Search

One of Jung's most significant contributions concerns the mysterious, inexplicable and always out‐of‐reach nature of the self. In this paper, I will focus on the borders of the self and their nature, location and dynamics of maintenance and change in geographically, historically, and culturally situated subjects. Reflecting on the refugee experience, I intend to gain more insights into our psychic functioning and the dynamics of the self in relation to itself, the other and groups. The experiences of some refugees, marked bysignificant trauma and migration, shed light on how the boundaries of the self are frequently contested and perpetually negotiated with others, and how our subjectivity is shaped by ongoing dynamics of occupation, dispute and/or negotiation, conducted at various levels of our social and individual existence. My argument is that these processes occur at a specific site: the boundaries of the self, involving intrapsychic, interpersonal and group psychological dynamics, with reverberations in the socio‐political and cultural spheres, and reciprocal influences between all these levels. This paper aims to concentrate on the shifts in these boundaries, illustrated through clinical vignettes. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Analytical Psychology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the diagnostic performance and application value of an artificial intelligence (AI) bone disease diagnosis system in the diagnosis of thoracic fractures. Methods A retrospective analysis was performed on 726 cases of thoracic fractures confirmed by chest CT re-examination 3-6 weeks after trauma emergency admission at Shenzhen University General Hospital. The recall rate, precision rate, and F1 score of AI, two radiologists, and the radiologists assisted by AI in diagnosing thoracic fractures were calculated.Results The recall rate and F1 score of AI in detecting rib fractures were 0.91 and 0.92, respectively, both higher than those of Radiologist 1 (0.77, 0.85) and Radiologist 2 (0.84, 0.90). The precision rate of AI (0.92) was lower than that of Radiologist 1 (0.95) and Radiologist 2 (0.96). With AI assistance, the recall rate, precision rate, and F1 score of Radiologist 1 and Radiologist 2 in detecting rib fractures were 0.94, 0.95, 0.94 and 0.97, 0.98, 0.97, respectively. For detecting other thoracic fractures, the recall rate and F1 score of AI (0.90, 0.90) were higher than those of Radiologist 1 (0.62, 0.74) and Radiologist 2 (0.73, 0.81). With AI assistance, the recall rate, precision rate, and F1 score of Radiologist 1 and Radiologist 2 in detecting other thoracic fractures were 0.94, 0.95, 0.94 and 0.97, 0.97, 0.97, respectively. Conclusion AI can efficiently and sensitively detect thoracic fractures in chest CT scans of emergency trauma patients, potentially optimizing the diagnosis and treatment process for emergency trauma patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: The application of robot-assisted technology for total knee arthroplasty is one of the current research hotspots. Since the 1980s, robot-assisted technology has been introduced into total knee arthroplasty outside China to achieve accurate osteotomy and good recovery of lower limb alignment. After decades of use, the robot has continuously improved its performance with new iterations, but has been criticized for increasing perioperative time and surgical trauma. OBJECTIVE: To summarize the advantages and disadvantages of current orthopedic surgical robots in total knee arthroplasty. METHODS: PubMed database and CNKI were searched to analyze the advantages and disadvantages of robot-assisted total knee arthroplasty in surgical trauma. English search terms were “arthroplasty, replacement, knee, knee replacement arthroplasty, procedure, robotic surgical, total knee arthroplasty, arthroplasty, replacement, knee, robotic-assisted”. The Chinese search terms were “robot-assisted, robotic arm, knee osteoarthritis, arthritis”. After the initial screening of all articles according to the inclusion and exclusion criteria, 62 articles with high quality and relevance were reviewed. RESULTS AND CONCLUSION: (1) Robot-assisted total knee arthroplasty did not increase the degree of surgical trauma in patients, and showed a lower trauma effect than conventional manual total knee arthroplasty. (2) Robot-assisted total knee arthroplasty has the advantages of accurate auxiliary osteotomy, individualized prosthesis implantation, better protection of soft tissue around the knee joint, reduction of analgesic drug use, reduction of postoperative inflammatory index changes, and shortening of hospital stay. However, there are also shortcomings such as prolonged operation time, increased complications, and increased medical costs. (3) It is concluded that preliminary clinical application studies have shown that robot-assisted total knee arthroplasty can reduce surgical trauma, but it is necessary to be alert to potential risks. Simultaneously, its exact advantages compared with conventional manual total knee arthroplasty need to be verified by large-sample randomized controlled studies and long-term follow-up. [ABSTRACT FROM AUTHOR]

The birth of a child has been associated with a decline in couple satisfaction, which has implications for the child's social‐emotional development. This study investigated the potential spillover effect on pregnant women's perceptions of their relationships with their partners of the Supporting the Transition to and Engagement in Parenthood (STEP) program, a brief trauma‐informed mentalization‐based prenatal group intervention. Participants (94% White) were recruited in prenatal clinics and through online advertisements in Quebec, Canada. Both quantitative and qualitative data were collected from participants assigned to the STEP program (n = 42) and those receiving treatment‐as‐usual (TAU; n = 125). Women participating in STEP reported significant improvements in their relationships with their partners compared to those assigned to TAU. More precisely, they reported higher couple satisfaction, enhanced communication, and increased interest in their partners' emotional experience. The qualitative analysis further substantiated these results, with participants reporting having involved their partners in their pregnancy, shared their insights about themselves with their partners and gained fresh perspectives on their relationships. Participants in STEP also expressed sharing program materials with their partners and considered that such interventions should be extended to expecting fathers. This study underscores the potential of mentalization‐based interventions to indirectly contribute to couple relationships, which may have positive implications for parenting and the infant. [ABSTRACT FROM AUTHOR]

BACKGROUND: Given the highly stressful environment surrounding the SARS-CoV-2 pandemic, healthcare workers (HCW) and public safety personnel (PSP) are at an elevated risk for adverse psychological outcomes, including posttraumatic stress disorder (PTSD) and alcohol/substance use problems. As such, the study aimed to identify associations between PTSD severity, related dissociation and emotion dysregulation symptoms, and alcohol/substance use problems among HCWs and PSP. METHODS: A subset of data (N = 498; HCWs = 299; PSP = 199) was extracted from a larger study examining psychological variables among Canadian HCWs and PSP during the pandemic. Structural equation modelling assessed associations between PTSD symptoms and alcohol/substance use-related problems with dissociation and emotion dysregulation as mediators. RESULTS: Among HCWs, dissociation fully mediated the relation between PTSD and alcohol-related problems (indirect effect β = .133, p = .03) and emotion dysregulation partially mediated the relation between PTSD and substance-related problems (indirect effect β = .151, p = .046). In PSP, emotion dysregulation fully mediated the relation between PTSD and alcohol-related problems (indirect effects β = .184, p = .005). For substance-related problems among PSP, neither emotion dysregulation nor dissociation (ps >.05) had any effects. CONCLUSION: To our knowledge, this is the first study examining associations between PTSD severity and alcohol/substance use-related problems via mediating impacts of emotion dysregulation and dissociation among HCWs and PSP during the SARS-CoV-2 pandemic. These findings highlight dissociation and emotion dysregulation as important therapeutic targets for structured interventions aimed at reducing the burden of PTSD and/or SUD among Canadian HCWs or PSP suffering from the adverse mental health impacts of the SARS-CoV-2 pandemic.

In the United States, scholarship concerning race has been the target of politicized criticism. This derision lacks concern for the matters of life and death at the center of racial scholarship, which necessarily includes histories of massacres, lynching, genocide, and extrajudicial killings in the young story of the United States alone. This article centers on the matter of trauma and presents it as an influential aspect of Black life in the United States. A principal aim is foregrounding the testimony of men who survived a 1947 massacre of imprisoned Black men near Brunswick, Georgia. The writing also makes a case for valuing studies that consider lived experiences of acute racial violence and the traumas that unstably emanate from it. [ABSTRACT FROM AUTHOR]

Metabolomics is a novel emerging technology recently applied in management of severe diseases and trauma, and has been widely used in gene analysis of disease metabolic disorders, clinical biomarker screening and disease diagnosis. This review comprehensively summarizes the latest research progress of the metabolomics in severe trauma and burns recently like traumatic brain injury(TBI), traumatic hemorrhagic shock, severe burns and so on. The paper elaborates the metabolomic technology which can quickly reflect the real-time metabolic changes of severely injured patients at different stages after injury, and uncovers new clinical biomarkers and potential drug targets of the patients with severe injuries thus improves the diagnosis and treatment strategies. Finally, we look forward to the current metabolomics research projects and tackling challenges on the burn-blast combined injuries, and the simultaneous development of multi-omics technology as well as artificial intelligence algorithms, which promotes the development of precision medicine. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of microRNA-582-5p (miR-582-5p) on neuronal damage in neonatal rats with hypoxic ischemic encephalopathy (HIE) through targeted regulation of forkhead box transcription factor O1 (FOXO1). Methods Newborn rats (n=90) were randomly grouped into the control (NC) group, the model (HIE) group, the miRNA non-specific control (LV-miRNA-NC) group, the miR-582-5p overexpression (LV-miR-582-5p) group, the miR)582-5p overexpression+mRNA control (LV-miR-582-5p+LV-NC) group and the miR-582-5p overexpression+FOXO1 overexpression (LV-miR-582-5p+LV-FOXO1) group. HIE model was established in all groups except the NC group, and neurological deficits were scored on rats. TTC staining was applied to measure the volume of cerebral infarction. Real-time PCR was applied to detect miR-582-5p and FOXO1 expression. Dual fluorescence reporter gene experiment was applied to detect the targeting relationship between miR-582-5p and FOXO1. HE staining method was applied to observe pathological changes in hippocampal tissue. TUNEL and NeuN fluorescence dual labeling co localization were applied to detect neuronal apoptosis in hippocampal tissue. Immunohistochemistry was applied to detect expressions of FOXO1 and Caspase-3 proteins. Results There was a targeting relationship between MiR-582-5p and FOXO1. Compared with the NC group, the neurological deficit score, cerebral infarction volume, FOXO1 expression, neuronal apoptosis rate, FOXO1 and Caspase-3 protein expression were increased in the HIE group, and the miR-582-5p expression obviously decreased, the hippocampal tissue showed obvious pathological damage (P<0.05). Compared with the LV-miRNA-NC group, the neurological deficit score, cerebral infarction volume, FOXO1 expression, neuronal apoptosis rate, FOXO1 and Caspase-3 protein expression obviously decreased in the LV-miR-582-5p group, and the miR-582-5p expression obviously increased, the pathological damage of hippocampus tissue was obviously improved (P<0.05). LV-FOXO1 was able to reverse the protective effect of LV-miR-582-5p on neuronal damage in HIE rats. Conclusion MiR-582-5p can directly target FOXO1, negatively regulate FOXO1 expression, reduce neuronal apoptosis in HIE neonatal rats, and have a protective effect on neural injury. [ABSTRACT FROM AUTHOR]

Copyright of Journal of China Medical University is the property of Journal of China Medical University Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

An injured small Indian civet (Viverricula indica) was rescued by the Wildlife Rescue Center of Jiangxi Province. The lateral dislocation of the right forelimb elbow joint combined with palmar trauma of V. indica was confirmed by general examination, blood test and imaging. Using aseptic debridement, surgical restoration, scientific nursing and other rescue techniques, the small Indian civet recovered after two months and was successfully released to the wild. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of quality control circle (QCC)activity on shortening the time from hospital admission to operation of trauma patients in the emergency department. Methods A QCC activity group was set up, and the theme of the activity was "shorten the time of emergency trauma surgery patients from self-diagnosis to operating room". The causes affecting the time from hospital admission to operating room were analyzed, and countermeasures were drawn up, implemented and reviewed. The time from admission to operation before and after the QCC activity was compared, and the comprehensive quality of QCC group members was evaluated. Results The time from hospital admission to operation decreased from(107. 17±13. 34) minutes to(58. 31±14. 25) minutes(P＜0. 05). Conclusion The implementation of QCC activity can effectively shorten the time from hospital admission to operation, resulting in reduced mortality of patients with severe trauma. (目的 探讨品管圈活动缩短急诊创伤患者自接诊至手术时间的应用效果。方法 成立品管圈活动小组, 确定“缩短紧急创伤手术患者自接诊至手术室时间”为活动主题, 分析影响紧急创伤手术患者自接诊至手术室时间的原因, 拟定对策, 进行对策实施与检讨。比较运用品管圈活动前后急诊创伤患者自接诊至手术时间, 评价圈员综合素质。结果 急诊创伤患者自接诊至手术时间由品管圈活动前的(107. 17±13. 34) min降至品管圈活动后的(58. 31±14. 25)min, 差异有统计学意义(P＜0. 05)。结论 实施品管圈活动可有效缩短严重创伤患者自接诊至手术时间, 降低患者死亡风险。)

To summarized the experience of nursing of a patient with wound ulceration and infection secondary to crushing injury of the left dorsalis pedis. A Multidisciplinar team was established to develop an individualized care plan for the patent. Based on the TIME principle and moist healing theory, specialist nurse used new type of dressing to accelerate the wound healing and reduce the pain. The psychological nurse conducted the distress screening and solution focused approach to relieve the mental distress of the patient. (本文总结1例左足背碾压后继发伤口破溃感染的护理经验。多学科协作制定个体化的护理方案, 由伤口专科护士主导, 基于TIME原则和湿性愈合理论, 使用新型敷料, 促使伤口快速愈合、减轻患者疼痛; 由心理专科护士主导进行心理痛苦筛查, 运用焦点解决干预模式, 缓解患者的心理痛苦, 促进积极转变。)

This paper expands the repertoire of comparative urbanism by putting forward a method of 'hopeful comparison', in which we explore an asynchronous comparison between post-war Poland and Syria. Similar to the way that Polish architects used urban design as a 'practice of hope' during the Second World War, contemporary Syrian architects are now drafting reconstruction plans even if their implementation does not seem politically possible. Yet what role can an ethical, affective stance such as hope play in the methodology of comparative urbanism? In our comparative strategy the role of radical hope is threefold. First, it creates the comparative connection between two cities destroyed by urbicide, thus countering the destructive connectivities of war and, in case of Syria, capitalism, and foregrounding resilience and human connection (which also opens up the potential of healing). Second, radical hope provides a temporal reorientation of knowledge, redirecting the analysis from the traumatic past towards an open future. Third, in this way a hopeful comparison becomes a practical tool for thinking through concrete ethical and political dilemmas concerning reconstruction and property regimes. How to think about reconstruction when the conflict is still ongoing, and, if the property system is now weaponised as part of the conflict, how to avoid inadvertently reproducing this violence in the process of property restitution and reconstruction. [ABSTRACT FROM AUTHOR]

In this paper, I will explore the role of art‐making, the experience of trauma and dissociation, and the process of working with self‐states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched's (2013) recommendation for a "binocular stance" to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client's unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth. [ABSTRACT FROM AUTHOR]

Background: The mental health impacts of climate change-related disasters are significant. However, access to mental health services is often limited by the availability of trained clinicians. Although building local community capability for the mental health response is often prioritised in policy settings, the lack of evidence-based programs is problematic. The aim of this study was to test the efficacy of the Skills for Life Adjustment and Resilience programme (SOLAR) delivered by trained local community members following compound disasters (drought, wildfires, pandemic-related lockdowns) in Australia. Method: Thirty-six community members were trained to deliver the SOLAR programme, a skills-based, trauma informed, psychosocial programme. Sixty-six people with anxiety, depression and/or posttraumatic stress symptoms, and impairment were randomised into the SOLAR programme or a Self-Help condition. They were assessed pre, post and two months following the interventions. The SOLAR programme was delivered across five 1-hourly sessions (either face to face or virtually). Those in the Self-Help condition received weekly emails with self-help information including links to online educational videos. Results: Multigroup analyses indicated that participants in the SOLAR condition experienced significantly lower levels of anxiety and depression, and PTSD symptom severity between pre – and post-intervention (T1 to T2), relative to the Self-Help condition, while controlling for scores at intake. These differences were not statistically different at follow-up. The SOLAR programme was associated with large effect size improvements in posttraumatic stress symptoms over time. Conclusion: The SOLAR programme was effective in improving anxiety, depression and posttraumatic stress symptoms over time. However, by follow-up the size of the effect was similar to an active self-help condition. Given the ongoing stressors in the community associated with compounding disasters it may be that booster sessions would have been useful to sustain programme impact. Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12621000283875.. We tested the efficacy of a brief, skills-based psychosocial programme under randomised controlled conditions following compound disasters. The SOLAR programme was associated with improvements in anxiety, depression and posttraumatic stress symptoms across time. The SOLAR programme may benefit from booster sessions especially where there are ongoing impacts of disaster. [ABSTRACT FROM AUTHOR]

Background: The experience of stalking presents a threat to the mental and physical health and wellbeing of victims. Although some studies have explored the impact of stalking on victims, few have gone into detail about specific mental health outcomes and their association with various types of stalking behaviour. Objective: To investigate the psychological consequences among Danish help-seeking victims of stalking who have contacted and received help through the Danish Stalking Center (DSC). Methods: We used survey-data from stalking victims who sought and received help from the DSC during 2015–2020 (N = 591). Descriptive statistics, correlation analysis, T-tests, and hierarchical logistic regression analysis were used to examine psychological distress symptoms and the relationship between psychopathological symptoms and stalking behaviour characteristics. Results: Victims reported considerable levels of stalking and psychological distress. Almost 80% of victims reported symptom levels indicative of a diagnosable disorder of PTSD, depression, or anxiety. T-test shoved that following behaviour had the greatest effect size for PTSD-symptoms (t(575) = −5.81, p <.01, d = −.58), anxiety (t(576) = −4.21, p <.01, d = −.42), and somatization (t(572) = −4.29, p <.01, d = −.43). Hierarchical logistic regression analysis showed that stalking victims who experienced following had significantly higher odds of experiencing symptoms of PTSD (OR 2.869; 95% CI, [1.641–5.016]) and anxiety (OR 2.274; 95% CI [1.265; 4.090]). Conclusion: Being stalked is associated with substantial PTSD-, affective and trauma-related symptoms and psychological distress in general. Together with the strikingly high levels of psychopathology and the particularly grave effects of being followed, it is indicated that stalking is a special type of trauma with many negative and harmful effects. Hence, further research into how to properly help stalking victims through preventive interventions and treatment is needed. Stalking is a special type of trauma with many negative and harmful effects. Being stalked is associated with substantial PTSD-, affective symptoms, functional impairment, general psychological distress, and strikingly high levels of psychopathology. Especially following behaviour has grave effects on victims' mental health. [ABSTRACT FROM AUTHOR]

Background: As Posttraumatic stress disorder (PTSD) in adolescents significantly impacts their well-being, effective treatment is of great importance. Little is known, however, about the novel, multi-modal virtual reality supported, exposure-based psychotherapeutic interventions such as 3MDR in this population. Objective: To describe the 3MDR treatment of an adolescent with PTSD who did not respond to previous exposure-based PTSD interventions. Method: A 14-year-old girl diagnosed with PTSD received six sessions of 3MDR embedded in family therapy. Result: The patient tolerated the 3MDR intervention very well. Personalized music and self-selected pictures appeared to be a good fit, contributing to enhanced engagement in and adherence to the therapy. She no longer met criteria for PTSD post-intervention, and at 18 months follow-up. Conclusion: This case report suggests that 3MDR has potential as a trauma treatment for adolescents with treatment-resistant PTSD. Trauma-focused therapy for youngsters is often complicated, with a high percentage of dropouts. Elements of 3MDR such as walking, self-selected pictures, and personalized music are a good fit, contributing to enhanced engagement in and adherence to 3MDR therapy. 3MDR has potential as a trauma treatment for adolescents with treatment-resistant PTSD. [ABSTRACT FROM AUTHOR]

ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) are stress-related disorders. The International Trauma Questionnaire (ITQ) is a widely used instrument to assess PTSD and CPTSD. To date, there is no evidence of the psychometric characteristics of the ITQ in Latin American countries. The aim of this study was to assess the construct and concurrent validity of the Latin American Spanish adaptation of the ITQ in a sample of Chilean adults. A sample of 275 Chilean young adults completed the ITQ, a traumatic life events checklist, the Adverse Childhood Experiences Questionnaire, the Depression Anxiety Stress Scales-21, and the Columbia-Suicide Severity Rating Scale short version. Four alternative confirmatory factor analysis models were tested. Correlation analyses were performed to determine concurrent validity with associated measures (number of reported traumatic events, number of adverse childhood experiences, anxiety, depression, and suicidal risk). The second-order two-factor (PTSD and DSO) and the correlated first-order six-factor model provided acceptable fit; however, the first model showed a better fit based on the BIC difference. The PTSD and DSO dimensions, as well as the six ITQ clusters showed positive correlations with reported number of traumatic life-events, reported number of adverse childhood experiences, levels of anxiety, depression, and suicidal risk. The ITQ Latin American Spanish adaptation provides acceptable psychometric evidence to assess PTSD and CPTSD in accordance with the ICD-11. This study is an initial validation of the Latin American Spanish adaptation of the ITQ with a Chilean young adults sample. The latent structure of the Latin American Spanish ITQ was better supported by a two-factor second-order model (PTSD/DSO); a six-factor correlated model was also acceptable. The six ITQ symptom clusters, as well as the PTSD/CPTSD dimensions were significantly positively correlated with three criterion variables: anxiety, depression, and suicidal risk. The number of potentially traumatic experiences, as well as number of exposure to adverse childhood experiences, was significantly associated with PTSD/CPTSD symptoms. [ABSTRACT FROM AUTHOR]

Moral injury can significantly negatively impact mental health, but currently no validated treatment for moral injury-related mental health difficulties exists in a UK context. This study aimed to examine whether the Restore and Rebuild (R&R) treatment was feasible to deliver, acceptable and well tolerated by UK military veterans with moral injury related mental health difficulties. The R&R treatment was delivered to 20 patients who reported distress related to exposure to a morally injurious event(s) during military service. R&R is a 20-session psychotherapy with key themes of processing the event, self compassion, connecting with others and core values. Treatment was delivered online, weekly, one-to-one by a single therapist. Qualitative interviews with patients and the therapist who delivered R&R were conducted to explore acceptability and analysed using thematic analysis. Following treatment, patients experienced a significant reduction in symptoms of post-traumatic stress disorder, depression, alcohol misuse and moral injury related distress. R&R was found to be well tolerated by patients and improved their perceived wellbeing. These results provide preliminary evidence that veterans struggling with moral injury related mental ill health can benefit from R&R treatment. Evidence before this study: Moral injury can negatively impact the mental health of military veterans. Currently no validated treatment for moral injury related mental health difficulties exists for UK military personnel/veterans. Added value of this study: Restore and Rebuild (R&R) is a co-designed psychotherapy for moral injury-related mental health difficulties. This study provides the first evidence that R&R treatment is associated with a significant improvement in patient symptoms of PTSD, depression, alcohol misuse and moral injury related distress. R&R was feasible to deliver, acceptable to patients and well tolerated. Implications of all the available evidence: These results provide preliminary evidence that veterans struggling with moral injury related mental ill health can benefit from R&R treatment. With further evaluation, R&R may be beneficial to other occupational groups affected by moral injury. [ABSTRACT FROM AUTHOR]

Background: Migration is a multi-stage social process linked to traumatic event exposure and a notably increased risk of psychosis. Although these conditions affect refugee and non-refugee immigrants, prior trauma research has focused mainly on the refugee population. Objective: To compare and describe the rate and the clinical characterization of PTSD and traumatic events between non-refugee immigrants and native-born individuals with psychotic disorder. Methods: 99 immigrants and 99 native-born individuals (n = 198) with at least one psychotic episode according to DSM-5 criteria were compared on the rate of PTSD diagnosis and traumatic events, using standardized and validated trauma scales. Results: In the non-refugee immigrant group, 31% met diagnostic criteria for PTSD compared to only 7.1% in the native-born group. Total scores in childhood trauma and last year stressful events were 1.5 and 2 times higher in non-refugee immigrants, respectively. Likewise, cumulative lifetime trauma was three times higher in non-refugee immigrants. Finally, non-refugee immigrants reported more violent and life-threatening traumatic events than native-born individuals. Conclusions: These results are relevant since they highlight that non-refugee immigrants with psychotic disorders are highly trauma-exposed, meaning a routine trauma assessment and a trauma-focused intervention for this population should be included in individualized treatment plans. Traumatic events and PTSD rates in the non-refugee immigrant population with psychotic disorder have previously received scant attention. This study found that in a psychotic population, 31% of the non-refugee immigrants presented a PTSD diagnosis compared to only 7.1% of the native-born individuals. Compared to native-born individuals with psychosis, non-refugee immigrants with psychosis have 1.5 times more childhood trauma exposure, 2 times more stressful events in the past year and 3 times more cumulative trauma over their lifetime. [ABSTRACT FROM AUTHOR]

Background: On 4 August 2020, an explosion occurred in Beirut, Lebanon. Hundreds of people were killed, thousands injured and displaced. An initiative was rapidly initiated to provide remote support informed by psychological first aid for the mental health of Lebanese young adults affected by the blast. However, little is known about recipients' experiences of such initiatives. Objective: This study aimed to qualitatively explore the experiences of supporters and recipients in the community-led initiative following the blast. Method: We recruited a diverse sample of four supporters and four Lebanese recipients who took part in the Beirut initiative. Semi-structured interviews were conducted with participants. Reflexive thematic analysis was used to analyse the qualitative data. Results: We developed five themes from the qualitative interviews, which highlighted ideas around accessibility, alienation, the relationship, elements of the safe space created by the initiative, and unmet needs and areas for improvement. Recipients described the detrimental impact of the blast on their mental health within the Lebanese context and beyond. Recipients and supporters elucidated complex experiences of the support and its impact. Conclusions: Our findings suggest remote support has the potential to be acceptable for young adults in Lebanon. Further research into support informed by psychological first aid after similar crisis events is warranted. Following the Beirut blast on 4 August 2020, an initiative was implemented to provide remote mental health support to Lebanese young adults. Reflexive thematic analysis was used to analyse qualitative data from interviews with supporters and recipients after support sessions were completed to identify themes across diverse experiences and views. Participants described a feeling of alienation after the blast, the development of a meaningful relationship between supporter and recipients, and gratitude for having a safe space to process and share difficult feelings. Possible avenues for improvement and implementation were suggested. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic stress disorder (PTSD) is a debilitating condition affecting millions of people worldwide. Existing treatments often fail to address the complexity of its symptoms and functional impairments resulting from severe and prolonged trauma. Electroencephalographic Neurofeedback (NFB) has emerged as a promising treatment that aims to reduce the symptoms of PTSD by modulating brain activity. Objective: We conducted a systematic review and meta-analysis of ten clinical trials to answer the question: how effective is NFB in addressing PTSD and other associated symptoms across different trauma populations, and are these improvements related to neurophysiological changes? Method: The review followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. We considered all published and unpublished randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving adults with PTSD as a primary diagnosis without exclusion by type of trauma, co-morbid diagnosis, locality, or sex. Ten controlled studies were included; seven RCTs and three NRSIs with a total number of participants n = 293 (128 male). Only RCTs were included in the meta-analysis (215 participants; 88 male). Results: All included studies showed an advantage of NFB over control conditions in reducing symptoms of PTSD, with indications of improvement in symptoms of anxiety and depression and related neurophysiological changes. Meta-analysis of the pooled data shows a significant reduction in PTSD symptoms post-treatment SMD of −1.76 (95% CI −2.69, −0.83), and the mean remission rate was higher in the NFB group (79.3%) compared to the control group (24.4%). However, the studies reviewed were mostly small, with heterogeneous populations and varied quality. Conclusions: The effect of NFB on the symptoms of PTSD was moderate and mechanistic evidence suggested that NFB leads to therapeutic changes in brain functioning. Future research should focus on more rigorous methodological designs, expanded sample size and longer follow-up. Neurofeedback (NFB) was found to have moderate beneficial effects on PTSD symptoms, and positive effects on secondary outcomes such as depression and anxiety, according to a meta-analysis of seven randomised controlled trials (RCTs). The beneficial effects of NFB were observed across diverse populations, including those with different types of trauma (military and civilians) and from different ethnic backgrounds. Results suggest that modulation of alpha rhythm might be a viable NFB protocol in patients with PTSD, as changes in neurophysiological functioning, such as connectivity in the Default Mode Network (DMN) and Salience Network (SN), were observed post-NFB and were correlated with a decrease in PTSD severity. [ABSTRACT FROM AUTHOR]

Background: Refugees with exposure to multiple traumatic events are at high risk for developing posttraumatic stress disorder (PTSD) and depression. Narrative exposure therapy (NET) is an effective treatment for the core symptoms of PTSD, but it does not reliably reduce depressive symptoms. Endurance exercise on the other hand was consistently found to be effective in treating depression making it a promising adjunct to NET. Up to date, no studies exist investigating the combination of NET and endurance exercise in a sample of refugees with PTSD and comorbid depression. Objectives: In the proposed randomized controlled trial, we aim to investigate whether a combination of NET and moderate-intensity aerobic exercise training (MAET) enhances treatment outcome for refugees with PTSD and comorbid depressive symptoms. We expect a greater improvement in psychopathology in participants who receive the combined treatment. Methods and analysis: 68 refugees and asylum seekers with PTSD and clinically relevant depressive symptoms will be recruited in the proposed study. Participants will be randomly assigned to receive either NET only (NET-group) or NET plus MAET (NET+-group). All participants will receive 10 NET sessions. Participants in the NET+-group will additionally take part in MAET. Primary (PTSD, depression) and secondary (general mental distress, agoraphobia and somatoform complaints, sleep quality) outcome measures will be assessed before treatment, after treatment, and at six-month follow-up. The hypotheses will be tested with multiple 2 × 3 mixed ANOVA's. Trial registration: German Clinical Trials Register identifier: DRKS00022145. Refugees are at particularly high risk of developing posttraumatic stress disorder and comorbid depressive symptoms due to exposure to multiple man-made traumatic events. Narrative exposure therapy reliably reduces symptoms of posttraumatic stress disorder, but many patients retain their clinical diagnosis, untreated comorbid depressive symptoms may interfere with treatment response. The randomized controlled trial aims to investigate whether combining narrative exposure therapy with moderate-intensity aerobic exercise training enhances treatment outcomes for refugees with posttraumatic stress disorder and comorbid depressive symptoms, compared to narrative exposure therapy as a stand-alone treatment. [ABSTRACT FROM AUTHOR]

This letter aims to explore the potential impact of the Turkey-Syria earthquake on the psychological well-being of the affected children and adolescents. It emphasises the crucial importance of prompt identification and management of emerging mental health disorders in this vulnerable population. The letter draws on existing research evidence to highlight the need for suitable mental health interventions to mitigate the anticipated suffering of many children and adolescents affected by the earthquake. A comprehensive overview of the mediating factors which may play a role in the extent of the impact of an earthquake on the mental health of children is discussed. A range of appropriate strategies and interventions are recommended and the call for continued global support is renewed. We have concluded that major earthquakes can potentially contribute to the development of mental health disorders among children and adolescents. However, by providing timely and effective support, it is possible to prevent long-term psychological consequences and facilitate early recovery. We propose the urgent implementation of effective mental health interventions in the aftermath of the Turkey-Syria earthquake to foster the recovery and resilience of the affected young population. Mental health disorders are more prevalent in children affected by earthquakes. Prompt identification of emerging mental health disorders among this population is crucial. Management of the psychological impact in this context must be practical and needs-based. A focused and continued global support response is needed to manage the long-term challenges. [ABSTRACT FROM AUTHOR]

To treat the impact of trauma, most current evidence supports the use of trauma-focused psychotherapy as the first line approach. However, millions of individuals exposed to trauma worldwide seek Complementary and Integrative Health (CIH) therapies in hopes of achieving wellness above and beyond reducing symptoms. But what is the evidence for CIH interventions? What are potential pitfalls? Given the growing popularity of and strong interest in CIH, EJPT is featuring research on these approaches in this special issue. The papers range from common interventions such as mindfulness to the use of service dogs and scuba diving to alleviate trauma related symptoms. A featured editorial highlights the importance of defining when, where, and how placebo responses work. Nonspecific elements of treatment such as positive expectations, therapeutic rituals, healing symbols, and social interactions are identified as factors influencing treatment response and scientists looking to add to the CIH evidence base are encouraged to consider the impact and methodological challenges these elements present. CIH interventions more specifically recognize and harness some of these factors in addition to intervention-specific factors such as attention or emotion regulation along with focus on overall wellbeing. The body of work in this special issue supports the emerging evidence for meditative and relaxation-based interventions and illustrates a creative but nascent state of the field. Cross-intervention mechanisms that may play a role in achieving wellness, such as arousal reduction, emotion regulation, posttraumatic growth, and positive affect are highlighted. The trauma field would benefit from accumulation of evidence for promising CIH interventions, evaluation of potential mechanisms, and examination of health and wellbeing outcomes. With the paucity of high-quality trials, it would be premature to recommend CIH interventions as first-line treatments. However, the emerging literature on CIH continues to advance our understanding of what works and how these interventions exert their effects. Complementary and Integrative Health (CIH) interventions for trauma that target holistic wellness above and beyond symptom reduction are increasingly used in the real world, though the evidence base lags. Papers in this issue support the emerging evidence for efficacy of mindfulness or other meditative or relaxation-based interventions. This special issue illustrates creative approaches but also the need for continued research establishing efficacy, evaluating more inclusive outcomes (e.g. a sense of wellbeing or ability to pursue valued life goals), and identifying potential mechanisms. [ABSTRACT FROM AUTHOR]

War is a highly traumatogenic experience that may result in trauma-related symptoms during exposure. Although most individuals exhibit recovery after the trauma ends, symptomatology during exposure may serve as an initial indicator underlying symptomatology at the posttraumatic phase, hence the imperative to identify risk factors for trauma-related symptoms during the peritraumatic phase. While research has uncovered several factors associated with peritraumatic distress, such as age, gender, history of mental disorder, perceived threat, and perceived social support, the role of sensory modulation has not been explored. To address this gap, 488 Israeli citizens were assessed using an online survey for sensory modulation and trauma-related symptoms during rocket attacks. Analyses revealed that while the association between high sensory responsiveness and elevated levels of specific trauma-related symptoms is somewhat weak (0.19

Background: Post-traumatic stress symptoms (PTSS) following childbirth are common within a stressful environment and are mitigated by social support. During the COVID-19 pandemic, an increase in such symptoms has been reported. The current study aims to longitudinally model the influence of general and pandemic-specific risk and protective factors on the temporal unfolding of symptoms among postpartum women. Methods: Participants were 226 women following a liveborn, term birth during the first lockdown in Israel. Participants completed questionnaires 10 weeks (T1) and 6 months (T2) after delivery. PATH analyses included predictors of symptoms in T1: demographics, exposure to traumatic events, medical complications during delivery or pregnancy, exposure to COVID-19-related events and their subjective impact, fear of COVID-19, and social support. Predictors of symptoms in T2 were: T1 predictors, both as direct effects and mediated by T1 PTSS, as well as predictors measured again in T2. Results: Results showed the suggested model fit the data. The effect of COVID-19-related fear and subjective impact at T1 on symptoms at T2 were fully mediated by PTSS in T1, as were the effects of marriage and high social support at T1. COVID-19-related fear at T2 positively predicted symptoms at T2, while social support at T2 had the opposite effect. Medical complications during pregnancy negatively predicted symptoms in T2 only. Discussion: Persistent fear appears to be a risk factor and supports a consistent buffer in postpartum PTSS during the COVID-19 pandemic. Medical complications during pregnancy served as a protective factor, possibly due to habituation to medical settings. Post-traumatic stress symptoms (PTSS) following childbirth during the COVID-19 pandemic may unfold in a unique manner, relating to pandemic-related stressors and fears. Women who experience stressful pandemic-related events are not at heightened risk of developing PTSS within the six months following birth, but those reporting COVID-19 related fears are. Women who had medical complications during pregnancy, but not delivery, are at lower risk of developing subsequent PTSS, perhaps due to their ongoing contact with medical facilities despite the pandemic. [ABSTRACT FROM AUTHOR]

Research has largely focused on the psychological consequences of refugee trauma exposure, but refugees living with visa insecurity face an uncertain future that also adversely affects psychological functioning and self-determination. This study aimed to examine how refugee visa insecurity affects the functional brain. We measured resting state brain activity via fMRI in 47 refugees with insecure visas (i.e. temporary visa status) and 52 refugees with secure visas (i.e. permanent visa status) residing in Australia, matched on key demographic, trauma exposure and psychopathology. Data analysis comprised independent components analysis to identify active networks and dynamic functional causal modelling tested visa security group differences in network connectivity. We found that visa insecurity specifically affected sub-systems within the default mode network (DMN) – an intrinsic network subserving self-referential processes and mental simulations about the future. The insecure visa group showed less spectral power in the low frequency band in the anterior ventromedial DMN, and reduced activity in the posterior frontal DMN, compared to the secure visa group. Using functional dynamic causal modelling, we observed positive coupling between the anterior and posterior midline DMN hubs in the secure visa group, while the insecure visa group displayed negative coupling that correlated with self-reported fear of future deportation. Living with visa-related uncertainty appears to undermine synchrony between anterior-posterior midline components of the DMN responsible for governing the construction of the self and making mental representations of the future. This could represent a neural signature of refugee visa insecurity, which is marked by a perception of living in limbo and a truncated sense of the future. Refugee visa insecurity disrupts default mode network (DMN) connectivity – a core network that supports the internal construction of the self. Refugees living with insecure visa status showed decreased connectivity in the DMN and more negative coupling between midline anterior–posterior hubs of the DMN, compared to refugees living with secure visas. Diminished DMN connectivity may represent a neural basis for the psychological effects of refugee visa insecurity, which is associated with prolonged uncertainty regarding the future self and increased risk for psychological distress. [ABSTRACT FROM AUTHOR]

Background: Exposure to adversity in utero is thought to increase susceptibility to develop posttraumatic stress disorder (PTSD) following later life trauma, due to neurobiological programming effects during critical developmental periods. It remains unknown whether effects of prenatal adversity on PTSD susceptibility are modulated by genetic variations in neurobiological pathways implicated in PTSD susceptibility. Objective: We investigated whether genetic variation in the glucocorticoid receptor (GR) modulated effects of prenatal famine exposure on late adulthood PTSD symptom severity after trauma exposure in childhood and mid-to-late adulthood. Method: We included N = 439 term-born singleton adults (mean age: 72 years, 54.2% women) from the Dutch Famine Birth Cohort, born around the time of the Dutch Famine of 1944/1945, divided into exposure and control groups based on timing of the famine during gestation. Participants filled out self-report questionnaires on childhood (Childhood Trauma Questionnaire) and mid-to-late adulthood (Life Events Checklist for DSM-5) trauma, and current PTSD symptom severity (PTSD Checklist for DSM-5). GR haplotypes were determined from four functional GR single nucleotide polymorphisms (ER22/23EK, N363S, BclI and exon 9β) in previously collected DNA. Linear regression analyses were performed to investigate associations of GR haplotype and prenatal famine exposure in conjunction with later life trauma on PTSD symptom severity. Results: We observed a significant three-way interaction between the GR Bcll haplotype, famine exposure during early gestation, and adulthood trauma exposure on PTSD symptom severity in late adulthood. Only participants exposed to famine during early gestation without the GR Bcll haplotype showed a significantly stronger positive association between adulthood trauma and PTSD symptom severity than non-exposed participants, indicating increased PTSD susceptibility. Conclusions: Our results illustrate the importance of integrated approaches considering genetics and environmental contexts throughout various life periods, including the rarely investigated prenatal environment, to elucidate how PTSD susceptibility evolves throughout life. HIGHLIGHTS Adversity during pregnancy is thought to increase offspring's PTSD risk following later life trauma, but exact neurobiological mechanisms underlying this process remain unknown. We found that effects of prenatal famine exposure on PTSD symptom severity were influenced by genetic variation in the glucocorticoid receptor, which signals effects of the stress hormone cortisol. Integrated approaches considering genetics and environmental contexts throughout both early and later life are important to understand how PTSD risk evolves throughout life. [ABSTRACT FROM AUTHOR]

Background: The occurrence of attenuated psychotic symptoms (APS) is a major concern in populations with substance use disorders (SUDs). However, APS also frequently develop in the course of Post-Traumatic Stress Disorder (PTSD). This study explores how the prevalence of APS differs between adolescent patients with only SUD, SUD with a history of traumatic experiences (TEs), and with SUD and self-reported PTSD. Methods: We recruited n = 120 treatment-seeking adolescents at a German outpatient clinic for adolescents with SUD. All participants filled out questionnaires assessing APS (PQ-16, YSR schizoid scale), trauma history, PTSD symptoms (both UCLA PTSD Index), and SUD severity (DUDIT) next to an extensive substance use interview. We performed a multivariate analysis of co-variance with the four PQ-16 scales and the YSR scale as outcomes and PTSD status as predictor. Additionally, we performed five linear regressions predicting each PQ-16 score and YSR score based on tobacco, alcohol, cannabis, ecstasy, amphetamine, and methamphetamine use. Results: Participants with co-occurring SUD and self-reported PTSD showed significantly higher APS prevalence rates (PQ-16 score, p =.00002), more disturbed thought content (p =.000004), more perceptual disturbances (p =.002), more negative symptoms (p =.004) and more thought problems (p =.001) compared to adolescents with SUD and a history of trauma and adolescents with only SUD. Past-year substance use was not predictive for APS prevalence (F(75) = 0.42; p =.86; R2 =.04). Conclusion: Our data suggests that the occurrence of APS in adolescents with SUD is better explained by co-occurring self-reported PTSD than by substance use frequency or substance class. This finding might indicate that APS might be reduced through treating PTSD or focusing on TEs in SUD therapy. Adolescents with co-occurring substance use disorders and PTSD show increased rates of Attenuated Psychotic Symptoms (APS). A history of traumatic experiences and PTSD are stronger predictors for APS than substance use. APS in adolescents with substance use disorders may be an indication of undiagnosed and/or untreated co-occurring PTSD. [ABSTRACT FROM AUTHOR]

Background: Moral injury (MI) has become a research and organizational priority as frontline personnel have, both during and in the years preceding the COVID-19 pandemic, raised concerns about repeated expectations to make choices that transgress their deeply held morals, values, and beliefs. As awareness of MI grows, so, too, does attention on its presence and impacts in related occupations such as those in public safety, given that codes of conduct, morally and ethically complex decisions, and high-stakes situations are inherent features of such occupations. Objective: This paper shares the results of a study of the presence of potentially morally injurious events (PMIEs) in the lived experiences of 38 public safety personnel (PSP) in Ontario, Canada. Method: Through qualitative interviews, this study explored the types of events PSP identify as PMIEs, how PSP make sense of these events, and the psychological, professional, and interpersonal impacts of these events. Thematic analysis supported the interpretation of PSP descriptions of events and experiences. Results: PMIEs do arise in the context of PSP work, namely during the performance of role-specific responsibilities, within the organizational climate, and because of inadequacies in the broader healthcare system. PMIEs are as such because they violate core beliefs commonly held by PSP and compromise their ability to act in accordance with the principles that motivate them in their work. PSP associate PMIEs, in combination with traumatic experiences and routine stress, with adverse psychological, professional and personal outcomes. Conclusion: The findings provide additional empirical evidence to the growing literature on MI in PSP, offering insight into the contextual dimensions that contribute to the sources and effects of PMIEs in diverse frontline populations as well as support for the continued application and exploration of MI in the PSP context. The objective of this study was to understand the types of events that Canadian public safety personnel (PSP) experience as potentially morally injurious events (PMIEs) as well as the impacts that they associate with these events. The findings illuminate that contextual dimensions are significant in the origin of PMIEs, which PSP experience in the completion of routine duties, because of the organizational culture, or as a result of issues in the broader healthcare system, which led to many negative consequences in their personal and professional lives. PMIEs reduced the trust PSP had in their leadership and the healthcare system to protect the public and themselves, were associated with feelings of anger, frustration, resignation, and helplessness, and connected to internal struggles marked by inner conflict and the erosion of self-concept. [ABSTRACT FROM AUTHOR]

Background: Emotion dysregulation is a hallmark characteristic of psychopathology following trauma. Yet, emotion dysregulation is multifaceted, and little is known about which aspects of emotion dysregulation predict depression and posttraumatic stress disorder (PTSD) symptom severity following traumatic injury. Objective: The aim of this longitudinal study was to evaluate how facets of dysregulation differentially predicted the severity of PTSD symptom clusters and depressive symptoms six months after a traumatic injury requiring medical treatment. Methods: Traumatically injured adults (N = 99) presenting to a Level 1 trauma centre completed a measure of emotion dysregulation 2 weeks post-injury, and PTSD and depression were assessed at 2-weeks and 6 months later. Results: Using stepwise regressions controlling for baseline symptoms, age, gender, race, and injury severity, results showed baseline emotion dysregulation significantly predicted the four symptom clusters of PTSD 6 months post-injury. Notably, hyperarousal symptoms and negative alterations in mood and cognition were predicted by a lack of clarity. On the other hand, depressive symptoms were significantly predicted by difficulty accessing emotion regulation strategies. Conclusion: Results highlight that specific facets of emotion dysregulation predict PTSD and depression symptom severity differentially after injury. Indeed, lack of emotional clarity appears to predict PTSD symptomatology, suggesting a potential mechanism driving worsening symptoms. Lack of clarity could also be detrimental to engagement in PTSD treatment. Conversely, lack of regulation strategies may represent a sense of helplessness in managing depression after trauma. As such, future research should elucidate whether interventions targeting aspects of emotion dysregulation based on symptom presentations are useful in treating PTSD and depression following injury. Specific facets of emotion dysregulation are differentially associated with PTSD symptom clusters and depression symptom severity after injury. Findings suggest that targeting lack of emotional clarity may be critical for patients with prominent hyperarousal and trauma-related changes in mood and cognitions (i.e. two PTSD symptom clusters). Patients with depressive symptoms following trauma may especially benefit from the development of emotion regulation strategies. [ABSTRACT FROM AUTHOR]

Background: Guilt and Shame, two core self-related emotions, often emerge following trauma and play an important role in the development and maintenance of post-traumatic stress disorder (PTSD). Importantly, Guilt and Shame exhibit specific focal and non-specific global impacts of trauma on self-perception, respectively. Objective and Methods: Integrating psychological theories with neuroscientific knowledge, we suggest a scheme of two diverging clinical phenotypes of PTSD, associated with distinct self-related processes and differential functionality of relevant neural networks. Proposal: The Guilt-driven phenotype is characterized by preoccupation with negative self-attributes of one's actions in the traumatic event. It involves altered functionality of both the salience network (SN) and the default-mode network (DMN), associated with heightened interoceptive signalling and ruminative introspection which may lead to hyperarousal and intrusive symptoms, respectively. On the contrary, the Shame-driven phenotype is characterized by global, identity-related negative self-attributions. It involves altered functionality of both the SN and the DMN, associated with blunted interoceptive signalling and diminished introspection which may result in withdrawal and anhedonia symptoms together with dissociative experiences, respectively. Conclusion: The proposed PTSD phenotypes may inform neuropsychological therapeutic interventions (e.g. self-focused psychotherapy and neuromodulation) aiming to restore the function of large-scale self-related neural processing. Guilt and Shame are two self-related emotions that often emerge following traumatic events and may contribute to the clinical profile of post-traumatic stress disorder (PTSD). Our framework suggests Guilt and Sham driven phenotypes of post-traumatic psychopathology, associated with two self-processing deficiencies related to specific action or global identity, respectively. The proposed phenotypes may inform neuropsychological treatments aiming to restore dysfunctional neural networks, later to be evident in alleviating Guilt and Shame and improving clinical outcomes. [ABSTRACT FROM AUTHOR]

Disrupted sleep and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a day-to-day basis. However, most of the previous research has focused on subjective measures of sleep only. Here, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective measures of sleep (actigraphy). Forty-one non-treatment seeking, trauma exposed young adults (age M = 24.68, SD = 8.15) with a range of PTSD symptom severities (PTSS, 0–53 on PCL-5) were recruited. Participants completed two surveys per day over four weeks to measure day-time PTSD symptoms (i.e. PTSS and number of intrusions) and night-time sleep subjectively, while wearing an actigraphy watch to measure sleep objectively. Linear mixed models revealed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and increasing number of intrusive memories both within and between participants. Similar results were found for daytime PTSD symptoms on night-time sleep. However, these associations were not found using objective sleep data. Exploratory moderator analyses including sex (male vs. female) found that these associations differed in strength between sexes but were generally in the same direction. These results were in line with our hypothesis with regards to the sleep diary (subjective sleep), but not actigraphy (objective sleep). Several factors which have implications on both PTSD and sleep, such as the COVID-19 pandemic and/ or sleep-state misperception, may be potential reasons behind those discrepancies. However, this study had limited power and needs to be replicated in larger samples. Nonetheless, these results add to the current literature about the bi-directional relationship between sleep and PTSD and have clinical implications for treatment strategies. Elevated day-time PTSD symptom severity (PTSS) and more frequent intrusive memories were generally associated with subjectively reported disruptions in sleep and vice versa, but not with objective measures of sleep. While longer subjective sleep duration predicted reductions in PTSS and shorter sleep onset latency predicted reduced numbers of intrusions the next day, reduced daytime PTSS was only associated with reductions in distress associated with nightmares during the following night. Exploratory analyses showed that sex (men vs. women) moderated the bi-directional relationships between night-time sleep and day-time PTSD symptoms with longer sleep onset latency and lower sleep efficiency being related to worse PTSD symptoms the next day in women, but was not associated with men. [ABSTRACT FROM AUTHOR]

Moral injury is an emerging concept that captures the psychosocial consequences of involvement in and exposure to morally transgressive events. In the past decade, research on moral injury has grown exponentially. In this special collection we review papers on moral injury published in the European Journal of Psychotraumatology from its inception until December 2022, that have a primary focus on moral injury as evidenced by the words 'moral injury' in the title or abstract. We included 19 papers on quantitative (n = 9) and qualitative (n = 5) studies of different populations including (former) military personnel (n = 9), healthcare workers (n = 4) and refugees (n = 2). Most papers (n = 15) focused on the occurrence of potentially morally injurious experiences (PMIEs), moral injury and associated factors, while four papers primarily concerned treatment. Together, the papers offer a fascinating overview of aspects of moral injury in different populations. Research is clearly widening from military personnel to other populations such as healthcare workers and refugees. Focal points included the impact of PMIEs involving children, the association of PMIEs and personal childhood victimisation, the prevalence of betrayal trauma, and the relationship between moral injury and empathy. As for treatment, points of interest included new treatment initiatives as well as findings that PMIE exposure does not impede help-seeking behaviour and response to PTSD treatment. We further discuss the wide range of phenomena that fall under moral injury definitions, the limited diversity of the moral injury literature, and the clinical utility of the moral injury construct. From conceptualisation to clinical utility and treatment, the concept of moral injury matures. Whether or not moral injury becomes a formal diagnosis, the need to examine tailored interventions to alleviate moral injury is clear. Moral injury is increasingly studied outside military populations, such as in healthcare workers and refugees. Among the most impactful potentially morally injurious experiences (PMIEs) are those involving children, but betrayal trauma may be the most prevalent type of PMIE. There is a need for tailored, evidence-based interventions to alleviate moral injury. [ABSTRACT FROM AUTHOR]

Despite high rates of traumatic experiences reported among Hispanic/Latino/a immigrants in the U.S., the effect of post‐traumatic stress on parenting stress among Hispanic/Latino/a immigrant parents with young children has been overlooked. The present study tested the direct and indirect relationships of self‐reported maternal post‐traumatic stress symptoms on parenting stress, and the mediating role of protective factors among Hispanic/Latino/a mothers with young children. Baseline data collected from mothers participating in a community‐based child‐parent dyadic intervention were analyzed. Measures included the post‐traumatic stress disorder (PTSD) Checklist, the Protective Factors Survey, and the Parenting Stress Index‐Short Form (PSI). The sample included 80 mothers with a child between ages 0–6 years. About 75% of these mothers were migrants from Central America. A multivariate regression analysis showed that maternal post‐traumatic stress symptoms predicted higher levels of PSI, and two protective factors (social support and family functioning/resilience) fully mediated the relationship between maternal post‐traumatic stress symptoms and PSI. Higher social support and family functioning/resiliency may have protective effects on Hispanic/Latino/a mothers with post‐traumatic stress, leading to lower levels of stress related to parenting. Findings underscore the importance of interventions that enhance access to social support and promote family functioning/resilience for Hispanic/Latino/a immigrant mothers with trauma histories to cope better with parenting stress. [ABSTRACT FROM AUTHOR]

In very rare cases, individuals survive the atrocities of abduction, imprisonment and torture that are part of the hallmark of enforced disappearances. Cases of people who survive torture and seek asylum in a third country help us understand some important aspects related to the crime of enforced disappearance. In the psychotherapy of torture survivors, at an early stage and for a long time, words often do not convey the core of the patient's experience. Survivors usually have tormented bodies in which individual and collective violence, hatred, anger, guilt and shame are painfully inscribed. Corporeal countertransference becomes the only possible way for a therapist to get in touch with a survivor's experience through a kind of body‐to‐body communication. The centrality of the body in these therapies suggests that the body is the involuntary recipient and container of mass political atrocities and, for this reason, the place where, in the case of horrific social violence, the possibility of social "knowing" is stored and can be retrieved. Thus, when it comes to forced disappearance, the determination of the relatives to get to the truth through the discovery of the remains of their disappeared demonstrates the importance of the body as the final witness of what happened, beyond any possible manipulation. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Analytical Psychology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

目的 探讨一体化急救结合院内预见性护理干预模式在严重创伤患者救治中的应用效果。 方法 选取2018年5月至2020年6月由该院负责急救的严重创伤患者52例,将其分为对照组(2018年5月 至2019年5月)和观察组(2019年6月至2020年6月),各26例。对照组采用传统创伤急救模式,观察组采用 一体化急救结合院内预见性护理干预模式,比较2组时间效能、创伤严重度评分(ISS评分)、循环-呼吸-腹部-运 动-语言(CRAMS)评分及并发症发生率。结果 观察组完成检查时间、急诊至手术时间、有效救治时间均短于 对照组,差异有统计学意义(P<0.05)。2组急救前ISS、CRAMS 评分比较,差异无统计学意义(P>0.05)。2 组急救后ISS、CRAMS 评分优于急救前,差异有统计学意义(P<0.05)。观察组急救后ISS评分显著低于对照 组, CRAMS 评分显著高于对照组,差异有统计学意义 (P<0.05)。2组并发症发生率比较,差异有统计学意义 (P<0.05)。结论 在严重创伤患者救治过程中,采用一体化急救结合院内预见性 护理干预模式有利于缩短救 治时间,改善患者创伤程度,降低并发症发生率。 [ABSTRACT FROM AUTHOR]

Posttraumatic stress symptoms are prominent in the lives of parents of young children with substance use disorders (SUD). Parenting experiences, particularly stress and competence, impact parenting behaviors and concomitant child growth and development. Factors that promote positive experiences of parenting, such as parental reflective functioning (PRF), and protect the mother and child from negative outcomes are crucial to understand to develop effective therapeutic interventions. The current US study analyzed baseline data from a parenting intervention evaluation to examine how length of substance misuse, PRF, and trauma symptoms were associated with parenting stress and parenting sense of competence among mothers in treatment for SUDs. Measures included the Addiction Severity Index, PTSD Symptom Scale‐Self Report, Parental Reflective Functioning Questionnaire, Parenting Stress Index/Short Form, and Parenting Sense of Competence Scale. The sample included 54 predominantly White mothers with SUDs who had young children. Two multivariate regression analyses found that (1) lower parental reflective functioning and higher posttraumatic stress symptoms were associated with higher parenting stress, and (2) only higher posttraumatic stress symptoms were associated with lower levels of parenting sense of competence. Findings underscore the importance of addressing trauma symptoms and PRF when aiming to improve parenting experiences for women with an SUD. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Foreign Literature Studies is the property of Foreign Literature Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Sexual and physical abuse have been associated with long-term systemic alterations such as low-grade inflammation and changes in brain morphology that may be reflected in the metabolome. However, data on the metabolic consequences of sexual and physical abuse remain scarce. Objective: This pilot study sought to investigate changes in the metabolite profile related to sexual and physical abuse in depressed adolescent psychiatric outpatients. Method: The study included 76 patients aged 14–18 years, whose serum samples were analysed with a targeted metabolite profiling methodology. We estimated the associations between metabolite concentrations and the Trauma and Distress Scale (TADS) Sexual and Physical Abuse factor scores using three linear regression models (one unadjusted and two adjusted) per metabolite and trauma type pair. Additional variables in the two adjusted models were 1) the lifestyle indicators body mass index, tobacco use, and alcohol use, and 2) depression scores and the chronicity of depression. Results: TADS Sexual Abuse scores associated positively with homogentisic acid, as well as cystathionine, and negatively with choline in linear regression analysis, whereas TADS Physical Abuse scores associated negatively with AMP, choline, γ-glutamyl cysteine and succinate, and positively with D-glucuronic acid. Conclusions: This pilot study did not include a healthy control group for comparison and the cohort was relatively small. Nevertheless, we observed alterations in metabolites related to one-carbon metabolism, mitochondrial dysfunction, oxidative stress, and inflammation in depressed patients with a history of sexual or physical abuse. Metabolomic profiles associate with sexual or physical abuse. Metabolites relate to mitochondria, one-carbon, oxidative stress, and inflammation. Metabolomics a possible tool for precision psychiatry in the future. [ABSTRACT FROM AUTHOR]

Background: How do we remember what happened shortly before a traumatic experience? There has been little focus on the temporal context of trauma memories, but a few studies suggest that aspects of what happened in the moments prior to a traumatic experience may be selectively enhanced and prioritized in memory. Objective: The main aim of this study was to investigate the occurrence, nature, and content of voluntary memories about what happened shortly before a disaster. The participants were individuals who had survived a fire on the passenger ferry Scandinavian Star 26 years earlier. Methods: Data collection took the form of face-to-face interviews. The analysis was carried out in two steps. First, all the narratives from participants who were aged 7 years or older at the time of the fire (N = 86) were coded in terms of the presence of detailed descriptions of what happened before the fire. Next, the narratives that included detailed descriptions of the moments before (N = 28) were included in a thematic analysis, focusing on coding the mode and the content. Results: More than one-third of the participants reported detailed accounts of what happened in the hours, minutes, or seconds before the fire. These memories included detailed descriptions of sensory impressions, dialogues, actions, and thoughts. Two themes stood out in the thematic analysis: (1) unusual observations and danger cues; and (2) counterfactual thoughts. Conclusion: The finding that specific details from the moments before a traumatic event may be vividly recalled indicates that peripheral details of traumatic events can be prioritized in memory. Such details may be interpreted as warning signals. Future research should examine whether such memories might stimulate long-standing thoughts of the world as being dangerous, and hence carry the threat forward in time. A qualitative study exploring the occurrence, nature, and content of memories about what happened shortly before a disaster. For some trauma survivors, experiences or observations shortly before a traumatic event can be vividly recalled in detail, after more than two decades. Such detailed memories of what happened before a traumatic experience may be interpreted as warning signals; furthermore, they may stimulate long-standing thoughts of the world as dangerous, thus carrying the threat forward in time. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic stress disorder (PTSD) is the clinical manifestation of traumatic events and is associated with sleep disturbances. Sleep disturbances, if left untreated, may perpetuate or even worsen symptoms of PTSD. Previous studies of other PTSD populations show a higher incidence of sleep impairments and sleep disorders compared to healthy controls (HCs); however, this has never been investigated in trauma-affected refugees diagnosed with PTSD. Objectives: To examine subjective sleep quality, measure sleep architecture, and identify latent sleep disorders in refugees diagnosed with PTSD compared to HCs. Method: This comparative study included 20 trauma-affected refugees diagnosed with PTSD and 20 HC matched on age, sex, and body mass index. All participants completed self-report questionnaires assessing sleep quality, insomnia severity, and disturbing nocturnal behaviour, and all took part in a one-night polysomnography (PSG) assessment. Results: Patients reported significantly poorer subjective sleep quality, sleep latency, sleep duration, and sleep efficiency compared to HCs. Subjective reports on hours spent in bed were not significantly different between patients and HCs. Patients reported significantly higher nightmare frequency and severity compared to HCs. PSG measures showed that patients had significantly reduced sleep efficiency, more awakenings, and longer REM sleep latency, and spent more time awake, whereas there was no significant differences regarding total time in bed, total sleep time, or sleep latency. The prevalence of sleep disorders was equal between groups. Conclusions: The study identified significant impairments in several sleep domains, with a preponderance of disturbed regulation of sleep resulting in awakenings. These results indicate a need for more focus on hyperarousal and nightmares as key elements of disturbed sleep in PTSD. Furthermore, the study identified a discrepancy between subjective and objective measures concerning total sleep time, raising questions regarding the causes of 'sleep state misperception'. Trial registration: ClinicalTrials.gov identifier: NCT03535636.. Trial registration: Sleep Impairments in Refugees Diagnosed with PTSD (PSG-PTSD). URL: . ClinicalTrials.gov NCT03535636. Date of registration: 24/05/2018. This is the first study assessing sleep impairments and sleep disorders in refugees diagnosed with post-traumatic stress disorder (PTSD) compared to healthy controls. The main finding is that both subjectively and objectively measured sleep is disrupted in refugees diagnosed with PTSD compared to healthy controls. The results suggest that these disturbances of sleep are significant targets in treatment of PTSD and stress the importance of focusing on treatment of sleep disturbances in PTSD. [ABSTRACT FROM AUTHOR]

Background: Social support is an important feature in understanding posttraumatic stress disorder (PTSD) and its treatment. Non-clinical research has identified distinct profiles of culturally appropriate social support. Despite this, little research has examined cultural influences on social support in the context of PTSD. Objective: This study examined cultural differences in the associations between social support and symptoms of PTSD. Method: The study employed a cross-sectional design. Australian (n = 91) and Malaysian (n = 91) trauma survivors completed an online survey assessing PTSD symptomatology and social support (explicit and implicit social support, perceived helpfulness of support provider, attitudes towards professional help-seeking). A quasi-experimental paradigm assessed the influence of mutual (i.e. the sharing of support between relationship partners) and non-mutual support (i.e. where one person constantly receives support, while the other person constantly provides support) on negative emotion and subjective distress. Results: First, explicit social support was negatively associated with PTSD symptoms for the Australian group but not the Malaysian group. Second, perceived helpfulness of support from family was negatively associated with PTSD symptoms for the Malaysian group but not the Australian group. Third, the Malaysian group reported significantly greater distress for non-mutual support and significantly fewer negative emotions and distress for mutual support than the Australian group. Fourth, the Malaysian group reported that they were significantly more open to acknowledging psychological problems and the possibility of seeking professional help for these problems than the Australian group. Conclusions: As the PTSD social support literature continues to evolve, it is essential that cultural influences are considered given the important theoretical and clinical implications. Social support is an important feature in understanding posttraumatic stress disorder (PTSD). While non-clinical research has identified distinct profiles of culturally appropriate social support, little research has examined cultural influences on social support in the context of posttraumatic stress disorder. Disclosing the trauma to others and explicating requesting assistance was negatively associated with PTSD symptoms for the Australian group but not the Malaysian group. Support from family was negatively associated with PTSD symptoms for the Malaysian group but not the Australian group. The Malaysian group reported significantly greater distress for non-mutual support and significantly less negative affect and distress for mutual support than the Australian group. As the psychotraumatology literature continues to evolve, it is essential that cultural influences on social support are considered given the important theoretical and clinical implications. [ABSTRACT FROM AUTHOR]

Background: Validation of post-traumatic stress disorder (PTSD) screening tools across various populations to ensure accurate PTSD estimates is important. Because of the high symptom overlap between PTSD and pain, it is particularly important to validate PTSD screening tools in trauma-exposed chronic pain patients. Objective: The present study is the first seeking to validate the PTSD Checklist for DSM-5 (PCL-5) in a sample of trauma-exposed, treatment-seeking chronic pain patients. Method: The validation and optimal scoring of the PCL-5 were investigated using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) in chronic pain patients exposed to traffic or work-related traumas (n = 84). Construct validity was investigated using confirmatory factor analyses testing six competing DSM-5 models in a sample of mixed trauma-exposed chronic pain patients (n = 566), and a subsample of chronic pain patients exposed to traffic or work-related trauma only (n = 202). Furthermore, concurrent validity and discriminant validity were investigated using correlation analysis. Results: The results showed moderate (κ =.46) diagnostic consistency between the PCL-5 and the CAPS-5 using the DSM-5 symptom cluster criteria, and the overall accuracy of the scale (area under the curve =.79) was highly acceptable. Furthermore, the Danish PCL-5 showed excellent construct validity both in the full sample and in the subsample of traffic and work-related accidents, with superior fit of the seven-factor hybrid model. Excellent concurrent validity and discriminant validity were also established in the full sample. Conclusion: The PCL-5 appears to have satisfactory psychometric properties in trauma-exposed, treatment-seeking chronic pain patients. The present study is the first seeking to validate the PCL-5 using the CAPS-5 in chronic pain patients following traffic and work-related injury. The results showed moderate diagnostic consistency and acceptable overall accuracy using the DSM-5 criteria. Excellent construct, concurrent, and discriminant validity was established in chronic pain patients following mixed traumatic exposure and traffic and work-related trauma only. [ABSTRACT FROM AUTHOR]

Background: International research has established that children and adolescents are at risk for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined by the WHO ICD-11. There is a need for a Danish language version of the International Trauma Questionnaire – Child and Adolescent (ITQ-CA) to assess symptoms of PTSD and CPTSD. Objective: To test the ICD-11 formulations of PTSD and DSO (Disturbances of Self-Organization) using the ITQ-CA version in a sample of children exposed to abuse. Additionally, to study the distribution of symptoms and probable prevalence of ICD-11 PTSD and CPTSD among the population of children exposed to violence or sexual abuse. Method: Confirmatory factor analysis of competing models of the dimensionality of the ITQ-CA was tested among a sample of 119 children and adolescents that were referred to the Danish Children Centres on suspicion of physical or sexual abuse or both. Latent class analysis (LCA) was used to study the distribution of symptoms and consequences of different operationalisations of functional impairment were explored. Results: Findings supported a two-factor second-order model corresponding to the operationalisation of CPTSD in ICD-11 as the best representation of the data. Findings from the LCA suggested that symptoms were distributed in a pattern consistent with the ICD-11 proposal for CPTSD. CPTSD was more prevalent than PTSD regardless of the operationalisation of functional impairment. Conclusion: ITQ-CA is a valid tool for identifying symptoms of ICD-11 PTSD and CPTSD among Danish children exposed to physical or sexual abuse. Further research is needed to study the relationship between ICD-11 C/PTSD symptomatology and anxiety and depression in this population. The International Trauma Questionnaire – Child and Adolescent version (ITQ-CA) is a valid measure of symptoms of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD among Danish children exposed to physical or sexual violence. The structure of the ITQ-CA in the Danish sample reflects the ICD-11 diagnostic algorithm. CPTSD is a more prevalent disorder among children recently exposed to violence than PTSD. [ABSTRACT FROM AUTHOR]

Background: The 2022 War in Ukraine has significantly affected the psychological well-being and daily lives of people in many countries. Objective: Two aims of this transnational study were (1) to compare psychological distress and coping strategies among people living in Ukraine, Poland, and Taiwan, (2) to examine whether the associations between various coping strategies (ie. problem-focused coping, emotion-focused coping, and avoidance) and psychological distress (ie. depression, anxiety, stress, posttraumatic stress disorder symptoms, and hopelessness about the ongoing war) differed among people of various countries during the initial stage of the 2022 War in Ukraine. Method: In total, 1,598 participants (362 from Ukraine, 1,051 from Poland, and 185 from Taiwan) were recruited using an online advertisement to complete online survey questionnaires, including the Brief Coping Orientation to Problems Experienced inventory; the 21-item Depression, Anxiety and Stress Scale; the Impact of Event Scale-Revised; and a questionnaire devised to assess the level of hopelessness about the ongoing war. Results: Psychological distress and adoption of coping strategies differed across people of various countries. Among Taiwanese and Polish respondents, avoidant coping strategies were most strongly associated with all categories of psychological distress compared with problem- and emotion-focused coping strategies. However, the associations of various coping strategies with psychological distress differed to a less extent among Ukrainian respondents. In addition, problem- and emotion-focused coping strategies had comparable associations with psychological distress among the people of Ukraine, Poland, and Taiwan. Conclusions: The 2022 War in Ukraine has affected the psychological well-being of people, especially the Ukrainians. Because of the strong association between the adoption of avoidance coping strategies and psychological distress, despite a less extent among Ukrainian respondents, adaptive coping strategies such as (problem- and emotion-focused) are suggested to help people during times of war. The 2022 War in Ukraine affected the psychological well-being in Ukraine and elsewhere. Compared with problem- and emotion-focused coping strategies, avoidant coping strategies had stronger association with psychological distress, but it varied among different cultures. [ABSTRACT FROM AUTHOR]