulthood or across cultures. The purpose of this study was to generate a fuller understanding of resilience and its contribution to the relationships between mental health problems and ACEs among Chinese young adults in Hong Kong. Using a sequential explanatory mixed-methods design, 433 Chinese young adults aged 18 to 24 years were surveyed online to examine the relationships between ACEs, resilience, and mental health problems (depression, anxiety, maladjustment, and posttraumatic stress symptoms). Among them, 34 participants with ACEs were purposively selected and interviewed to explore cultural factors that influenced their resilience. Quantitative data were analyzed using multiple hierarchical regression analyses; qualitative data were analyzed using a qualitative descriptive approach. Higher cumulative ACE exposure was associated with higher severity of adjustment disorder and odds for screening positive for posttraumatic stress disorders, but not for symptoms of depression or anxiety. Resilience significantly contributed to explaining variances across all mental health outcomes over and beyond ACEs and in a protective fashion. Four themes emerged from qualitative interviews: (a) Privacy, emotional restraint, and “saving face”; (b) Conforming to preserve harmony; (c) A will to excel; and (d) Viewing adversity as a matter of luck. These findings suggest Chinese young adults’ resilience was influenced by cultural norms of restraint, conformity, competition, and superstition. The present study provides a model for future studies using a mixed-methods design to deeply examine resilience among younger people exposed to early adversities within sociocultural, historical, or geographical contexts.

Background: Co-occurrence of psychosis and posttraumatic stress disorder (PTSD) symptoms has been demonstrated, but the ICD-11 marks a significant divergence in the formulation of PTSD with a focus on the core symptoms and the addition of complex PTSD (CPTSD). Objective: To evaluate the distribution of psychosis and traumatic stress symptoms using the ICD-11 conceptualisation of PTSD and CPTSD. Method: A latent class analysis was conducted on psychosis symptoms, PTSD and CPTSD among a random adult sample from the UK general population with a history of traumatic events (N = 1,051). Results: Six classes were identified; a low-symptom class, a PTSD-class, a CPTSD-class, a class characterized by disturbances in self-organization alone as well as two classes characterized by CPTSD and various levels of psychosis symptom endorsement. Cumulative childhood adversity predicted membership of the PTSD, CPTSD and comorbid classes in a dose-response manner with the strongest effects observed for classes characterised by comorbid symptoms. Conclusion: The present study confirms the co-occurrence of psychosis symptoms and ICD-11 PTSD and CPTSD. Psychosis symptoms did not emerge in isolation from traumatic stress symptoms, underpinning the need for a greater recognition of psychosis symptoms as part of the broader clinical picture among trauma-exposed populations.

Objectives\ud \ud The COVID-19 Psychological Research Consortium (C19PRC) Study aims to assess the impact of the COVID-19 pandemic in the adult population in multiple countries. This paper describes the third wave of the UK survey (the ‘parent’ strand of the Consortium) during July-August 2020.\ud \ud \ud Methods\ud \ud Adults (N = 2025) who participated in the baseline and/or first follow-up surveys were reinvited to participate in this survey, which assessed: (1) COVID-19 related knowledge, attitudes, and behaviours; (2) the occurrence of common mental disorders; as well as the role of (3) psychological factors and (4) social and political attitudes, in influencing the public’s response to the pandemic. Weights were calculated using a survey raking algorithm to ensure that the cross-sectional sample is nationally representative in terms of gender, age, and household income, and representative of the baseline sample characteristics for household composition, ethnicity, urbanicity and born/raised in UK.\ud \ud \ud Results\ud \ud 1166 adults (57.6% of baseline participants) provided full interviews at Wave 3. The raking procedure successfully re-balanced the cross-sectional sample to within 1% of population estimates across selected socio-demographic characteristics.\ud \ud \ud Conclusion\ud \ud This paper demonstrates the strength of the C19PRC Study data to facilitate and stimulate interdisciplinary research addressing important public health questions relating to the COVID-19 pandemic.

The COVID-19 pandemic has brought about unprecedented global changes in individual and collective behaviour. To reduce the spread of the virus, public health bodies have promoted social distancing measures while attempting to mitigate their mental health consequences. The current study aimed to identify cognitive predictors of social distancing adherence and mental health symptoms, using computational models derived from delay discounting (the preference for smaller, immediate rewards over larger, delayed rewards) and patch foraging (the ability to trade-off between exploiting a known resource and exploring an unknown one). In a representative sample of the UK population (N = 442), we find that steeper delay discounting predicted poorer adherence to social distancing measures and greater sensitivity to reward magnitude during delay discounting predicted higher levels of anxiety symptoms. Furthermore, under-valuing recently sampled information during foraging independently predicted greater violation of lockdown guidance. Our results suggest that those who show greater discounting of delayed rewards struggle to maintain social distancing. Further, those who adapt faster to new information are better equipped to change their behaviour in response to public health measures. These findings can inform interventions that seek to increase compliance with social distancing measures whilst minimising negative repercussions for mental health.

Background Existing research on post-traumatic sequelae suggests a positive association between fatalism and symptoms of post-traumatic stress disorder (PTSD). However, the associations between fatalism and the new ICD-11 diagnosis of complex PTSD (CPTSD) have never been explored before. Objective The current study explored the association between fatalism and PTSD and CPTSD in samples from three African countries. Methods A total of 2,524 participants from Nigeria (n = 1018), Kenya (n = 1006), and Ghana (n = 500) completed measures of fatalism (non-judgemental fatalism, current fatalism, pessimistic fatalism, prospective fatalism) and the International Trauma Questionnaire (ITQ). A combination of a multinomial regression and path analysis was used to identify fatalism predictors of PTSD and CPTSD versus no diagnosis, and CPTSD versus PTSD, adjusted for demographic variables and trauma exposure. Results While PTSD was not predicted by any of the fatalism types, compared to no diagnosis, CPTSD was significantly predicted by pessimistic, non-judgemental and current fatalism, both compared to no diagnosis and PTSD. Conclusions The results broaden the knowledge on potential correlates of the new diagnosis of CPTSD. Addressing fatalistic beliefs by empowering people to think that they can choose their fate should be further explored as a possible target for intervention in the treatment of CPTSD., HIGHLIGHTS The study explored the association between fatalism and PTSD and CPTSD according to ICD-11 definition in samples from three African countries.The results broaden the knowledge beyond Western population on potential correlates of the new diagnosis of CPTSD.

Background Numerous studies found robust associations between psychosis and posttraumatic stress disorder (PTSD), but few have examined the relationships between psychosis and recently formulated ICD-11 Complex PTSD (CPTSD). Further, no known study has examined the effects of different traumatic life events on CPTSD and psychotic-like symptoms in a manner that permits gender-specific effects to be identified. Objective Using a nationally representative sample of 1,020 Irish adults, we examined gender-differences in (a) psychotic-like symptoms, CPTSD, and exposure to 21 different traumatic life events, and (b) the unique associations between different traumas with CPTSD and Psychosis. Method Bivariate analyses and structural equation modelling were performed. Results Consistent with the literature, no gender differences were observed in psychotic-like symptoms. Females reported slightly higher levels of CPTSD and were more likely to be exposed to sexual and emotional abuse, whereas men reported greater exposure to physical violence, accidents, and disasters. Psychosis symptoms were explained by trauma exposure to a considerate degree and at a level similar to CPTSD; a moderate correlation was also found between CPTSD and Psychosis. Physical/emotional neglect was the only traumatic life event that significantly and most strongly predicted both conditions. Two gender-specific associations between different traumatic life events and CPTSD and Psychosis were identified out of the 42 possible effects modelled. Conclusions The present investigation provides initial evidence that psychotic-like symptoms and CPTSD are moderately correlated constructs in the general population. Results also highlight the importance of conducting a detailed assessment of trauma history for all clients presenting with symptoms of CPTSD, psychosis, or both., HIGHLIGHTS Structural equation modelling of data from 1,020 Irish adults showed symptoms of psychosis and complex posttraumatic stress disorder moderately correlate.Physical emotional neglect was the only traumatic life event that significantly and most strongly predicted both conditions.

Few studies have examined changes in mental health before and after the outbreak of COVID-19. We examined changes in the prevalence of major depression and generalized anxiety disorder (GAD) between February 2019 and March-April 2020; if there were changes in major depression and GAD during six weeks of nationwide lockdown; and we identified factors that predicted major depression and GAD across the six-week lockdown period. Nationally representative samples of Irish adults were gathered using identical methods in February 2019 (N = 1020) and March-April 2020 (N = 1041). The latter was reassessed six weeks later. Significantly more people screened positive for depression in February 2019 (29.8% 95% CI = 27.0, 32.6) than in March-April 2020 (22.8% 95% CI = 20.2, 25.3), and there was no change in GAD. There were no significant changes in depression and GAD during the lockdown. Major depression was predicted by younger age, non-city dwelling, lower resilience, higher loneliness, and higher somatic problems. GAD was predicted by a broader set of variables including several COVID-19 specific variables. These findings indicate that the prevalence of major depression and GAD did not increase as a result of, or during the early phase of the COVID-19 pandemic in Ireland.

Background: The Global Forum for Health Research, with the support of the World Health Organization, highlighted the need to prioritize mental health research in Africa. The introduction of revised descriptions of Posttraumatic Stress Disorder (PTSD) and Adjustment Disorder, along with new diagnoses of Complex PTSD and Prolonged Grief Disorder, in the ICD-11 creates a need for additional national-level epidemiological studies on the prevalence of stress-related disorders. Methods: The prevalence rates of these four ICD-11 stress disorders were assessed in three African countries including Nigeria (N = 1006), Kenya (N = 1018), and Ghana (N = 500). Participants completed disorder-specific measures for each disorder. Findings: Across the entire sample, the current prevalence rate of probable Adjustment Disorder was 8.4% (95% C.I. = 7.4%, 9.6%), probable PTSD was 18.6% (95% C.I. = 17.2, 20.2%), probable Complex PTSD was 15.9% (95% C.I. = 14.5%, 17.4%) and probable Prolonged Grief Disorder was 3.7% (95% C.I. = 3.1%, 4.5%). Interpretation: The results are applicable primarily to well-educated urban and suburban adults in these African countries. Results indicated that Adjustment Disorder, PTSD, and CPTSD are highly prevalent in these three African countries. There is now a pressing need to develop culturally sensitive interventions to enable recovery from these conditions.

Objectives\ud \ud The C19PRC study aims to assess the impact of the COVID‐19 pandemic in the adult population of the UK, Republic of Ireland, and Spain. This paper describes the conduct of the first two waves of the UK survey (the “parent” strand of the Consortium) during March–April 2020.\ud \ud \ud \ud Methods\ud \ud A longitudinal, internet panel survey was designed to assess: (1) COVID‐19 related knowledge, attitudes, and behaviors; (2) the occurrence of common mental health disorders as well as the role of (3) psychological factors and (4) social and political attitudes, in influencing the public's response to the pandemic. Quota sampling (age, sex, and household income) was used to recruit a nationally representative sample of adults.\ud \ud \ud \ud Results\ud \ud Two thousand and twenty five adults were recruited at baseline, and 1406 were followed‐up one‐month later (69.4% retention rate). The baseline sample was representative of the UK population in relation to economic activity, ethnicity, and household composition. Attrition was predicted by key socio‐demographic characteristics, and an inverse probability weighting procedure was employed to ensure the follow‐up sample was representative of the baseline sample.\ud \ud \ud \ud Conclusion\ud \ud The C19PRC study data has strong generalizability to facilitate and stimulate interdisciplinary research on important public health questions relating to the COVID‐19 pandemic.

Exposure to traumatic events has been associated with negative psychological outcomes. There is, however, a dearth of research on revictimization (i.e., experiences of victimization during both childhood and adulthood). The current study examined different patterns of lifetime interpersonal victimization based on six types of childhood maltreatment, physical and sexual assault, and assault with a weapon during adulthood via latent class analysis (LCA) with gender as covariate. Using a 3-step approach the study assessed differences across the latent classes in symptoms and diagnosis of depression, anxiety, and DSM-5 posttraumatic stress disorder. An adult sample representative of the United Kingdom population with exposure to trauma (N = 1,051) was recruited online through a research panel. Mean age of the sample was 47.18 years (SD = 15.00, range = 18-90 years; 68.4% female). LCA identified five classes, namely, lifetime polyvictimization (8.3%; 69.5% female), sexual revictimization (13.7%; 96.5% female), physical revictimization (12.5%; 1.5% male), childhood trauma (25.9%; 85.6% female), and limited victimization (39.7%; 40.3% female). The revictimization class had elevated scores in anxiety, depression, and posttraumatic stress symptoms, followed by the childhood trauma class compared to the other classes. The polyvictimization class had nearly a 9 to 33-fold increase in risk of a diagnosis of depression, anxiety and PTSD, compared to the limited victimization class. Findings facilitate the identification of individuals at risk for revictimization and indicate that evidence-based clinical interventions should be targeted towards those with exposure to revictimization and childhood trauma to alleviate symptoms of posttraumatic stress, depression, and anxiety.

Background Complex traumatic events associated with armed conflict, forcible displacement, childhood sexual abuse, and domestic violence are increasingly prevalent. People exposed to complex traumatic events are at risk of not only posttraumatic stress disorder (PTSD) but also other mental health comorbidities. Whereas evidence-based psychological and pharmacological treatments are effective for single-event PTSD, it is not known if people who have experienced complex traumatic events can benefit and tolerate these commonly available treatments. Furthermore, it is not known which components of psychological interventions are most effective for managing PTSD in this population. We performed a systematic review and component network meta-analysis to assess the effectiveness of psychological and pharmacological interventions for managing mental health problems in people exposed to complex traumatic events. Methods and findings We searched CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, International Pharmaceutical Abstracts, MEDLINE, Published International Literature on Traumatic Stress, PsycINFO, and Science Citation Index for randomised controlled trials (RCTs) and non-RCTs of psychological and pharmacological treatments for PTSD symptoms in people exposed to complex traumatic events, published up to 25 October 2019. We adopted a nondiagnostic approach and included studies of adults who have experienced complex trauma. Complex-trauma subgroups included veterans; childhood sexual abuse; war-affected; refugees; and domestic violence. The primary outcome was reduction in PTSD symptoms. Secondary outcomes were depressive and anxiety symptoms, quality of life, sleep quality, and positive and negative affect. We included 116 studies, of which 50 were conducted in hospital settings, 24 were delivered in community settings, seven were delivered in military clinics for veterans or active military personnel, five were conducted in refugee camps, four used remote delivery via web-based or telephone platforms, four were conducted in specialist trauma clinics, two were delivered in home settings, and two were delivered in primary care clinics; clinical setting was not reported in 17 studies. Ninety-four RCTs, for a total of 6,158 participants, were included in meta-analyses across the primary and secondary outcomes; 18 RCTs for a total of 933 participants were included in the component network meta-analysis. The mean age of participants in the included RCTs was 42.6 ± 9.3 years, and 42% were male. Nine non-RCTs were included. The mean age of participants in the non-RCTs was 40.6 ± 9.4 years, and 47% were male. The average length of follow-up across all included studies at posttreatment for the primary outcome was 11.5 weeks. The pairwise meta-analysis showed that psychological interventions reduce PTSD symptoms more than inactive control (k = 46; n = 3,389; standardised mean difference [SMD] = −0.82, 95% confidence interval [CI] −1.02 to −0.63) and active control (k-9; n = 662; SMD = −0.35, 95% CI −0.56 to −0.14) at posttreatment and also compared with inactive control at 6-month follow-up (k = 10; n = 738; SMD = −0.45, 95% CI −0.82 to −0.08). Psychological interventions reduced depressive symptoms (k = 31; n = 2,075; SMD = −0.87, 95% CI −1.11 to −0.63; I2 = 82.7%, p = 0.000) and anxiety (k = 15; n = 1,395; SMD = −1.03, 95% CI −1.44 to −0.61; p = 0.000) at posttreatment compared with inactive control. Sleep quality was significantly improved at posttreatment by psychological interventions compared with inactive control (k = 3; n = 111; SMD = −1.00, 95% CI −1.49 to −0.51; p = 0.245). There were no significant differences between psychological interventions and inactive control group at posttreatment for quality of life (k = 6; n = 401; SMD = 0.33, 95% CI −0.01 to 0.66; p = 0.021). Antipsychotic medicine (k = 5; n = 364; SMD = –0.45; –0.85 to –0.05; p = 0.085) and prazosin (k = 3; n = 110; SMD = −0.52; −1.03 to −0.02; p = 0.182) were effective in reducing PTSD symptoms. Phase-based psychological interventions that included skills-based strategies along with trauma-focused strategies were the most promising interventions for emotional dysregulation and interpersonal problems. Compared with pharmacological interventions, we observed that psychological interventions were associated with greater reductions in PTSD and depression symptoms and improved sleep quality. Sensitivity analysis showed that psychological interventions were acceptable with lower dropout, even in studies rated at low risk of attrition bias. Trauma-focused psychological interventions were superior to non-trauma-focused interventions across trauma subgroups for PTSD symptoms, but effects among veterans and war-affected populations were significantly reduced. The network meta-analysis showed that multicomponent interventions that included cognitive restructuring and imaginal exposure were the most effective for reducing PTSD symptoms (k = 17; n = 1,077; mean difference = −37.95, 95% CI −60.84 to −15.16). Our use of a non-diagnostic inclusion strategy may have overlooked certain complex-trauma populations with severe and enduring mental health comorbidities. Additionally, the relative contribution of skills-based intervention components was not feasibly evaluated in the network meta-analysis. Conclusions In this systematic review and meta-analysis, we observed that trauma-focused psychological interventions are effective for managing mental health problems and comorbidities in people exposed to complex trauma. Multicomponent interventions, which can include phase-based approaches, were the most effective treatment package for managing PTSD in complex trauma. Establishing optimal ways to deliver multicomponent psychological interventions for people exposed to complex traumatic events is a research and clinical priority., Peter Coventry and colleagues investigate evidence for the effectiveness and acceptability of psychological and pharmacological treatments for mental health problems following complex traumatic events., Author summary Why was the study done? Complex traumatic events are of a multiple or prolonged nature and are increasingly prevalent owing to unprecedented levels of population displacement, armed conflict, and increased recognition of childhood sexual abuse and domestic violence. People exposed to complex traumatic events are at risk of not only posttraumatic stress disorder (PTSD) but also other mental health problems. There are evidence-based psychological and pharmacological treatments for single-event PTSD, but it is not known if people who have experienced complex traumatic events can benefit and tolerate commonly available treatments. To inform treatment guidelines and future research, a broad evidence synthesis is needed that goes beyond existing knowledge to identify candidate interventions for mental health problems associated with complex trauma. What did the researchers do and find? We undertook a systematic review and meta-analysis of the effectiveness and acceptability of psychological and pharmacological treatments for mental health problems in veterans, refugees, victims of childhood sexual abuse and domestic violence, and war-affected populations. We used network meta-analysis to disentangle the relative contribution of different components of psychological treatments. The meta-analysis showed that psychological treatments are effective for treating PTSD, anxiety, and depression and improving sleep in people with a history of complex traumatic events. Pharmacological interventions were less effective than psychological interventions for treating PTSD symptoms and improving sleep. Trauma-focused treatments were the most effective approaches, but these treatments tended to be less effective in veterans and war-affected populations. Multicomponent interventions that included two or more components were the most effective for treating PTSD symptoms, and these approaches were promising for the management of disturbances of self-organisation. What do these findings mean? Existing evidence-based trauma-focused psychological treatments can be effectively used as first-line therapy for PTSD and mental health comorbidities in people exposed to complex trauma. Because phasing of treatment was categorised as a constituent part of multicomponent interventions, there is a case to move beyond binary distinctions of phase-based versus non-phase-based interventions, which has hampered progress in PTSD research. Future studies could test the most effective means to deliver patient-centred and multicomponent interventions for people exposed to complex trauma, especially in those with higher levels of mental health comorbidity.

Purpose: Emerging evidence suggests that ICD-11 CPTSD is a more common condition than PTSD in treatment seeking samples although no study has explored risk factors and comorbidities of PTSD and CPTSD in veteran populations. In this study risk factors and comorbidity between veterans meeting criteria for PTSD or CPTSD using the ICD-11 International Trauma Questionnaire (ITQ) were explored. Methods: A sample of help-seeking veterans who had been diagnosed with a mental health difficulty (n=177) was recruited. Participants completed a range of mental health and functioning measures. Multinomial logistic regression analysis was conducted to explore differences in the above factors between participants meeting case criteria for PTSD, CPTSD or another mental health disorder. Results: Those with CPTSD appeared to have taken longer to seek help, reported higher rates of childhood adversity and more experiences of emotional or physical bullying during their military careers. Further, participants with CPTSD reported a greater burden of co-morbid mental health difficulties including high levels of dissociation, anger, difficulties related to moral injury and common mental health difficulties and greater degree of impairment including social isolation, sleep difficulties and impaired functioning. Conclusions: Considering that CPTSD is a more debilitating condition than PTSD, there is now an urgent need to test the effectiveness of new and existing interventions in veterans with CPTSD.

Background: Extant research relating to the psychological impact of infectious respiratory disease epidemics/pandemics suggests that frontline workers are particularly vulnerable.Methods: The current study used data from the first two waves of the United Kingdom (UK) survey of the COVID-19 Psychological Research Consortium (C19PRC) Study to compare frontline workers with the rest of the UK population on prevalence estimates of depression, anxiety, and PTSD during the first week of ‘lockdown’ (Wave 1) and one month later (Wave 2).Results: Compared to the rest of the population, frontline workers generally, and individual frontline worker groups, had significantly higher prevalence estimates of depression, anxiety, and PTSD during both wave 1 and wave 2. While prevalence estimates of depression significantly increased among Local & National Government Workers from Wave 1 (15.4%) to Wave 2 (38.5%), no significant improvement or deterioration in mental health status was recorded for any other frontline worker group. Multivariate binary logistic regression analysis showed that, beyond other risk factors, food workers were nearly twice as likely as others to screen positive for anxiety, while all frontline worker groups, other than transport workers, were significantly more likely to screen positive for PTSD (Odds Ratios ranged from 1.74 – 3.43). Finally, while frontline workers, generally, were significantly more likely than the general public to have received mental health advice during the pandemic (26.9% versus 20.3% respectively), this was largely reflective of health and social care workers (37.9%).Conclusions: These findings offer timely and valuable information on the psychological health status of UK’s frontline workforce during the early stages of the COVID-19 pandemic and may aid in preparations for their future psychological and mental health support.

The C19PRC Study aims to assess the psychological, social, and economic impact of the COVID-19 pandemic in the UK, Republic of Ireland, and Spain. This paper describes the the first two waves of the UK survey (the ‘parent’ strand of the Consortium) during March-April 2020. A longitudinal, internet panel survey assessed: (1) COVID-19 related knowledge, attitudes, and behaviours; (2) the occurrence of common mental health disorders (e.g. anxiety, depression); as well as the role of (3) psychological factors (e.g. personality, locus of control, resilience) and (4) social and political attitudes (e.g. authoritarianism, social dominance), in influencing the public’s response to the pandemic. Quota sampling was used to recruit a nationally representative (in terms of age, sex, and household income) sample of adults (N=2025), 1406 of whom were followed-up one month later (69.4% retention rate). The baseline sample was representative of the UK population in terms of economic activity, ethnicity, and household composition. Attrition was predicted by key socio-demographic characteristics, and an inverse probability weighting procedure was employed to ensure the follow-up sample was representative of the baseline sample. C19PRC Study data has strong generalisability to facilitate and stimulate interdisciplinary research on important public health questions relating to the COVID-19 pandemic.

Background: The COVID-19 pandemic in the Republic of Ireland precipitated the temporary closure of all non-essential services and a nationwide quarantine as of March 27th, 2020. This study represents the first assessment of the mental health of the nation during the initial phase of the COVID-19 response, as part of a multi-wave investigation into the social, behavioural, and psychological impact of the pandemic.Aims: First, estimate prevalence rates of depression, generalized anxiety disorder, and combined anxiety and depression, and identify risk factors associated with screening positive for anxiety/depression. Second, determine if COVID-19-related anxiety was highest amongst those identified with the greatest mortality risk from the virus. Method: Self-report data from a nationally representative Irish sample (N = 1,041) was collected online between March 31 and April 5; the first week of the Republic of Ireland’s nationwide quarantine measures. Results: A substantial proportion of people screened positive for depression (22.77%), generalized anxiety (20.00%), and anxiety/depression (27.67%). Screening positive for anxiety/depression was associated with younger age, female sex, loss of income due to COVID-19, COVID-19 infection, and higher perceived risk of COVID-19 infection. Citizens aged 65 and older reported significantly higher levels of COVID-19 anxiety than adults aged 18-34. Sex, underlying health conditions, and proximity to COVID-19 deaths were not associated with COVID-19 anxiety.Conclusions: Government responses to the current pandemic should ensure that measures protect not only the population’s physical health, but its mental health also, as an equally important component of health and wellbeing.

Background The COVID-19 pandemic has created an unprecedented global crisis, necessitating drastic changes to living conditions, social life, personal freedom and economic activity. No study has yet examined the presence of psychiatric symptoms in the UK population under similar conditions. Aims We investigated the prevalence of COVID-19-related anxiety, generalised anxiety, depression and trauma symptoms in the UK population during an early phase of the pandemic, and estimated associations with variables likely to influence these symptoms. Method Between 23 and 28 March 2020, a quota sample of 2025 UK adults aged 18 years and older, stratified by age, gender and household income, was recruited by online survey company Qualtrics. Participants completed standardised measures of depression, generalised anxiety and trauma symptoms relating to the pandemic. Bivariate and multivariate associations were calculated for demographic and health-related variables. Results Higher levels of anxiety, depression and trauma symptoms were reported compared with previous population studies, but not dramatically so. Anxiety or depression and trauma symptoms were predicted by young age, presence of children in the home, and high estimates of personal risk. Anxiety and depression were also predicted by low income, loss of income and pre-existing health conditions in self and others. Specific anxiety about COVID-19 was greater in older participants. Conclusions This study showed a modest increase in the prevalence of mental health problems in the early stages of the pandemic, and these problems were predicted by several specific COVID-related variables. Further similar surveys, particularly of those with children at home, are required as the pandemic progresses.

Background: Adjustment disorder (AjD) is one of the most frequently used diagnoses in psychiatry but a diagnostic definition for AjD was only introduced in release of the ICD-11. This study sought to develop and validate a new measure operationalizing the ICD-11's narrative description of AjD, and to determine the current rate of people meeting the symptoms indicative of AjD in the general population of the Republic of Ireland. Methods: The International Adjustment Disorder Questionnaire (IADQ) was constructed to measure the core diagnostic criteria of ICD-11 AjD: stressor exposure, preoccupations with, and failure to adapt to, the stressor, timing of symptom onset, and functional impairment. A nationally representative sample (N = 1,020) of adults from Ireland completed the IADQ. Results: Confirmatory factor analysis supported construct validity and the reliability estimates were excellent. The IADQ correlated strongly with depression, anxiety, and posttraumatic stress. The criteria were met by 7.0% of the sample, adjusted for other exclusionary disorders. Discussion: The IADQ is a measure based on the ICD-11's description and produces reliable scores, however it should not be used for clinical assessment until validated with clinical interviews.

Objectives: Existing qualitative studies focussed predominantly on exploring immigrants’ stress, distress and coping aimed at reducing stress. Little attention has been paid to immigrants’ psychological growth or positive life changes. In the present study the impact of post-migration experiences on well-being among economic immigrants has been explored. Design: Semi-structured interviews were conducted with a sample of 17 immigrants. Transcripts were analysed by a deductive and inductive thematic analysis. Results: All immigrants reported positive life changes as a result of migration. Experiences related to migration helped immigrants rebuild their sense of self-worth and find ‘mental peace’ after living a demanding and burdensome life in Poland. Immigrants’ accounts also suggested that their thinking and behaviour patterns may be shaped by their cultural values and socio-economic background. Conclusion: Overall, the study indicates that migration is not merely a stressful life event but can have a positive impact on many aspects of immigrants’ lives and may provide opportunities for personal growth

Background There is very little work on the role of positive or benevolent childhood experiences and how such events might offer protection from the insidious effects of adverse experiences in childhood or later in life. Objectives We set out to test, using latent variable modelling, whether adverse and benevolent childhood experiences could be best described as a single continuum or two correlated constructs. We also modelled the relationship between adverse and benevolent childhood experiences and ICD-11 PTSD and Complex PTSD (CPTSD) symptoms and explored if these associations were indirect via psychological trauma. Methods Data were collected from a trauma-exposed sample (N = 275) attending a specialist trauma care centre in the UK. Participants completed measures of childhood adverse and benevolent experiences, traumatic exposure, and PTSD and CPTSD symptoms. Results Findings suggested that adverse childhood experiences operate only indirectly on PTSD and CPTSD symptoms through lifetime trauma exposure, and with a stronger effect for PTSD. Benevolent childhood experiences directly predicted only CPTSD symptoms. Conclusions Benevolent and traumatic experiences seem to form unique associations with PTSD and CPTSD symptoms. Future research is needed to explore how benevolent experiences can be integrated within existing psychological interventions to maximise recovery from traumatic stress.

The current study investigated the mediating role of Early Maladaptive Schemas (EMS) in the association between childhood trauma and Complex PTSD (CPTSD) symptom severity in a clinical sample of 42 older adults (>64 years). It was found that EMS total score mediated the relationship between childhood trauma and CPTSD symptom severity. Two second order schema factors (Disconnection; Impaired Autonomy) also had a mediating role in this relationship. Results provide preliminary support for the utility of interventions targeting EMS, particularly in the domains of Disconnection and Impaired Autonomy, in order to alleviate CPTSD symptoms. Future research is required to replicate these results within larger samples and to examine the efficacy of schema and cognitive interventions within trauma exposed older adults.

This letter to the editor responds to a recent EJPT editorial and following commentary which express concerns about the validity of the ICD-11 complex PTSD (CPTSD) diagnosis. Achterhof and colleagues caution that latent profile analyses and latent class analyses, which have been frequently used to demonstrate the discriminative validity of the ICD-11 PTSD and CPTSD constructs, have limitations and cannot be relied on to definitively determine the validity of the diagnosis. Ford takes a broader perspective and introduces the concept of 'cPTSD' which describes a wide ranging set of symptoms identified from studies related to DSM-IV, DSM-V and ICD-11 and proposes that the validity of the ICD-11 CPTSD is in question as it does not address the multiple symptoms identified from previous trauma-related disorders. We argue that ICD-11 CPTSD is a theory-driven, empirically supported construct that has internal consistency and conceptual coherence and that it need not explain nor resolve the inconsistencies of past formulations to demonstrate its validity. We do agree with Ford and with Achterhof and colleagues that no one single statistical process can definitively answer the question of whether CPTSD is a valid construct. We reference several studies utilizing many different statistical approaches implemented across several countries, the overwhelming majority of which have supported the validity of ICD-11 as a unique construct. We conclude with our own cautions about ICD-11 CPTSD research to date and identify important next steps.Un reciente artículo de la EJPT comentario editorial y siguiente han manifestado preocupaciones acerca de la validez del diagnóstico de TEPT complejo (TEPT-C) de la CIE-11. Achterhof y colegas argumentan que la validez del TEPT-C requiere más evidencia de la que puede ser otorgada por el análisis de clase latente (ACL) y análisis de perfil latente (APL). Ford toma una visión más amplia proponiendo que la actual conceptualización de TEPT-C no capta el rango completo de síntomas asociados o los individuos que sufren los efectos del trauma y concluye que la actual definición de TEPT-C requiere de una revisión para poder representar un constructo distinto, cohesivo y válido. En esta carta resumimos los datos sustantivos que en total, apoyan la validez del constructo del diagnóstico de TEPT-C e indican la coherencia conceptual y la integridad del TEPT-C como es presentado en la CIE-11. Estamos de acuerdo tanto con Ford como con Achterhof y colegas que la validez para el constructo de TEPT-C debería estar construido sobre la evidencia de distintas metodologías, cuidadosa revisión de cómo el TEPT-C es lo mismo versus diferente de otros trastornos, y evaluación de su valour en la comprensión y tratamiento de los individuos que han experimentado trauma. Concluimos, basados en la evidencia actual de los estudios epidemiológicos, clínicos y de neurociencia que el diagnóstico de TEPT-C de la CIE-11 provee un fundamento científicamente sólido para investigaciones futuras acerca del TEPT complejo.Achterhof和同事（2019）最近发表在EJPT的社论，和随后Ford（2020）发表的评论，表达了对ICD-11复合型PTSD（CPTSD）诊断效度的担忧。Achterhof及其同事认为，CPTSD的效度需要比潜在类别分析（LCA）和潜在剖面分析（LPA）提供的证据更多。Ford则提出了一个更宽泛的观点，即当前CPTSD的概念并未涵盖遭受创伤影响后的全部症状，并总结CPTSD的当前定义需要修订以代表一个独特的、连贯的和有效的结构。在这封信中，我们总结了实证数据，这些数据总体上支持CPTSD诊断的结构效度，并指出了ICD-11中提出的CPTSD概念上的连贯性和完整性。我们同意Ford 和 Achterhof及其同事的观点，即CPTSD的结构效度应建立在不同方法学的证据之上，仔细审查CPTSD与其他疾病的区别与区别，以及评估其在理解和治疗创伤暴露个体中的价值。基于流行病学、临床和神经科学研究的最新证据，我们得出结论：ICD-11中CPTSD诊断为未来有关复杂型PTSD的研究提供了科学的基础。.

The prevalence of posttraumatic stress disorder (PTSD) as it relates to individuals' experiences of the COVID-19 pandemic has yet to be determined. This study was conducted to determine rates of COVID-19-related PTSD in the Irish general population, the level of comorbidity with depression and anxiety, and the sociodemographic risk factors associated with COVID-19-related PTSD. A nationally representative sample of adults from the general population of the Republic of Ireland (N = 1,041) completed self-report measures of all study variables. The rate of COVID-19-related PTSD was 17.7% (n = 184), 95% CI [15.35%, 19.99%], and there was a high level of comorbidity with generalized anxiety (49.5%) and depression (53.8%). Meeting the diagnostic requirement for COVID-19-related PTSD was associated with younger age, male sex, living in a city, living with children, moderate and high perceived risk of COVID-19 infection, and screening positive for anxiety or depression. Posttraumatic stress symptoms related to the COVID-19 pandemic are common in the general population. Our results show that health professionals responsible for responding to the COVID-19 pandemic should expect to routinely encounter symptoms and concerns related to posttraumatic stress.

Background: Individuals with intellectual disability (ID) are at greater risk of exposure to traumatic life events compared with the non‐ID population. Yet no study to date has examined the role of multiple traumatisation and subsequent psychopathology in people with ID. The aim of this study was to explore the association between multiple traumatisation and subsequent mental health. Methods: A preliminary cross‐sectional study involving 33 participants with DSM‐5 post‐traumatic stress disorder completed self‐report questionnaires on exposure to traumatic life events and post‐traumatic stress disorder symptoms, anxiety, depression and general distress. Results: A proportion of 42.4% of the sample reported multiple traumatisation, including exposure to life events in both childhood and adulthood. Those who reported exposure to life events in childhood and adulthood reported significantly higher risk of harm, depression and general psychological distress compared with those who reported exposure to life events only in adulthood. Conclusions: Preliminary results indicate that more severe psychopathology is associated with multiple traumatisation in childhood and adulthood compared with trauma experienced solely in adulthood.

BackgroundWe aimed to test a mindfulness-based psychoeducation group (MBPEG), v. a conventional psychoeducation group (CPEG) v. treatment as usual (TAU), in patients with schizophrenia-spectrum disorders over a 24-month follow-up.MethodThis single-blind, multi-site, pragmatic randomized controlled trial was conducted in six community treatment facilities across three countries (Hong Kong, mainland China and Taiwan). Patients were randomly allocated to one of the treatment conditions, and underwent 6 months of treatment. The primary outcomes were changes in duration of re-hospitalizations and mental state (Positive and Negative Syndrome Scale; PANSS) between baseline and 1 week, and 6, 12 and 18 months post-treatment.ResultsA total of 300 patients in each country were assessed for eligibility between October 2013 and 30 April 2014, 38 patients per country (n = 342) were assigned to each treatment group and included in the intention-to-treat analysis. There was a significant difference in the length of re-hospitalizations between the three groups over 24 months (F2,330 = 5.23, p = 0.005), with MBPEG participants having a shorter mean duration of re-hospitalizations than those in the other groups. The MBPEG and CPEG participants had significant differential changes in proportional odds ratios of complete remission (all individual PANSS items 2 = 8.9 and 8.0, p = 0.001 and 0.003, relative risk = 3.5 and 3.1, 95% confidence interval 2.0–7.2 and 1.6–6.3).ConclusionsCompared with TAU and CPEG, MBPEG improves remission and hospitalization rates of people with schizophrenia spectrum disorders over 24 months.

BackgroundThe 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.MethodsWe conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.ResultsFifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = −0.90 (CBT; k = 27, 95% CI −1.11 to −0.68; moderate quality) to g = −1.26 (EMDR; k = 4, 95% CI −2.01 to −0.51; low quality). CBT and EA each had moderate–large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate–large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.ConclusionsThe development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.

Objective: To report the results of the first randomised feasibility trial of Eye MovementDesensitisation and Reprocessing (EMDR) plus Standard Care (SC) vs. SC alone for DSM-5Posttraumatic Stress Disorder (PTSD) in adults with intellectual disabilities (IDs). Method: A total of 29 participants were randomised to either to EMDR + SC (n= 15) or SC (n= 14). Participants completed measures on traumatic stress (PCL-C) and . comorbid distress at baseline, 1-week post-treatment and 3-month follow-up. Results: In the EMDR + SC group, 9 (60%) participants at post-treatment and 7 (47%) participants at 3-month follow-up were diagnosis free. In SC, 4 (27%) at post-treatment and follow-up were diagnosis free. At post-treatment 3 participants (20%) dropped out from the EMDR + SC group, and 1 (7%) dropped out from the SC group. Conclusions: It is feasible, acceptable and potentially effective to deliver EMDR in this population group.

BackgroundThe ICD-11 includes a new disorder, complex post-traumatic stress disorder (CPTSD). A network approach to CPTSD will enable investigation of the structure of the disorder at the symptom level, which may inform the development of treatments that target specific symptoms to accelerate clinical outcomes.AimsWe aimed to test whether similar networks of ICD-11 CPTSD replicate across culturally different samples and to investigate possible differences, using a network analysis.MethodWe investigated the network models of four nationally representative, community-based cross-sectional samples drawn from Germany, Israel, the UK, and the USA (totalN= 6417). CPTSD symptoms were assessed with the International Trauma Questionnaire in all samples. Only those participants who reported significant functional impairment by CPTSD symptoms were included (N= 1591 included in analysis; mean age 43.55 years, s.d. 15.10, range 14–99, 67.7% women). Regularised partial correlation networks were estimated for each sample and the resulting networks were compared.ResultsDespite differences in traumatic experiences, symptom severity and symptom profiles, the networks were very similar across the four countries. The symptoms within dimensions were strongly associated with each other in all networks, except for the two symptom indicators assessing aspects of affective dysregulation. The most central symptoms were ‘feelings of worthlessness’ and ‘exaggerated startle response’.ConclusionsThe structure of CPTSD symptoms appears very similar across countries. Addressing symptoms with the strongest associations in the network, such as negative self-worth and startle reactivity, will likely result in rapid treatment response.Declaration of interestA.M. and M.C. were members of the World Health Organization (WHO) ICD-11 Working Group on the Classification of Disorders Specifically Associated with Stress, reporting to the WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. The views expressed in this article are those of the authors and do not represent the official policies or positions of the International Advisory Group or the WHO.