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Background: Little peer-reviewed research has been done on trauma exposure, Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) prevalence among Greenlandic children and adolescents. There is a need for a validated Greenlandic version of the International Trauma Questionnaire – Child and Adolescent version (ITQ-CA) to assess symptoms of ICD-11 PTSD and CPTSD, as well as investigations of the prevalence of these disorders. This information is imperative in a Greenlandic context, where general epidemiological knowledge on traumatic exposure and reactions is lacking.Objective: The present study examined the factor structure of the Greenlandic ITQ-CA, estimated the prevalence of trauma exposure, ICD-11 PTSD and CPTSD, and examined the relationship between potentially traumatic events (PTEs), PTSD, CPTSD, and demographic variables in a Greenlandic adolescent population.Method: Confirmatory factor analysis of competing models of the dimensionality of the ITQ-CA was tested among Greenlandic adolescents (N = 704) aged 11–17 years (M = 13.4, SD = 1.77). Using the ITQ-CA, PTSD and CPTSD was assessed.Results: Findings supported the factorial validity of the Greenlandic ITQ-CA although factor structure differed across boys and girls. A total of 82.8% of the adolescents had been directly exposed to at least 1 PTE (M = 3.2), and 57.0% had been indirectly exposed (M = 3.1). The estimated prevalence of PTSD and CPTSD was 7.8% and 8.5%, while an additional 13.9% and 7% reached subclinical levels. Older age, female gender, several different and cumulative PTEs significantly elevated the risk of PTSD and CPTSD.Conclusion: ITQ-CA is a valid tool for identifying symptoms of ICD-11 PTSD and CPTSD. Results indicate that type and quantity of direct traumatic exposure are important predictors of PTSD and CPTSD. Events not normally considered traumatic as well as non-interpersonal events are significantly associated with CPTSD symptoms.

Background: International research has established that children and adolescents are at high risk for being exposed to violence. A systematic review published in 2023 recommended six child and adolescent self-report violence against children (VAC) measures, based on their psychometric properties, in a systematic COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) review. However, the degree of overlap and heterogeneity was not part of the analysis.Objective: To compare the six measures with respect to item overlap and differences concerning specification of exposure dimensions.Method: A content analysis of the original 174 items resulted in a reduction to 38 unique items. These items were organized visually in a co-occurrence circle using an adapted version of Fried’s R code. Furthermore, a pairwise comparison of event lists was performed using the Jaccard index.Results: There was a modest overlap among the six measures. Only one item was present in all six measures, only two items were present in four measures, and 78% of the items were present in just one or two measures. The overall overlap between the six measures was 25%.Conclusions: The lack of overlap among measures reflects a heterogeneity of definitions and purposes. It also impedes progress in research, as comparisons between various studies are difficult to make in a valid and reliable way. The lack of consensus also delays efficient political initiatives, because solid, consensual knowledge about the prevalence of VAC does not exist.

Intimate partner violence (IPV) is a public health issue throughout the world, and it can have many severe and lifelong sequelae for its victims. Women from ethnic minority groups experience and report more IPV than ethnic Danish women. In shelters, the former group have a higher occurrence of post-traumatic stress than Danish women. The study analyses the reasons women choose to stay or leave abusive relationships using Lacan’s discourse analysis using five Arab and three Danish women who tell and reflect upon their gender roles, their attitudes and beliefs, their concrete experiences, their backgrounds, their religion, the family relations, and social forces. A deeper understanding of what is at stake for these women will hopefully help professionals to listen to the women and to explore the many profound dilemmas that many of these minority women suffer.

IntroductionSocial support is considered an important factor in prevention of mental illness. However, little is known about the association between ambulance personnel’s use of multiple types of social support and post-traumatic stress symptoms (PTSS). This study aims to assess if number of used social support types predicts PTSS for ambulance personnel. Apart from assessing the main effect of social support utilization, we were interested in investigating if social support utilization moderated the effect of frequency of critical events on PTSS.Materials and methodsA total of 383 ambulance personnel completed a survey consisting of validated questionnaires. Hierarchical multiple linear regression analyses were performed to assess the association between frequency of traumatic exposure and utilization of social support and PTSS as outcome variable.ResultsHigher number of utilized social support types was associated with higher levels of PTSS (β = 0.15, p

ABSTRACTBackground: 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

Abstract Background Adolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms. Methods We analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes’ procedures (2008). Results Immature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters. Conclusions Maladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.

Exposure to adverse childhood experiences (ACEs) is related to higher morbidity and mortality among adolescents. The present study analyzed the independent and cumulative effects of ACE exposure on the likelihood of PTSD and a CPSTD diagnosis in Ugandan adolescents. A sample of 401 schoolchildren participated in the study. The primary aim was to collect information on ACEs, PTSD, CPTSD, and attachment styles among adolescents living in different countries. It was found that exposure to 2–3 ACEs and exposure to 4–5 ACEs were significantly associated with PTSD diagnosis, while exposure to sexual abuse, bullying, threats of violence, and near-drowning were significantly related to CPTSD diagnosis. Fearful attachment style was significantly associated with PTSD diagnosis. The results propose that biological, psychological, and social issues interact and contribute to the differential prevalence of ACE, attachment styles, and PTSD/CPTSD. This study underscores the importance of addressing childhood-averse and traumatic experiences as a public health priority in Uganda.

Danish prosecutors report exposure to negative acts from professional counterparts in courtrooms, which is associated with an increased risk of burnout. However, knowledge of the characteristics of these acts is limited. Based on existing theoretical frameworks, this study aims to characterize these negative acts. A nation-wide survey of Danish prosecutors (response rate: 81%) yielded 687 descriptions of experiences with negative acts from professional counterparts from a career perspective. These were analyzed using theory-directed content analysis based on the Stress-as-Offense-to-Self (SOS) theory by Semmer and colleagues and Cortina and colleagues’ characterization of incivility in American courtrooms. We identified a total of 15 types of behavior within the three main themes: illegitimate tasks (n = 22), illegitimate stressors (n = 68), and illegitimate behavior (n = 612). Tentative differences in the distribution of experienced negative acts from a career perspective were found for gender and seniority. Women reported negative acts more frequently than men, and assistant prosecutors reported verbal abuse more frequently than senior prosecutors, who, conversely, more often reported a perceived lack of court management. More prospective research is needed on negative acts experienced by prosecutors to assess the scope of these in Danish courtrooms and how they impact the risk of burnout.

ABSTRACTThe Strengths and Difficulties Questionnaire (SDQ) is a brief screening questionnaire of child behaviour, used to evaluate mental health. It is applicable for children 2–17 years, available to both parents and professionals, and exists in a self-report version available from the age of 11 years. This paper aims to generate Greenlandic norms on the self-report and parent-report versions of the SDQ. In 2023, the self-report version was translated, and a representative sample of children and adolescents completed the SDQ (N = 641). In 2008, the parent-report version was translated into Greenlandic and used in a study of children’s well-being (N = 939). Data from both samples were analysed, generating normative scores. Results show significant differences between genders (effect sizes of .006-.145), and discrepancies between parent and self-report. Parents report higher total problems for boys, while self-reporting indicate higher total problems for girls. Cut-off values are higher for self-report norms than parent-report norms. Mean scores on the SDQ total score and subscales differ across age, area of living, caregiver constellation and caregiver’s educational level (effect sizes of .011–.064). With the availability of Greenlandic norms, we anticipate further use of the SDQ in clinical practice and research settings, strengthening screening and assessment of children and adolescents.

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

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.

Background: Children with disabilities are at heightened risk of violence compared to their non-disabled peers. However, extant research suffers from several limitations, focusing on child abuse and one or few types of disability, ignoring conventional violent crimes. Objective: The aim was to assess 10 disabilities and to examine whether different disabilities vary in their risk of criminal victimization. Method: Using the Danish Psychiatric Case Register, the Criminal Register, and other population-based registers, we included nine birth cohorts (n = 570,351) and followed them until 18 years of age. We compared children exposed to violence with non-exposed children. We estimated odds ratios (ORs) for the disabilities and adjusted the ORs for several risk factors. Results: We identified 12,830 cases of reported violence (2.25% of the population) towards children and adolescents. Children with disabilities were overrepresented, as were boys and ethnic minorities. After controlling for risk factors, four disabilities had heightened risk for criminal violence: attention-deficit hyperactivity disorder (ADHD), brain injury, speech, and physical disabilities. When we compared risk factors controlling for the various disabilities, parental history of violence, family break-up, out-of-home placement, and parental unemployment contributed especially to the violence, while parental alcohol/drug abuse was no longer a predictor. Having several disabilities increased the risk of violence. Conclusions: Criminal victimization of children and adolescents with specific disabilities was common. However, compared to the previous decade, a considerable reduction of one-third has taken place. Four risk factors contributed particularly to the risk of violence; therefore, precautions should be taken to further reduce the violence.

Background: The ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD diagnoses have been examined in several studies using the International Trauma Questionnaire (ITQ). The cross-cultural validity of the ITQ has not previously been studied using item responses theory methods focused on the issue of equal item functioning and thus comparability of scores across language groups. Objective: To investigate the cross-cultural validity of the ITQ scales considering specifically local independence of items and differential item functioning (DIF) in a cross-cultural sample of refugees. Method: Data from 490 treatment-seeking refugees were included, covering Danish, Arabic, and Bosnian languages and different levels of interpreter-assisted administration. Rasch and graphical log-linear Rasch models were used. Results: There was strong local dependence among items from the same symptom clusters in the PTSD and disorders in self-organization (DSO) scales, except between affective dysregulation items. Weak local dependence was discovered between an item from the affective dysregulation cluster and an item from the disturbed relationship cluster. There was no evidence of DIF related to language or interpreter assistance. There was evidence of DIF for two PTSD items relative to gender and time since the traumatic event. The targeting of the scales to the study population was not optimal. Reliability varied from 0.55 to 0.78 for subgroups. Conclusions: The PTSD and the DSO scales have stable psychometric properties across the Danish, Arabic, and Bosnian language versions and different levels of assisted administration. Scores are comparable across these groups. However, DIF relative to gender and time since trauma introduces considerable measurement bias. DIF-adjusted summed scale scores or estimated person parameters should be used to avoid measurement bias. Future research should investigate whether scales including more and/or alternative items that require higher levels of PTSD and DSO to be endorsed will improve targeting and measurement precision for refugee populations.

ABSTRACTBackground: Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking.Objectives: This systematic review and meta-analysis aimed to evaluate associations between exposure to ACEs and chronic pain and pain-related disability in adults.Methods: We searched 10 electronic databases from inception to February 2023. We included observational studies assessing associations between direct ACEs (childhood sexual, physical, emotional abuse, or neglect) alone or in combination with indirect ACEs (witnessing domestic violence, household mental illness), and adult chronic pain (≥3 months duration) and pain-related disability (daily activities limited by chronic pain). Pairs of reviewers independently extracted data and assessed study risks of bias. Random-effect models were used to calculate pooled adjusted odds ratios [aOR]. Tau square [T2], 95% prediction intervals [95%PI] and I2 expressed the amount of heterogeneity, and meta-regressions and subgroup meta-analyses investigated sources of heterogeneity (PROSPERO: CRD42020150230).Results: We identified 85 studies including 826,452 adults of which 57 studies were included in meta-analyses. Study quality was generally good or fair (n = 70). The odds of reporting chronic pain in adulthood were significantly higher among individuals exposed to a direct ACE (aOR, 1.45, 95%CI, 1.38–1.53). Individuals reporting childhood physical abuse were significantly more likely to report both chronic pain (aOR, 1.50, 95CI, 1.39–1.64) and pain-related disability (1.46, 95CI, 1.03–2.08) during adulthood. Exposure to any ACEs alone or combined with indirect ACEs significantly increase the odds of adult chronic painful conditions (aOR, 1.53, 95%CI, 1.42–1.65) and pain-related disability (aOR, 1.29; 95%CI, 1.01–1.66). The risk of chronic pain in adulthood significantly increased from one ACE (aOR, 1.29, 95%CI, 1.22–1.37) to four or more ACEs (1.95, 95%CI, 1.73–2.19).Conclusions: Single and cumulative ACEs are significantly associated with reporting of chronic pain and pain-related disability as an adult.

Abstract Background Sexual assault and rape are the traumatic life events with the highest probability for posttraumatic stress disorder (PTSD), which can have devastating consequences for those afflicted by the condition. Studies indicate that modified prolonged exposure (mPE) therapy may be effective in preventing the development of PTSD in recently traumatized individuals, and especially for people who have experienced sexual assault. If a brief, manualized early intervention can prevent or reduce post-traumatic symptoms in women who have recently experienced rape, healthcare services targeted for these populations (i.e., sexual assault centers, SACs) should consider implementing such interventions as part of routine care. Methods/design This is a multicenter randomized controlled add-on superiority trial that enrolls patients attending sexual assault centers within 72 h after rape or attempted rape. The objective is to assess whether mPE shortly after rape can prevent the development of post-traumatic stress symptoms. Patients will be randomized to either mPE plus treatment as usual (TAU) or TAU alone. The primary outcome is the development of post-traumatic stress symptoms 3 months after trauma. Secondary outcomes will be symptoms of depression, sleep difficulties, pelvic floor hyperactivity, and sexual dysfunction. The first 22 subjects will constitute an internal pilot trial to test acceptance of the intervention and feasibility of the assessment battery. Discussion This study will guide further research and clinical initiatives for implementing strategies for preventing post-traumatic stress symptoms after rape and provide new knowledge about which women may benefit the most from such initiatives and for revising existing treatment guidelines within this area. Trial registration ClinicalTrials.gov NCT05489133. Registered on 3 August 2022

Abstract Introduction Employees working at psychiatric wards are at risk for work-related threats and violence that may impact their physical and mental health. Studies have found that crisis social support may mitigate these adverse health effects. Purpose To examine the effects crisis social support on depressive symptoms 3 months after a violent or threating work incident and furthermore, to examine the effect of variations in prolonged social support on depressive symptoms during 3 months after a violent or threating incident. Methodology After exposure to work-related violence and threats at work, the employees received a questionnaire within the first month and after 3 months. Right after the incident, 374 employees answered both the depression and crisis support items and were included in the analyses. 3 months later 276 employees answered both the depression and social support items. Prospective associations between crisis social support and depression were calculated using stepwise regressions and linear mixed models. Results Crisis social support at T1 was significantly and inversely associated with a lower level of depressive symptoms at T2, Std. Beta = − 012, t (3) = − 2.1, p = .040. Employees experiencing either a stable or increasing level of support from T1 to T2 had significantly lower levels of depressive symptoms compared to employees who experienced a decrease in support in the same period, mean differenceStable–Decreasing = 4.0 t (190) = 5.2, p = 0.006 and mean differenceIncreasing–Decreasing = 7.6, t (189) = 5.3, p

Background: Although it is well-established that people can experience multiple traumatic events, there are few studies examining the co-occurrence of such experiences in non-Western nations. The current study sought to examine the occurrence of multiple potentially traumatic experiences (PTEs) and their associations with posttraumatic stress disorder (PTSD) among adolescents from two Asian nations. Methods: Latent class analysis (LCA) was employed to model the co-occurrence of PTEs in two school samples of adolescents from India (n = 411) and Malaysia (n = 469). Demographic correlates (i.e., sex, age, household composition, parent education) of the latent classes and the association between latent class membership and probable diagnosis of posttraumatic stress disorder (PTSD) were examined. Results: The LCA identified three latent classes for the Indian sample: ‘Low Risk – moderate sexual trauma’, ‘Moderate Risk’, and ‘High Risk’. Similarly, three classes were also identified for the Malaysian sample: ‘Low Risk’, ‘Moderate Risk’, and ‘High Risk’. Membership of ‘Moderate Risk’ was associated with male sex in both samples, and with older age and lower levels of parental education attainment in the Malaysian sample. No correlates of ‘High Risk’ class were identified in either sample. Membership of the ‘High Risk’ class was significantly associated with probable PTSD diagnosis in both samples, while membership of the ‘Moderate Risk’ class was associated with probable PTSD diagnosis in the Malaysian sample. Conclusion: Findings from this study correspond with Western studies indicating co-occurrence of PTEs to be common and to represent a salient risk factor for the development of PTSD.

Introduction Police officers are frequently exposed to potentially traumatic events at work that increases risk of developing mental health problems, in particular post-traumatic stress disorder (PTSD). Individual and organisational factors may influence the detrimental effects of cumulative exposure to traumatic events. Occupational stress and lack of organisational support are associated with increased risk of PTSD among police officers. The Are You All right? (AYA) project is a prospective cohort study investigating the cumulative effect of traumatic events at work on mental health problems and absenteeism among police officers. The study also investigates whether potential risk and protective factors modify the association of traumatic events at work with mental health problems and absenteeism.Method and analysis The AYA-study includes the entire Danish police force. Prospective survey data are collected over a 3-year period beginning in the spring of 2021. Electronic surveys are sent out at baseline with 1-year, 2-year and 3-year follow-up. Further, short surveys are sent out every third month, covering exposure to traumatic events and current mental health status. The survey data are paired with workplace register data on sickness absence. Register data on sickness absence cover the period from 2020 to 2025.Ethics and dissemination This study was presented for evaluation at the National Ethics Committee in Denmark (reference number: 20202000-216), but according to Danish legislation, survey studies do not require approval by official Danish scientific or ethical committees. Participation in the project is based on informed consent, and data are handled in accordance with the Danish data legislation (journal number: 20/41457). Results are published in scientific journals and disseminated at international conferences.

Abstract Background A growing body of research highlights the pervasive harms of adverse childhood experiences (ACEs) on health throughout the life-course. However, findings from prior reviews and recent longitudinal studies investigating the association between types of ACEs and persistent pain have yielded inconsistent findings in the strength and direction of associations. The purpose of this review is to appraise and summarize evidence on the relationship between ACEs and persistent pain and disability outcomes in adulthood. The specific aims are (1) to determine whether there is a relationship between exposure to ACE and persistent pain and disability in adults and (2) to determine whether unique and cumulative ACEs exposures (number and type) increase the risk of developing persistent pain and disability in adulthood. Method A systematic review and meta-analysis of observational studies will be conducted. Our eligibility criteria are defined following a PECOS approach: population, adults with persistent (≥ 3 months) musculoskeletal and somatoform painful disorders exposed to single or cumulative direct ACEs alone (i.e., physical, sexual, emotional abuse or neglect) or in combination to indirect types of ACE (e.g., parental death, exposure to domestic violence) in the first 18 years of life; comparators, unexposed individuals; outcomes, measurements for persistent pain (≥ 3 months) and disability using discrete and/or continuous measures; and settings, general population, primary care. A comprehensive search of MEDLINE (Ovid) and nine other pertinent databases was conducted from inception to 29 August 2019 using a combination of key words and MeSh terms (the search will be updated prior to conducting the analyses). Pairs of reviewers will independently screen records and full text articles, and a third reviewer will be consulted in cases of disagreement. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Review Manager (RevMan) Version 5.3. The Scottish Intercollegiate Guidelines Network (SIGN) and the Joanna Briggs Institute (JBI) checklists will be used to assess the quality of the included studies. If heterogeneity is high, the findings will be presented in narrative form. Discussion The present review will help consolidate knowledge on persistent pain and disability by evaluating whether frequency and type of adverse childhood experiences produces the most harm. Findings may help inform practitioners and policy-makers who endeavor to prevent and/or mitigate the consequences of ACEs and promote healthy development and well-being of children, youth, and families. Systematic review registration PROSPERO CRD42020150230

[Background] Sex differences are widely reported in clinical psychology but are rarely examined in interventions. [Method] This mixed-method explorative study examined sex differences in 13 mothers and 10 fathers of children in the off-therapy phase of acute lymphoblastic leukaemia. Parents underwent an expressive writing intervention using the guided written disclosure protocol (GWDP). [Results] Mothers had more negative mood profiles than fathers but improved more during the intervention. [Conclusion] Though preliminary, our findings highlight the importance of sex as a potential moderator of intervention and treatment outcome that could be of great clinical significance.

Abstract Background/aim Psychological violence is estimated to be the most common form of intimate partner violence (IPV). Despite this, research on the independent effect of psychological violence on mental health is scarce. Moreover, the lack of a clear and consistent definition of psychological violence has made results difficult to compare. The present study therefore aims to consolidate knowledge on psychological violence by conducting a systematic review and random-effects meta-analysis on the association between psychological violence and mental health problems, when controlling for other types of violence (e.g. physical and sexual) and taking into account severity, frequency, and duration of psychological violence. Method The present study is registered in the International Prospective Register for Systematic Reviews (PROSPERO; #CRD42018116026) and the study design follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Additional file 1). A dual search will be conducted in the electronic databases PsycINFO, PubMed, EMBASE, and Web of Science. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Metafor-package in the programming language R. The Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project will be used to assess the quality of the included studies (i.e. weak, moderate and strong). Results and discussion The present review will help consolidate knowledge on psychological violence by evaluating whether frequency, severity or actual “type” of psychological violence produces the most harm. A thorough quality assessment will help overcome potential limitations regarding expected variations in terminology and assessment of psychological violence. Systematic review registration PROSPERO CRD42018116026.

BackgroundHistorically social connection has been an important way through which humans have coped with large-scale threatening events. In the context of the COVID-19 pandemic, lockdowns have deprived people of major sources of social support and coping, with others representing threats. Hence, a major stressor during the pandemic has been a sense of social disconnection and loneliness. This study explores how people's experience of compassion and feeling socially safe and connected, in contrast to feeling socially disconnected, lonely and fearful of compassion, effects the impact of perceived threat of COVID-19 on post-traumatic growth and post-traumatic stress.MethodsAdult participants from the general population (N = 4057) across 21 countries worldwide, completed self-report measures of social connection (compassion for self, from others, for others; social safeness), social disconnection (fears of compassion for self, from others, for others; loneliness), perceived threat of COVID-19, post-traumatic growth and traumatic stress.ResultsPerceived threat of COVID-19 predicted increased post-traumatic growth and traumatic stress. Social connection (compassion and social safeness) predicted higher post-traumatic growth and traumatic stress, whereas social disconnection (fears of compassion and loneliness) predicted increased traumatic symptoms only. Social connection heightened the impact of perceived threat of COVID-19 on post-traumatic growth, while social disconnection weakened this impact. Social disconnection magnified the impact of the perceived threat of COVID-19 on traumatic stress. These effects were consistent across all countries.ConclusionsSocial connection is key to how people adapt and cope with the worldwide COVID-19 crisis and may facilitate post-traumatic growth in the context of the threat experienced during the pandemic. In contrast, social disconnection increases vulnerability to develop post-traumatic stress in this threatening context. Public health and Government organizations could implement interventions to foster compassion and feelings of social safeness and reduce experiences of social disconnection, thus promoting growth, resilience and mental wellbeing during and following the pandemic.

Background: Psychological trauma has only recently been considered a traumatic event. Therefore, research on Posttraumatic Stress Disorder (PTSD) and Complex-PTSD following exposure to psychological violence, is less studied compared with physical and sexual violence. Objectives: This study aimed to establish the prevalence of PTSD and C-PTSD of among female victims of partner violence (IPV) and examine the unique association between different subtypes of IPV (i.e. physical, psychological and sexual IPV) and the traumatic response. Methods: The study includes a shelter-based sample of female victims of IPV (N = 147). Validated measures were used to estimate IPV exposure and mental health outcomes. Partial Correlation and Hierarchical Regression was used to examine the association between IPV and PTSD and C-PTSD, respectively. Results: The study found a high prevalence of both PTSD (56.5%) and C-PTSD (21.1%) in the sample. Overall, when controlling for the other types of violence, psychological violence correlated with PTSD, C-PTSD, negative affect and somatization. When controlling for psychological violence, neither physical nor sexual violence correlated with any of the mental health outcomes. Hierarchical regression models helped explain 23.5% and 29.7% of the variance in symptoms of PTSD and C-PTSD, respectively. Conclusion: A relatively large subgroup of the women had symptoms of C-PTSD, which demonstrate a potentially unmet need for trauma-informed treatment services in Danish Women Shelters. Psychological violence was found to be the strongest risk factor for all mental health outcomes and thus, it is important to acknowledge the severity of this IPV subtype.

Background: The 11th version of the International Classification of Diseases (ICD-11) revised the diagnosis of Posttraumatic Stress Disorder (PTSD) and introduced Complex PTSD as a sibling disorder to PTSD. As the Danish Health Authorities will implement the ICD-11 in 2022, it is more relevant than ever to introduce a measure that enables the identification of ICD-11 PTSD and CPTSD. Objective: The primary aim of the present study was to test the construct validity of the ICD-11 conceptualization of PTSD and DSO in five clinical samples using translated versions of the International Trauma Questionnaire (ITQ). Method: Data from existing studies of adult survivors of sexual abuse (n = 385), women in shelters (n = 147), psychiatric outpatients endorsing an ICD-10 diagnosis of PTSD (n = 111), a heterogenous sample of psychiatric outpatients (n = 178) and refugees and torture survivors (n = 385) was used for the current study. Confirmatory factor analyses were conducted to test the internal structure of the ITQ, and regression models were conducted to test the convergent and discriminant validity of the factor solutions for each sample. Results: Findings supported the ICD-11 formulation of PTSD and disorders in self-organization (DSO) as a representation of the latent structure of the ITQ across five Danish clinical samples. Uniquely for women in shelters, however, the model displayed an unacceptable fit. A revised operationalization of re-experiencing proved a better fit when ‘recurrent nightmares’ was exchanged with symptoms of intense emotional reactions to reminders of the trauma for women in shelter as well as ICD-10 PTSD psychiatric outpatients. Conclusion: This study supports the use of a Danish translated version of the ITQ to assess symptoms of ICD-11 PTSD and DSO for the introduction of ICD-11 in 2022. Future research is needed to further explore the operationalization of re-experiencing across different trauma exposed populations.

Background: The formulations of post-traumatic stress disorder (PTSD) and the newly included disorder complex PTSD (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11) have not been evaluated on a broad range of maladaptive personality traits. Objective: The aim of this study was to evaluate ICD-11 PTSD and CPTSD on maladaptive personality traits. Method: In a cross-sectional study of 106 Danish outpatients with ICD-10 PTSD, we used the International Trauma Questionnaire (ITQ) to identify patients with either ICD-11 PTSD or CPTSD (N = 84). We utilized the Personality Inventory for DSM-5 (PID-5) from the alternative model of personality disorders in DSM-5, section III, to evaluate personality trait differences between ICD-11 PTSD and CPTSD. Furthermore, PID-5 was also used to investigate relationships between personality traits and ICD-11 PTSD/CPTSD symptom clusters. The Life Event Checklist was used to assess traumatic experiences, and the MINI International Neuropsychiatric Interview was applied to assess comorbidity. Results: Patients with ICD-11 PTSD or CPTSD had elevated scores on personality traits indicative of internalizing psychopathology. However, higher impairment levels of the trait domains Negative Affectivity (d= 0.75) and Psychoticism (d = 0.80) discriminated patients with ICD-11 CPTSD from patients with PTSD. The PID-5 trait domain Detachment was moderately positively correlated to most of the ITQ symptom clusters and, the ITQ Negative Self-concept symptom cluster showed a relatively high number of significant correlations across all the PID-5 trait domains and facets. The PID-5 domain Negative Affectivity and almost all the encompassing facets were significantly correlated with DSO symptom clusters. Conclusions: The findings demonstrate the relevance of applying dimensional assessment of personality features to study the psychopathology of ICD-11 PTSD and CPTSD and potential differences. The results suggest that CPTSD is a more debilitating disorder than PTSD considering the severity of the personality features.

Background: Interpersonal violence is a pervasive global public health problem associated with myriad health, social and economic consequences. In recent years the rates of interpersonal violence have decreased, however, high numbers of individuals continue to present to emergency departments for non-fatal violence-related injuries. Objective: This study aimed to examine a range of risk factors associated with violence-related injuries in an emergency department in Denmark. Method: A case-control study was conducted on a sample of 3,940 victims of violence collected by the Accident Analysis Center for Aarhus County Municipality. Using the Danish Civil Registry System, controls were matched 10:1 on age, gender and municipality. Risk factors were rendered from Danish health and social registers five years prior to the violent assault. These included marital status, educational qualification, employment status, national origin, involvement with child protective services (CPS), prior convictions, and a diagnosis of adjustment disorder and alcohol and/or substance use disorders. Results: Multivariate logistic regression identified that being male, divorced, unmarried, non-Danish origin, attending compulsory education, being outside the labour force, students, involvement with CPS, prior criminal conviction and a diagnosis of alcohol and/or substance use disorders were associated with an increased likelihood of being exposed to violence. The dominant risk factors were alcohol and/or substance use disorders (OR = 3.62) and prior criminal conviction (OR = 3.54). Attainment of tertiary education was associated with a reduced likelihood of being a victim of violence. Conclusion: These findings highlight that research into effective interventions offered in emergency departments may help the public health effort to reduce the health, social and economic burden of interpersonal violence.

Background: The International Classification of Diseases (ICD-11) is currently under development with proposed changes recommended for the posttraumatic stress disorder (PTSD) diagnosis and the inclusion of a separate complex PTSD (CPTSD) disorder. Empirical studies support the distinction between PTSD and CPTSD; however, less research has focused on non-western populations. Objective: The aim of this study was to investigate whether distinct PTSD and CPTSD symptom classes emerged and to identify potential risk factors and the severity of impairment associated with resultant classes. Methods: A latent class analysis (LCA) and related analyses were conducted on 314 young adults from Northern Uganda. Fifty-one percent were female and participants were aged between 18 and 25 years. Forty percent of the participants were former child soldiers (n=124) while the remaining participants were civilians (n=190). Results: The LCA revealed three classes: a CPTSD class (40.2%), a PTSD class (43.8%), and a low symptom class (16%). Child soldier status was a significant predictor of both CPTSD and PTSD classes (OR=5.96 and 2.82, respectively). Classes differed significantly on measures of anxiety/depression, conduct problems, somatic complaints, and war experiences. Conclusions: To conclude, this study provides preliminary support for the proposed distinction between PTSD and CPTSD in a young adult sample from Northern Uganda. However, future studies are needed using larger samples to test alternative models before firm conclusions can be made.

Background: Every year a substantial number of children are affected by natural disasters worldwide. However, data are scarce on long-term psychological impact of natural disasters on children's health. Identifying risk factors and outcomes associated with the long-term sequelae of posttraumatic stress disorder (PTSD) can provide a gateway to recovery as well as enhancement of preventive measures. Objective: Among childhood avalanche survivors, we aimed to investigate risk factors for PTSD symptoms and the relationship between socioeconomic status (SES) and PTSD symptoms in adulthood. Methods: Childhood survivors (aged 2–19 at the time of exposure) of two avalanches were identified through nationwide registers 16 years later. The Posttraumatic Diagnostic Scale was used to assess current PTSD symptoms. One-way ANOVA was used to explore PTSD symptoms by background and trauma-specific factors, as well as associations with current SES. Predictors of PTSD symptoms were examined by multivariable regression analysis. Results: Response rate was 66% (108/163). Results from univariate ANOVA analysis revealed that female sex was associated with PTSD symptoms (F=5.96, p

Objective: The present study investigated the relationship between different types of childhood maltreatment (emotional, sexual, overall abuse, and no abuse) and the symptoms of attention deficit hyperactivity disorder (ADHD) in young adulthood. Method: Data were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4,718 young adults (24 years of age) were randomly selected using the total birth cohort of children born in 1984. Structured interviews were conducted with a response rate of 63%, equating to a total sample size of 2,980 participants. Results: Chi-square analyses revealed significant relationships between child maltreatment groups and a probable diagnosis of ADHD using the Adult ADHD Self-Report Scale (ASRS). Binary logistic regression analysis showed that the overall abuse class was more strongly associated with probable ADHD (OR=5.08), followed by emotional abuse (OR=3.09) and sexual abuse (OR=2.07). Conclusions: The results showed that childhood maltreatment was associated with increased risk of ADHD symptoms in young adulthood. The findings of this study are discussed within the existing literature and suggestions for future research are outlined in order to replicate these findings in other adult populations.

Background: The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment outcome. Objective: The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. Method: The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients’ past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed. Results: Overall, the total score of the CTP Predictor Index was significantly correlated to pre- to post treatment score changes on the majority of the ratings mentioned above. While employment status was the only single item significantly correlated to HTQ-score changes, a number of single items from the CTP Predictor Index correlated significantly with changes in depression and anxiety symptoms, but the size of the correlation coefficients were modest. Conclusions: The total score of the CTP Predictor Index correlated significantly with outcomes on most of the rating scales, but correlations were modest in size, possibly due to the number of different factors influencing treatment outcome.

Background: Childhood sexual abuse (CSA) is a common occurrence and a robust, yet non-specific, predictor of adult psychopathology. While many demographic and abuse factors have been shown to impact this relationship, their common and specific effects remain poorly understood. Objective: This study sought to assess the prevalence of Axis I disorders in a large sample of help-seeking victims of sexual trauma, and to examine the common and specific effects of demographic and abuse characteristics across these different diagnoses. Method: The participants were attendees at four treatment centres in Denmark that provide psychological therapy for victims of CSA (N=434). Axis I disorders were assessed using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Multivariate logistic regression analysis was used to examine the associations between CSA characteristics (age of onset, duration, number of abusers, number of abusive acts) and 10 adult clinical syndromes. Results: There was significant variation in the prevalence of disorders and the abuse characteristics were differentially associated with the outcome variables. Having experienced sexual abuse from more than one perpetrator was the strongest predictor of psychopathology. Conclusions: The relationship between CSA and adult psychopathology is complex. Abuse characteristics have both unique and shared effects across different diagnoses.

Background Accurate assessment of childhood adversity is fundamental in understanding risk and resilient factors that can inform appropriate intervention and prevention strategies. Different statistical and methodological approaches (e.g., prospective, selfreported data) have been used to assess pathways and outcomes associated with childhood adversity, however, each is limited in a number of ways. Objectives Linking administrative data to population-based studies provides a powerful tool to overcome some of the challenges in trauma research and permits the estimation of temporally ordered models of risk. The current study seeks to assess the effect of childhood adversity on a diagnosis of traumatic disorder (TD). Methods Data were collected from a Danish national study in 2008/2009. A sample of 4,718 young adults were randomly selected from the birth cohort of children born in 1984. Structured interviews were conducted on 2,980 participants. This data was then linked with parental data (including 4 years prior to birth of child) and a ICD 10 diagnosis of a TD using information from the Danish registries. Findings Hierarchical regression analysis was used to examine parental risk factors, self-reported child maltreatment, experiencing violence in young adulthood and risk of a TD diagnosis at age 28. Findings indicated the dominant factor associated with TD was self-reported PTSD symptoms at age 24 (OR =3.82); followed by a parental mental health diagnosis (OR = 2.80). Being of female gender (OR = 2.42) and experiencing violence in young adulthood (OR = 1.94) also increased risk of a TD diagnosis. Conclusion This study highlights the benefits of incorporating administrative data with self-report data to provide a more nuanced understanding of childhood adversity across different developmental stages. These findings have important conceptual and methodological implications and may be useful in informing future trauma studies.

Objective: This study investigated whether pre-deployment dissociation was associated with previously identified post-traumatic stress disorder (PTSD) symptom trajectories from before to 2.5 years after military deployment. Furthermore, it examined whether the tendency to dissociate, pre-deployment personality factors, conceptualized by the Big Five model, and previous trauma represented independent risk factors for post-deployment PTSD symptoms. Method: This prospective study included the entire team of 743 soldiers from the Danish Contingent of the International Security Assistance Force 7 deployed to Afghanistan in 2009. Data consisted of self-report measures and were collected six times: before deployment; during deployment; and 1–3 weeks, 2 months, 7 months and 2.5 years after homecoming. Results: The findings indicate significant associations between pre-deployment dissociation and six PTSD trajectories (p

With the publication of the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11) due for release in 2018, a number of studies have assessed the factorial validity of the proposed post-traumatic stress disorder (PTSD) and complex (CPTSD) diagnostic criteria and whether the disorders are correlated but distinct constructs. As the specific nature of CPTSD symptoms has yet to be firmly established, this study aimed to examine the dimension of affect dysregulation as two separate constructs representing hyper-activation and hypo-activation. Seven alternative models were estimated within a confirmatory factor analytic framework using the International Trauma Questionnaire (ITQ). Data were analysed from a young adult sample from northern Uganda (n = 314), of which 51% were female and aged 18–25 years. Forty per cent of the participants were former child soldiers (n = 124) while the remainder were civilians (n = 190). The prevalence of CPTSD was 20.8% and PTSD was 13.1%. The results indicated that all models that estimated affective dysregulation as distinct but correlated constructs (i.e. hyper-activation and hypo-activation) provided satisfactory model fit, with statistical superiority for a seven-factor first-order correlated model. Furthermore, individuals who met the criteria for CPTSD reported higher levels of war experiences, symptoms of anxiety and depression, and somatic problems than those with PTSD only and no diagnosis. There was also a much larger proportion of former child soldiers that met the criteria for a CPTSD diagnosis. In conclusion, these results partly support the factorial validity of the ICD-11 proposals for PTSD and CPTSD in a non-Western culture exposed to mass violence. These findings highlight that more research is required across different cultural backgrounds before firm conclusions can be made regarding the factor structure of CPTSD using the ITQ.

Objective: To investigate the changes in psychological and social domains associated with treatment in survivors of child sexual abuse. Method: Participants from four centers were assessed at baseline and were followed up after six and 12 months. The battery covered posttraumatic and general distress symptoms, attachment, coping styles, self-worth, and social support. Results: The estimated prevalence of Posttraumatic Stress Disorder (PTSD) was 78% at baseline; this rate declined to 40% after one year. There were no differences in outcome measures across the different centers or between the individual and group treatments. Half of the PTSD variation at 12 months was explained by four factors: education, avoidance attachment, emotional coping, and social support. Conclusion: The findings in this study indicated a substantial reduction in mental health problems in survivors following 12 months of treatment and identified personality and social factors important for recovery.

Background: In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the symptom profile of posttraumatic stress disorder (PTSD) was expanded to include 20 symptoms. An alternative model of PTSD is outlined in the proposed 11th edition of the International Classification of Diseases (ICD-11) that includes just six symptoms. Objectives and method: The objectives of the current study are: 1) to independently investigate the fit of the ICD-11 model of PTSD, and three DSM-5-based models of PTSD, across seven different trauma samples (N=3,746) using confirmatory factor analysis; 2) to assess the concurrent validity of the ICD-11 model of PTSD; and 3) to determine if there are significant differences in diagnostic rates between the ICD-11 guidelines and the DSM-5 criteria. Results: The ICD-11 model of PTSD was found to provide excellent model fit in six of the seven trauma samples, and tests of factorial invariance showed that the model performs equally well for males and females. DSM-5 models provided poor fit of the data. Concurrent validity was established as the ICD-11 PTSD factors were all moderately to strongly correlated with scores of depression, anxiety, dissociation, and aggression. Levels of association were similar for ICD-11 and DSM-5 suggesting that explanatory power is not affected due to the limited number of items included in the ICD-11 model. Diagnostic rates were significantly lower according to ICD-11 guidelines compared to the DSM-5 criteria. Conclusions: The proposed factor structure of the ICD-11 model of PTSD appears valid across multiple trauma types, possesses good concurrent validity, and is more stringent in terms of diagnosis compared to the DSM-5 criteria.