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The study explored the interplay between PTG and PTSS in older South African adults exposed to trauma. A quantitative cross-sectional design was employed. 195 participants from a low-resourced setting in South Africa were interviewed using the UCLA Life Adversities Screener, the PTSD Checklist (DSM-5), and the PTG-Inventory. Hayes Model SPSS Macro PROCESS for moderation was used. Overall, the relationship between cumulative trauma exposure and PTSS was moderated by the PTG level (b = -0.09, SE = 0.04, p =.0113). The findings suggest that cumulative trauma exposure is a significant predictor of PTSS, and the relationship is moderated by the threshold level of PTG. Higher levels of PTG mitigated the effect of cumulative trauma exposure on PTSS. [ABSTRACT FROM AUTHOR]

First responders (FRs) are continuously exposed to critical incidents, considered traumatic events (TEs). This cumulative exposure increases the risk for post-traumatic stress disorder (PTSD). However, there is no evidence about the relationship between PTSD symptoms and emergency decision-making (EDM). The objective of this study was to examine the EDM of FRs during a virtual reality through the simulation of two emergency scenarios to collect data on the reaction time and the number of incorrect decisions. We also assessed PTSD symptoms, TE, and sociodemographics. The sample included 368 Portuguese FRs, were 295 (80.20%) males and 73 (19.80%) females, with a mean age of 33.96 (SD = 9.38). Considering the probable PTSD diagnosis according to the DSM-5, 85 (23.10%) of the FRs met the criteria. These individuals who meet the criteria exhibited higher EDM scores (M = 19.60, SD = 5.99) compared to those without probable PTSD (M = 17.87, SD =.5.66) (F(1, 360) = 5.32, p =.02, partial η2 =.015). We found that TEs had a direct effect on EDM, β = −.16, Z = −3.74, p <.001), and the pathway of trauma-PTSD symptoms-decision-making an indirect effect, β =.02, Z = 3.10, p =.002). Individuals exposed to more TEs demonstrated faster and more accurate decision-making in the context of EDM. However, when these individuals developed PTSD symptoms, their decision-making became slower and less accurate. The inclusion of a trauma-informed approach for FRs to prevent individual and job-related consequences is discussed. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodResultsConclusionThe present study aimed to examine the association between socio-demographic characteristics, damage to perceived needs, post-traumatic stress symptoms, general effect of flood and behavior problems among flood-affected children.Cross-sectional research design was used. A sample of 76 children (aged 8–16 years, experienced extreme hazard flood event) was collected from two schools in a flood-affected rural community in South Punjab-Pakistan through purposive sampling. Children revised impact of event scale-13 and a pediatric symptom checklist were used to screen for post-traumatic stress disorder (PTSD) and internalizing, externalizing or inattention behavior problems respectively.Primary school children who reported financial loss in terms of damage to houses, difficulty faced by parents in building new houses and living in tents were more affected by the flood. Age was a significant positive predictor of the general effect of flood on children. Female children positively predicted arousal PTSD and pediatric behavior problems including inattention problems. Moreover, children who lost their pets had more post-traumatic stress symptoms, as well as externalizing and inattention behavior problems. Number of times previously exposed to floods positively predicted arousal PTSD. Post-traumatic stress symptoms positively predicted behavior problems.Primary school children affected by a flood are at greatest risk of developing behavior and mental health problems. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Implications for the profession and/or patient care Patient or public contribution To determine the longitudinal trajectories of anxiety and depression among pregnant women who have experienced pregnancy loss, and to explore the association between post‐traumatic stress symptoms (PTSS) related to pregnancy loss and these trajectories.A prospective longitudinal study.Between October 2022 and August 2023, pregnant women with a history of pregnancy loss were recruited from four hospitals in Guangdong Province, China. Eligible participants were screened for PTSS related to pregnancy loss upon enrolment. Anxiety and depression symptoms were assessed in early, mid and late pregnancy using the Pregnancy‐related Anxiety Questionnaire‐Revised 2 and the Patient Health Questionnaire‐9, respectively. Latent class growth analysis was employed to categorize anxiety and depression trajectories, and multinomial logistic regression analysis was conducted to examine the association between PTSS and these trajectories.Of the 388 participants included in the analysis, 158 individuals (40.7%) reported high PTSS scores. The best‐fitting models identified three trajectories for both anxiety and depression: low (anxiety: 35.6%, depression: 48.7%), moderate (anxiety: 44.8%, depression: 40.5%) and high (anxiety: 19.6%, depression: 10.8%). Pregnant women with high PTSS levels were significantly more likely to experience moderate‐to‐high trajectories of anxiety and depression compared to those with low PTSS levels.Pregnant women who have experienced pregnancy loss exhibit higher incidences of elevated anxiety and depression trajectories. Screening for PTSS and targeted supportive care are recommended to alleviate anxiety and depressive symptoms in this population.This study underscores the importance of early psychological screening and tailored interventions for pregnant women with a history of pregnancy loss. Trauma‐informed care should be prioritized to mitigate anxiety and depression trajectories in this vulnerable population.There was no patient or public involvement. [ABSTRACT FROM AUTHOR]

Using a stress process lens, this paper considers the interrelationship between individual and family‐level stress exposures and military spouse resources, including problem‐solving appraisals and problem‐solving support (PSS), and their associations with posttraumatic stress symptoms (PTSS) among both partners in military marital dyads. The study employs data from the Millennium Cohort Family Study, a longitudinal survey of married military dyads, with an initial panel of 9,872 spouses enroled from 2011 to 2013. A structural equation model explored the associations between service member and spouse childhood maltreatment exposure, nonmilitary and military stressors, as well as interactions with spouse resources on self‐reported PTSS among both service member (SM) and spouse (SP). Among our findings, spouse childhood maltreatment muted later self‐reported problem‐solving appraisal and support. Spouse resources, in turn, had both protective (problem‐solving appraisal) and promotive (problem‐solving support) effects on PTSS for both service members and spouses. These findings emphasise the central role of spouses in military families, as more psychological resources among spouses appeared to buffer against the deleterious effects of stress exposure on both their own and their partners mental health. [ABSTRACT FROM AUTHOR]

There is emerging literature regarding the efficacy of trauma-focussed writing therapies (TF-WTs) for posttraumatic stress. Such therapies have the potential to reduce posttraumatic stress symptoms (PTSS) in a brief time frame and can be delivered remotely. There remains a need for further research assessing the efficacy of different types of TF-WTs, as well comparing them to alternative control conditions not previously assessed. The present study assessed two TF-WTs that had differing writing instructions in comparison to an intervention that involved writing about positive experiences. Adult community participants (n = 83) with subthreshold or clinical PTSD symptoms were randomized to one of three conditions (two of which involved trauma-focussed writing, and the other involved writing about positive experiences). All conditions involved three weekly telehealth-delivered writing appointments. Outcomes were measured using the PTSD Checklist (PCL-5) and the Depression, Anxiety and Stress Scales (DASS-21), and were evaluated at baseline, one-week post-intervention, and five-weeks post-intervention. This trial was registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR Protocol 12620001065987). There was no evidence that the two TF-WTs were more efficacious in reducing PTSS or producing clinically meaningful change in comparison to positive experiences writing. Instead, a significant reduction from baseline to follow-up in PTSS, depression, anxiety and stress was observed in all three conditions. The results should be interpreted with consideration of the modest sample size and absence of longer-term follow-up. Three-session trauma-focussed writing delivered via telehealth may not be superior to writing about positive experiences. • There is emerging evidence for the efficacy of brief, trauma-focussed writing interventions for posttraumatic stress. • Two trauma-focussed writing interventions were compared to writing about past positive experiences. • Trauma-focussed writing was not efficacious in comparison to writing about past positive experiences. • Writing about either past traumatic experiences or past positive experiences may reduce symptoms of posttraumatic stress. [ABSTRACT FROM AUTHOR]

Abstract Background Playing Tetris is a relatively new concept when considering how to treat or prevent post-traumatic stress symptoms (PTSS). Benefits have been identified regarding how playing the game can influence traumatic memory processing and storage. However, the concept is under-explored and can potentially help populations who are at risk of and are known to experience post-traumatic stress, such as parents of preterm infants in the Neonatal Unit. The aim of the review was to establish if preterm parents playing Tetris was a feasible option to potentially minimise PTSS. Method A scoping review was conducted using PRISMA-ScR guidance. Databases searched were Cinahl, Medline and PsychInfo, over a 20 year period (2003-2023). Titles and abstracts were screened before analysis of full-text articles. A variety of clinical and experimental studies were examined, with differing trauma exposure experienced by participants. Results Thirteen articles were reviewed and four common themes identified. These were memory consolidation, playing Tetris and its effect on intrusive memories (IMs), the effect on the brain and the acceptability as a technique to minimize PTSS in clinical trials. Conclusion Tetris, in theory, is a first-aid intervention and has the potential to minimise the impact of trauma. Based on the findings of the review, Tetris has been effective in other clinical areas and deemed acceptable by participants. Therefore, Tetris is worthy of consideration for use in the population of preterm parents.

Objectives: To investigate the clinical epidemiological characteristics and occurrence of post-traumatic stress symptoms (PTSS) in patients with traumatic fractures, we sought to analyze the factors that influence the prognosis of a length of hospital stay (LOS) and provide valuable insights to prevent PTSS in fracture patients and improve their prognosis. Methods: Inpatients with traumatic fractures were recruited from a third-class comprehensive general hospital in southwest China between November 2019 and October 2020. Case data of traumatic fracture patients were collected, and a questionnaire that included general information and basic fracture details was completed. The post traumatic stress disorder Self-rating Scale was used to assess PTSS among the fracture inpatients. Results: A total of 204 inpatients who experienced traumatic fractures were included in this study. Falls accounted for the largest proportion of traumatic fractures. A Cox's regression analysis revealed that serious injury [Hazard Ratio (HR) = 2.44, 95% Confidence Interval (CI): 1.33-4.46], critical illness during hospitalization (HR = 1.70, 95% CI: 1.13-2.54), and undergoing two surgeries (HR = 1.87, 95% CI: 1.20-2.93) were risk factors for longer LOS. Among the fracture patients, 30.39% exhibited positive PTSD symptoms, and physical activity during the fracture [Odds Ratio (OR) = 0.63, 95% CI: 0.45-0.88] and increased pain (OR = 3.34, 95% CI: 1.82-6.11) were identified as influencing factors. Conclusions: Given the high detection rate of PTSS following traumatic fractures, it is crucial for relevant departments to implement targeted measures to protect high risk individuals. Furthermore, strengthening the care provided to the patients' physical and mental health is urgently needed to reduce the incidence of PTSS. [ABSTRACT FROM AUTHOR]

Objectives Design Methods Results Conclusions During the perinatal period, women and their birth companions form expectations about childbirth. We aimed to examine whether a mismatch between birth expectations and experiences predict childbirth‐related post‐traumatic stress symptoms (CB‐PTSS) for mothers and birth companions. We also explored the influence of the mismatch between mothers' and birth companions' expectations/experiences on CB‐PTSS.Dyadic longitudinal data from the Self‐Hypnosis IntraPartum Trial.Participants (n = 469 mothers; n = 358 birth companions) completed questionnaires at 27 and 36 weeks of gestation and 2 and 6 weeks post‐partum. We used the measures of birth expectations (36 weeks gestation), birth experiences (2 weeks post‐partum) and CB‐PTSS (6 weeks post‐partum).Correlations revealed that birth expectations were associated with experiences for both mothers and birth companions but were not consistently associated with CB‐PTSS. Birth experiences related to CB‐PTSS for both mothers and birth companions. The response surface analysis results showed no support for the effect of a mismatch between expectations and experiences on CB‐PTSS in mothers or birth companions. Similarly, a mismatch between mothers' and birth companions' expectations or experiences was unrelated to CB‐PTSS.Following previous literature, birth expectations were associated with experiences, and experiences were associated with CB‐PTSS. By testing the effect of the match between birth experiences and expectations using an advanced statistical method, we found that experiences play a more substantial role than the match between experiences and expectations in CB‐PTSS. The impact of birth experiences on CB‐PTSS highlights the importance of respectful and supportive maternity care. [ABSTRACT FROM AUTHOR]

Background: Playing Tetris is a relatively new concept when considering how to treat or prevent post-traumatic stress symptoms (PTSS). Benefits have been identified regarding how playing the game can influence traumatic memory processing and storage. However, the concept is under-explored and can potentially help populations who are at risk of and are known to experience post-traumatic stress, such as parents of preterm infants in the Neonatal Unit. The aim of the review was to establish if preterm parents playing Tetris was a feasible option to potentially minimise PTSS. Method: A scoping review was conducted using PRISMA-ScR guidance. Databases searched were Cinahl, Medline and PsychInfo, over a 20 year period (2003-2023). Titles and abstracts were screened before analysis of full-text articles. A variety of clinical and experimental studies were examined, with differing trauma exposure experienced by participants. Results: Thirteen articles were reviewed and four common themes identified. These were memory consolidation, playing Tetris and its effect on intrusive memories (IMs), the effect on the brain and the acceptability as a technique to minimize PTSS in clinical trials. Conclusion: Tetris, in theory, is a first-aid intervention and has the potential to minimise the impact of trauma. Based on the findings of the review, Tetris has been effective in other clinical areas and deemed acceptable by participants. Therefore, Tetris is worthy of consideration for use in the population of preterm parents. [ABSTRACT FROM AUTHOR]

Chronic traumatic neck pain has a high prevalence of post-traumatic stress symptoms (PTSS). However, whether PTSS moderates treatment effects is unknown. This study investigated: 1) whether PTSS was associated with patient-reported outcomes and clinical test results at baseline; 2) whether PTSS moderated the effect of a multimodal physiotherapy intervention of exercise therapy and patient education; and 3) whether adherence to the intervention differed across PTSS groups. Secondary data analysis from a randomized controlled trial on chronic neck pain with 12-month follow-up was conducted. Patients were divided into three groups (NT = non-traumatic, LT = traumatic low PTSS, HT = traumatic high PTSS) based on self-reported onset of pain and the Impact of Event Scale. The baseline data were used to analyze the association of PTSS with patient demographics and scores of physical and mental health-related quality of life, depression, neck-related disability, kinesiophobia, and clinical tests. Baseline, 4-month and 12-month follow-up data were analyzed to investigate possible moderating effects on outcomes. Data on adherence were collected at four months. 115 participants were included (NT n = 45; LT n = 46; HT n = 24). The HT group reported lower mental health scores and more depressive symptoms at baseline. PTSS did not significantly moderate the treatment effect on any outcomes. The HT group tended to have lower adherence to the multimodal physiotherapy intervention than the LT group. For patients with traumatic neck pain, high levels of PTSS are associated with poorer psychological outcomes but do not affect the outcomes of multimodal physiotherapy intervention. [ABSTRACT FROM AUTHOR]

Background: This study aims to provide a better understanding of the individual impact of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) post-traumatic stress symptoms (PTSS) on functional impairment in trauma-exposed children and adolescents. Identifying PTSS that have the most impact on functional impairment can broaden our understanding of post-trauma reactions and guide the selection of treatment components and techniques required to help patients to restore functioning following trauma exposure. Method: Utilizing relative importance analyses, unique shared variance of each DSM-5 PTSS with functional impairment were estimated in clinical samples of 3400 Norwegian (Mage = 14.18, SDage = 2.49, rangeage = 7–17) and 747 US (Mage = 10.76, SDage = 3.10, rangeage = 7–17) children and adolescents from naturalistic settings. Results: Negative beliefs, detachment from others, inability to experience positive emotions, and diminished interest in activities within the symptom cluster negative alterations in cognitions and mood, and the hyperarousal symptom concentration problems accounted for the largest proportions of unique variance explained in functional impairment in both samples. Further, the hyperarousal symptom irritability showed a unique high association with functional impairment in the US sample. Conclusion: As negative beliefs, emotional numbing symptoms, concentration problems and irritability may be especially related to functional impairment in traumatized children and adolescents, monitoring and targeting these symptoms throughout therapy might be of particular importance to restore functioning as early as possible and to facilitate overall recovery. [ABSTRACT FROM AUTHOR]

Background: Pediatric transplantation can be a stressful process for patients and caregivers. Some individuals may experience post‐traumatic stress symptoms (PTSS) and post‐traumatic growth (PTG) as a result. Although post‐traumatic stress disorder (PTSD) has been well‐studied in this population, the purpose of the present scoping review is to provide a first synthesis of the existing literature on PTG in pediatric transplant populations. Methods: We conducted a literature search of PsycINFO and Scopus in May 2023. Eligible articles must have included a sample of solid organ transplant (SOT) or stem cell transplant (SCT) recipients under age 18, siblings of recipients, or caregivers; and must have examined PTG. Results: Twenty‐three studies were identified, and nine studies met inclusion criteria and were included in the review (n = 5 cross sectional; n = 4 qualitative). Cross‐sectional studies examined demographic, mental health, and medical correlates of PTG in children and caregivers. PTG was correlated with PTSS among caregivers. Qualitative studies identified themes along each of the five factors of PTG. Conclusion: Findings overwhelmingly focused on caregiver PTG. Qualitative study findings align with the theoretical model of PTG. Additional research is needed to investigate PTG in siblings of children with a transplant and associations between PTG and medication adherence. This scoping review provides insight into positive change processes following a transplant among children and their caregivers. [ABSTRACT FROM AUTHOR]

Background Cardiac rehabilitation improves health and quality of life and reduces risk of further cardiac events. Twenty-eight per cent of cardiac rehabilitation patients experience clinically significant anxiety and 19% suffer depression. Such patients are at greater risk of death, further cardiac events and poorer quality of life and use more health care, leading to higher NHS costs. The available psychological treatments for cardiac patients have small effects on anxiety and depression and quality of life; therefore, more effective treatments are needed. Research shows that a thinking style dominated by rumination and worry maintains anxiety and depression. A psychological intervention (metacognitive therapy) effectively reduces this style of thinking and alleviates depression and anxiety in mental health settings. The PATHWAY study evaluated two versions of metacognitive therapy applied in cardiac rehabilitation services. Objectives The primary aim was to improve psychological outcomes for cardiac rehabilitation patients. We evaluated two formats of metacognitive therapy: (1) a group-based face-to-face intervention delivered by cardiac rehabilitation staff (group-based metacognitive therapy) and (2) a paper-based, self-directed intervention (home-based metacognitive therapy). Each was compared with usual cardiac rehabilitation alone in separate randomised controlled trials. Design A randomised feasibility trial (work stream 1) and a full-scale randomised controlled trial (work stream 2) evaluated group-metacognitive therapy, while separate feasibility and full-scale trials (work stream 3 and work stream 3+, respectively) evaluated home-based metacognitive therapy. A cost-effectiveness analysis of group-metacognitive therapy was conducted, along with stated preference surveys and qualitative studies examining patient psychological needs and therapists’ perspectives on metacognitive therapy. Setting Seven NHS cardiac rehabilitation services across the north-west of England. Participants Adults aged ≥ 18 years who met cardiac rehabilitation eligibility criteria, scored ≥ 8 on depression or anxiety subscales of the Hospital Anxiety and Depression Scale, and were able to read, understand and complete questionnaires in English. Interventions Work stream 1 and work stream 2 – a 6-week group-metacognitive therapy intervention delivered by cardiac rehabilitation staff plus usual cardiac rehabilitation compared with usual cardiac rehabilitation alone. Group-metacognitive therapy was delivered once per week for 6 weeks, with each session lasting 90 minutes. Work stream 3 and work stream 3+ – home-based metacognitive therapy plus usual cardiac rehabilitation compared with usual cardiac rehabilitation alone. Home-metacognitive therapy was a paper-based manual that included six modules and two supportive telephone calls delivered by cardiac rehabilitation staff. Main outcome measures The Hospital Anxiety and Depression Scale total score at 4-month follow-up was the primary outcome in all trials. A range of secondary outcomes were also evaluated. Results Our qualitative study with 46 patients across three cardiac rehabilitation services suggested that cardiac rehabilitation patients’ psychological needs were not met by current approaches and that metacognitive therapy might offer an improved fit with their psychological symptoms. The internal pilot feasibility study (work stream 1; n = 54) demonstrated that a full-scale randomised controlled trial was feasible and acceptable and confirmed our sample size estimation. A subsequent full-scale, single-blind randomised controlled trial (work stream 2; n = 332) showed that adding group-based metacognitive therapy to cardiac rehabilitation was associated with statistically significant improvements on the Hospital Anxiety and Depression Scale (primary outcome) in anxiety and depression compared with cardiac rehabilitation alone at 4-month (adjusted mean difference −3.24, 95% confidence interval −4.67 to −1.81, p < 0.001; standardised mean difference 0.52) and 12-month follow-up (adjusted mean difference −2.19, 95% confidence interval −3.72 to −0.66, p = 0.005; standardised mean difference 0.33). The cost-effectiveness analysis suggested that group-metacognitive therapy was dominant, that it could be cost saving (net cost −£219, 95% confidence interval −£1446 to £1007) and health increasing (net quality-adjusted life-year 0.015, 95% confidence interval −0.015 to 0.045). However, confidence intervals were wide and overlapped zero, indicating high variability in the data and uncertainty in the estimates. A pilot feasibility trial (work stream 3; n = 108) supported a full-scale trial of home-metacognitive therapy and was extended (work stream 3+; n = 240). In the full trial, the adjusted mean difference on the Hospital and Anxiety and Depression Scale favoured the metacognitive therapy + cardiac rehabilitation arm (adjusted mean difference −2.64, 95% confidence interval −4.49 to −0.78, p = 0.005; standardised mean difference 0.38), with statistically significant greater improvements in anxiety and depression in home-metacognitive therapy plus cardiac rehabilitation than in cardiac rehabilitation alone at 4-month follow-up. A stated preference survey on clinic-delivered psychological therapy (not specific to metacognitive therapy) indicated a preference for including psychological therapy as part of cardiac rehabilitation. Participants favoured individual therapy, delivered by cardiac rehabilitation staff, with information provided prior to therapy and at a lower cost to the NHS. A pilot stated preference study focused on preferences for home- or clinic-based psychological therapy. Preferences were stronger for home-based therapy than for centre-based, but this was not statistically significant and participants highly valued receiving therapy and having reduced waiting times. Limitations Limitations include no control for additional contact as part of metacognitive therapy to estimate non-specific effects. Work stream 3+ did not include 12-month follow-up and therefore the long-term effects of home-based metacognitive therapy are unknown. The health economics analysis was limited by sample size and large amount of missing data in the final follow up. Findings from the qualitative study cannot necessarily be generalised. Conclusions Both group-based and home-based metacognitive therapy were associated with significantly greater reductions in anxiety and depression symptoms at 4 months, compared with cardiac rehabilitation alone. The results in group-based metacognitive therapy appeared to be stable over 12 months. Introducing metacognitive therapy into cardiac rehabilitation has the potential to improve mental health outcomes. Future work Future studies should evaluate the long-term effects of home-metacognitive therapy and the effect of metacognitive therapy against other treatments offered in cardiac rehabilitation. Given the uncertainty in the economic evaluation, further work is needed to determine the cost-effectiveness of metacognitive therapy. Trial registration Work stream 1/work stream 2: NCT02420431 and ISRCTN74643496; work stream 3: NCT03129282; work stream 3+: NCT03999359. The trial is registered with clinicaltrials.gov NCT03999359. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research Programme (NIHR award ref: RP-PG-1211-20011) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information. Plain language summary Depression and anxiety are common among cardiac rehabilitation patients. Cardiac patients with anxiety and depression are at greater risk of death, further cardiac events and poorer quality of life and use more health care, leading to higher NHS costs. Current talking-based therapies have small effects on anxiety and depression in patients with cardiovascular disease. It is important that more effective treatments for mental health are added to cardiac rehabilitation. We applied two versions of a recent treatment called metacognitive therapy in cardiac rehabilitation: a group version and a home-based (self-help) paper-based manual. The programme had three work streams conducted across seven NHS trusts. In work stream 1, we ran a pilot trial showing that adding group-metacognitive therapy to cardiac rehabilitation was feasible and acceptable A full-scale trial (work stream 2) followed, and this showed that adding group-metacognitive therapy to cardiac rehabilitation was associated with greater improvement in anxiety and depression than cardiac rehabilitation alone. In work stream 3, we created a home-based version of metacognitive therapy and ran a feasibility trial, which was extended to a full-scale trial and showed that home-metacognitive therapy plus cardiac rehabilitation was associated with improved anxiety and depression outcomes compared with cardiac rehabilitation alone. Interview studies of patients’ needs, treatment preferences and reactions to treatment were included, and our patient and public involvement group advised the research team throughout the trial. The originator of metacognitive therapy, Adrian Wells, was the chief investigator of the study and is the director of the Metacognitive Therapy Institute. He has funding for the study ‘Implementing Group Metacognitive Therapy in Cardiac Rehabilitation Services (PATHWAY-Beacons; NIHR29567)’ as chief investigator. To maintain objectivity along with the trial statistician and research assistants he did not know patient treatment allocation, data were managed by a separate clinical trials unit and a plan for analysis was devised before analysis took place. Project oversight and monitoring were undertaken by an independent Trial Steering Committee. Scientific summary Background Cardiac rehabilitation (CR) aims to improve heart disease patients’ health and quality of life and reduce the risk of further cardiac events: 28% of cardiac patients have clinically significant anxiety and 19% have depression. Such patients are at greater risk of death, further cardiac events and poorer quality of life and use more health care, leading to higher NHS costs. Available psychological treatments for patients with heart disease have small effects on improving anxiety, depression and quality of life. Therefore, more effective treatments for depression and anxiety need to be explored and made available in CR services. Research in mental health contexts shows that a style of thinking dominated by rumination and worry maintains distress. A psychological intervention [metacognitive therapy (MCT)] reduces this style of thinking and alleviates depression and anxiety. The PATHWAY study evaluated two versions of MCT applied in heart disease patients attending CR: (1) a 6-week intervention delivered face to face in a group setting by CR staff (group-based MCT) and (2) a paper-based, six-module, self-directed intervention (home-based MCT). Objectives The primary aim is to improve access to more effective psychological interventions for the range of heart disease patients attending CR services. The specific objectives were to: conduct a pilot randomised controlled trial (RCT) of group-based MCT (Group-MCT) to evaluate the acceptability and feasibility of delivering the intervention to CR patients who have symptoms of anxiety and depression establish evidence of the effectiveness and cost-effectiveness of Group-MCT in CR in a full-scale RCT produce a rigorous, well-specified Group-MCT package develop a home-based metacognitive intervention (Home-MCT) for CR patients with depression and/or anxiety establish the feasibility and acceptability of integrating Home-MCT into the CR pathway in a pilot RCT establish provisional evidence of the effectiveness and cost-effectiveness of Home-MCT develop a protocol and manual for Home-MCT to inform a full-scale RCT conduct a full-scale RCT evaluating the effectiveness of Home-MCT. Methods We conducted a randomised controlled pilot trial and a full-scale RCT comparing usual CR alone against CR plus group-based MCT [work stream (WS) 1 and WS2; n = 332)]. We also conducted a randomised controlled pilot trial and a full-scale RCT of home-based metacognitive therapy (WS3 and WS3+; n = 240). All trials included integrated qualitative (n = 52) and economic evaluations (n = 339; stated preference survey). Participants A total of seven NHS trusts that provided a routine CR service participated in the research, with the number of participants and specific sites varying by trial. Work streams 1 and 2 explored the acceptability and effectiveness of Group-MCT integrated into usual CR in hospital settings, whereas WS3 and WS3+ explored the acceptability and effectiveness of Home-MCT integrated into usual CR in hospital and community settings. Work stream 1 recruited participants from three NHS trusts in north-west England. Participant recruitment for WS2 took place in five NHS trusts across north-west England. WS3 and WS3+ patients were recruited from CR services at five NHS hospital trusts across north-west England. Participating CR patients in all trials had to score ≥ 8 on the anxiety and/or depression subscale of the Hospital Anxiety and Depression Scale (HADS), be aged ≥ 18 years and meet the British Association for Cardiovascular Prevention and Rehabilitation criteria for attending CR. Participants were randomly allocated in a one-to-one ratio to receive either MCT plus usual CR or usual CR only using a randomisation procedure that balanced the trial arms with respect to gender, HADS scores and trial sites. Interventions Group-MCT: a 6-week manualised MCT intervention delivered face to face in a group setting. Therapists were CR staff who were not mental health specialists (e.g. clinical psychologists) but were trained to deliver the intervention. The intervention was developed by Adrian Wells based on the metacognitive model of psychological disorder and uses effective metacognitive therapy methods tested in mental health settings. Home-MCT: a paper-based, self-directed MCT intervention consisting of six modules in a treatment manual following a structure and content like that of the group-based MCT intervention. Adrian Wells provided pre-trial training for staff but was not involved in the ongoing supervision of staff delivering the intervention to maintain blinding and objectivity. Outcome measures The primary outcome was HADS total score at 4 months, with HADS total scores at 12 months as a secondary outcome (WS1 and WS2, i.e. Group-MCT only). Other secondary outcomes were the separate HADS anxiety and depression subscales, traumatic stress symptoms, and psychological mechanisms including metacognitive beliefs and repetitive negative thinking. For both interventions, qualitative interviews were conducted to assess patients’ emotional experiences and needs following cardiac events, and their understanding and experience of MCT. In Group-MCT, practitioners were interviewed to understand their experience of delivering the intervention and their understanding of patients’ responses to it and patients’ emotional needs. Statistical analysis For the pilot studies, statistical analysis was principally descriptive. We assessed the acceptability of adding Group-MCT and Home-MCT to usual CR regarding rates of recruitment into the study, attrition by the primary end point, and numbers of MCT and CR modules/sessions completed. The feasibility of conducting a full RCT was assessed against the completion of follow-up questionnaires, adequate variability in the outcome measures, and re-estimation of the required sample size based on pilot study findings. Therapist adherence to the Group-MCT treatment protocol was also assessed. The full-scale RCTs of Group-MCT and Home-MCT were designed to detect a standardised mean difference (SMD) between trial arms of 0.4 in HADS total score at 4-month follow-up with 90% power, based on effect sizes reported for other psychological interventions for depression. Analysis was conducted following a prespecified plan detailing the analytic models, primary and secondary outcomes, choice of covariates, sensitivity analyses, and all other key aspects of the analysis. The primary analyses used intention-to-treat principles. To reduce bias, data from the trial were managed by a separate clinical trials unit and locked prior to analysis. The chief investigator (AW), trial statisticians and research assistants were kept unaware of patient treatment allocation throughout the programme and the analyses followed a prespecified plan. Cost-effectiveness analysis For Group-MCT only, a within-trial cost-effectiveness analysis with a 12-month time horizon compared the cost-effectiveness of MCT plus usual CR with that of CR alone, from a UK health and social care perspective. Key measures included health status (measured using the EuroQol-5 Dimensions, five-level) and self-reported health and social care use. Total costs and quality-adjusted life-years (QALYs) were calculated for the trial follow-up. Missing values were addressed using multiple imputation. The primary outcome was the incremental cost-effectiveness ratio. Regression analysis was used to estimate net costs and net QALYs, and 10,000 bootstrapped pairs of net costs and QALYs were generated to inform the probability of cost-effectiveness. For the home-based MCT pilot study, a simple between-group comparison of the available economic data (health status and NHS and social care costs), using summary statistics, was performed. Two stated preference studies (using discrete choice experiment designs), one focused on Group-MCT and the other on Home-MCT, were conducted to explore patient preferences for the delivery of psychological therapy in CR. Participants were asked to choose between two hypothetical interventions, described using five attributes. The cost to the NHS was used to estimate willingness to pay for aspects of intervention delivery. Results Group-MCT Fifty-two CR patients were consented to the pilot trial of Group-MCT + CR versus CR alone, of whom 23 were randomly allocated to Group-MCT + CR and 29 to CR. The trial recruited to target, and > 70% of participants completed the 4-month follow-up questionnaire. More than half of the patients in both arms attended at least six CR sessions, and 57% of Group-MCT participants completed an a priori defined minimal dose of the intervention likely to produce the benefit of at least four of the six MCT sessions. The addition of MCT to rehabilitation did not negatively impact on CR attendance, and we observed high therapist adherence to the protocol. The trial concluded that Group-MCT is an acceptable and feasible intervention to deliver in CR services. The Trial Steering Committee and NIHR as funder agreed to support the progression to a full-scale RCT of the Group-MCT intervention. No substantive changes were required to the trial procedures; therefore, the pilot and full RCT samples were pooled for final analysis. A total of 332 patients (including 52 from the pilot trial) consented to the full-scale RCT of Group-MCT + CR versus CR alone, with 163 randomly allocated to Group-MCT + CR and 169 randomly allocated to CR alone; 81% returned data at 4-month follow-up. The adjusted group difference on the primary outcome of HADS total score at 4 months significantly favoured Group-MCT + CR [–3.24, 95% confidence interval (CI) –4.67 to –1.81, p < 0.001; SMD 0.52], as did the difference at the 12-month secondary outcome point (–2.19, 95% CI –3.72 to –0.66, p < 0.01; SMD 0.33). Patients in the Group-MCT + CR arm also had lower mean HADS anxiety and depression subscale scores at 4 months (p < 0.001). Differences in anxiety remained statistically significant at 12 months (p < 0.01), but those in depression did not (p = 0.065). Most of the other secondary outcomes also favoured the MCT intervention. Attendance at CR sessions did not differ between trial arms. Over 60% of Group-MCT + CR participants attended four or more of the six MCT intervention sessions. However, Group-MCT did not appeal to some patients, with 40 (25%) of the 163 patients randomised to receive MCT attending no MCT intervention sessions. Home-MCT One hundred and eight CR patients consented to the pilot trial of Home-MCT, with 54 randomised to Home-MCT + CR and 54 randomised to CR alone. The trial recruited to target, with 96% of CR only and 83% of Home-MCT + CR participants completing 4-month follow-up measures. Forty-four per cent of patients in the MCT arm completed a minimally effective dose of more than four out of six modules. Exit questionnaire ratings were good. However, views about telephone support were mixed and the quality of calls was rated low. Home-MCT appeared to be acceptable and feasible to deliver in CR services. The Trial Steering Committee and NIHR as funder agreed to support the progression to a full-scale RCT of the Home-MCT intervention. We submitted a no-additional-cost variation to contract (VTC) on 29 January 2019 to progress WS3 to a full-scale RCT (WS3+). The VTC was awarded on 12 March 2019. No substantive changes were required to the trial procedures; therefore, the pilot sample was pooled with the sample from the full RCT in final analysis. A total of 240 patients (including 108 from the pilot trial) were consented to the full-scale RCT of Home-MCT, with 118 randomly allocated to Home-MCT + CR and 122 randomly allocated to CR alone; 89% returned 4-month follow-up data. The adjusted group difference on the primary outcome of HADS total score at 4 months significantly favoured the MCT + CR arm (−2.64, 95% CI −4.49 to −0.78, p = 0.005; SMD 0.38). Patients in the MCT + CR arm also reported significantly lower mean HADS anxiety and depression scores (p < 0.05). Most other secondary outcomes also favoured the MCT intervention. Attendance at CR sessions did not differ between the trial arms. Over 70% of participants in the Home-MCT arm completed more than four MCT modules, but the intervention did not appeal to some patients; 21 participants (18%) withdrew or were not contactable at 4 months, compared with only one in the CR-alone arm. An investigation of the impact of differential attrition on the findings using last-observation-carried-forward resulted in no changes in statistical significance for the primary outcome and most of the secondary outcomes. In the primary cost-effectiveness analysis, the Group-MCT intervention was dominant, that is cost saving (net cost −219, 95% CI −£1446 to £1007) and health increasing (net QALY 0.015, 95% CI −0.015 to 0.045). However, the CIs are wide and overlap zero, indicating a high level of variability in the data and uncertainty in the estimates. Stated preference research indicated a preference for the inclusion of psychological therapy as part of a programme of CR. Conclusions There is not currently a standardised approach for psychological interventions in CR, and interventions can vary. There is a preference for the inclusion of psychological therapy in rehabilitation. Group-based MCT and Home-MCT were associated with significantly better anxiety and depression outcomes when added to CR compared with CR alone. The implications for health care are (1) MCT could be provided as part of the menu of approaches used in CR and (2) patients could be given the option to choose between group-based or home-based treatment to increase access. The recommendations for future research are (1) implementation studies that assess barriers to and enablers of roll-out in the NHS, (2) studies of longer-term outcomes of home-based MCT and (3) an evaluation of MCT against alternative therapies. Trial registration Work stream 1/work stream 2: NCT02420431 and ISRCTN74643496; work stream 3: NCT03129282; work stream 3+: NCT03999359. The trial is registered with clinicaltrials.gov NCT03999359. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-1211-20011) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.

Abstract Among disabling post-traumatic stress symptoms (PTSS) are irritability, aggressive behavior, distressing memories and general impaired cognition and negative mood. Art therapy interventions, including mask-making, can potentially alleviate these symptoms. We tested the hypothesis that art conveys emotions and predicted that blinded viewers would be able to perceive changes in theoretically derived emotional profiles expressed in art made by military personnel with PTSS from the onset to the end of therapy. Five service members and veterans exhibiting PTSS were enrolled in an 8-session art therapy protocol, during which they artistically transformed papier-mâché masks at the beginning and end of the protocol. We found that blinded viewers without knowledge of the masks’ creation stage (onset or end of therapy) read initial masks as conveying more negative emotions (e.g., angry, upset, and challenged) and later masks as conveying more positive emotions (calm and pleasure). Based on the assessments from the blinded evaluators, we infer the emotional transition experienced by the participants was expressed in the masks. In an exploratory arm of the study, we also found that viewers were better able to empathize with the negative emotions experienced by participants with PTSS when asked to explicitly take their perspective.

Objective To explore the impact of trauma interventions using mindfulness based extinction and reconsolidation (TIMBER) on post-traumatic stress symptoms in rehabilitation patients with limb dysfunction after accidental trauma. Methods Convenient sampling was used to select 46 rehabilitation patients with limb dysfunction after accidental trauma (impact of event scale-revised, IES-R total score ≥33) admitted to Department of Rehabilitation Medicine of the First Affiliated Hospital from March 2022 to May 2023.They were randomly divided into an intervention group (TIMBER intervention) and a control group (health education of knowledge about mental health).IES-R, Hospital Anxiety and Depression Scale (HADS), and Self-Rating Scale of Sleep (SRSS) were employed to survey the participants before (T1), at the end of (T2), and 1 month after intervention (T3).The changes in post-traumatic stress symptoms, anxiety symptoms, depression symptoms, and sleep were compared between the 2 groups of patients. Results There were no statistically differences in demographic information and various psychological variables between the 2 groups at T1(P>0.05).The intervention group got their total and various dimensional scores of IES-R, and scores of anxiety, depression, and sleep at T2 and T3 significantly decreased when compared with these scores at T1(P < 0.01), and all the scores at T2 and T3 were obviously lower in the intervention group than the control group (P < 0.05).Compared with T1, the avoidance and intrusion scores and total IES-R score were declined in the control group at T2 and T3, with statistical significance (P < 0.05), while no such differences were observed in the scores of high alertness, anxiety, depression, and sleep (P>0.05). Conclusion TIMBER significantly improves the post-traumatic stress symptoms, anxiety symptoms, depression symptoms, and sleep in rehabilitation patients with limb dysfunction after accidental trauma.

ABSTRACTBackground: High levels of post-traumatic stress are well documented among refugees. Yet, refugee adolescents display high heterogeneity in their type of trauma and symptom levels.Objective: Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children’s Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan (n = 148), Syria (n = 234), and Somalia (n = 175) living in Europe.Method: The model fit for the confirmatory factor structures was tested, as well as measurement invariance between the three groups. The robustness of results was evaluated by testing measurement invariance between recently arrived and settled adolescents, and between different response labelling options. Reliability (α, ω, and ordinal α), criterion validity, and prevalence estimates were calculated.Results: The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali adolescents, and strong measurement invariance between Syrian and Somali adolescents. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian adolescents (.717−.856), whereas it was higher among Somali adolescents (.831−.887). The total score had medium-sized correlations with emotional problems (.303−.418) and low correlations with hyperactivity (.077−.155). There were statistically significant differences in symptom prevalence: Afghan adolescents had higher prevalence (55.5%) than Syrian (42.8%) and Somali (37%) adolescents, and unaccompanied refugee minors had higher symptom prevalence (63.5%) than accompanied adolescents (40.7%).Conclusions: This study mostly supports the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult, as the risk of misclassification is high.

Purpose: The unveiling of child sexual abuse (CSA) can elicit symptoms of post-traumatic stress disorder (PTSD) in non-offending parents. The impact of disclosure is stronger for mothers who have already experienced interpersonal trauma, such as CSA or intimate partner violence (IPV). Alexithymia often serves as a coping mechanism in the aftermath of a trauma, as it creates a distance between oneself and distressing events. It could prevent individuals from resolving their trauma, be a risk factor for PTSD symptoms and compromise mothers' capacity to support their child. The objective of this study was to examine whether alexithymia mediated the relationship between the experiences of interpersonal violence (IPV and CSA) of mothers of sexually abused children, and mothers' PTSD symptoms following disclosure of their child's abuse. Method: A sample of 158 mothers of sexually abused children completed questionnaires assessing CSA and IPV and the Toronto Alexithymia Scale, which measures the capacity to identify and express emotions. The Modified PTSD symptom Scale-Self-Report evaluated PTSD symptoms related to their child's disclosure of sexual abuse. Results: Results of a mediation model revealed that alexithymia significantly mediated the relationship between IPV and PTSD symptoms. Mothers' CSA was directly associated with higher levels of PTSD following their child's disclosure of abuse, but the relationship was not mediated by alexithymia. Conclusions: Our findings highlight the importance of assessing mothers' history of interpersonal trauma and ability to recognize and identify emotions as well as the need to offer support and specific intervention programs to mothers. [ABSTRACT FROM AUTHOR]

Among disabling post-traumatic stress symptoms (PTSS) are irritability, aggressive behavior, distressing memories and general impaired cognition and negative mood. Art therapy interventions, including mask-making, can potentially alleviate these symptoms. We tested the hypothesis that art conveys emotions and predicted that blinded viewers would be able to perceive changes in theoretically derived emotional profiles expressed in art made by military personnel with PTSS from the onset to the end of therapy. Five service members and veterans exhibiting PTSS were enrolled in an 8-session art therapy protocol, during which they artistically transformed papier-mâché masks at the beginning and end of the protocol. We found that blinded viewers without knowledge of the masks' creation stage (onset or end of therapy) read initial masks as conveying more negative emotions (e.g., angry, upset, and challenged) and later masks as conveying more positive emotions (calm and pleasure). Based on the assessments from the blinded evaluators, we infer the emotional transition experienced by the participants was expressed in the masks. In an exploratory arm of the study, we also found that viewers were better able to empathize with the negative emotions experienced by participants with PTSS when asked to explicitly take their perspective. [ABSTRACT FROM AUTHOR]

The detrimental effects of Post-Traumatic Stress Symptoms (PTSS) and Post-Traumatic Stress Disorder (PTSD) and the benefits of Post-Traumatic Growth (PTG) are well established for cancer survivors. Increased cancer survival rates necessitate an understanding of how these two paradoxical outcomes, PTSS/PTSD and PTG, are targeted through interventions. This systematic scoping review aims to (a) examine existing evidence on interventions targeting PTSS/PTSD and/or PTG among cancer survivors and (b) identify knowledge gaps to inform future research. Following the six steps of a scoping review, 76 articles met the inclusion criteria. Quantitative articles were examined using descriptive analysis. Frequency counts of the collated data were tabulated into summary tables. Qualitative articles were reviewed using meta-synthesis. Most articles were quantitative (n = 52) and targeted PTG (n = 68) through promising intervention approaches such as psychotherapy, mindfulness, physical activity, and psilocybin-assisted therapy. Three key implications for future research and practice were synthesized: (1) mechanistic considerations for intervention design that provide a roadmap for rigorous and theoretically-grounded research; (2) the need for improved representation of cancer survivors in trials; and (3) potential facilitators of intervention efficacy. Together, these findings can direct future research to optimize interventions to reduce PTSS/PTSD and promote PTG achievement among cancer survivors. [ABSTRACT FROM AUTHOR]

Investigating the contributing factors of post-traumatic stress symptoms (PTSS) has always been an important topic in the field of traumatic psychology research. The current study explored the influences of pandemic/epidemic experiences, meditation experiences, and trait mindfulness on PTSS and the mediating role of emotional resilience during the COVID-19 pandemic. A total of 522 participants in Hubei province completed the Five Facet Mindfulness Questionnaire, the Adolescents' Emotional Resilience Questionnaire, and the PTSD Checklist for DSM-5. The results showed that (1) participants who had family or friends diagnosed with COVID-19 scored higher on avoidance. (2) Participants who had family or friends had been diagnosed with SARS or H1N1 scored higher on PTSS. (3) Participants with meditation experience scored significantly higher on all dimensions of PTSS, other than avoidance. (4) The mediating role of recovering from negative emotions in the relationship between trait mindfulness and PTSS was significant (95%CI= [-0.212, -0.094]), while the generating positive emotion was not significant (95%CI= [-0.050, 0.071]). Individuals with pandemic/epidemic experience are more likely to have a high level of PTSS. Individuals who have meditation experience also express a higher level of PTSS, which may be a result of the quality of meditation. Trait mindfulness and the ability to recover from negative emotions were protective factors against PTSS. [ABSTRACT FROM AUTHOR]

The 2019 coronavirus disease (COVID-19) and the recommended social isolation presented a challenge to people's mental health status. Optimism is a psychological factor that plays a key role in the evaluation of stressful situations. The purpose of this study was to investigate the mediating role of perceived stress and Covid-19-related stress anticipation in the relationship between optimism and post-traumatic stress symptoms. Our sample included 1015 participants ranging in age from 18 to 79 years, 80% of whom were Spaniards. At the beginning of the worldwide pandemic, participants were confined to their homes for at least seven days and completed an online survey measuring various sociodemographic and psychological variables. We found an indirect effect of optimism on intrusion and hyperarousal through perceived stress and stress anticipation. In addition, we observed an indirect effect of optimism on avoidance through perceived stress. Finally, the results showed a significant indirect effect of optimism on the total post-traumatic stress symptoms score through perceived stress and stress anticipation. Our results indicate that positive beliefs inherent to optimism are related to less psychological impact of the COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

Abstract Background Post-traumatic stress symptoms are one of the most commonest, but un-recognized psychological morbidity found in female breast cancer patients. However, there are insufficient prospective studies concerning the trajectory of post-traumatic stress symptoms and their risk factors in Nigerian women living with breast cancer. Objective To determine the changes in the prevalence and risk factors of post-traumatic stress symptoms among newly diagnosed female breast cancer patients across different timelines over 6 months. Method This was a prospective longitudinal study of 183 newly diagnosed female breast cancer patients selected using a systematic random sampling method. The Six-Item Impact of Events Scale, Visual Analogue Scale of Pain, Functional Assessment of Cancer Therapy-Breast, and a Socio-Demographic questionnaire were administered to the participants. Results The prevalence of post-traumatic stress symptoms was 46%, 31%, and 22% at baseline, 3 months, and 6 months respectively, indicating a decline in post-traumatic stress symptoms over time. In the final assessment at 6 months, identified risk factors of post-traumatic stress symptoms were: religiosity, accessibility to treatment, illness perception, chemotherapy, and quality of life. Conclusion Post-traumatic stress symptoms are prevalent in newly diagnosed female breast cancer patients, there is a need for regular screening of these symptoms in these women to allow for early psycho-social intervention, and better treatment outcomes.

Although infection rates may increase after relaxation of the zero COVID strategy, the extensive vaccination campaign in China could potentially curb the spread of COVID-19, which may be associated with a low level of risk perception and post-traumatic stress symptoms (PTSS). However, the relationship between vaccination, risk perception and PTSS has not been studied extensively. This study aims to examine the associations between the number of COVID-19 vaccine doses, consistency in the type of each dose and time since vaccination with PTSS, and the mediating role of risk perception on such relationships in China. Cross-sectional sampling with a self-report questionnaire was used to measure vaccination, PTSS and risk perception. The survey was conducted in Beijing, China, from 13 January to 9 February 2023. Linear regression analyses were conducted to test the relationship between vaccination, risk perception and PTSS. The analysis included 55,803 individuals. In total, 72.86 % of participants received two doses of the COVID-19 vaccine. Regression results indicated that people with two doses of the COVID-19 vaccine had a lower level of PTSS (β = −1.232, 95 % confidence interval [CI]: −1.930, −0.534) than those who had not received any doses of the COVID-19 vaccine. Only the negative relationship between two-dose vaccination and PTSS was mediated by risk perception, while the negative relationship between the time since vaccination and PTSS was suppressed by risk perception. This study showed that receiving the COVID-19 vaccine reduced PTSS by decreasing perceived risk. Vaccination time was negatively associated with PTSS, but this relationship was suppressed by risk perception. [ABSTRACT FROM AUTHOR]

Background: High levels of post-traumatic stress are well documented among refugees. Yet, refugee adolescents display high heterogeneity in their type of trauma and symptom levels. Objective: Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children’s Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan (n = 148), Syria (n = 234), and Somalia (n = 175) living in Europe. Method: The model fit for the confirmatory factor structures was tested, as well as measurement invariance between the three groups. The robustness of results was evaluated by testing measurement invariance between recently arrived and settled adolescents, and between different response labelling options. Reliability (α, ω, and ordinal α), criterion validity, and prevalence estimates were calculated. Results: The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali adolescents, and strong measurement invariance between Syrian and Somali adolescents. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian adolescents (.717−.856), whereas it was higher among Somali adolescents (.831 −.887). The total score had medium-sized correlations with emotional problems (.303−.418) and low correlations with hyperactivity (.077−.155). There were statistically significant differences in symptom prevalence: Afghan adolescents had higher prevalence (55.5%) than Syrian (42.8%) and Somali (37%) adolescents, and unaccompanied refugee minors had higher symptom prevalence (63.5%) than accompanied adolescents (40.7%). Conclusions: This study mostly supports the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult, as the risk of misclassification is high. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic stress symptoms are one of the most commonest, but un-recognized psychological morbidity found in female breast cancer patients. However, there are insufficient prospective studies concerning the trajectory of post-traumatic stress symptoms and their risk factors in Nigerian women living with breast cancer. Objective: To determine the changes in the prevalence and risk factors of post-traumatic stress symptoms among newly diagnosed female breast cancer patients across different timelines over 6 months. Method: This was a prospective longitudinal study of 183 newly diagnosed female breast cancer patients selected using a systematic random sampling method. The Six-Item Impact of Events Scale, Visual Analogue Scale of Pain, Functional Assessment of Cancer Therapy-Breast, and a Socio-Demographic questionnaire were administered to the participants. Results: The prevalence of post-traumatic stress symptoms was 46%, 31%, and 22% at baseline, 3 months, and 6 months respectively, indicating a decline in post-traumatic stress symptoms over time. In the final assessment at 6 months, identified risk factors of post-traumatic stress symptoms were: religiosity, accessibility to treatment, illness perception, chemotherapy, and quality of life. Conclusion: Post-traumatic stress symptoms are prevalent in newly diagnosed female breast cancer patients, there is a need for regular screening of these symptoms in these women to allow for early psycho-social intervention, and better treatment outcomes. [ABSTRACT FROM AUTHOR]

A significant number of individuals receiving mental health care exhibit a history of traumatic experiences. Accompanying dissociative symptoms often amplify the complexity of their required treatment. This article introduces a novel understanding and treatment approach for post-traumatic stress symptoms, inclusive of dissociation, derived from attachment and mentalization theories. Initially, we outline the different expressions of dissociation and the prevailing knowledge concerning their associations with diverse clinical manifestations and their role in trauma. We subsequently reinterpret these clinical symptoms through an attachment and mentalization lens, then proceed to elaborate on the new trauma-focused mentalization-based treatment and its therapeutic objectives. The article culminates with a case study that exemplifies the application of this approach in a clinical setting. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease of 2019 (COVID‐19) pandemic is an unprecedented traumatic event that has severely impacted social, economic, and health well‐being worldwide. The COvid Mental hEalth Trial was specifically designed to evaluate the impact of the COVID‐19 pandemic and its containment measures on the mental health of the Italian general population in terms of COVID‐19‐related acute stress disorder (ASD) symptoms. Methods: The present cross‐sectional study is based on an online survey carried out in the period March–May 2020. Italian general adult population was invited to compile an anonymous survey, which included the severity of acute stress symptoms scale/National Stressful Events Survey Short Scale to investigate the occurrence and severity of ASD symptoms. Results: The final sample consisted of 20,720 participants. During the lockdown, subjects with pre‐existing mental health problems reported a statistically significant higher risk of acute post‐traumatic symptoms compared to the general population (B: 2.57; 95% CI:2.04–3.09; p <.0001) and health care professionals (B:.37; 95% CI:.02–0.72; p <.05). According to multivariate regression models, the levels of acute post‐traumatic symptoms (p <.0001) were higher in younger and female respondents. Social isolation and sleep disorder/insomnia represented positive predictors of acute stress (B = 3.32, 95% CI = 3.08–3.57). Conclusions: Concerns about the risk of infection as well as social isolation caused a higher incidence of acute post‐traumatic stress symptoms that may predict the subsequent development of post‐traumatic stress disorder symptoms in the long term. [ABSTRACT FROM AUTHOR]

The present study elucidates heterogeneity in post-traumatic stress symptoms (PTSS) across adolescence in a sample of youth who have experienced myriad types and combinations of potentially traumatic events (PTEs), including substantiated physical abuse, sexual abuse, neglect and/or at least one other self-reported PTE. A machine learning technique was used to assess a multivariate set of variables (e.g., PTEs, individual risk and protective factors, social risk and protective factors, and racial and ethnic minority status) as predictors of PTSS trajectory group membership. The sample included 498 maltreated (n = 275) and comparison (n = 223) 14-19-year-old female adolescents (M = 15.27, SD = 1.06 at Time 1) assessed annually until age 19. 45.7% of participants were White, 45.3% Black, 0.4% Native American, 0.8% Hispanic, and 7.7% other. Growth mixture modeling identified three distinct trajectories of PTSS: (1) recovery (56%); (2) moderate, chronic (25%); and (3) high, chronic (19%). An elastic net model was used to test predictors of membership in the recovery versus the high, chronic PTSS trajectory groups. Results demonstrated that the recovery trajectory was characterized by the absence of sexual abuse, physical abuse, and other traumas, higher self-esteem, less affective dysregulation, less risky peers, lower levels of parent depression, and being of racial/ethnic minority status. Findings help to characterize individual variation in trajectories of PTSS following PTEs by underscoring the unique trauma responses of racial and ethnic minority youth and offering possible targets of interventions to promote recovery from PTSS. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has led to escalations in substance use, including alcohol consumption. Of particular concern are the potential impacts during the postpartum period, a time of heightened vulnerability to stress and potential transmission of the negative sequelae of substance use to offspring. However, postpartum alcohol consumption during the COVID-19 pandemic has not been well characterized. Postpartum drinking habits and COVID-19-related stress were repeatedly assessed (every two weeks for 12 weeks, and at one-, six-, and 12-months postpartum) from N = 378 individuals during the COVID-19 pandemic. Average alcohol use trajectories as well as heterogeneity in trajectories were characterized. COVID-19-related trauma symptoms and coping were examined in relation to alcohol use over time. Average postpartum alcohol use included an initial quadratic increase from one-to-four-months postpartum, followed by a plateau between four-to-12-months. Higher (15.08%), moderate (26.90%), and lower consumption (57.90%) subgroups were identified. Endorsement of COVID-19-related trauma symptoms and using alcohol to cope with stress predicted higher consumption. Findings suggest a potential sensitive period in establishing postpartum alcohol use patterns from one-to-four-months postpartum. Findings further suggest that postpartum alcohol use is heterogenous and that individual response to major traumatic stressors, like the COVID-19 pandemic, may influence emerging patterns of postpartum alcohol use. [ABSTRACT FROM AUTHOR]

Background: Civil wars in Libya have impacted the mental health of the general population. The ways in which individuals cope with traumatic events are influenced by several psychological variables. Objectives: The present study aimed to investigate how post-traumatic stress symptoms (PTSS) are associated with psychological symptoms and post-traumatic growth (PTG), and to evaluate the role of avoidant and anxious attachment dimensions as mediators in these associations, among Libyan citizens. Method: Three-hundred participants (147 females; age 31.0 ± 8.4 years) completed the Impact of Event Scale – Revised, Experiences in Close Relationships, Patient Health Questionnaire, and Post-traumatic Growth Inventory – Short Form. Results: The structural equation model revealed that insecure attachment dimensions mediated the association between PTSS and psychological symptoms and PTG. PTSS were positively associated with psychological symptoms, PTG, and both insecure attachment dimensions. Insecure attachment dimensions were positively associated with psychological symptoms and negatively with PTG. Conclusion: The present findings contribute to growing empirical research on the roles of insecure attachment dimensions in the association between the impact of war, psychological symptoms, and PTG. Insecure attachment dimensions mediated the association between the impact of war and psychological symptoms, as well as posttraumatic growth, among Libyan citizens. Higher psychological symptoms were negatively correlated with posttraumatic growth. Psychological interventions should consider insecure attachment dimensions, when evaluating the consequences of prolonged and repeated wars. [ABSTRACT FROM AUTHOR]

Background: Ample research has documented the potential of both negative and positive impacts secondary to the COVID-19 pandemic on global mental health in adults and families, but less work has focused on mothers who experience economic marginalization. This longitudinal study aims to assess the impact of positive changes from the pandemic on the association between COVID-related stressors and psychopathology before and after the start of the pandemic. Methods: Seventy-five mothers from low income, economically marginalized backgrounds (mean age=30 years, 80 % Black) completed a pre-pandemic visit (T1;2015-2019) and an online survey (T2;2020-2021) mid-pandemic. The study assessed mother's depressive and posttraumatic stress symptoms and lifetime adversity, COVID-19 related stressors, and positive changes associated with the pandemic. Results: Controlling for pre-pandemic psychopathology symptoms, lifetime adversity and educational attainment, there was a significant, positive association between exposure to COVID-19 related stressors and risk for T2 psychopathology. Positive life changes buffered this association, however, such that exposure to COVID-19 related stressors and psychopathology were unrelated for mothers who reported a moderate to high level of positive changes associated with the pandemic. Limitations: The sample was small and generalizability of results is limited. Conclusions: The pandemic was associated with an increase in mental health problems and unique stressors, especially among caregivers who are low-income. These findings shine light on how both material and psychological access to positive experiences (e.g., more time with family) can buffer the impact of stressors on mental health symptoms.

Background: Adverse childhood experiences (ACE), which can be separated into abuse and neglect, contribute to the development of post-traumatic stress symptoms (PTSS). However, which brain structures are mainly affected by ACE as well as the mediating role these brain structures play in ACE and PTSS relationship are still being investigated. The current study tested the effect of ACE on brain structure and investigated the latter's mediating role in ACE-PTSS relationship. Methods: A total of 78 adults with self-reported ACE were included in this study. Participants completed the childhood trauma questionnaire (CTQ) and a Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) to ascertain ACE history and PTSS, respectively. T1w images and diffusion MRI scans were then acquired to assess cortical morphometry and white matter (WM) integrity in fibre tracts connecting key areas where ACE-related cortical volume alterations were observed. Results: The combined effect of ACE was negatively associated with total grey matter volume and local cortical area in the right superior parietal region (rSP). Childhood abuse was negatively related to right superior parietal volume after controlling for neglect and overall psychological burden. The right superior parietal volume significantly mediated the relationship between childhood abuse and avoidance-related PTSS. Post-hoc analyses showed that the indirect relation was subsequently moderated by dissociative symptoms. Lastly, a complementary examination of the WM tracts connected to abuse-associated cortical GM regions shows that abuse was negatively related to the normalised fibre density of WM tracts connected to the right superior parietal region. Conclusion: We provide multimodal structural evidence that ACE in the first years of life is related to alterations in the right superior brain region, which plays a crucial role in spatial processing and attentional functioning. Additionally, we highlight that the cortical volume alteration in this region may play a role in explaining the relationship between childhood abuse and avoidance symptoms.

Abstract Background The coronavirus disease of 2019 (COVID‐19) pandemic is an unprecedented traumatic event that has severely impacted social, economic, and health well‐being worldwide. The COvid Mental hEalth Trial was specifically designed to evaluate the impact of the COVID‐19 pandemic and its containment measures on the mental health of the Italian general population in terms of COVID‐19‐related acute stress disorder (ASD) symptoms. Methods The present cross‐sectional study is based on an online survey carried out in the period March–May 2020. Italian general adult population was invited to compile an anonymous survey, which included the severity of acute stress symptoms scale/National Stressful Events Survey Short Scale to investigate the occurrence and severity of ASD symptoms. Results The final sample consisted of 20,720 participants. During the lockdown, subjects with pre‐existing mental health problems reported a statistically significant higher risk of acute post‐traumatic symptoms compared to the general population (B: 2.57; 95% CI:2.04–3.09; p

ABSTRACTBackground: Civil wars in Libya have impacted the mental health of the general population. The ways in which individuals cope with traumatic events are influenced by several psychological variables.Objectives: The present study aimed to investigate how post-traumatic stress symptoms (PTSS) are associated with psychological symptoms and post-traumatic growth (PTG), and to evaluate the role of avoidant and anxious attachment dimensions as mediators in these associations, among Libyan citizens.Method: Three-hundred participants (147 females; age 31.0 ± 8.4 years) completed the Impact of Event Scale – Revised, Experiences in Close Relationships, Patient Health Questionnaire, and Post-traumatic Growth Inventory – Short Form.Results: The structural equation model revealed that insecure attachment dimensions mediated the association between PTSS and psychological symptoms and PTG. PTSS were positively associated with psychological symptoms, PTG, and both insecure attachment dimensions. Insecure attachment dimensions were positively associated with psychological symptoms and negatively with PTG.Conclusion: The present findings contribute to growing empirical research on the roles of insecure attachment dimensions in the association between the impact of war, psychological symptoms, and PTG.

Introduction: Stressful global situation due to the COVID-19 pandemic caused a tremendous impact on mental health in hospitalized patients with schizophrenia. The mediating roles of psychological impact related to COVID-19, sleep quality, and psychological distress were investigated in the association between childhood trauma and suicidal risk in hospitalized patients with schizophrenia. Methods: We analyzed cross-sectional data of 147 patients with schizophrenia and 189 healthy controls (HCs). Results: Histories of childhood trauma and schizophrenia were good predictors of COVID-19-related psychological impact, global sleep quality, and psychological distress. Moreover, the series mediation model showed that the effect of childhood trauma on suicidal risk in hospitalized patients with schizophrenia was totally sequential mediated by the psychological impact of COVID-19, sleep quality, and psychological distress. Conclusion: Clinicians need to recognize the increased suicidal risk associated with COVID-19-related psychological distress in schizophrenia patients with a history of childhood trauma. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the moderating role of trait mindfulness in the relationship between emotion regulation strategies and post-traumatic stress symptoms (PTSS) among children and adolescents who experienced an explosion accident. A total of 712 participants, aged 7-15, (Mage = 11.45, SD = 1.77; 48.9% male) who have experienced an explosion accident completed the Emotion Regulation Questionnaire, the Trauma Screening Questionnaire and the Mindful Attention Awareness Scale. The results showed that trait mindfulness significantly moderated the relationship of the expressive suppression and PTSS under the control of sex, age, trauma exposure, and cognitive reappraisal strategy (ß = -0.27, p < 0.05). However, the moderating effect of trait mindfulness between cognitive reappraisal strategy and PTSS was not significant (p> 0.05). Findings suggested that traumatized children with low levels of mindfulness may report severer PTSS when they adopt expressive suppression strategy. [ABSTRACT FROM AUTHOR]

Breast cancer impacts not only the physical and mental health of patients but also the people around them—especially their caregivers. This study examined the relationship between post-traumatic stress symptoms (PTSS) and caregiver burden in breast cancer patients through the mediating pathway of anxiety and depression. Methods: A total of 236 breast cancer patients from China completed the Chinese Version of the Posttraumatic Stress Disorder Symptom Scale (PSS), the Chinese version of the Patient Health Questionnaire (PHQ-9), the Chinese version of the General Anxiety Symptoms Scale (GAD-7). In addition, caregivers of these breast cancer patients were surveyed by the Caregiver Self-Assessment Questionnaire (CSAQ). Results: Structural equation model showed that our model fitted well [χ2 /df = 1.966, TLI = 0.959, CFI = 0.994, RMSEA (90% CI) = 0.065 (0–0.12)] and revealed that anxiety, but not depression, mediated the relationship between PTSS in breast cancer patients and caregiver burden. Conclusion: The level of PTSS was positively correlated with anxiety and depression in breast cancer patients, and the level of anxiety and depression was positively related to caregiver burden. The PTSS of patients positively predicted caregiver burden and this relationship appears to be mediated by the patient's anxiety. [ABSTRACT FROM AUTHOR]

Background: In the context of disease outbreaks, healthcare workers are exposed to multiple physical and psychological stressors, which may result in severe mental health outcomes. Although existing literature explores this impact, it is focused on frontline workers, with limited evidence exploring the mental well-being of mental healthcare workers (MHCWs). Aim: To explore post-traumatic stress symptoms (PTSS) and associated factors among MHCWs within the context of the coronavirus disease 2019 (COVID-19) pandemic. Setting: Four academic hospitals in the Gauteng province, South Africa, with specialised psychiatric units. Methods: A cross-sectional study design was used. Participants were selected using a simple random sampling technique and invited to participate in structured interviews. Measurement tools included a demographic questionnaire, the post-traumatic stress disorder checklist for DSM-5 and the Brief Resilient Coping Scale. Results: A total of 120 MHCWs participated. The prevalence of PTSS was 11.7%. The MHCWs’ profession was a significant predictor of the occurrence of PTSS (p = 0.046), with nurses being the most affected. Other socio-demographic, employment, COVID-19-related factors and coping skills were not predictors of PTSS. Conclusion: An elevated prevalence of PTSS has been found and was significantly associated with the profession of the MHCW. It is recommended that existing employee wellness programmes be strengthened to promote mental well-being and improve resilience among MHCWs, particularly vulnerable employee groups. Contribution: This study provides insight into the prevalence of PTSS among MHCWs following the COVID-19 outbreak, as well as associated factors.

The present study aimed at evaluating how post-traumatic stress symptoms (PTSS) are associated with rest-activity circadian and sleep-related parameters, assessed both subjectively (via questionnaires) and objectively (via actigraphy). Specifically, we explored whether chronotype could moderate the association between sleep/circadian parameters and PTSS. Participants (n = 120 adults; mean age 35.6 ± 14; 48 male) were assessed through the Trauma and Loss Spectrum Self Report (TALS-SR) for lifetime PTSS, the reduced version of the Morningness-Eveningness Questionnaire (rMEQ) for chronotype, the Pittsburgh Sleep Quality Index (PSQI) for self-reported sleep quality, and wrist actigraphy for sleep and circadian parameters. Eveningness, poor self-reported sleep quality, lower sleep efficiency (SE), lower interdaily stability (IS), and higher intradaily variability (IV) were correlated with higher TALS-SR scores. Regression analyses showed that IV, SE, and PSQI remained associated with TALS symptomatic domains after adjusting for potentially confounding factors (age and gender). Moderation analysis showed that only the PSQI remained significantly associated with TALS symptomatic domains; however, the interaction with chronotype was not significant. Targeting self-reported sleep disturbances and rest-activity rhythms fragmentation could mitigate PTSS. Although the effect of chronotype as a moderator of the associations between sleep/circadian parameters and PTSS was not significant, eveningness was associated with higher TALS scores, thus confirming the vulnerability of evening types to worse stress reactions. [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to explore the prevalence of symptoms of depression and traumatic stress in fathers in the setting of poor fetal, neonatal, and maternal outcomes. Methods A prospective mixed-methods study was conducted at an outer metropolitan public teaching hospital in Brisbane, Australia, with quantitative results presented here. Subjects included 28 fathers whose male partners had experienced pregnancy or childbirth complicated by a significant congenital abnormality or aneuploidy, termination of pregnancy, fetal death in-utero, stillbirth, admission to the neonatal intensive care unit or special care nursery or significant maternal morbidity, such as a postpartum haemorrhage or an emergency postpartum hysterectomy. These experiences were classified into two groups: anticipatory (time to prepare) and sudden (no warning). The fathers were screened using the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale-Revised (IES-R) to assess subjective distress at 2-3 weeks (timepoint 1) and 3-4 months (timepoint 2) after the event. Results Data for both the EPDS and IES-R scales was available for 26 fathers (92.9%) at timepoint 1 and for 15 fathers (53.6%) at timepoint 2. High overall EPDS scores (≥10) were noted in 16/27 (59.3%) fathers at timepoint 1 and 6/15 fathers (40.0%) at timepoint 2. High overall IES-R scores ≥33 were noted in 12/26 (46.2%) fathers at timepoint 1 and 4/15 fathers (26.7%) at timepoint 2. A higher percentage of fathers who experienced anticipatory events had EPDS and IES-R score above these cut-offs at timepoint 1 (8/13 or 61.5%) compared to those experiencing sudden events (8/14 or 57.1%), however, percentages were similar between groups at time point 2 (2/7 or 28.6%% and 4/8 or 50.0%, respectively). More fathers who experienced anticipatory events had IES-R scores ≥33 at timepoint 1 (7/13 or 53.8%) compared to those experiencing sudden events (5/14 or 38.0%). Conclusion Our study indicates high rates of distress in fathers exposed to poor fetal, neonatal, and maternal outcomes, which can persist for months after the event. Increased support for fathers in this setting may be required to prevent poor mental health. Further research on the long-term effects of these adverse events is warranted.

• Depressive, anxiety, and stress-related symptoms decreased 14 months into the COVID-19 pandemic in Italy. • Most of the sample showed a resilient profile. • A high proportion of participants displayed a persistent condition of general distress. • Women and younger individuals may be at higher risk of endorsing persistent mental health outcomes. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) is a pathological condition that may lead to a significant deterioration in the quality of life over time. Therefore, the study of the elements that can characterize the disorder could be considered of great clinical interest and relevance. The aim of the present research was to empirically discriminate the influence of perceived stress, state anxiety, worry, and defense mechanisms (mature, neurotic, and immature) at different levels of post-traumatic stress symptoms. A sample of 1250 participants (69.5% women, 30.5% men; Mage = 34.52, SD = 11.857) completed an online survey including the Impact of Event Scale—Revised, Ten-Item Perceived Stress Scale, Penn State Worry Questionnaire, Forty Item Defense Style Questionnaire, and State-Trait Anxiety Inventory—Form X3. Data were analysed by implementing MANOVA and discriminant analysis. Results showed significant differences in the levels of perceived stress, state anxiety, and worry, as well as neurotic and immature defenses based on the levels of post-traumatic stress symptoms: F(12,2484) = 85.682, p < 0.001; Wilk's Λ = 0.430. Furthermore, these variables discriminate significant accuracy between participants who reported a mild psychological impact and those with a probable presence of PTSD, with perceived stress, which was found to be the best predictor. Classification results indicated that the original grouped cases were classified with 86.3% overall accuracy. Such findings may provide useful insight for clinical practice. [ABSTRACT FROM AUTHOR]

Patients with hypermobile Ehlers Danlos Syndrome often experience psychological distress resulting from the perceived hostility and disinterest of their clinicians. We conducted 26 in-depth interviews with patients to understand the origins of this trauma and how it could be addressed in practice. We found that the cumulative effects of numerous negative encounters lead patients to lose trust in their healthcare providers and the healthcare system, and to develop acute anxiety about returning to clinic to seek further care. We describe this as clinician-associated traumatization. Ultimately, our interviewees described the result of this traumatization as worse – but preventable – health outcomes.

Background: In India, intimate partner violence against women is a major problem that leads to terrible physical, sexual, emotional, psychological and economic consequences. In 55-92% of women who have a history of being abused wives, high levels of symptoms of post-traumatic stress disorder have been discovered. Therefore, the quality of life is significantly low among them regardless of regions and countries. The purpose of the current study was to create and evaluate the effectiveness of a self-supportive intervention on the quality of life and post-traumatic stress symptoms among abused wives in Madhya Pradesh, India. Methods: The post-traumatic Symptoms Scale Interview version for DSM-5 (PSS-I-5) and WHO Quality of Life-BREF (WHOQOL) were used in this study as assessment tools. The Need assessment results showed that 51% of battered wives met the criteria of PTSD symptoms from moderate to severe and 83% experienced low quality of life. This study utilized a mixed research method and was executed in three phases, based on the main three elements of Conklin’s (1997) program development model, namely (1) planning; (2) design and implementation; and (3) evaluation of the newly created Self-Supportive Intervention program (SSI). The SSI program consisted of six modules, focused on addressing the issues that emerged through qualitative data and need assessments. Results: Excellent inter-rater reliability (.845) was found in the expert evaluation's findings, which supported the recommendation to use the SSI as it is with minor modification. The SSI was further pilot-tested for its feasibility with 10 battered wives and validated through the paired sample t-test, which showed a substantial decrease in post-traumatic stress symptoms and enhanced quality of life at 0.05 level of significance. Conclusion: This is an indication that the SSI program can be recommended as a psychological intervention in eliminating the PTSD symptoms and improving the quality of life.

Abstract Background Clinical training stress may negatively affect nursing students’ academic achievement, clinical performance, learning outcomes, well-being, general health, and quality of life. This study aimed to evaluate the effect of mindfulness-based intervention on post-traumatic stress symptoms among emergency nursing students. This study was conducted at the technical institute of nursing, Zagazig University. Three tools were used in the current study: the sociodemographic data sheet, the impact of event scale, and the 15-item Five-Facet Mindfulness Questionnaire. Results Emergency nursing students had a wide range of PTSS at the pre-intervention period. These symptoms significantly improved after the implementation of a mindfulness-based intervention. Mindfulness level also improved after the intervention. Post-traumatic stress symptoms were positively correlated with the number of training hours and negatively correlated with students’ age, mother’s occupation, and educational level. Conclusions Mindfulness-based intervention was effective in reducing post-traumatic stress symptoms among emergency nursing students.