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Objective: Despite growing evidence demonstrating the association between racial and ethnic discrimination and traumatic stress symptoms in adult populations, the research among youth remains sparse. Drawing upon race-based traumatic stress models, and following the PRISMA-2020 guidelines, this systematic review and meta-analysis aimed to identify the state of the empirical evidence in the association between racism-related experiences and traumatic stress symptoms in ethnoracially minoritized youth., Method: Scientific databases were searched to identify articles with ethnoracially minoritized youth participants under age 18 years old that examined the association between racial and/or ethnic discrimination and traumatic stress symptoms., Results: A total of 18 articles comprising 16 studies ( N  = 4,825 participants) met inclusion criteria. Studies were largely cross-sectional, used nonrandom sampling strategies, focused on Black and Latinx youth, and were conducted in the United States. Furthermore, most studies were theoretically grounded and operationalized racism-related experiences as frequency of direct, personal, everyday discrimination. Few studies examined other dimensions of racism-related experiences. The meta-analysis demonstrated a significant positive association with a medium effect size, r pooled  = .356, 95% confidence interval [CI] = 0.27, 0.44, between racism-related experiences and traumatic stress symptoms. No evidence of moderation by age, sex/gender, race/ethnicity, country, or recruitment setting was detected., Conclusion: Racism-related experiences may confer risk for traumatic stress symptoms in ethnoracially minoritized youth. Attending to racism-related experiences is critical to improve the cultural responsiveness of trauma-informed services.

Violent injury is a leading cause of death and disability among young Black men, with the highest rates occurring in low-income urban populations. Hospital-based violence intervention programs (HVIPs) offer a promising opportunity to address the biopsychosocial factors that adversely affect this population. However, there are major gaps between the needs of young Black male survivors of violent injury and the forms of care provided by HVIPs. Patient-centered outcomes research provides a useful mode of inquiry to develop strategies to decrease these differences. Care for survivors, including treatment for traumatic stress disorders, must be reconceptualized to center the lived experiences of young Black men. This paper qualitatively explores how these survivors of gun violence express symptoms of traumatic stress and the ways in which their narratives can inform the implementation of the biopsychosocial model in HVIPs. A phenomenological variant ecological systems theory framework was used to analyze participant narratives to aid in understanding their symptoms of traumatic stress and post-injury affective changes as both psychologically and socially important experiences. Such insight may inform changes to HVIP practice to address persistent health disparities related to violence.

Health-care workers operating in conflict zones are at severe risk of psychological consequences, given their extended exposure to traumatic events under conditions of stress and violence. This quantitative, cross-sectional study was designed to explore the relationships between personal resources (sources of functioning)-operationalized as sense of coherence, posttraumatic growth, and perceived well-being-psychological distress, and trauma symptoms in a specific population of health workers exposed to war and violence. Palestinian health professionals ( N = 181) completed quantitative measures of well-being, posttraumatic growth, sense of coherence, psychological distress, and traumatic response. The data were analyzed using structural equation modeling (SEM). The outcomes suggest that sources of psychological functioning consistently play a role in the mental health of different types of health professionals. Health-care workers in an environment characterized by instability and ongoing risk need to protect their own mental health by mobilizing sources of resistance and resilience, such as a sense of coherence, subjective well-being, and growth. We discuss the clinical implications of these findings and offer recommendations for training and supervision. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Empirical evidence demonstrates that racism is a source of traumatic stress for racial/ethnic minorities, particularly African Americans. Like race and racism, skin tone and experiences of colorism-an often overlooked form of discrimination that privileges lighter skinned over darker skinned individuals, although not uniformly, may also result in traumatic stress. This article proposes a new conceptual model of skin-tone trauma. The model depicts how historical and contemporary underpinnings of colorism lead to colorist incidents that may directly and indirectly, by eliciting traumatic stress reactions, lead to negative effects on the health and interpersonal relationships of African Americans. Key tenets of critical race and intersectionality theories are used to highlight the complexities of skin-tone trauma as a result of intersectional identities on the basis of existing social hierarchies. Last, we present suggestions for researchers, as well as recommendations and strategies for practitioners, to unmask "skin-tone wounds" and promote healing for individuals, families, and communities that suffer from skin-tone trauma. Skin-tone trauma should be acknowledged by researchers, scholars, and practitioners to better understand and assess the widespread scope of trauma in the African American community.

Background: The accurate assessment of childhood maltreatment (CM) is important in medical and mental health settings given its association to adverse psychological and physical outcomes. Reliable and valid assessment of CM is also of critical importance to research. Due to the potential of measurement bias when comparing CM across racial and ethnic groups, invariant measurement is an important psychometric property of such screening tools., Objective: In this study, differential item function (DIF) by race and ethnicity was tested. Uniform DIF refers to the influence of bias on scores across all levels of childhood maltreatment, and non-uniform DIF refers to bias in favor of one group., Method: Participants were N=1,319 women and men (M age =36.77, SD age =10.37) who completed the Child Trauma Questionnaire-Short Form; 42.7% were women, 57.3% were male; 58.9% were White-American, 22.1% Black-American, and 8.0% as other; 26.3% were Hispanic., Results: Using empirical thresholds, non-uniform DIF was identified in five items by race, and no items by ethnicity., Conclusions: Uniform DIF is less problematic given that mathematical corrections can be made to adjust scores for DIF. However, non-uniform DIF can usually only be corrected by removing the DIF items from the scale. Further methodological research is needed to minimize measurement bias to effectively assess racially diverse populations., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

We examined the relationship between source of social support and mental health (and the moderating impact of age) in 64 low socioeconomic status, racial minority lesbian, gay, and bisexual adolescents/young adults. Social support from family ( β = -.302, p = .03; β = -.364, p = .008), but not friends or significant others, was independently related to posttraumatic stress disorder and depression symptoms, respectively. Family social support was associated with lower posttraumatic stress disorder and depression symptoms in participants aged 16-19 years, while friend social support was associated with lower symptoms for participants aged over 20 years. Friend social support was also associated with lower posttraumatic stress disorder symptoms in participants aged 16-17 years. Interventions should target age-appropriate sources of social support.

Purpose: This study investigated secondary traumatic stress and its relationship to burnout among nurses working at a Turkish hospital., Design: A mixed-methods design included a cross-sectional survey administering the Professional Quality of Life instrument and Maslach Burnout Inventory to 106 nurses. Interviews with a subgroup of eight participants explored nurses' experiences and coping strategies related to caring for chronically ill pediatric patients., Results: High risk levels of secondary traumatic stress existed among 40.6% participants, and those over the age of 40 years were at greater risk. Two main interview themes emerged that identified (a) consequences and (b) coping strategies while caring for chronically ill children. Nurses experience emotional burdens and may purposefully distance themselves from chronically ill children. Social support from nurse colleagues and spiritual beliefs assist coping., Implications: Workplaces should acknowledge stressors inherent in chronic pediatric nursing care. Environments that welcome spiritual practices and actively encourage social support could address job hazards.

Trauma is a transgenerational process that overwhelms the community and the ability of family members to cope with life stressors. An anthropologist trained in ethnographic methods observed three focus groups from a non-profit agency providing trauma and mental health services to Asian Americans living in the San Francisco Bay Area of United States. Supplemental information also was collected from staff interviews and notes. Many of the clients were immigrants, refugees, or adult children of these groups. This report consisted of authentic observations and rich qualitative information to characterize the impact of trauma on refugees and immigrants. Observations suggest that collective trauma, direct or indirect, can impede the success and survivability of a population, even after many generations., Competing Interests: The authors declare no conflict of interest.

The present study examined how stress reactions after traumatic events influence subjective well-being (SWB) via the indirect effect of posttraumatic growth (PTG) in two samples of Palestinian professional helpers from the Gaza Strip and West Bank ( n = 201). Using the General Health Questionnaire (GHQ-12) as a dependent measure of well-being, and PTGI-10, PANAS-20, WHO-5 BREF, and IES-13 questionnaires as independent variables, structural equation modelling (SEM) was used to examine whether: (a) cumulative trauma was negatively and directly related to subjective well-being; (b) levels of trauma were positively and directly related to posttraumatic growth; and (c) PTG was positively and directly related to subjective well-being. The findings suggest that posttraumatic growth contributes to mitigating and buffering (on the order of approximately 10%) the effect of trauma on subjective well-being. PTG seems to be a resource that can help aid workers deal with the consequences of stressful life events. Clinical implications and directions for supervision and training are discussed.

Over 50 million people have been displaced, some as a result of conflict, which exposure can lead to psychiatric sequelae. The aims of this study were to provide estimates of pre-emigration trauma, post-migration stress, and psychological sequelae of immigrants and refugees from predominantly Sub-Saharan Africa who immigrated to Sweden. We also examined the predictors of the psychiatric sequelae as well as acculturation within the host country. A total of 420 refugees and immigrants were enrolled using stratified quota sampling. A battery of questionnaires including the Harvard Trauma Questionnaire, Post-Migration Living Difficulties Scale, the Cultural Lifestyle Questionnaire; and the Hopkins Checklist were administered. Descriptive statistics, Chi square analyses, Pearson correlations, analysis of variance, and logistic and linear regression were performed to test the aims of the study. Eighty-nine percent of participants reported at least one traumatic experience prior to emigration. Forty-seven percent of refugees reported clinically significant PTSD and 20 % reported clinically significant depressive symptoms. Males reported a significantly greater number of traumatic events [F(1, 198) = 14.5, p < 0.001] and post-migration stress than females [F(1, 414) = 5.3, p = 0.02], particularly on the financial, discrimination, and healthcare subscales. Females reported a higher prevalence of depressive symptoms when compared to males [F(1, 419) = 3.9, p = 0.05]. Those with a shorter duration in Sweden reported higher rates of PTSD [F(63, 419) = 1.7, p < 0.001]. The greater number of traumatic events was found to be significantly associated with the severity of PTSD symptoms [F(34, 419) = 9.6, p < 0.001]. Using regression analysis, 82 and 83 % of the variances associated with anxiety and depression, respectively, was explained by gender, education, religion, PTSD and post-migration stress. Sixty-nine percent of the variance associated with PTSD included education, number of traumatic events, depressive symptoms and post-migration stress. Forty-seven percent of the variance for acculturation was accounted for by a model that included age, education, duration in Sweden, anxiety, depression, and post-migration stress. These predictors were also significant for employment status with the exception of depressive symptoms. Multidimensional interventions that provide treatments to improve psychiatric symptoms in combination with advocacy and support to reduce stress (e.g., financial, access to health care) are recommended. The focus of the intervention may also be modified based on the gender of the participants.

The 'tend-and-befriend' approach (Taylor et al., ) posits that in times of stress, women in particular may tend to their loved ones and seek out social support as a coping mechanism. Two corollaries of this model are that when confronted with a situation of extreme stress, marriage may be more of a protective factor for men, as central beneficiaries of their wives 'tending' or nurturing response, and social support from a wider network may be more of a protective factor for women, as part of women's 'befriending' response to stress. Using a sample of 508 Israelis (M = 47 years; 48% women) under the real condition of a population under missile attacks, we investigated the latter two corollaries of the tend-and-befriend model, hypothesizing that marriage would buffer against symptoms of traumatic stress for men in particular and that social support would buffer against symptoms of traumatic stress for women in particular. Our findings revealed gender differences affirming both hypotheses and offering interpretive evidence in support of the tend-and-befriend model based on a gender-informed field study of responses to traumatic stress in real time. Copyright © 2015 John Wiley & Sons, Ltd., (Copyright © 2015 John Wiley & Sons, Ltd.)

Background: Chronic stress and/or lifetime traumatic stress can create a self-reinforcing cycle of unhealthy behaviors, such as overeating and sedentary behavior, that can lead to further increases in stress. This study examined the relationship between stress and sedentary behavior in a sample of Hispanic/Latino adults (N = 4244) from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study., Methods: Stress was measured as the number of ongoing difficulties lasting 6 months or more and as lifetime exposure to traumatic events. Sedentary behavior was measured by self-report and with accelerometer. Multivariable regression models examined associations of stress measures with time spent in sedentary behaviors adjusting by potential confounders., Results: Those who reported more than one chronic stressor spent, on average, 8 to 10 additional minutes per day in objectively measured sedentary activities (P < .05), whereas those with more than one lifetime traumatic stressor spent (after we adjusted for confounders) 10 to 14 additional minutes in sedentary activities (P < .01) compared with those who did not report any stressors. Statistical interactions between the 2 stress measures and age or sex were not significant., Conclusion: Interventions aimed at reducing sedentary behaviors might consider incorporating stress reduction into their approaches.

Objective: The current study examined multiple stress indicators (chronic, perceived, traumatic) in relation to prevalent coronary heart disease, stroke, and major cardiovascular disease (CVD) risk factors (i.e., diabetes, dyslipidemia, hypertension, and current smoking) in the multisite Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (2010-2011)., Methods: Participants were 5313 men and women 18 to 74 years old, representing diverse Hispanic/Latino ethnic backgrounds, who underwent a comprehensive baseline clinical examination and sociocultural examination with measures of stress., Results: Chronic stress burden was related to a higher prevalence of coronary heart disease after adjusting for sociodemographic, behavioral, and biological risk factors (odds ratio [OR; 95% confidence interval], 1.22 [1.10-1.36]) and related to stroke prevalence in the model adjusted for demographic and behavioral factors (OR [95% confidence interval], 1.26 [1.03-1.55]). Chronic stress was also related to a higher prevalence of diabetes (OR = 1.20 [1.11-1.31]) and hypertension (OR = 1.10 [1.02-1.19]) in individuals free from CVD (n = 4926). Perceived stress (OR = 1.03 [1.01-1.05]) and traumatic stress (OR = 1.15 [1.05-1.26]) were associated with a higher prevalence of smoking. Participants who reported a greater number of lifetime traumatic events also unexpectedly showed a lower prevalence of diabetes (OR = 0.89 [0.83-0.97]) and hypertension (OR = 0.88 [0.82-0.93]). Effects were largely consistent across age and sex groups., Conclusions: The study underscores the advantages of examining multiple indicators of stress in relation to health because the direction and consistency of associations may vary across distinct stress conceptualizations. In addition, the study suggests that chronic stress is related to higher CVD risk and prevalence in Hispanics/Latinos, the largest US ethnic minority group.

This article examines children's enactment of spirit possession idioms and witchcraft in Africa including the meanings such idioms provide and the local healing resources they mobilize. Idioms of haunting spirits in Northern Uganda and witch-children elsewhere in Africa can be interpreted as manifestations of social crises and mass traumatic stress. On the other hand, such idioms also allow children to articulate, reflect upon, and communicate the complex feelings resulting from their precarious positions within families and communities under duress. With the help of Dow's transactional model of symbolic healing, this article explores obstacles to the effectivity of the rich variety of symbolic healing available for haunting spirits in Uganda and points to the generational gap between children and their families and communities. Elsewhere, witchcraft idioms may act as a healing resource at the group level, but at the expense of the accused child. The idioms of evil spirits and witchcraft speak of these children's navigation of the moral universe of their postconflict communities. Given that children's appraisal of their experiences through these notions may also exacerbate their anxiety, interdisciplinary research examining the microprocesses that lead to children being haunted or accused, including emotional and physiological levels effects, is urgently needed.

Objectives: We investigated whether 1 form of traumatic stress, discrimination-related trauma (e.g., physical assault because of race), was associated with unprotected anal intercourse, especially when compared with non-discrimination-related trauma, among African American men who have sex with men., Methods: A convenience sample of 131 HIV-positive African American men who have sex with men receiving antiretroviral treatment completed audio computer-assisted self-interviews that covered unprotected anal intercourse, interpersonal trauma, and whether trauma was because of discrimination on the basis of race/ethnicity, HIV serostatus, or sexual orientation., Results: Sixty percent reported at least 1 interpersonal trauma; they attributed at least 1 trauma to being gay (47%), African American (17%), or HIV positive (9%). In a multivariate regression, experiencing discrimination-related trauma was significantly associated with unprotected anal intercourse (adjusted odds ratio [AOR] = 2.4; 95% confidence interval [CI] = 1.0, 5.7; P = .04), whereas experiencing non-discrimination-related trauma was not (AOR = 1.3; 95% CI = 0.6, 3.1; P = .53)., Conclusions: HIV-positive African American men who have sex with men experience high levels of discrimination-related trauma, a stressor associated with greater risk taking. HIV prevention interventions should consider the potential damaging effects of discrimination in the context of trauma.

Objectives: To evaluate ethnic group differences in the association between trauma exposure and health status among an ethnically diverse sample originating in Hawai'i., Design: Across a 10-year period (1998-2008), participants (N=833) completed five waves of questionnaire assessments. Trauma exposure was measured retrospectively at the most recent assessment (wave 5), socioeconomic resources (educational attainment and employment status) were measured at wave 1, and self-rated health was measured at each of the five waves., Results: Results indicated that greater exposure to trauma was associated with poorer self-rated health, as were lower educational attainment and lower work status. In addition, there was ethnic group variation in health ratings, as well as in how strongly trauma exposure predicted health status. Specifically, within Filipino American and Native Hawaiian ethnic groups, there was a stronger negative association between trauma exposure and self-rated health., Conclusion: These results suggest complex interrelations among trauma, ethnicity, socioeconomic status, and physical health. Further understanding these relations may have implications for medical and behavioral interventions in vulnerable populations.

Trauma affects children from all ethnicities, nationalities and socioeconomic backgrounds. However, indigenous children may experience trauma differently than their majority population peers due to traumatic histories of colonization and marginalization. This article reports on an exploratory qualitative study of how service providers in Western Montana and Northern Norway conceptualize Native American and Sámi children's experiences of trauma today. Findings reveal that participants relate current trauma experiences of indigenous youth to historical and intergenerational traumas.

This study examined the influence of pre-immigration trauma on the acculturation process of refugees, as reflected in the manifestations of their continuing bonds with native cultures. Six African refugees who sought refuge in Egypt because of wars and political persecution were interviewed about the circumstances of their departure from their home countries, as well as their life experiences in Egypt. All participants kept continuing bonds with their native cultures, but these bonds manifested differently depending on their ability to assimilate pre-immigration trauma and cultural losses. Participants who successfully assimilated both pre-immigration trauma and cultural losses developed continuing bonds with their native cultures that helped them (a) integrate the Egyptian culture into their life experiences and (b) tolerate difficult political conditions in Egypt. Participants who could not assimilate their pre-immigration trauma and cultural losses also developed continuing bonds with their native culture, but these bonds only provided them with solace.

Gang violence is a growing public health concern in the United States, and adolescents are influenced by exposure to gang violence. This study explored the influence of exposure to gang violence on adolescent boys' mental health using a multi-method design. A semi-structured interview guide and the Trauma Symptom Checklist for Children were used to collect data from adolescents. Parents, primary caregivers, and community center employees completed the Child Behavior Checklist or Teacher Report Form. Ten adolescent boys, their parents or primary caregivers, and six community center employees participated in the study. Exposure to gang violence was common among these adolescents and they had a variety of reactions. Parents, primary caregivers, and community center employees had differing perceptions of adolescents' exposure to violence and their mental health. Adolescent boys' exposure to gang violence in the community is alarming. These adolescents encountered situations with violence that influenced their mental health.

Based on interviews with Beirut intellectuals and architects, this essay endeavours to trace the contours for a phenomenology or anthropology of civil war. Thomas Hobbes serves as a guide, with his idea of civil war representing a relapse into the ‘state of nature’; as absence of sovereignty resulting in a ‘war of everybody against everybody’. The effects of ever-latent civil war in Beirut are far-reaching: the fragmentation of urban space and the disappearance of public space, the loss of memory and the fragmentation of time, even the reification of language. In the collective imagination and in the arts, Beirut appears as a ghost town, a spectral city with a spectral civility. What we discover is a city, its inhabitants, its social behaviour, but also its art and literature, in the grip of post-traumatic stress syndrome. From all this, we take home two things: first, any city can (at least in principle) relapse into a similar state of nature — Beirut can become a paradigm of latent civil war; and second, the traumatic modernity of Beirut mirrors the traumatic artistic expressions of modernism — the shock of modernity is also always a modernity of shock.

This study describes predictors of secondary traumatic stress and burnout in a national sample of helping professionals, with a specific focus on the unique responses of child welfare (CW) workers. Specific worker and exposure characteristics are examined as possible predictors of these forms of occupational distress in a sample of 669 professionals from across the country who responded to mailed (e-mail and post) invitations to participate in an online survey. E-mail and home mailing addresses were secured from licensure boards and professional membership organizations in six states from across the country that had high rates of child related deaths in 2009. Respondents completed the Professional Quality of Life IV (Stamm, 2005) to ascertain compassion fatigue (CF) and burnout symptoms. Being male, young, Hispanic, holding rural residence, and endorsing a lack of religious participation were significant predictors of secondary traumatic stress. Similarly, being male and young predicted high burnout rates, while actively participating in religious services predicted lower burnout. CW worker job status as a professional was significantly more likely to predict CF and burnout compared to all other types of behavioral healthcare professionals. Based on the findings from this study, this paper proposes strategies for enhancing self-care for CW workers, and describes the essential elements of a trauma-informed CW agency that addresses secondary traumatic stress and burnout.

Past research on idioms of distress among U.S. Latinos has revealed that ataque de nervios and altered perceptions, such as hearing and seeing things when alone, are independent markers of higher morbidity and mental health utilization despite having no one-to-one relationships with any single psychiatric diagnosis. It has been proposed that the idioms exert this effect because they are signs of distressing dissociative capacity associated with traumatic exposure. This study examines the relationships in an ethnically diverse Latino psychiatric outpatient sample (N = 230) among interpersonal trauma, posttraumatic stress disorder (PTSD), major depressive disorder, dissociative capacity and four cultural idioms of distress associated with the popular overall category of nervios. We particularly explore how these relationships change with varied measures of traumatic exposure, including trauma severity and timing or persistence of trauma. A series of adjusted bivariate regressions assessed the matrix of associations between the idioms and the clinical variables. In this highly traumatized population, we identified a strong 'nexus' of associations between dissociation and three of the idioms: currently being ill with nerves, ataque de nervios and altered perceptions. These idioms were largely independent from PTSD and depression and were associated with trauma persistence and severity. A fourth idiom, being nervous since childhood, was not associated with any other variable and may represent a personality trait rather than a diagnosable condition. Our results validate the clinical utility of the construct of nervios as a set of specific idioms associated with dissociation that are useful markers of mental health need among Latinos independently of their association with clinical diagnoses.

In this introduction to the Special Issue on Trauma and Idioms of Distress, we provide an overview of the concept and typology of "idioms of distress," focusing particularly on their clinical utility. This includes the role of idioms as indicators of trauma exposure, of various types of psychopathology and of levels of distress, risk and functioning. It likewise includes the fact that idioms of distress may profoundly influence the personal meaning of having a trauma-related disorder, may shape the interpersonal course of the disorder and may pattern help-seeking and self-treatment. Finally, it illustrates the fact that idioms may also help clinicians understand sufferers' views of the causes of their distress, constitute key therapeutic targets and help increase therapeutic empathy and treatment adherence. This special issue focuses on the role played by idioms of distress in the local trauma ontology, the associations between the idioms and psychiatric disorders occurring in the context of trauma and the mechanisms by which the idioms profoundly influence the personal and interpersonal course of trauma-related disorders.

This article examines some of the long-term health outcomes of extreme adversities and the ways in which social inequalities and idioms of distress are historically and socially produced in the Peruvian context. We describe how the highland Quechua of northern Ayacucho construct and experience expressions of distress and suffering such as pinsamientuwan (worrying thoughts, worries), ñakary (suffering) and llaki (sorrow, sadness), in a context of persistent social inequalities, social exclusion and a recent history of political violence. It is concluded that the multiple expressions of distress and suffering are closely related to past and current events, shaped by beliefs, core values and cultural norms and, in this process, transformed, recreated and invested with new meanings and attributions.

In 1984, a healing cult for young barren women in southern Guinea Bissau developed into a movement, Kiyang-yang, that shook society to its foundations and had national repercussions. "Idiom of distress" is used here as a heuristic tool to understand how Kiyang-yang was able to link war and post-war-related traumatic stress and suffering on both individual and group levels. An individual experience born from a traumatic origin may be generalized into an idiom that diverse sectors of society could embrace for a range of related reasons. We argue that, for an idiom to be understood and appropriated by others, there has to be resonance at the level of symbolic language and shared experiences as well as at the level of the culturally mediated contingent emotions it communicates. We also argue that through its symbolic references to structural causes of suffering, an idiom of distress entails a danger for those in power. It can continue to exist only if its etiology is not exposed or the social suffering it articulates is not eliminated. We finally argue that idioms of distress are not to be understood as discrete diagnostic categories or as monodimensional expressions of "trauma" that can be addressed.

The focus of this paper is the intercultural process through which Open Mole and trauma-related mental illnesses are brought together in the postconflict mental health encounter. In this paper, I explore the historical dimension of this process by reviewing the history of Open Mole, and the ways in which it has been interpreted, acted on, and objectified by external observers over the last half-century. Moving into Liberia's recent war and postconflict period, I examine the process by which Open Mole is transformed from a culture-bound disorder into a local idiom of trauma, and how it has become a gateway diagnosis of PTSD-related mental illnesses, and consider how it is produced as an objectified experience of psychiatric disorder in clinical humanitarian contexts. By studying how Open Mole is transformed in the humanitarian encounter, I address the structure and teleology of the humanitarian encounter and challenge some of the foundational assumptions about cultural sensitivity and community-based mental health care in postconflict settings that are prevalent in scholarship and practice today.

Spirit possession is a common, worldwide phenomenon with dissociative features. Studies in Europe and the United States have revealed associations among psychoform and somatoform dissociation and (reported) potential traumatic events. The aim of this study was to explore the relationships among spirit possession, dissociative symptoms and reported potentially traumatizing events in Uganda. One hundred nineteen persons with spirit possession, diagnosed by traditional healers, were compared to a matched control group of 71 nonpossessed persons. Assessments included demographic items and measures of dissociation and potentially traumatizing events. Compared to the nonpossessed group, the possessed group reported more severe psychoform dissociation and somatoform dissociation and more potentially traumatizing events. The associations between these events and both types of dissociation were significant. Yet, consistent with the cultural perception of dissociative symptoms, the participants subjectively did not associate dissociative symptoms with potentially traumatizing events. In conclusion, spirit possession deserves more interest as a possible idiom of distress and a culture-specific expression of dissociation related to potential traumatizing events.

In the aftermath of a decade-long Maoist civil war in Nepal and the recent relocation of thousands of Bhutanese refugees from Nepal to Western countries, there has been rapid growth of mental health and psychosocial support programs, including posttraumatic stress disorder treatment, for Nepalis and ethnic Nepali Bhutanese. This medical anthropology study describes the process of identifying Nepali idioms of distress and local ethnopsychology and ethnophysiology models that promote effective communication about psychological trauma in a manner that minimizes stigma for service users. Psychological trauma is shown to be a multifaceted concept that has no single linguistic corollary in the Nepali study population. Respondents articulated different categories of psychological trauma idioms in relation to impact on the heart-mind, brain-mind, body, spirit, and social status, with differences in perceived types of traumatic events, symptom sets, emotion clusters and vulnerability. Trauma survivors felt blamed for experiencing negative events, which were seen as karma transmitting past life sins or family member sins into personal loss. Some families were reluctant to seek care for psychological trauma because of the stigma of revealing this bad karma. In addition, idioms related to brain-mind dysfunction contributed to stigma, while heart-mind distress was a socially acceptable reason for seeking treatment. Different categories of trauma idioms support the need for multidisciplinary treatment with multiple points of service entry.

Race-based traumatic stress assessments are difficult because of the insidious nature of racism, the lack of scientific research, and the disregard of the nondominant cultural experience. Although there is a large body of scientific literature about the harmful psychological effects of racism, most of that literature is not directly applicable to individual assessment. Carter and Forsyth begin to correct that deficiency. Implicit in their attempt is the beginnings of defining a race-based traumatic stress syndrome. At present, the psychiatric expert can be useful to the court through a psychological description of the evaluee within a racial-cultural context.

Approaches to the mental health care of refugees and disaster survivors have recently been subject to sustained critique. This article critically examines the notion of ;mental trauma' as it has been used by psychosocial intervention programmes addressing the aftermath of the 2004 Asian tsunami. The objective is to shed light on the guidelines' implicit and explicit assumptions about how people are expected to act and feel after a disaster, thereby implying a certain 'metaphysic' of emotional experience. It will be argued that feelings can not be separated from intersubjective and public spheres, for they shape and motivate expression and experience. Instead, it is necessary to explore the particular ways in which cultural meaning and social structure relate to discourses and practices through which suffering is produced and represented. To conclude, a method is outlined to operationalize particular experiences of suffering and the institutionalized discourses and practices in which they obtain social meaning and force.

Objective: We sought to compare female African-American (n = 84) and Caucasian (n = 99) veterans from primary care clinics at 4 Veterans Affairs Medical Centers (VAMCs) on rates of trauma, posttraumatic stress disorder, other psychiatric diagnoses, functional status, and use of VA services and disability benefits., Methods: Analyses were based on a cross-sectional, epidemiologic design incorporating self-report measures, structured interviews, and chart reviews., Results: With the exception of higher rates of child sexual abuse among Caucasian women and higher rates of physical assault among African-American women, there were no other statistically significant racial differences across analyses. However, some clinically meaningful trends emerged, and the implications of these findings are discussed within the context of our other results., Conclusions: Among female veterans seen in VA primary care clinics, African-Americans and Caucasians do not differ dramatically with regard to the manifestation or severity of psychopathology, or in their use of relevant VA health care services and disability benefits. These data are important because women represent the fastest growing segment of the VA population after aging veterans. Further research is needed to replicate and extend these findings to ensure that female veterans' needs are adequately identified and met by VAMC providers.

Background: Students are unable to benefit from many school programs designed to address their mental health needs if their parents do not consent to their participation. As part of an ongoing effort in a large urban school district to meet the mental health needs of students traumatized by violence exposure, this paper examines the impact of alternative approaches on parental response and consent rates for an initial screening to participate in a school mental health program., Methods: Two alternative approaches were used to obtain consent for students to participate in a school-based intervention for students exposed to violence. For one cohort, consent forms were distributed along with school information and other school forms during a parent orientation meeting. In the other cohort, school mental health clinicians visited student homerooms to distribute consent forms and explain the program and evaluation to students., Results: There were significantly higher rates of return of consent forms (89.8% vs 53.2%) and parents consenting to participate (69.6% vs 27.9%) among parents receiving consent forms at a school meeting than among parents whose forms were distributed to children in a classroom, with comparable rates of active refusals to participate (20.1% vs 25.3%)., Conclusions: Overall return rates and rates of consent for screening participation were substantially higher when the consent form and accompanying materials were provided directly to parents rather than distributed in the classroom and sent home with students. These findings have implications for efforts to obtain active consent from parents for students to participate in school mental health programs.

This article describes a methodology for developing culturally grounded assessment measures in conflict and postconflict situations. A mixed-method design was used in Kabul, Afghanistan, to identify local indicators of distress and develop the 22-item Afghan Symptom Checklist (ASCL). The ASCL contains several indigenous items and items familiar to Western mental health professionals. The ASCL was pilot tested and subsequently administered to 324 adults in 8 districts of Kabul. It demonstrated excellent reliability (alpha=.93) and good construct validity, correlating strongly with a measure of exposure to war-related violence and loss (r=.70). Results of the survey indicate moderate levels of distress among Afghan men and markedly higher levels of distress and impaired functioning among women (and widows in particular)., ((c) 2007 APA, all rights reserved)

A comparative cross-national study investigating the level of experience with community interpersonal violence, level of psychological distress, and the relationship between exposure and distress among adolescents is presented. Participants were 617 first-year college students comprising African Americans and Jamaican Americans living in New York City, and Jamaicans living in Kingston, Jamaica. The three groups are similar in terms of age, gender, educational level, and race; they differ in location of residence, culture, and immigration status. Location of residence is related to exposure; immigration status is related to distress; but culture is not related to vulnerability when exposed. The effect size of the relationship between exposure and distress appears to be robust across variations in culture, amount of exposure, and level of distress.

This paper discusses the tsunami disaster in Sri Lanka with special reference to Buddhism, which is the majority religion in the island. The role of religious beliefs and of religion in general in strengthening coping skills is well known. Buddhism, with its specific views on the human condition and its use of psychological strategies, is almost unique among world religions. The Buddhist responses to the tsunami have been discussed widely, if largely informally, in Sri Lanka, and many concepts and practices have been highlighted and focused on. This paper provides an overview of the relationship between culture and traumatic experiences, with a brief discussion of the role of religion in mental health. It then goes on to explore some relevant Buddhist concepts and practices which can be used in clinical settings.

A cross-sectional study addressed the experience of Lebanese hostages of war in Lebanon. It specifically assessed the prevalence of general distress and its relationship to captivity-related factors and selected psychosocial variables. Trained field researchers using standard measurements interviewed 118 Lebanese hostages released from Khiam prison, an Israeli detention center in Lebanon. Questionnaires administered included the GHQ-12 and the Harvard Trauma Questionnaire. Individuals were detained for 3.4 years on average, and 86% were tortured. Psychological distress was present in 42.1% of the sample compared to 27.8% among the control group. In the multivariate analysis, the significant predictors for distress were: years of education and increase in religiosity after release. In conclusion, even after 2 years of release, more than one-third of the Lebanese hostages released from Khiam prison were found to have psychological distress. Caregivers need to pay special attention to the mental health of hostages of war. The paper discusses the meaning and implications of the factors predicting resilience and vulnerability in this particular population.

Background: Each refugee group experiences specific migration and resettlement experiences. There are no epidemiological data on risk factors for psychiatric symptoms among adult Somalis in the UK., Methods: We interviewed a community sample of 180 Somalis. We assessed the relationship between symptoms of psychosis (BPRS), anxiety and depression (SCL-90) and suicidal thinking (BDI) and migration-related experiences such as traumatic events, immigration difficulties, employment and income., Results: Anxiety and depression was incrementally more common with each pre-migration traumatic event (OR per trauma event = 1.31, 1.06-1.62, p = 0.01). Shortages of food, being lost in a war situation, and being close to death and suffering serious injury were each related to specific psychiatric symptoms. Suicidal thinking was more common among Somalis who were unemployed before migration and those using qat in the UK., Conclusions: War-related experiences, occupational status before migration and current Qat use are risk factors for psychiatric symptoms among Somali refugees.

Susto, a folk illness not recognized by biomedical practitioners as a disease, is now formally part of the diagnostic classification system in psychiatry as a "culture-bound syndrome." Susto has been reported among diverse groups of Latin Americans, but most of those reports are several decades old and many were conducted in Indian communities. This study focuses on contemporary descriptions of susto and uses a cross-cultural, comparative design to describe susto in three diverse Latino populations. Mestizo/ladino populations were interviewed in Guatemala, Mexico, and south Texas. An initial set of open-ended interviews was conducted with a sample of "key" informants at each site to obtain descriptive information about susto. A structured interview protocol was developed for use at all three sites, incorporating information from those initial interviews. A second set of structured interviews was then conducted with a representative sample at each site. Results indicate a good deal of consistency in reports of what susto is: what causes it, its symptoms, and how to treat it. There appear to be, however, some notable regional variations in treatments and a difference between past descriptions and contemporary reports of etiology.

Data relating to the standardisation of a short version of the 21 item Hopkins Symptom Checklist (HSCL 21) is presented. It confirms the presence of three factors, and provides group means and percentile scales that enable comparisons to be made between the scores of a non-clinical sample and those of two separate target groups that had been under stress. These comparisons give confidence that the rating scale is appropriate for the purpose for which it was used, and suggest that the HSCL 21 could be a useful tool for clinicians in Fiji to use as an adjunct to standard interviews in the assessment of the effects of trauma.

Objectives: This article proposes a new stress-coping model for American Indians and Alaska Natives (AIs) that reflects a paradigmatic shift in the conceptualization of Native health. It reviews sociodemographic information on AIs, rates of substance abuse and related health outcomes, and the research supporting the model's pathways., Observations: Although health outcomes among AIs are improving, large disparities with other racial and ethnic groups in the United States remain. Many health-related problems are directly linked to high rates of substance use and abuse., Conclusion: Eurocentric paradigms focus on individual pathology. An "indigenist" perspective of health incorporates the devastating impact of historical trauma and ongoing oppression of AIs. The model emphasizes cultural strengths, such as the family and community, spirituality and traditional healing practices, and group identity attitudes.

Background: This study examines the association between trauma and HIV risk behaviors among women at sexual risk for HIV infection., Methods: From April to August 1998, high-risk HIV negative women were recruited in the South Bronx into a year-long cohort study. At the 12-month visit, 116 women were interviewed face-to-face about recent and lifetime violent and non-violent traumas., Results: The women reported a substantial prevalence of sexual risk behaviors associated with the acquisition of HIV. At baseline, almost two-thirds (64%) reported unprotected vaginal sex in the previous six months, and in the previous year, 62% had smoked crack, 52% reported sex-for-money-or-drugs exchanges, and 47% had five or more male sex partners. The lifetime prevalence of trauma was high: 81% had experienced one or more violent traumas and 97% had experienced one or more non-violent traumas. Women who had experienced violent trauma--physical assault by a partner (OR = 2.88; 95% CI 1.12; 7.41)--and those who had experienced non-violent trauma--loss of a child to foster care (OR = 3.34; 95% CI 1.04; 10.65)--were more likely to use crack than others. Those who had experienced non-violent trauma, by witnessing a physical assault (OR = 2.31; 95% CI 0.99; 5.40), were also more likely than others to have exchanged sex., Conclusions: Both violent and non-violent traumas appear to play a role in the behaviors that place women at risk of HIV infection, particularly using crack and exchanging sex.