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Attempts to shift the ways disasters have traditionally been managed away from authoritarian, top-down approaches toward more bottom-up and inclusive processes often involve incorporating viewpoints from marginalised and vulnerable groups. Recently as part of this process, there have been calls for greater inclusion of Indigenous peoples in disaster management. In theory, this also suggests a shift in power structures, towards recognising Indigenous peoples as experts in disaster management. However, in popular imagination and policy Indigenous peoples often appear to be caricatured and misrepresented, for instance through tropes of Indigenous peoples as custodians of the environment or especially vulnerable to environmental change. These framings matter because they can result in disaster management policies and practices that do not capture Indigenous peoples' complex realities. However, these framings have not been analysed in the context of disasters. In this article, we aim to better understand these framings through a critical discourse analysis of how Indigenous peoples in disasters are represented in the expert news media. We identify five discourses, including a dominant one of disasters as natural phenomena to be addressed through humanitarianism and technocratic interventions. Such discourses render Indigenous peoples helpless, depoliticize disasters and are justified by framing governments and NGOs as caring for Indigenous peoples. However, we also identify competing discourses that focus on systems of oppression and self-determination in disaster management. These discourse recognise disasters as political and include discussion of the role of colonialism in disaster creation. As care emerged as a means through which intervention was justified, we conclude by asking questions of who is cared for/about in disasters and how that care is performed. [ABSTRACT FROM AUTHOR]

Although affect dysregulation is considered a core component of borderline personality disorder (BPD) and somatoform disorders (SoD), remarkably little research has focused on prevalence and nature of affect dysregulation in these disorders. BPD and SoD diagnoses were confirmed or ruled out in 472 psychiatric inpatients using clinical interviews. Three qualitatively different forms of affect dysregulation were identified: under-regulation, over-regulation of affect and combined under- and over-regulation of affect. BPD was associated with under-regulation of affect, and SoD was associated with over-regulation of affect. However, one in five patients with BPD also reported substantial over-regulation, and one in six patients with SoD reported clinically significant under-regulation, and the comorbid BPD and SoD group reported more frequently both over- and under-regulation than patients diagnosed with BPD or SoD alone or those with other psychiatric disorders. [ABSTRACT FROM AUTHOR]

The goal of the current study was to examine types of exposure to traumatic events and affective and anxiety disorders of 81 civilian war survivors seeking treatment for war-related stress almost one decade following the war in the area of former conflict. Furthermore, the study investigated changes in symptoms of mental health and in well-being amongst these individuals during a treatment period of 6 months. The results indicated that civilian war survivors seeking treatment reported multiple war-related traumatic events and high levels of psychiatric morbidity. Individuals assessed at follow-up (n = 67) reported no change in post-traumatic stress symptoms or psychological well-being, but improvement in symptoms of depression, overall psychiatric distress and quality of life. The only significant difference between participants classified as achieving clinically significant improvement as compared with those who did not achieve such change was in less symptom severity of depression, post-traumatic stress, general distress and higher psychological well-being at the time of first assessment. Neither the assessment of initial diagnoses nor war or post-war trauma types emerged as significantly different amongst the two groups. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: · Civilian survivors of war seeking treatment report high levels of psychiatric morbidity. · Treatment for survivors of war may require adaptations to evidence-based treatments based on their culture and life circumstances in order to recover from PTSD and experience general emotional relief. [ABSTRACT FROM AUTHOR]

Psychological trauma and posttraumatic stress disorder (PTSD) are prevalent among adults with severe mental illness. A sample of 38 women in intensive community mental health services was assessed with psychometrically validated structured interview measures. Exposure to multiple types of psychological traumas was reported by 95% of respondents; almost half (44%) met criteria for current PTSD, and an equal number met criteria for Disorders of Extreme Stress Not Otherwise Specified (DESNOS). Another 40% did not meet criteria for either PTSD or DESNOS. Women of color were less likely than White women to meet criteria for PTSD. Although no specific type of psychological trauma was particularly associated with PTSD, sexual and medical trauma were strongly and consistently associated with DESNOS. Among women of color, domestic violence and traumatic loss due to drunk driving fatalities were particularly prevalent. Income was generally low but not associated with risk of trauma exposure or either PTSD or DESNOS. Implications for trauma-informed services for women with severe mental illness are discussed. [ABSTRACT FROM AUTHOR]

Objective: This study explored sociodemographic and mental health correlates of intensity of mental health care use in two large-scale surveys, aiming to discover the set of correlates with the greatest predictive capacity.Methods: Data were examined from persons aged 15 to 54 in two nationally representative U.S. household surveys: the National Comorbidity Survey (NCS) (N=5,877), which gathered information from 1990 to 1992, and the NCS Replication (N=4,320), which gathered information from 2001 to 2003. Outcome variables were the number of mental health care visits in the past year to mental health providers, social service providers, and medical providers. This study implemented state-of-the-art statistical methods designed for modeling such outcomes as treatment intensity-that is, visit counts.Results: Across provider types, significant univariate associations were found for intensity of mental health care use based on access variables (for example, employment and health insurance) and two need variables-psychiatric diagnoses and psychiatric disability. Demographic variables and treatment need variables were not consistent service use correlates. Multivariate regression accounting for excessive zero values demonstrated that after the analyses controlled for sociodemographic and access variables, mental disorders (mood, anxiety, and substance use disorders) and psychiatric disability added incrementally to variance in visit counts for mental health care. However, when mental health service use was dichotomized (any use versus no use) demographic and access variables, as well as psychiatric disorders, emerged as correlates. In both sets of analyses, different patterns of psychiatric disorder and disability were associated with provider service use.Conclusions: These findings extend research on correlates of mental health care use, addressing intensity of use, suggesting that sociodemographic factors and presence of a psychiatric disorder and associated disability drive the initial use of services, whereas presence of a psychiatric disorder and associated disability are associated with continued service use. [ABSTRACT FROM AUTHOR]

As the prevalence of homelessness among men increases, the impact of trauma and post-traumatic stress disorder in the lives of homeless men warrants attention. We will review research and clinical reports on the impact of traumatic event exposure, the antecedents and consequences of traumatic events, and homelessness among males in order to begin to develop scientific, public health, and social policy answers to several questions. The nascent clinical and scientific literature provides evidence of the need for prospective studies of the etiology, epidemiology, course, and prevention of post-traumatic stress disorder among males who are at risk for or in the early stages of homelessness. We attempt to summarize, categorize, and suggest important variables and causal relationships that can inform future research studies and interventions in order to contribute to the growth of this underdeveloped and important knowledge base. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We conducted a population-based telephone survey in an attempt to determine correlates of formal and informal help seeking after September 11, 2001. METHODS: Between October 15 and December 31, 2001, 1774 Connecticut Behavioral Risk Factor Surveillance System respondents were asked questions directly related to their experiences of September 11. RESULTS: Multivariate logistic regression analyses showed that receipt of formal help was predicted by sleep problems, close association with a victim, reports of increased smoking or drinking, and receipt of informal help. Age, gender, reports of 1 or more problems, and formal help seeking predicted receipt of informal help. CONCLUSIONS: Public health planning and bioterrorism preparedness should include programs addressing increased smoking and drinking, sleep problems, and bereavement in the wake of disasters. [ABSTRACT FROM AUTHOR]

A number of studies suggest similarities between the psychosocial impairment caused by traumatic victimization and the 'cascade' (Patterson, 1993) of problems experienced by youths with severe and persistent problems with oppositional-defiance. Evidence indicating that traumatic victimization may be a factor in disruptive behavior disorders is reviewed. A preliminary conceptual model is proposed as a basis for clinical and research hypothesis testing concerning the potential relationship between traumatic victimization and problematic oppositional-defiance. The model postulates a chronological sequence from (a) victimization in childhood, to (b) escalating dysregulation of emotion and social information processing ('survival coping'), to (c) severe and persistent problems with oppositional-defiance and overt or covert aggression which are compounded by post-traumatic symptoms ('victim coping'). Implications for diagnosis, prevention, treatment, and research are discussed. [ABSTRACT FROM AUTHOR]

Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: CZ-C declares that her salary was covered partially with funds from the University of Alberta and the University of Leeds while working on this manuscript. Also, she identifies herself as an Indigenous scientist of a Quechua heritage from the Peruvian Northern Andes. JC is Director of Dietary Assessment Ltd supporting myfood24. Also, leads a WHO Collaborating Centre in Nutritional Epidemiology Other authors do not have competing interest to declare

Background: Available empirical evidence on participant-level factors associated with dropout from psychotherapies for post-traumatic stress disorder (PTSD) is both limited and inconclusive. More comprehensive understanding of the various factors that contribute to study dropout from cognitive-behavioural therapy with a trauma focus (CBT-TF) is crucial for enhancing treatment outcomes., Objective: Using an individual participant data meta-analysis (IPD-MA) design, we examined participant-level predictors of study dropout from CBT-TF interventions for PTSD., Methods: A comprehensive systematic literature search was undertaken to identify randomised controlled trials comparing CBT-TF with waitlist control, treatment-as-usual or another therapy. Academic databases were screened from conception until 11 January 2021. Eligible interventions were required to be individual and in-person delivered. Participants were considered dropouts if they did not complete the post-treatment assessment., Findings: The systematic literature search identified 81 eligible studies (n=3330). Data were pooled from 25 available CBT-TF studies comprising 823 participants. Overall, 221 (27%) of the 823 dropped out. Of 581 civilians, 133 (23%) dropped out, as did 75 (42%) of 178 military personnel/veterans. Bivariate and multivariate analyses indicated that military personnel/veterans (RR 2.37) had a significantly greater risk of dropout than civilians. Furthermore, the chance of dropping out significantly decreased with advancing age (continuous; RR 0.98)., Conclusions: These findings underscore the risk of premature termination from CBT-TF among younger adults and military veterans/personnel., Clinical Implication: Understanding predictors can inform the development of retention strategies tailored to at-risk subgroups, enhance engagement, improve adherence and yield better treatment outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.)

Competing Interests: Declaration of interests Thirteen of the authors (ZA, S-CH, LJ, AM, CO, MO, JP, YP-S, DS, LB-V, MRo, MW, and HW) were compensated for their time while drafting and developing the Lancet Countdown's report. LC was supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health. CD received funding from the European Research Council (FLORA, grant number 101039402). RD was supported by a grant from the High Tide Foundation and subcontracts on funds from the Wellcome Trust and US Centers for Disease Control and Prevention. GG-S received funding from the UK National Institute for Health and Care Research for the Global Health Research Group on Diet and Activity (NIHR133205, with sub-award contract number G109900-SJ1/171 with the University of Cambridge). SHG's research was supported by the National Research Foundation, Prime Minister's Office, Singapore, under its Campus for Research Excellence and Technological Enterprise programme (grant number NRF2019-THE001-0006). JJH was supported by two grants from the Wellcome Trust and a grant from the US National Science Foundation. RH, RK, and MSo acknowledge funding from Academy of Finland projects HEATCOST (grant 334798) and VFSP-WASE (grant 359421), together with EU Horizon projects FirEUrisk (grant number 101003890) and EXHAUSTION (grant number 820655). OJ was supported by grants from the National Health Medical Research Council (Heat and Health: building resilience to extreme heat in a warming world, GNT1147789); Wellcome Trust (Heat stress in ready-made garment factories in Bangladesh and the Heat inform pregnant study); and Resilience New South Wales (A new heat stress scale for general public); holds a patent for the Environmental Measurement Unit; and has received consulting fees from the National Institutes of Health. HM received funding from the Oak Foundation to support work on climate change through RealZero, is partly funded by the National Institute for Health Research's Comprehensive Biomedical Research Centre at University College London Hospitals, and received fees from Bayer Pharmaceuticals and Chiesl for sustainability consulting. JM-U was supported by grants PID2021-127107NB-I00 from Ministerio de Ciencia e Innovación (Spain) and 2021 SGR 00526 from Generalitat de Catalunya (Spain). JRo's work is supported by the Alexander von Humboldt foundation. RL, JRo, and MRo were supported by Horizon Europe through the IDAlert project (101057554) and UK Research and Innovation (reference number 10056533). RNS reports a contract with Massachusetts General Hospital. MSo and AU were supported by the Finnish Foreign Ministry project IBA-ILMA (grant number VN/13798/2023). MSp was supported by funding from the Wellcome Trust, through Our Planet Our Health (Livestock, Environment and People, award number 205212/Z/16/Z) and a Wellcome Career Development Award (Towards the full cost of diets, award number 225318/Z/22/Z). JDSh was supported by the Canadian Institutes of Health Research, the Commonwealth Fund, and the Emergency Care Research Institute and has received consulting fees from the Institute for Healthcare Research. JT was supported by the Research Council of Finland (T-Winning Spaces 2035 project), the UK Medical Research Council (PICNIC project), and the Finnish Ministry of the Environment (SEASON project). JB is employed as a consultant by the Global Climate and Health Alliance. ML received consulting fees from YarCom for advisory services and was supported by general use gifts awarded to the Center on Global Energy Policy at Columbia University, USA. JMil acknowledges consulting fees from the C40 Climate Leadership Group. CZ-C received a consultancy from the University of Alberta and was supported by contracts with her university (Universidad Peruana Cayetano Heredia), University of Leeds, WHO, and the Wellcome Trust; she was also supported by a letter of agreement between her university and the Food and Agriculture Organization's Indigenous Peoples Unit. MD was supported by the Wellcome Trust via the Complex Urban Systems for Sustainability and Health project (grants 205207/Z/16/Z and 209387/Z/17/Z). IH, S-CH, MRo, CT, and RL were supported by the Horizon Europe CATALYSE project (CATALYSE grant number 101057131, HORIZON-HLTH-2021-ENVHLTH-02, with UK Research and Innovation reference number 10041512). The work of YH, YL, DT, and QZ was supported by the National Aeronautics and Space Administration's Earth Action programme (grant number 80NSSC21K0507). AJP was supported by the Bezos Earth Fund and the Schmidt Family Foundation. ER and SD were supported by a Process-based models for climate impact attribution across sectors (PROCLIAS) grant (COST Action PROCLIAS grant CA19139), funded by European Cooperation in Science and Technology. All other authors declare no competing interests.

Objective: As a result of the coronavirus pandemic, mental health professionals have faced the challenge of helping their clients cope with pandemic-related distress on top of ongoing therapeutic issues. This article describes a telehealth-delivered peer/mutual support program for mental health professionals during the pandemic and the key themes identified by participants., Method: An interdivisional American Psychological Association task force formed a working group to identify practical ways to provide mental health professionals with direct support during the pandemic. A mutual support program, the Clinician Support Collaborative, was initiated using virtual video technology. This article describes the program and themes that emerged, including the challenges and benefits of using virtual video technology to host mutual support meetings., Results: Mutual support meetings were conducted on a weekly basis in 2020 and 2021, with mental health professionals and trainees in the Americas, Australasia, and India participating. Key themes identified included the logistical, therapeutic, and privacy concerns participants faced when shifting to telehealth, professional isolation, compassion fatigue, moral injury, burnout, stigma, disparities, and the intersection of personal/family stressors and work stressors., Conclusions: Recommendations for future use of virtual video technology to provide mutual support by and for mental health professionals are provided. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Youth who have been exposed to potentially traumatic events are at risk of developing chronic and severe adjustment problems. However, some youth exposed to potentially traumatic events exhibit better-than-expected adaptation. Person-centered analyses, based on multiple criteria for adaptive behavior and adversity, are well-suited to empirically identifying different patterns of adaptation among high-risk youth., Method: Data from 381 youth from three at-risk subgroups in Portugal were collected using self-reported measures of trauma history, trauma-related symptomatology, coping skills, and perceived social support. Distinct classes of adaptation after traumatic experiences were examined with latent class analysis., Results: Four classes were identified: (a) trauma-related psychopathology class (13.6%), (b) adaptive resilience class (36.8%), (c) low resources class (11.4%), and (d) high resources class (38.2%). Trauma-related psychopathology class and low resources class were characterized by high levels of maladjustment. Similarly to the low resources class, the trauma - related psychopathology class reported a significantly higher likelihood of trauma-related psychopathology and higher levels of problem-solving skills. The adaptive resilience class and high resources class also reported lower levels of maladjustment, and the high resources class reported higher levels of coping skills and lower levels of externalizing problems than any other class., Conclusion: Clinicians treating children's internalizing mental health or externalizing behavior problems should assess trauma history and trauma-related psychopathology, as well as protective resources that may enhance resilience such as skills for problem solving and social support seeking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Indigenous knowledge and responses were implemented during the COVID-19 pandemic to protect health, showcasing how Indigenous communities participation in health systems could be a pathway to increase resilience to emergent hazards like climate change. This study aimed to inform efforts to enhance climate change resilience in a health context by: (1) examining if and how adaptation to climate change is taking place within health systems in the Peruvian Amazon, (2) understanding how Indigenous communities and leaders' responses to climatic hazards are being articulated within the official health system and (3) to provide recommendations to increase the climate change resilience of Amazon health systems., Methods: This study was conducted among two Peruvian Amazon healthcare networks in Junin and Loreto regions. A mixed methodology design was performed using a cross-sectional survey (13 healthcare facilities), semistructured interviews (27 official health system participants and 17 Indigenous participants) and two in-person workshops to validate and select key priorities (32 participants). We used a climate-resilient health system framework linked to the WHO health systems building blocks., Results: Indigenous and official health systems in the Peruvian Amazon are adapting to climate change. Indigenous responses included the use of Indigenous knowledge on weather variability, vegetal medicine to manage health risks and networks to share food and resources. Official health responses included strategies for climate change and response platforms that acted mainly after the occurrence of climate hazards. Key pathways to articulate Indigenous and official health systems encompass incorporating Indigenous representations in climate and health governance, training the health work force, improving service delivery and access, strengthening the evidence to support Indigenous responses and increasing the budget for climate emergency responses., Conclusions: Key resilience pathways call for a broader paradigm shift in health systems that recognises Indigenous resilience as valuable for health adaptation, moves towards a more participatory health system and broadens the vision of health as a dimension inherently tied to the environment., Competing Interests: Competing interests: CZ-C declares that her salary was covered partially with funds of this study. All other authors declare no competing interests., (© World Health Organization 2024. Licensee BMJ.)

Longitudinal assessment of climate vulnerability is essential for understanding the complex factors affecting how people experience and respond to climate change. We report on the first longitudinal assessment of climate vulnerability in the Himalayan region, exploring the evolving landscape, perceptions, and experiences of communities of climate change impacts, vulnerability, and adaptation in Kashmir over an 8-year period from 2017 to 2024. We provide the Himalayan Re-study Framework (HRF) to monitor, characterise, and conceptualise climate change in the Himalayas. Utilising mixed methods, we showcase how climate change is affecting social, economic, political, and environmental dimensions, examining how the impacts of climate change and vulnerability evolve over time, shaping and reshaping how climate risks are experienced and responded to by communities. Our analysis reveals a nuanced understanding of vulnerability, highlighting the impact on communities' livelihoods and water security, differential impacts on marginalised communities, and the gendered nature of climate change. We examine how certain sections of the population face marginalisation, discrimination, and racism, and how climate change exacerbates these challenges. Kashmir's vulnerability to climate change extends beyond environmental factors, intertwining with culture, livelihoods, social dynamics, and politics. Climate change continues to compete for attention with immediate political and socio-economic challenges, highlighting the need for integrated approaches to address both environmental and societal issues in Kashmir., (© 2024. The Author(s).)

Adolescents from ethnoracially minoritized backgrounds increasingly report high rates of attempted suicide, trauma exposure, and limited access to mental healthcare services. However, less is known regarding their use of services across different youth-serving systems. This study examines the associations and interactions between self-injurious thoughts and behaviors (SITBs), race/ethnicity, and service sector utilization (mental healthcare, general healthcare, school, and social services) among a sample of trauma-exposed and treatment-seeking adolescents. Participants were treatment-seeking adolescents (N = 4406) ages 12-17 from the National Child Traumatic Stress Network Core Data Set who had available data for SITBs, race/ethnicity, services utilized, and other key variables. Mixed effects logistic regression was used to examine main and interactive effects for whether adolescents' race/ethnicity and SITBs were associated with service utilization in each of the identified service sectors. SITBs were associated with adolescents' utilization of mental healthcare (OR = 1.38 p < 0.001), general healthcare (OR = 2.30; p < 0.001), and school services (OR = 1.38 p < 0.001). NH Black adolescents reporting SITBs were less likely to use mental health services than other NH Black youths (OR = 0.53; p = 0.004). Hispanic adolescents reporting SITBs were more likely to utilize healthcare services than other Hispanic youths (OR = 1.51; p = 0.039). Trauma-exposed adolescents reporting SITBs are more likely to utilize mental healthcare, general healthcare, and school-based services than other trauma-exposed adolescents. However, NH Black adolescents experiencing SITBs may face additional barriers to utilizing mental healthcare services. Findings can be used to develop nursing practices and policies to address barriers faced by adolescents reporting SITBs., (© 2024 The Authors. Research in Nursing & Health published by Wiley Periodicals LLC.)

The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.

Background: Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators., Methods: This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6-18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954., Findings: We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=-13·17, 95% CI -17·84 to -8·50, p<0·001, τ 2 =103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=-0·15, 95% CI -0·29 to -0·01, p=0·041, τ 2 =0·03) for each unit increase in pre-treatment post-traumatic stress symptoms., Interpretation: This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress., Funding: Swiss National Science Foundation., Competing Interests: Declaration of interests RM-S received personal payment for teaching on the delivery of cognitive therapy for post-traumatic stress disorder for children and young people at various UK universities and training bodies, and he is an unpaid council member of the UK Trauma Council. EBF received payment for contributing to a post-traumatic stress disorder manual and workbook and for post-traumatic stress disorder workshops, lectures, and meetings. JDF served as a consultant for Advanced Trauma Solutions Professionals. SK received minor side income from lecturing in a clinical training program for Narrative Exposure Therapy (University of Turku, Turku, Finland). PS received a share of royalties from Routledge publishers from publication of a cognitive therapy for post-traumatic stress disorder manual for young people; he was an unpaid member of the research committee of the Children and War Foundation (a non-profit based in Norway) and an unpaid trustee of the Children and War UK (a non-profit based in the UK). CHi received personal payment for writing an article regarding treatment of therapy for post-traumatic stress disorder in preschool-aged children from the Aeon Media Group. TD received personal payment for teaching on the delivery of cognitive therapy for post-traumatic stress disorder for children and young people at various UK universities and training bodies. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Pregnancy can exacerbate or prompt the onset of stress-related disorders, such as post-traumatic stress disorder (PTSD). PTSD is associated with heightened stress responsivity and emotional dysregulation, as well as increased risk of chronic disorders and mortality. Further, maternal PTSD is associated with gestational epigenetic age acceleration in newborns, implicating the prenatal period as a developmental time period for the transmission of effects across generations. Here, we evaluated the associations between PTSD symptoms, maternal epigenetic age acceleration, and infant gestational epigenetic age acceleration in 89 maternal-neonatal dyads. Trauma-related experiences and PTSD symptoms in mothers were assessed during the third trimester of pregnancy. The MethylationEPIC array was used to generate DNA methylation data from maternal and neonatal saliva samples collected within 24 h of infant birth. Maternal epigenetic age acceleration was calculated using Horvath's multi-tissue clock, PhenoAge and GrimAge. Gestational epigenetic age was estimated using the Haftorn clock. Maternal cumulative past-year stress (GrimAge: p  = 3.23e-04, PhenoAge: p  = 9.92e-03), PTSD symptoms (GrimAge: p  = 0.019), and difficulties in emotion regulation (GrimAge: p  = 0.028) were associated with accelerated epigenetic age in mothers. Maternal PTSD symptoms were associated with lower gestational epigenetic age acceleration in neonates ( p  = 0.032). Overall, our results suggest that maternal cumulative past-year stress exposure and trauma-related symptoms may increase the risk for age-related problems in mothers and developmental problems in their newborns.

Background: Exposure to minority stressors specific to LGBTQ+ individuals, such as heterosexism and cissexism (or cisheterosexism) is not covered under the traditional adverse childhood experiences framework. This is important because childhood identity-related abuse by a parent/caregiver can lead to mental health challenges in later life through the adoption of maladaptive coping mechanisms., Objective: The present study aimed to examine the role of cisheterosexism and expressive suppression as serial mediators in the associations between identity-related abuse and depressive symptoms and suicide behavior., Participants and Setting: Participants included 563 LGBTQ+ identifying adults between 18 and 64 years (M = 30.02, SD = 9.05) from different regions of Spain and were recruited through social media (e.g., Twitter, Facebook, and Instagram)., Method: A serial mediation model was conducted with cisheterosexism and expressive suppression as the mediators in the associations between LGBTQ+ identity-related childhood abuse and depressive symptoms and suicide behavior., Results: Findings indicated a positive indirect effect of identity-related abuse on depressive symptoms through cumulative cisheterosexism (B = 0.628, p < .01), and via cumulative cisheterosexism and suppression (B = 0.146, p < .05). No significant indirect effect was found for identity-related abuse on depressive symptoms via suppression (B = 0.086). An indirect effect was found for identity-related abuse on suicide behavior via cumulative cisheterosexism (B = 0.250, p < .01)., Conclusions: Findings reveal that LGBTQ+ identity-related cisheterosexist experiences perpetrated by parents or caregivers are associated with harmful, long-term impacts on symptoms of depression and suicide behavior via experiences of cisheterosexism and expressive suppression., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Potentially traumatic experiences are a major risk factor for mental disorders in children and adolescents. Posttraumatic psychopathology includes trauma-specific disorders such as posttraumatic stress disorder (PTSD) as well as other psychiatric disorders. Developmental Trauma Disorder (DTD) has been proposed as a developmentally sensitive diagnosis. We aimed to further illuminate the co-occurrence of psychiatric conditions with DTD and PTSD., Method: In a convenience sample of families of 507 children and adolescents (mean age = 12.11 years old, SD = 2.92; 48.5% female), we assessed DTD, PTSD, and screened for psychiatric disorders. We estimated network models including DTD, PTSD and ten psychiatric conditions., Results: We found that DTD and PTSD share both common and differential comorbidity features on disorder-, domain-, and symptom-level. The differential comorbidity patterns of the DTD and PTSD domains placed DTD close to both externalizing and internalizing psychopathology while PTSD was primarily linked to internalizing conditions., Conclusions: Our study provides evidence for the complex clinical presentation of posttraumatic psychopathology over and above PTSD in children. DTD and PTSD provide useful and distinct diagnostic categories for children who are also experiencing internalizing conditions, and DTD may be especially relevant for children who are experiencing externalizing psychopathology., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Diarrheal disease, particularly in children under 5 years old, remains a global health challenge due to its high prevalence and chronic health consequences. Public health interventions that reduce diarrheal disease risk include improving access to water, sanitation, and hygiene. Although Peru achieved the 2015 Millennium Development Goal (MDG) indicators for water access, less progress was achieved on sanitation. Furthermore, many Indigenous Peoples were overlooked in the MDG indicators, resulting in a prioritization of Indigenous Peoples in the 2030 Sustainable Development Goals (SDGs). This study aimed to estimate the prevalence of childhood diarrhea, characterize access to water and sanitation, and determine the association of childhood diarrhea with water access and sanitation indicators in 10 Shawi Indigenous communities along the Armanayacu River in the Peruvian Amazon., Methods: A cross-sectional survey (n=82) that captured data on diarrheal disease, sociodemographic variables, and water and sanitation exposures was conducted in 10 Shawi communities. Nutritional status of children under 5 was also assessed via physical examination. Descriptive and comparative statistics were conducted., Results: A small proportion (n=7; 8.54%) of participating children reported an episode of diarrhea in the previous month. Almost half (46.30%) of participating children had stunting, wasting, or both. Although not statistically significant, children living in households that used latrines were 4.29 times (95% confidence interval (CI) 1.01-18.19) more likely to report an episode of diarrhea than children living in households that practiced open defecation. Although not statistically significant, children living in households that used water treatment methods were 4.25 times (95%CI 0.54-33.71) more likely to report an episode of diarrhea than children living in households that did not., Conclusion: The prevalence of childhood diarrhea was lower for Shawi than for other Amazon areas. The higher prevalence of childhood diarrhea in households that used latrines and water treatments warrants further investigation into local risk and protective factors. These Shawi communities scored low for the WHO/UNICEF Joint Monitoring Programme indicators for water and sanitation, indicating that they should be prioritized in future water, sanitation, and hygiene initiatives. Research will be required to understand and incorporate local Indigenous values and cultural practices into water, sanitation, and hygiene initiatives to maximize intervention uptake and effectiveness.

Competing Interests: CZ-C declares that the university where she works received funds from the UK Research and Innovation (UKRI) agency under a Global Challenges Research Fund and Newton Fund Consolidation Account (GCNA) award, via the University of Leeds, to complete the current research in Peru. DBN declares that the institution where he works received funds from UKRI under a GCNA award, via the University of Leeds, to complete the current research in Uganda. JJM declares that grant support and payments have been made to his institution from the Alliance for Health Policy and Systems Research, Bloomberg Philanthropies (via the University of North Carolina Gillings School of Global Public Health), the Chilean National Fund for Scientific and Technological Development (via CIENCIACTIVA/CONCYTEC), the British Council, the British Embassy and the Newton-Paulet Fund, Wellcome Global Health Trials, Fogarty International Center, Grand Challenges Canada, International Development Research Center Canada, the Inter-American Institute for Global Change Research, the US National Cancer Institute, the US National Heart, Lung and Blood Institute, the US National Institute of Mental Health, the Swiss National Science Foundation, the UKRI Biotechnology and Biological Sciences Research Council, the UKRI Engineering and Physical Sciences Research Council, the UKRI Medical Research Council, and the World Diabetes Foundation, and had a contract with Health Action International, all of which were unrelated to this work. JJM is also co-chair of the UN Independent Group of Scientists 2023 Global Sustainable Development Report, a member of the Scientific Expert Committee of the Global Data Collaborative for CV Population Health of the World Heart Federation, Microsoft, and Novartis Foundation, a member of the Scientific and Technical Advisory Committee of the Alliance for Health Policy and Systems Research, WHO, a member of the WHO Technical Advisory Group on NCD-related Research and Innovation of the Department of Noncommunicable Diseases, WHO, and a member of the Advisory Scientific Committee of the Instituto de Investigación Nutricional (Peru). JJM also participated in the data safety monitoring board for the Nigeria Sodium Study (NaSS), the trial steering committee of the Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage trial (INTERACT 3), the international advisory board of the Latin American Brain Health Institute of Universidad Adolfo Ibáñez (Chile), the consultative board of the Programa de Gastronomía of the Facultad de Estudios Interdisciplinarios, Pontificia Universidad Católica del Perú, and an advisory board for the InterAmerican Heart Foundation. All other authors declare no competing interests.

COVID-19 has had uneven impacts on health and well-being, with Indigenous communities in the Global South facing some of the highest risks. Focusing on the experience of Sri Lanka, this study identifies key policy responses to COVID-19, documents how they evolved over two years of the pandemic, and examines if and how government responses have addressed issues pertaining to Indigenous Peoples. Drawing upon an analysis of policy documents (n = 110) and interviews with policymakers (n = 20), we characterize seven key policy responses implemented by the Sri Lankan government: i) testing for and identifying COVID-19; ii) quarantine procedures; iii) provisional clinical treatments; iv) handling other diseases during COVID-19; v) movement; vi) guidelines to be adhered to by the general public; and vii) health and vaccination. The nature of these responses changed as the pandemic progressed. There is no evidence that policy development or implementation incorporated the voices and needs of Indigenous Peoples., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Objective: The current study examines dynamic, bidirectional associations between parent and adolescent symptom improvement in response to children's therapy for posttraumatic stress disorder (PTSD)., Method: Data were collected from a racially and ethnically heterogeneous sample of 1,807 adolescents (age 13-18 years old; 69% female) and a parent participating in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) at a community outpatient behavioral health clinic. Parents self-reported their depressive symptoms and youth self-reported their PTSD and depressive symptoms at the onset of treatment and every three months for up to nine months. Using a bivariate dual change score model (BDCSM) we examine: (a) individual dyad members' change in symptoms and (b) the bidirectional associations between changes in the parent's and youth's symptoms across treatment., Results: Parents' and adolescents' symptoms at the start of treatment were correlated and both parents' and adolescents' symptoms decreased over the course of treatment. Parents' elevated depressive symptoms at each time point contributed to smaller decreases in their children's PTSD and depressive symptoms at the subsequent time point. Adolescents' elevated symptoms at each time point contributed to greater decreases in their parents' symptoms at the subsequent time point., Conclusions: These findings highlight the impact that parents and children have on each other's response to children's trauma-focused psychotherapy. Notably, parents' depressive symptoms appeared to slow their children's progress in treatment, suggesting that attending to parents' symptoms and providing them with supportive services may be an important adjunct to children's interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Introduction: Poly-victimization (PV) has a greater adverse impact on adolescents' lives than any single victimization type, even when repeatedly experienced. Adolescents who experience PV tend to present with an array of adjustment problems, and research has begun to identify mechanisms linking PV to adjustment problems. Both posttraumatic stress disorder (PTSD) and dissociation are linked to PV and adjustment problems; however, it is unclear how these variables play a role in the pathways from PV to adjustment problems. This study assessed PTSD and dissociation as serial mediators in the PV-adjustment problems link., Method: Two hundred eighteen Portuguese youth identified as poly-victims (56% girls) and aged between 12 and 17 years old ( M = 15.63; SD = 1.26) were recruited from three at-risk contexts' cohorts. Participants completed self-report measures of trauma exposure, posttraumatic symptoms, dissociative symptoms, and emotional and social adjustment problems., Results: The study results suggest that, among poly-victim adolescents, PTSD and dissociation may be mediators of the relationship between the cumulative extent of victimization and adjustment problems., Conclusion: The current study's findings highlight the importance of careful assessment of both PTSD and dissociative symptoms and indicate that targeted interventions are essential when working with poly-victimized youth with the highest scores of cumulative victimization. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exposure to prolonged and/or multiple types of psychological trauma and stressors has been shown to be more strongly associated with ICD-11 complex posttraumatic stress disorder (CPTSD) than posttraumatic stress disorder (PTSD). Lesbian, gay, bisexual, trans- and queer adults (LGBTQ+) are at a heightened risk of exposure to traumatic events, and minority stressors including harassment, discrimination, rejection by family, and isolation., Objective: To examine the factor structure of the international trauma questionnaire (ITQ), a self-report measure of PTSD and CPTSD, and the associations of cumulative lifetime trauma exposure assessed via the life events checklist and minority stress assessed via the daily heterosexist experiences scale, with CPTSD (three PTSD symptom clusters, three clusters reflecting disturbances in self-organization [DSO]) among LGBTQ + adults., Method: Participants comprised 225 LGBTQ + adults (including 74 transgender and gender diverse individuals; age range: 18-60 years; M/SD = 31.35/9.48) residing in Spain., Results: Confirmatory factor analyses indicated that both a first-order six-factor model and a hierarchical two-factor model, comprising PTSD and DSO as second-order factors, fit the data best. Cumulative traumatic events score was associated with PTSD, and cumulative minority stress was associated with PTSD and DSO. Among the minority stress subscales, harassment based on gender expression was positively associated with all symptom clusters of PTSD and DSO., Conclusion: This is the first study to examine the role of minority stressors alongside exposure to psychological traumas in ICD-11 PTSD and CPTSD and emphasizes the inclusion of minority stressors in trauma-related assessments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Past influenza pandemics including the Spanish flu and H1N1 have disproportionately affected Indigenous Peoples. We conducted a systematic scoping review to provide an overview of the state of understanding of the experience of Indigenous peoples during the first 18 months of the COVID-19 pandemic, in doing so we capture the state of knowledge available to governments and decision makers for addressing the needs of Indigenous peoples in these early months of the pandemic. We addressed three questions: (a) How is COVID-19 impacting the health and livelihoods of Indigenous peoples, (b) What system level challenges are Indigenous peoples experiencing, (c) How are Indigenous peoples responding? We searched Web of Science, Scopus, and PubMed databases and UN organization websites for publications about Indigenous peoples and COVID-19. Results were analyzed using descriptive statistics and content analysis. A total of 153 publications were included: 140 peer-reviewed articles and 13 from UN organizations. Editorial/commentaries were the most (43%) frequent type of publication. Analysis identified Indigenous peoples from 19 different countries, although 56% of publications were centered upon those in Brazil, United States, and Canada. The majority (90%) of articles focused upon the general adult population, few (<2%) used a gender lens. A small number of articles documented COVID-19 testing (0.04%), incidence (18%), or mortality (16%). Five themes of system level challenges affecting exposure and livelihoods evolved: ecological, poverty, communication, education and health care services. Responses were formal and informal strategies from governments, Indigenous organizations and communities. A lack of ethnically disaggregated health data and a gender lens are constraining our knowledge, which is clustered around a limited number of Indigenous peoples in mostly high-income countries. Many Indigenous peoples have autonomously implemented their own coping strategies while government responses have been largely reactive and inadequate. To 'build back better' we must address these knowledge gaps., (© 2023 The Author(s). Published by IOP Publishing Ltd.)

Transportation systems in northern Canada are highly sensitive to climate change. We project how access to semi-permanent trails on land, water, and sea ice might change this century in Inuit Nunangat (the Inuit homeland in northern Canada), using CMIP6 projections coupled with trail access models developed with community members. Overall trail access is projected to diminish, with large declines in access for sea ice trails which play a central role for Inuit livelihoods and culture; limits to adaptation in southern regions of Inuit Nunangat within the next 40 years; a lengthening of the period when no trails are accessible; and an unequal distribution of impacts according to the knowledge, skills, equipment, and risk tolerance of trail users. There are opportunities for adaptation through efforts to develop skillsets and confidence in travelling in more marginal environmental conditions, which can considerably extend the envelope of days when trails are accessible and months when this is possible. Such actions could reduce impacts across emissions scenarios but their potential effectiveness declines at higher levels of global warming, and in southern regions only delays when sea ice trails become unusable., Competing Interests: Competing interestsThe authors declare no competing interests., (© The Author(s) 2023.)