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Following trauma exposure, two frequently co-occurring forms of psychopathology include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Although these diagnoses have been identified as distinct constructs, the proper classification of these disorders remains a challenge due to overlapping symptoms. Instead, systematically establishing higher- and lower-order personality traits associated with each diagnosis may avoid this confound and improve differential diagnosis. In the present study, we examined how higher-order negative affect and its lower-order facets (i.e., anxiousness, emotional lability, and separation insecurity) may be associated with a diagnosis of PTSD only, MDD only, both diagnoses, or neither diagnosis. Participants were 1,175 veterans enrolled in the Veterans After Discharge Longitudinal Registry. Higher- and lower-order negative affect were assessed using the Personality Inventory for DSM-5 (PID-5), and PTSD and MDD diagnoses were based on the Structured Clinical Interview for DSM-5 (SCID-5). Multinomial logistic regressions were used to model the association between higher- and lower-order negative affect and diagnostic status, after controlling for potential covariates. Diagnostic utility analyses were conducted to examine the degree to which higher- and lower-order negative affect classified participants across groups. Higher-order negative affect and lower-order anxiousness differentiated diagnostic groups, ORs = 1.76-4.66, and had strong specificity and negative predictive value for individuals with PTSD and MDD and those with MDD only. These findings help explain the role of higher-order negative affect and lower-order anxiousness in differentiating PTSD from MDD and comorbid PTSD and MDD and may have implications for assessment, differential diagnosis, and treatment planning.

Cumulative lifetime trauma has a profound impact on the development of schizophrenia spectrum disorders. However, few studies have determined participants' most distressing (i.e., "worst") life event in childhood or adulthood or examined whether this event contributes to poorer clinical outcomes. The present study aimed to (a) determine the associations between the worst life event and demographic/clinical variables and (b) examine the associations between the worst life event and psychiatric symptoms (i.e., positive, negative, depressive, and anxiety symptoms). Participants (N = 150) were outpatients newly diagnosed with schizophrenia spectrum disorders who were assessed for lifetime trauma exposure, positive and negative symptoms of schizophrenia, and symptoms of depression and anxiety. Multinomial logistic regression analysis was conducted to examine the associations between demographic and clinical variables and worst life events (none, childhood, or adulthood). Multiple linear regression analyses were performed to examine the associations between worst life events and psychiatric symptoms. More participants reported that their worst life event occurred during adulthood (31.1%) than childhood (21.3%). Adulthood trauma was associated with male gender, older age, non-Chinese ethnicity, and psychiatric comorbidities; childhood trauma was associated with a family history of depression/anxiety. Adulthood trauma was significantly associated with more severe positive psychotic symptoms, f2 = 0.19, whereas childhood and adulthood trauma exposure were both significantly associated with more severe depressive and anxiety symptoms, f2 s = 0.19 and 0.25, respectively. Our findings underscore the importance of conducting assessments for worst life events and the associated risk factors to develop meaningful formulations and appropriate trauma-focused treatment plans.

The debate around the construct validity of complex posttraumatic stress disorder (CPTSD) has begun to examine whether CPTSD diverges from posttraumatic stress disorder (PTSD) when it co-occurs with the diagnosis of borderline personality disorder (BPD). The present study (a) examined the construct validity of CPTSD through a latent class analysis of a non–treatment-seeking sample of young trauma-exposed adults and (b) characterized each class in terms of trauma characteristics, social emotions (e.g., shame, guilt, blame), and interpersonal functioning. A total of 23 dichotomized survey items were chosen to represent the symptoms of PTSD, CPTSD, and BPD and administered to 197 trauma-exposed participants. Fit statistics compared models with 2–4 latent classes. The four-class model showed the best fit statistics and clinical interpretability. Classes included a “high PTSD+CPTSD+BPD” class, characterized by high-level endorsement of all symptoms for the three diagnoses; a “moderate PTSD+CPTSD+BPD” class, characterized by endorsement of some symptoms across all three diagnoses; a “PTSD” class, characterized by endorsement of the ICD-11 PTSD criteria; and a “healthy” class, characterized by low symptom endorsement overall. Pairwise comparisons showed individuals in the high PTSD+CPTSD+BPD class to have the highest levels of psychological distress, traumatic event history, adverse childhood experiences, and PTSD symptoms. Shame was the only social emotion to significantly differ between the classes, p = .002, η(2) = .16. The findings diverge from the literature, indicating an overlap of PTSD, CPTSD, and BPD symptoms in a non–treatment-seeking community sample. Further, shame may be a central emotion that differentiates between presentation severities following trauma exposure.

Posttraumatic stress disorder (PTSD) is related to dysfunctional emotional processing, thus motivating the search for physiological indices that can elucidate this process. Toward this aim, we compared pupillary response patterns in response to angry and fearful auditory stimuli among 99 adults, some with PTSD (n = 14), some trauma-exposed without PTSD (TE; n = 53), and some with no history of trauma exposure (CON; n = 32). We hypothesized that individuals with PTSD would show more pupillary response to angry and fearful auditory stimuli compared to those in the TE and CON groups. Among participants who had experienced a traumatic event, we explored the association between PTSD symptoms and pupillary response; contrary to our prediction, individuals with PTSD displayed the least pupillary response to fearful auditory stimuli compared those in the TE, B = -0.022, p = .077, and CON, B = -0.042, p = .002, groups, but they did not differ on angry auditory stimuli, B = 0.019, p = .118 and B = 0.006, p = .634, respectively. It is important to note that within-group analyses revealed that participants with PTSD differed significantly in their response to angry versus fearful stimuli, B = -0.032, p = .015. We also found a positive association between PTSD symptoms and pupillary response to angry stimuli. Our findings suggest that differential pupil response to anger and fear stimuli may be a promising way to understand emotional processing in PTSD.

As a result of the precarious conditions in which they migrate, refugees are likely to have experiences that increase their risk of mental health problems. Refugees tend to be predisposed to relatively high levels of distress upon resettlement, and a key predictor of these issues is traumatic experiences that occur before their arrival. Despite high initial levels of ill-health, on average, refugees tend to experience mental health recovery over time. However, both levels of mental health upon settlement and recovery over time may be negatively influenced by stressors in the postsettlement period. The present study examined changes in psychological distress and posttraumatic stress symptoms over 5 years among 2,169 refugees from various backgrounds, predominately from Iraq and Afghanistan, who participated in the Building a New Life in Australia (BNLA) study. A multivariate latent growth curve model found mental ill-health decreased on average, β = -.21 for distress and β = -.31 for PTSD, ps < .001, and premigration trauma exposure predicted more initial PTSD symptoms and reduced recovery over time, βIntercept = .21, βSlope = -.54, p < .001. Postmigration stressors, such as loneliness, financial concerns, and cultural integration, predicted higher levels of mental health problems as well as reduced recovery over time. These findings suggest that beyond trauma exposure, the mental health of refugees upon resettlement and their recovery over time is impacted by stressors in the early resettlement period, which has important implications for interventions and services to support and encourage well-being in refugee populations.

Prior research has provided robust evidence that exposure to potentially traumatic events (PTEs) during a disaster is predictive of adverse postdisaster mental health outcomes, including posttraumatic stress symptoms (PTSS) and nonspecific psychological distress (PD). However, few studies have explored the role exposure to other PTEs over the life-course has in shaping postdisaster mental health. Based on the broader literature on trauma exposure and mental health, we hypothesized a path analytic model linking predisaster PTEs to long-term postdisaster PTSS and PD via predisaster PD, short-term postdisaster symptoms, and disaster-related and postdisaster PTEs. We tested this model using data from the Resilience in Survivors of Katrina study, a longitudinal study of low-income, primarily non-Hispanic Black mothers exposed to Hurricane Katrina and assessed before the disaster and at time points 1, 4, and 12 years thereafter. The models evidenced a good fit with the data, RMSEA < .01–.04, CFIs > .99. In addition, 44.1%–67.4% of the effect of predisaster PTEs on long-term postdisaster symptoms was indirect. Descriptive differences were observed across models that included PTSS versus PD, as well as models that included all pre- and postdisaster PTEs versus only those that involved assaultive violence. The results suggest the importance of incorporating disaster preparedness in clinical work with trauma survivors and the value in attending to other lifetime PTEs when working in postdisaster contexts.

Previous studies evaluating the impact of trauma history and posttraumatic stress disorder (PTSD) on pain sensitivity have yielded inconsistent findings. The presence of trauma-related negative affective states may account for these discrepancies. The current study aimed to evaluate the effect of PTSD and trauma-related negative affect on sensory, affective, physiological, and neuroendocrine responses to an experimental pain task. Trauma-exposed adult women (N = 87) with or without probable PTSD underwent an emotional disclosure paradigm during which they wrote about a traumatic event or a neutral topic. Participants then completed a pain induction procedure. Sensory and affective reports of pain, as well as physiological and neuroendocrine reactivity, were assessed. Compared to women without PTSD, those with PTSD demonstrated decreased sensory pain responses, η(p)(2) = .11, including increased time to pain detection (i.e., threshold) and ability to withstand the pain stimuli (i.e., tolerance) after accounting for relevant covariates. Women with PTSD also demonstrated increased cortisol reactivity following the pain stimulus, η(p)(2) = .06. The main and interactive effects of PTSD group and writing condition did not significantly predict alterations in affective reports of pain or heart rate reactivity. The results suggest that PTSD symptoms may contribute to alterations in pain sensitivity in trauma-exposed women, but this association is complex and requires further exploration.

The concept of psychological trauma implies that people experiencing traumatic stress are wounded, thus relating to the metaphor of a physical injury. Although this notion is widely accepted by clinicians and researchers in mental health, there is evidence of a broad range of metaphorical idioms for extremely aversive experiences or catastrophic events across different cultures. In this ethnopsychological study, we aimed to investigate and contrast culturally shared metaphors for trauma among four distinct cultural groups: two indigenous communities (Pitaguary from Brazil, Adivasis from India) and two rural communities (mountain villagers of Gondo, Switzerland; the Lemko ethnic minority in Poland). The communities in Brazil and in Poland were marked by historical trauma, and the communities in India and Switzerland each suffered from a natural disaster. Semistructured interviews that focused on metaphors shared within each community were conducted with key informants and laypersons (Brazil: N = 14, India: N = 28, Poland, N = 13, Switzerland: N = 9). We conducted separate metaphor analyses, then cross-culturally contrasted the findings from the four samples. Across the four cultural groups, we found similar metaphorical concepts of trauma related to bodily processes, such as shock, burden, and wound.

The Active Inhibition Scale (AIS; Ayers, Sandler, & Twohey, 1998) is an 11-item, self-report measure of emotional suppression among children and adolescents. Previous research with the AIS has linked emotional suppression to several clinically significant outcomes, such as posttraumatic stress symptoms (PTSS) and suicide, among trauma-exposed and bereaved youth; however, there are no published evaluations of its psychometric properties. We examined the factor structure and criterion validity of the AIS in two samples. Sample 1 included youth (M = 12.22 years, SD = 2.96, range: 6-18 years; 55.4% female) referred to an outpatient psychology clinic specializing in childhood trauma and grief. Sample 2 included youth (M = 13.18 years, SD = 2.58, range: 8-18 years; 61.8% female) referred to a community grief counseling center. Confirmatory factor analytic results supported a one-factor solution, Cronbach's α = .94. Additionally, AIS scores correlated positively with PTSS, depression, and maladaptive grief, rs = .43-.64. Evidence of factorial invariance was found across gender, race/ethnicity, and age group. Emotional suppression scores were higher among girls compared to boys, Black and Hispanic youth compared to White youth, and older compared to younger age groups. The magnitude of correlations between AIS and symptom measure scores was comparable across groups. These results support the reliability and criterion validity of the AIS with diverse youth populations and underscore the role that emotional suppression may play in explaining group differences in mental health symptoms.

Accumulating evidence suggests that lifetime trauma exposure is associated with adulthood cognitive functioning. However, the nature and extent of this relation have yet to be fully explored. We used multilevel modeling to examine trauma exposure and age at first trauma exposure as predictors of the level of and change in cognitive functioning over a 9-year period. Data were from the Midlife in the United States study, a national survey that began in 1995. Data regarding trauma exposure and age at first exposure were obtained from the 2004 wave, whereas cognitive data were obtained from the 2004 and 2013 waves. The analyses were conducted using data from the 2,471 participants (age range: 28-84 years) who had complete data on all variables from the 2004 wave. Lifetime trauma exposure predicted change in executive functioning (EF), B = -0.03, SE = 0.01, p = .015, 95% CI [-0.05, -0.01]; and episodic memory, B = -0.05, SE = 0.02, p = .023, 95% CI [-0.10, -0.01], such that individuals with more trauma exposure had more decline over 9 years. Age at first exposure also predicted change in EF, B = -0.002, SE = 0.00, p = .009, 95% CI [-0.004, -0.001], such that individuals who were first exposed to trauma later in life had greater EF decline than individuals whose first traumatic event occurred earlier in life. Delta pseudo- R 2 values were moderate, ΔpseudoR2 = .17-.39. These findings identify trauma exposure as a risk factor for cognitive decline in adulthood and highlight the elevated risk associated with adulthood trauma exposure.

Findings from studies of predominately school-aged children indicate that few children complete trauma-focused treatment; however, researchers have not specifically examined risk factors for dropout among young trauma-exposed children. The purpose of the present study was to investigate risk factors for attrition among young children receiving trauma-focused therapy. Study participants were 189 treatment-seeking children aged 3-5 years (M = 4.86 years, SD = 0.71; 54.1% female, 47.7% White) and their nonoffending legal guardian(s). Child and family characteristics, number of traumatic events, and pretreatment posttraumatic stress symptoms (PTSS) were examined in relation to two attrition definitions: (a) clinician-rated dropout and (b) whether the child received an adequate treatment dose (i.e., 12 or more sessions). Although 70.3% of children prematurely terminated therapy per their clinician, a nearly equivalent portion (67.4%) received an adequate treatment dose. Family characteristics were largely not associated with attrition, although residing farther from the clinic was related to clinician-rated treatment dropout, OR = 0.96. As expected, higher levels of externalizing symptoms were associated with clinician-rated dropout and inadequate dose status, ORs = .95 and .96, respectively, whereas lower levels of trauma-related anger were related to clinician-rated treatment completion, OR = 1.03, and lower levels of PTSS and sexual concerns corresponded with an increased likelihood the child received an inadequate treatment dose, ORs = 1.03 and 1.02, respectively. Thus, child and family factors appear to play a small role in predicting attrition; however, higher levels of externalizing problems and lower levels of PTSS may increase the risk for dropout.

Behavioral couples therapy (BCT) for substance use disorder shares similar intervention strategies with empirically supported couples therapies for posttraumatic stress disorder (PTSD). Like couples-based PTSD therapies, BCT includes interventions that may help to improve PTSD, such as increasing positive behavioral exchanges and improving communication. Studies have yet to examine whether BCT, which has demonstrated efficacy for improving substance-related outcomes, is efficacious for reducing PTSD. We conducted a secondary analysis of a randomized clinical trial comparing individually based treatment (IBT) to BCT plus IBT (BCT+IBT) for women with drug use disorders. Women in both conditions received 26 therapy sessions over 13 weeks. Women completed the PTSD Diagnostic Scale at baseline, posttreatment, and quarterly during the 1-year follow-up. Of the 61 women who were randomized to treatment, 51 (83.6%) reported a lifetime traumatic event. Of the 50 women who endorsed a "worst traumatic event," 25 (50.0%) had a baseline PTSD diagnosis. The treatments did not differ on baseline PTSD severity or diagnosis. Women who received BCT+IBT had significant reductions in PTSD severity from baseline to each of four posttreatment follow-ups, ds = 0.34-0.80; there were no changes in the IBT group. Generalized estimating equation results showed that women who received BCT+IBT had significantly lower PTSD severity during follow-up versus those who received IBT, d = 0.35. There were no differences in the proportion of participants diagnosed with PTSD following treatment. This was the first study to show that BCT+IBT is efficacious for reducing PTSD among women with drug use disorders.Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Eficacia de la Terapia conductual de pareja frente a la Consejería de recuperación individual para tratar el TEPT entre las mujeres con Trastornos de Uso de Drogas. ABUSO DE DROGAS EN MUJERES Y TEPT La terapia conductual de pareja (TCP) para el trastorno por consumo de sustancias comparte estrategias de intervención con apoyo empírico similares a la terapia de pareja para el trastorno de estrés postraumático (TEPT). Al igual que las terapias de pareja basadas en TEPT, la TCP incluye intervenciones que pueden ayudar a mejorar el TEPT, como el aumento de los intercambios conductuales positivos y la mejora de la comunicación. Los estudios aún no han examinado si la TCP, la cual ha demostrado ser eficaz para mejorar los resultados relacionados con sustancias, es eficaz para reducir el TEPT. Se realizó un análisis secundario de un ensayo clínico aleatorio que comparó el tratamiento individualizado (TI) con la TCP más la TI (TI+ TCP) para las mujeres con trastornos por el consumo de drogas. Las mujeres en ambas condiciones recibieron 26 sesiones de terapia durante 13 semanas. Las mujeres completaron la Escala de Diagnóstico del TEPT al inicio, después del tratamiento y trimestralmente durante el seguimiento de un año. De las 61 mujeres que fueron asignadas al azar al tratamiento, 51 (83.6%) reportaron un evento traumático en la vida. De las 50 mujeres que señalaron un “peor evento traumático”, 25 (50.0%) tuvieron un diagnóstico inicial de TEPT. Los tratamientos no difirieron según la gravedad o el diagnóstico inicial del TEPT. Las mujeres que recibieron TCP +TI tuvieron reducciones significativas en la gravedad del TEPT desde el inicio hasta cada uno de los cuatro seguimientos posteriores al tratamiento, ds = 0.34 - 0.80; no hubo cambios en el grupo de TI. Los resultados de la ecuación de estimación generalizada mostraron que las mujeres que recibieron TCP+TI tuvieron una gravedad de TEPT significativamente menor durante el seguimiento en comparación con las que recibieron TI, d = 0.35. No hubo diferencias en la proporción de participantes diagnosticados con TEPT después del tratamiento. Este fue el primer estudio en mostrar que la TCP +TI es eficaz para reducir el TEPT entre las mujeres con trastornos por el uso de drogas.Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Efficacy of Behavioral Couples Therapy versus Individual Recovery Counseling for Addressing PTSD among Women with Drug Use Disorders Traditional Chinese 標題: 比較行為取向的伴侶治療與個人復康輔導在改善濫用藥物女性的PTSD方面的功效 撮要: 為治療濫用藥物提供的行為取向的伴侶治療(BCT), 跟具實證支持用以治療創傷後壓力症(PTSD)的伴侶治療有相似的干預策略。與PTSD的伴侶治療一樣, BCT包含可改善PTSD的干預, 例如提升正向的行為交流和改善溝通。BCT已顯示能有效改善濫用藥物相關的症狀。然而, 目前仍未有研究檢視其是否能有效改善PTSD。我們對一隨機臨床試驗進行次級資料分析, 比較濫用藥物的女性樣本只接受個人治療(IBT), 與共同接受BCT和IBT(BCT+IBT)的效果。兩組的女性樣本都於13週內接受了26個治療節段, 並於基線、完成療程後、及完成療程後的一年跟進期內每3個月接受PTSD診斷量表測量。在61名接受隨機分派治療組別的樣本中, 51人(83.6%)經歷過一次生命創傷事件。50名經歷過「最壞的創傷事件」的樣本中, 25人(50.0%)在基線被診斷出患PTSD。治療效果並無因基線PTSD嚴重度或診斷而生異。接受BCT+IBT的樣本, 其PTSD嚴重度從基線到完成療程後每3個月的跟進都有顯著改善(ds = 0.34-0.80), 而接受IBT的樣本則沒變。廣義估計方程式結果顯示, 接受BCT+IBT的女性樣本, 相比只接受IBT的樣本, 其PTSD嚴重度於跟進期有顯著改善(d = 0.35)。治療後有PTSD的樣本比例沒變。這是首個研究證實BCT+IBT能有效改善濫用藥物女性的PTSD。 Simplified Chinese 标题: 比较行为取向的伴侣治疗与个人复康辅导在改善滥用药物女性的PTSD方面的功效 撮要: 为治疗滥用药物提供的行为取向的伴侣治疗(BCT), 跟具实证支持用以治疗创伤后压力症(PTSD)的伴侣治疗有相似的干预策略。与PTSD的伴侣治疗一样, BCT包含可改善PTSD的干预, 例如提升正向的行为交流和改善沟通。BCT已显示能有效改善滥用药物相关的症状。然而, 目前仍未有研究检视其是否能有效改善PTSD。我们对一随机临床试验进行次级数据分析, 比较滥用药物的女性样本只接受个人治疗(IBT), 与共同接受BCT和IBT(BCT+IBT)的效果。两组的女性样本都于13周内接受了26个治疗节段, 并于基线、完成疗程后、及完成疗程后的一年跟进期内每3个月接受PTSD诊断量表测量。在61名接受随机分派治疗组别的样本中, 51人(83.6%)经历过一次生命创伤事件。50名经历过「最坏的创伤事件」的样本中, 25人(50.0%)在基线被诊断出患PTSD。治疗效果并无因基线PTSD严重度或诊断而生异。接受BCT+IBT的样本, 其PTSD严重度从基线到完成疗程后每3个月的跟进都有显著改善(ds = 0.34-0.80), 而接受IBT的样本则没变。广义估计方程式结果显示, 接受BCT+IBT的女性样本, 相比只接受IBT的样本, 其PTSD严重度于跟进期有显著改善(d = 0.35)。治疗后有PTSD的样本比例没变。这是首个研究证实BCT+IBT能有效改善滥用药物女性的PTSD。.

The most robust finding of moral injury (MI) research thus far-that past exposure to potentially morally injurious events predicts current symptoms of posttraumatic stress disorder (PTSD)-challenges conceptions that trauma is exclusively the result of fear-evoking brushes with death or sexual assault. It also calls into question the applicability to MI of treatments for PTSD grounded in the fear model of trauma. In the current article, two divergent theoretical models that have been applied to the understanding and treatment of moral injury are compared: the stress-appraisal-coping model and the stress injury model. Attention is drawn to the differences between how these models conceptualize stress and distress, including psychological trauma, and to their potential implications for the sustainment of mental health stigma, especially in military and veteran populations.

Childhood adversity (CA) and adulthood traumatic experiences (ATEs) are common and unequally distributed in the general population. Early stressors may beget later stressors and alter life-course trajectories of stressor exposure. Gender differences exist regarding the risk of specific stressors. However, few studies have examined the associations between specific types of CA and ATEs. Using a large-scale sample of older adults, we aimed to (a) determine if specific or cumulative CA increased the risk for specific or cumulative ATEs and (b) examine whether these associations were moderated by gender. In a sample from the U.S. Health and Retirement Study (N = 15,717; Mage = 67.57 years, SD = 10.54), cross-sectional Poisson and logistic regression models were fitted to assess the specific and cumulative associations between CA and ATEs. Overall, cumulative CA was associated with a larger risk ratio of ATEs, adjusted for covariates: aRRRs = 1.28, 1.63, and 1.97 for 1, 2, and 3-4 adverse events in childhood, respectively. Cumulative CA was particularly strongly associated with adulthood physical attacks, aOR = 5.66, and having a substance-abusing spouse or child, aOR = 4.00. Childhood physical abuse was the strongest independent risk factor for cumulative ATEs, aRRR = 1.49, and most strongly associated with adulthood physical attacks, aOR = 3.41. Gender moderated the association between cumulative CA and cumulative ATEs, with slightly stronger associations between cumulative CA and ATEs for women than men. Given that CA and ATEs perpetuate health disparities worldwide, reducing their incidence and effects should be major priorities for public health.

Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child–parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.

Lithuanian National Health Insurance (NHI) registry data from 2014 and 2015 were used to estimate the annual rates of posttraumatic stress disorder (PTSD) and other stress-related disorders in Lithuania. A large gap was found between 12-month PTSD prevalence based on epidemiological data and annual PTSD rates based on health care service utilization in Lithuania. Estimations from the health care service's utilization data revealed that only about 0.01% to 0.02% of the population in Lithuania is diagnosed with PTSD annually, indicating that the national health care system identifies only about 1% of potential PTSD cases in Lithuania. The low rates of PTSD diagnoses in the health care system seem to indicate a lack of recognition of psychological trauma among general practitioners and mental health professionals in Lithuania. The lack of visibility of PTSD in the national health care system could be a major barrier to the treatment of PTSD in the country. The study indicates the importance of social factors, especially the recognition of trauma and PTSD, among health care professionals.

Refugees who suffer from posttraumatic stress disorder (PTSD) often react with strong emotions when confronted with trauma reminders. In this study, we aimed to investigate the associations between low emotion regulation capacity (as indexed by low heart rate variability [HRV]), probable PTSD diagnosis, and fear and anger reaction and recovery to trauma-related stimuli. Participants were 81 trauma-exposed refugees (probable PTSD, n = 23; trauma-exposed controls, n = 58). The experiment comprised three 5-min phases: a resting phase (baseline); an exposition phase, during which participants were exposed to trauma-related images (stimulus); and another resting phase (recovery). We assessed HRV at baseline, and fear and anger were rated at the end of each phase. Linear mixed model analyses were used to investigate the associations between baseline HRV and probable DSM-5 PTSD diagnosis in influencing anger and fear responses both immediately after viewing trauma-related stimuli and at the end of the recovery phase. Compared to controls, participants with probable PTSD showed a greater increase in fear from baseline to stimulus presentation, d = 0.606. Compared to participants with low emotion regulation capacity, participants with high emotion regulation capacity showed a smaller reduction in anger from stimulus presentation to recovery, d = 0.548. Our findings indicated that following exposure to trauma-related stimuli, probable PTSD diagnosis predicted increased fear reactivity, and low emotion regulation capacity predicted decreased anger recovery. Impaired anger recovery following trauma reminders in the context of low emotion regulation capacity might contribute to the increased levels of anger found in postconflict samples.Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Reactividad Emocional, Capacidad de Regulación Emocional y trastorno por Estrés Postraumático en Refugiados Traumatizados: Una Investigación Experimental REACTIVIDAD EMOCIONAL, REGULACION EMOCIONAL Y TEPT Los refugiados que sufren de trastorno de estrés postraumático (TEPT) a menudo reaccionan con emociones fuertes cuando se enfrentan a recordatorios de trauma. El objetivo de este estudio fue investigar las asociaciones entre la baja capacidad de regulación emocional (según la variabilidad de la frecuencia cardíaca [HRV en su sigla en inglés]), el diagnóstico probable de TEPT y la reacción de miedo e ira, y la recuperación ante estímulos relacionados-al-trauma. Los participantes fueron 81 refugiados expuestos a traumas (TEPT probable, n = 23; controles expuestos a traumas, n = 58). El experimento estuvo compuesto por tres fases de 5 minutos: una fase de reposo (línea base); una fase de exposición, durante la cual los participantes fueron expuestos a imágenes relacionadas-al-trauma (estímulo); y otra fase de reposo (recuperación). Se evaluó la HRV al inicio, y el miedo y la ira se evaluaron al final de cada fase. Se utilizaron análisis de modelos lineales mixtos para investigar las asociaciones entre la HRV basal y el diagnóstico probable de TEPT DSM-5 para influir en las respuestas de ira y miedo, inmediatamente después de ver los estímulos relacionados-al-trauma y al final de la fase de recuperación. En comparación con los controles, los participantes con TEPT probable mostraron un mayor incremento en miedo desde la línea base hasta la presentación del estímulo, d = 0.606. En comparación a los participantes con baja capacidad de regulación emocional, los participantes con alta capacidad de regulación emocional mostraron una menor reducción en ira desde la presentación del estímulo a la recuperación, d = 0.548. Nuestros hallazgos indican que el diagnóstico de TEPT probable predice un aumento de la reactividad al miedo y una baja capacidad de regulación emocional predice una disminución de la recuperación de ira tras la exposición a estímulos relacionados-al-trauma. Nuestros hallazgos indican que el diagnóstico de TEPT probable predice un aumento de la reactividad al miedo y una baja capacidad de regulación emocional predice una disminución de la recuperación de ira después de la exposición a estímulos relacionados-al-trauma. La recuperación de ira deteriorada seguida a los recuerdos traumáticos en el contexto de una baja capacidad de regulación emocional podría contribuir al aumento de los niveles de ira que se encuentran en las muestras posteriores al conflicto.Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Emotional Reactivity, Emotion Regulation Capacity and Posttraumatic Stress Disorder in Traumatized Refugees: An Experimental Investigation Traditional Chinese 標題: 受創難民的情緒反應度、情緒調節能力及創傷後壓力症:一項實驗性探查 撮要: 患有創傷後壓力症(PTSD)的難民༌面對使其憶起創傷的東西時༌經常有強烈的情緒反應。本研究旨在探查低水平的情緒調節能力(透過心率變異度低 [HRV])反映出來)、確診患PTSD的可能、恐懼及憤怒的反應與康復༌與創傷相關刺激的關連。樣本為81名受創難民(有可能確診患PTSD, n = 23; 受創的對照, n = 58)。本實驗由三個各五分鐘的階段組成:休息階段(基線);暴露階段༌這一階段中༌樣本會暴露於創傷相關圖像(刺激);另一休息階段(康復)。我們評估基線的HRV༌並測量每個階段結束時的恐懼及憤怒。透過線性混合模型分析༌探查基線的HRV與確診患PTSD的可能之間的關連༌及此關連如何影響樣本分別於看見創傷相關刺激後即時、及在康復階段結束時的恐懼與憤怒反應。與對照樣本相比༌有可能患PTSD的樣本༌從基線到受刺激時༌恐懼有較大提升(d = 0.606)。與情緒調節能力為低水平的樣本相比༌高水平情緒調節能力的樣本在受刺激到康復階段中༌恐懼減低的幅度較小(d = 0.548)。結果反映༌有可能確診患PTSD༌可以預測個人承受創傷相關刺激後的恐懼反應提升༌而低水平的情緒調節能力༌可以預測個人承受創傷相關刺激後༌從憤怒恢復過來的幅度減小。低水平情緒調節能力的人༌在面對使其憶起創傷的刺激後憤怒的恢復能力受損༌可能致使經歷戰亂的樣本中憤怒水平較高。 Simplified Chinese 标题: 受创难民的情绪反应度、情绪调节能力及创伤后压力症:一项实验性探查 撮要: 患有创伤后压力症(PTSD)的难民༌面对使其忆起创伤的东西时༌经常有强烈的情绪反应。本研究旨在探查低水平的情绪调节能力(透过心率变异度低 [HRV])反映出来)、确诊患PTSD的可能、恐惧及愤怒的反应与康复༌与创伤相关刺激的关连。样本为81名受创难民(有可能确诊患PTSD, n = 23; 受创的对照, n = 58)。本实验由三个各五分钟的阶段组成:休息阶段(基线);暴露阶段༌这一阶段中༌样本会暴露于创伤相关图像(刺激);另一休息阶段(康复)。我们评估基线的HRV༌并测量每个阶段结束时的恐惧及愤怒。透过线性混合模型分析༌探查基线的HRV与确诊患PTSD的可能之间的关连༌及此关连如何影响样本分别于看见创伤相关刺激后实时、及在康复阶段结束时的恐惧与愤怒反应。与对照样本相比༌有可能患PTSD的样本༌从基线到受刺激时༌恐惧有较大提升(d = 0.606)。与情绪调节能力为低水平的样本相比༌高水平情绪调节能力的样本在受刺激到康复阶段中༌恐惧减低的幅度较小(d = 0.548)。结果反映༌有可能确诊患PTSD༌可以预测个人承受创伤相关刺激后的恐惧反应提升༌而低水平的情绪调节能力༌可以预测个人承受创伤相关刺激后༌从愤怒恢复过来的幅度减小。低水平情绪调节能力的人༌在面对使其忆起创伤的刺激后愤怒的恢复能力受损༌可能致使经历战乱的样本中愤怒水平较高。.

Increasing attention has been drawn to the symptom of emotional numbing in the phenomenology of posttraumatic stress disorder (PTSD), particularly regarding its implications for maladaptive outcomes in adolescence such as delinquent behavior. One change in the definition of emotional numbing according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) was the limitation to the numbing of positive emotions. Previous research with youth, however, has implicated general numbing or numbing of negative emotions in PTSD, whereas numbing of positive emotions may overlap with other disorders, particularly depression. Consequently, the goal of this study was to investigate whether numbing of positive emotions was associated with PTSD symptoms above and beyond numbing of negative emotions, general emotional numbing, or depressive symptoms among at-risk adolescents. In a sample of 221 detained youth (mean age = 15.98 years, SD = 1.25; 50.7% ethnic minority), results of hierarchical multiple regressions indicated that only general emotional numbing and numbing of anger accounted for significant variance in PTSD symptoms (total R(2) = .37). In contrast, numbing of sadness and positive emotions were statistical correlates of depressive symptoms (total R(2) = .24). Further tests using Hayes' Process macro showed that general numbing, 95% CI [.02, .45], and numbing of anger, 95% CI [.01, .42], demonstrated indirect effects on the association between trauma exposure and PTSD symptoms.

Multiple pathways have been suggested to account for the relationship of adverse childhood experiences (ACEs) and well-being in adulthood, including interpersonal difficulties, the underestimation of one's sense of mastery, and a greater propensity to experience stressors later in life. This study was conducted to examine the association between ACEs and mental health in Canadian Armed Forces (CAF) personnel, and the possible mediating roles of social support, mastery, and combat stressors in that relationship. The study consisted of a prospective analysis involving 3,319 CAF members upon their return from an overseas deployment. Results were that ACEs were associated with poorer mental health (β = -.14, p < .001) and that approximately 42.6% of this relationship could be explained by the mediating effects of low social support, low mastery, and a greater number of combat stressors. The full model, including the covariates, ACEs, social support, mastery, and combat stressors as correlates of postdeployment mental health, was statistically significant with adjusted R(2) = .28, F(9, 3309) = 141.96, p < .001. On the whole, results suggested that social support, mastery, and life stressors may be possible targets for interventions to minimize the impact of ACEs on later mental health in military personnel.

Research suggests that racial and ethnic minorities are more likely to attrit from longitudinal trauma studies than non-Hispanic Whites. Yet, little is known about how the loss of minority participants influences longitudinal findings as well as internal and external validity of study findings. Thus, the present study examined the effects of race/ethnicity on attrition in a longitudinal trauma study of women (minority = 223, non-Hispanic White or majority = 459) exposed to a campus shooting. Survival analyses were used to compare the attrition rates of minority participants to majority participants and assess the extent to which race/ethnicity, among other variables, predicted attrition. Minority participants were more likely to attrit than majority participants, hazard ratio (HR) = 0.69, 95% CI [0.48, 0.99], even after adjusting for study variables. A main effect was also found for age, HR = 1.06, 95% CI [1.01, 1.12]. Race/ethnicity did not interact with other study variables to influence attrition. The findings underscored the importance of assessing the effects of attrition on longitudinal findings and external validity.

In the present study, we sought to replicate recent findings of Polimanti et al. (2017), who conducted a genome-wide gene-by-environment interaction study (GEWIS) and identified a gene-by-trauma interaction that predicts alcohol misuse among African Americans. Consistent with the findings published by Polimanti and colleagues, results of the current study demonstrated an interaction effect, b = 0.41, of trauma exposure and rs1729578 in the intron of PRKG1 on alcohol misuse in a subsample of ancestral African Americans. The minor allele (rs1729578*C) was positively associated with increased alcohol use disorder symptoms in trauma-exposed subjects and negatively associated in non-trauma-exposed subjects. This effect, however, was only significant for one out of three alcohol outcome measures we investigated, suggesting the interaction may be most salient when predicting higher severity of alcohol misuse. Additionally, the effect did not remain significant after we accounted for testing the effect on three different outcome variables. Also in line with the original study, the gene-by-environment effect was not demonstrated among the ancestral European subsample. The findings suggest this gene variant may increase an individual's susceptibility to environmental influences, both adverse and supportive.

The inclusion of a complex posttraumatic stress disorder (CPTSD) diagnosis in the 11th revision of the International Classification of Diseases reflects growing evidence that a subgroup of individuals with PTSD also suffer from disturbances in emotion regulation, interpersonal skills, and self-concept, which together are termed "disturbances in self-organization" (DSO). Although CPTSD is assumed to result from exposure to complex traumatic events, emotional neglect may be an important contributor. This study investigated the presence of CPTSD, defined by endorsement of PTSD and DSO symptoms in a clinical postwar generation sample. The sample consisted of 218 patients who had been exposed to emotional neglect in childhood, a subgroup of whom had also been exposed to potentially traumatic events. Using items from the Harvard Trauma Questionnaire and the Brief Symptom Inventory, a latent class analysis revealed two classes: high endorsement of almost all CPTSD symptoms (n = 83; 38.1%) and low endorsement of all CPTSD symptoms (n = 135; 61.9%). Contrary to our hypothesis, no DSO-only class was found. The R3step method showed gender and number of traumatic events to be significant predictors of class membership. Compared to the low endorsement class, individuals in the CPTSD class were more likely to be female, p = .013, and to report a higher number of traumatic experiences, p.001. The potential intermediary role of emotional neglect in the development of DSO and CPTSD is discussed.Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Tept complejo en pacientes expuestos a negligencia emocional y eventos traumáticos: un análisis de clases latentes TEPTC EN PACIENTES EXPUESTOS A NEGLIGENCIA: ACL El diagnóstico de trastorno de estrés postraumático complejo (TEPTC) propuesto en la 11′ revisión de la Clasificación Internacional de Enfermedades refleja una evidencia creciente que un subgrupo de individuos con TEPT también sufre de problemas en la regulación emocional, habilidades interpersonales, y auto- concepto (conocido como "problemas en la auto-organización" [DSO], por sus siglas en inglés). Aunque se asume que el TEPTC es el resultado de la exposición a eventos traumáticos complejos, la negligencia emocional puede ser un contribuyente. Este estudio investigó la confirmación del TEPT y síntomas DSO (que juntos calificaban para TEPTC) en una muestra clínica de una generación post guerra. La muestra consistió en 218 pacientes que estuvieron expuestos a negligencia emocional en su infancia, un subgrupo que también había estado expuesto a potenciales eventos traumáticos. Usando los ítems del Cuestionario de Trauma de Harvard y el Inventario de Síntomas Abreviado, un análisis de clases latentes (ACL) reveló dos clases: alta confirmación de casi todos los síntomas de TEPTC (n=83; 38.1%) y baja confirmación de todos los síntomas de TEPTC (n=135; 61.9%). Contrario a nuestra hipótesis, no se encontró ninguna clase de sólo DSO. El método de pasos R3 mostró que el género y el número de eventos traumáticos son predictores significativos para la pertenencia a alguna clase. Comparado con la clase de baja probabilidad, los individuos de la clase TEPTC tenían más probabilidad de ser mujer, p = .013, y reportar un mayor número de experiencias traumáticas, p = .000. Se discute el rol intermediario potencial de la negligencia emocional en el desarrollo de DSO y TEPTC.Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Complex PTSD in Patients Exposed to Emotional Neglect and Traumatic Events: Latent Class Analysis Traditional Chinese 標題: 曾經歷情感忽略與創傷事件人士的複雜性PTSD:潛在類別分析 撮要: 國際疾病分類第十一版就複雜性創傷後壓力症(CPTSD) 提出診斷準則༌進一步反映༌部分PTSD患者亦有情緒調節障礙、人際技巧障礙及自我概念障礙(亦即「自我組織障礙 [DSO]」)。雖然CPTSD被假設為經歷複雜性創傷事件所致༌但情感上受到忽略可能也是促成因素。本研究探查一個戰後世代組成的臨床樣本༌當中的PTSD與DSO症狀(兩者結合即CPTSD)。樣本為218名兒時曾經歷情感忽略人士༌當中一個子組別為曾經歷潛在創傷事件人士。我們採用哈佛創傷問卷與簡要症狀量表。潛在類別分析顯示兩個類別:很大可能擁有全部CPTSD症狀(n = 83; 38.1%)༌及很小可能擁有全部CPTSD症狀(n = 135; 61.9%)。與我們的假設相反༌當中並無DSO的單一類別。R3step方法反映༌樣本的性別以及經歷過的創傷事件數目༌為所屬潛在類別的顯著預測變量。與低可能類別相比༌CPTSD類別的樣本較大機會為女性(p = .013)༌並有較多創傷經歷(p = .000)。我們亦討論到༌情感忽略在DSO與CPTSD發展中的調節角色。 Simplified Chinese 标题: 曾经历情感忽略与创伤事件人士的复杂性PTSD:潜在类别分析 撮要: 国际疾病分类第十一版就复杂性创伤后压力症(CPTSD) 提出诊断准则༌进一步反映༌部分PTSD患者亦有情绪调节障碍、人际技巧障碍及自我概念障碍(亦即「自我组织障碍 [DSO]」)。虽然CPTSD被假设为经历复杂性创伤事件所致༌但情感上受到忽略可能也是促成因素。本研究探查一个战后世代组成的临床样本༌当中的PTSD与DSO症状(两者结合即CPTSD)。样本为218名儿时曾经历情感忽略人士༌当中一个子组别为曾经历潜在创伤事件人士。我们采用哈佛创伤问卷与简要症状量表。潜在类别分析显示两个类别:很大可能拥有全部CPTSD症状(n = 83; 38.1%)༌及很小可能拥有全部CPTSD症状(n = 135; 61.9%)。与我们的假设相反༌当中并无DSO的单一类别。R3step方法反映༌样本的性别以及经历过的创伤事件数目༌为所属潜在类别的显著预测变量。与低可能类别相比༌CPTSD类别的样本较大机会为女性(p = .013)༌并有较多创伤经历(p = .000)。我们亦讨论到༌情感忽略在DSO与CPTSD发展中的调节角色。.

Traumatic events (TEs), posttraumatic stress disorder (PTSD) symptoms, and alcohol use disorder (AUD) symptoms can significantly impair functioning, yet little is known about whether associations among these variables differ between men and women within young adult samples. The current study conducted a path analysis of archival, longitudinal data from the Drug Use Trajectories: Ethnic/Racial Comparisons 1998-2002 (DUT) study (Turner, 2011) to examine gender differences as a possible moderator of the relations between TEs, PTSD symptoms, and AUD symptoms among 1,076 young adults (aged 18-23 years) residing in South Florida. The sample included 580 male (53.9%) and 496 female (46.1%) participants, whose ethnicity was self-reported as African American (n = 280, 26.0%), non-Hispanic White (n = 268, 24.9%), other Hispanic (n = 267, 24.8%), and Cuban (n = 261, 24.3%). Significant positive associations were found between TEs and PTSD symptoms, βs = .08-.30; PTSD and AUD symptoms, βs = .09 - .10; PTSD symptoms over time, β = .52; and AUD symptoms over time, β = .46. In addition, for male but not female participants, a higher frequency of PTSD symptoms at Wave I was related to more AUD symptoms at Wave II, β = .09. Findings build upon existing research to further elucidate the role of gender as a potential moderator of the associations among TEs, PTSD symptoms, and AUD symptoms for young adults and provide important implications for future research and clinical practice, including informing mental health prevention and treatment efforts.Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) El género como posible moderador de las relaciones entre Trauma, síntomas del Trastorno de Estrés Postraumático, y síntomas del trastorno por consumo de alcohol en adultos jóvenes. GÉNERO, EXPOSICIÓN AL TRAUMA. TEPT Y CONSUMO DE ALCOHOL. Los eventos traumáticos (ETs), los síntomas del trastorno de estrés postraumático (TEPT) y los síntomas del trastorno por consumo de alcohol (TCA) pueden afectar significativamente el funcionamiento, pero se sabe poco acerca de si las asociaciones entre estas variables difieren entre hombres y mujeres en una muestra de adultos jóvenes. El presente estudio llevó a cabo un análisis de ruta de los datos longitudinales archivados de las trayectorias de consumo de drogas: Estudio de Comparaciones Étnica/Racial 1998-2002 (DUT en sus siglas en inglés) (Turner, 2011) para examinar las diferencias de género como posible moderador de las relaciones entre los ETs, los síntomas de TEPT y los síntomas de TCA entre 1,076 adultos jóvenes (de 18 a 23 años) que residen en el sur de Florida. La muestra incluyó 580 participantes, hombres (53.9%) y 496 mujeres (46.1%), cuya etnia fue autorreportada como afroamericanos (n = 280, 26.0%), blancos no hispanos (n = 268, 24.9%), otros hispanos (n = 267, 24.8%), y cubanos (n = 261, 24.3%). Se encontraron asociaciones positivas significativas entre ETs y los síntomas de TEPT, βs = .08-.30; los síntomas de TEPT y los síntomas de TCA, βs = .09-.10; los síntomas de TEPT con el tiempo, β = .52; y los síntomas de TCA con el tiempo, β = .46. Además, para los participantes masculinos pero no femeninos, se encontró una frecuencia más alta de síntomas de TEPT en la medición I la cual se relacionó con más síntomas de TCA en la medición II, β = .09. Los hallazgos se basan en investigaciones existentes para dilucidar aún más el papel del género como posible moderador de las asociaciones entre los ETs, los síntomas del TEPT y los síntomas de la TCA en adultos jóvenes, y proporcionan importantes implicancias para la investigación futura y la práctica clínica, incluida la información sobre la prevención y el tratamiento de la salud mental.Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Gender as Potential Moderator of Relations Between Trauma, Posttraumatic Stress Disorder Symptoms, and Alcohol Use Disorder Symptoms in Young Adults Traditional Chinese 標題: 初成年人士中, 性別作為創傷 、創傷後壓力症症狀、酒精使用失常症狀的關連間潛在的調節變量 撮要: 創傷事件(TEs)、創傷後壓力症(PTSD)症狀、酒精使用失常(AUD)症狀皆可對功能運作構成顯著傷害。可是, 我們並不清楚這些變量之間的關連是否會在初成年的樣本中因性別而生異。本研究對「藥物使用軌跡:種族比較1998-2002 (DUT)研究(Turner, 2011)」中的縱貫數據進行路徑分析, 檢視性別差異是否為TEs、PTSD 症狀及AUD症狀的關連間潛在的調節變量。樣本為居於南佛羅里達州1,076名初成年人士(年齡為 18-23 歲)。樣本中有580名男性(53.9%) 、496 名女性 (46.1%)。透過自評報告所得的種族比例為:非裔美國人(n = 280, 26.0%)、非西班牙裔白人(n = 268, 24.9%)、其他西班牙裔人(n = 267, 24.8%)、古巴人(n = 261, 24.3%)。TEs 與 PTSD 症狀之間(βs = .08-.30)以及PTSD與 AUD 症狀之間(βs = .09- .10), 都有顯著的正向關連;隨時間發展, PTSD 症狀之間 (β = .52)及AUD症狀之間(β = .46)亦有顯著的正向關連。此外, 男性樣本中, PTSD 症狀頻率在第一波較高, 跟第二波有較多AUD症狀有關(β = .09)。是次發現進一步延伸過往的研究, 闡明在初成年人士中, 性別是TEs、PTSD 症狀及AUD症狀的關連間潛在的調節變量, 並為未來研究和臨床工作提供重要資料, 包括有關心理健康的保障和治療方法的建議。 Simplified Chinese 标题: 初成年人士中, 性别作为创伤 、创伤后压力症症状、酒精使用失常症状的关连间潜在的调节变量 撮要: 创伤事件(TEs)、创伤后压力症(PTSD)症状、酒精使用失常(AUD)症状皆可对功能运作构成显著伤害。可是, 我们并不清楚这些变量之间的关连是否会在初成年的样本中因性别而生异。本研究对「药物使用轨迹:种族比较1998-2002 (DUT)研究(Turner, 2011)」中的纵贯数据进行路径分析, 检视性别差异是否为TEs、PTSD 症状及AUD症状的关连间潜在的调节变量。样本为居于南佛罗里达州1,076名初成年人士(年龄为 18-23 岁)。样本中有580名男性(53.9%) 、496 名女性 (46.1%)。透过自评报告所得的种族比例为:非裔美国人(n = 280, 26.0%)、非西班牙裔白人(n = 268, 24.9%)、其他西班牙裔人(n = 267, 24.8%)、古巴人(n = 261, 24.3%)。TEs 与 PTSD 症状之间(βs = .08-.30)以及PTSD与 AUD 症状之间(βs = .09- .10), 都有显著的正向关连;随时间发展, PTSD 症状之间 (β = .52)及AUD症状之间(β = .46)亦有显著的正向关连。此外, 男性样本中, PTSD 症状频率在第一波较高, 跟第二波有较多AUD症状有关(β = .09)。是次发现进一步延伸过往的研究, 阐明在初成年人士中, 性别是TEs、PTSD 症状及AUD症状的关连间潜在的调节变量, 并为未来研究和临床工作提供重要资料, 包括有关心理健康的保障和治疗方法的建议。.

There is a paucity of knowledge concerning the underlying symptomatology of heterogeneous posttraumatic stress symptom (PTSS) trajectories following mass trauma, such as a terrorist attack. This study examined longitudinal PTSS trajectories using latent growth mixture modeling in 2,355 World Trade Center (WTC) tower survivors surveyed by the WTC Health Registry an average of 2.5, 5.5, and 10.5 years after the September 11, 2001 terrorist attacks. Covariates included sociodemographic characteristics, WTC-related exposure, and other traumas/stressors. Four curvilinear PTSS trajectories were identified: low symptom (74.9%), recovering (8.0%), worsening (6.7%), and chronic (10.4%). The majority of WTC survivors (85.3%) maintained stable symptom trajectories over time, with PTSS changes occurring less often. Although WTC-related exposure was associated with initial PTSS severity, exposure was not associated with chronicity or change of PTSS over time. Male gender and a higher number of post-WTC disaster life-stressors were associated with worsening symptom severity over time. Individuals with more severe hyperarousal symptoms at Wave 1, particularly of anxious arousal, were more likely to have PTSS that worsened over time, adjusted odds ratio (aOR) = 1.55. Less severe emotional numbing symptoms, particularly of dysphoria, at Wave 1, were marginally significantly associated with subsequent PTSS recovery, aOR = 0.75. Interventions that target hyperarousal and emotional numbing symptoms may mitigate a worsening of symptoms and facilitate posttraumatic recovery following future mass traumas, such as terrorist attacks. Further clinical implications are discussed.Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Trayectorias de estrés postraumático en sobrevivientes de la torre del World Trade Center: Hiperactivación y adormecimiento emocional predicen un cambio en los síntomas TRAYECTORIAS DE TEPT RELACIONADAS CON EL WORLD TRADE CENTER Existe una escasez de conocimientos sobre la sintomatología subyacente de las trayectorias heterogéneas de los síntomas de estrés postraumático (TEPT) después de un trauma masivo, como un ataque terrorista. Este estudio examinó las trayectorias longitudinales de TEPT utilizando modelos de mezcla de crecimiento latente en 2.355 sobrevivientes de las torres del World Trade Center (WTC), encuestados por el Registro de Salud de WTC con un promedio de 2.5, 5.5 y 10.5 años después de los ataques terroristas del 11 de septiembre de 2001. Las covariables incluyeron características sociodemográficas, exposición relacionada con el WTC y otros traumas/factores estresantes. Se identificaron cuatro trayectorias curvilíneas de TEPT: síntomas bajos (74.9%), recuperación (8,0%), empeoramiento (6,7%) y crónico (10,4%). La mayoría de los sobrevivientes del WTC (85.3%) mantuvieron trayectorias de síntomas estables a lo largo del tiempo, con cambios en TEPT que ocurren con menos frecuencia. Aunque la exposición relacionada con el WTC se asoció con la gravedad inicial del TEPT, la exposición no se asoció con la cronicidad o el cambio del TEPT a lo largo del tiempo. El género masculino y un mayor número de factores estresantes de vida después del WTC se asociaron con el empeoramiento de la gravedad de los síntomas con el tiempo. Las personas con síntomas de hiperactivación más severos en la primera evaluación (1), particularmente de agitación ansiosa, tenían más probabilidades de tener TEPT, el cual empeoró a través del tiempo, la razón de probabilidades ajustada (aOR) = 1.55. Los síntomas de adormecimiento emocional menos severos, particularmente de disforia, en la primera evaluación (1), se asociaron marginalmente de manera significativa con la recuperación subsecuente de TEPT, aOR = 0.75. Las intervenciones dirigidas a los síntomas de hipersensibilidad y adormecimiento emocional pueden mitigar el empeoramiento de los síntomas y facilitar la recuperación postraumática después de futuros traumas masivos, como los ataques terroristas. Se discuten las implicaciones clínicas.Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Posttraumatic Stress Trajectories in World Trade Center Tower Survivors: Hyperarousal and Emotional Numbing Predict Symptom Change Traditional Chinese 標題: 世界貿易中心生還者的創傷後壓力軌跡:過度激發及情感麻木可預測症狀改變 撮要: 我們對在如恐怖襲擊等集體創傷後༌構成創傷後壓力症狀(PTSS)異質軌跡背後的症狀學理解甚少。本研究採用潛在成長混合模型༌檢視PTSS的縱貫軌跡。樣本為2,355名於世界貿易中心(WTC)經歷九一一襲擊事件的生還者。樣本在2001年9月11日的恐怖襲擊平均2.5、5.5、10.5 年後༌接受世貿中心健康狀況登記系統進行的調查。共變量包括:社會人口特徵、WTC相關經歷、及其他創傷/壓力源。我們發現四種PTSS的曲線軌跡:低水平症狀(74.9%)、康復中(8.0%)、惡化中(6.7%)、慢性(10.4%)。大多數WTC生還者(85.3%)都有穩定的症狀軌跡༌而且PTSS的改變逐漸減弱。雖然༌WTC相關經歷跟初期的PTSS嚴重度有關༌可是༌WTC相關經歷跟慢性PTSS或PTSS的長遠改變無關。性別為男性༌以及在九一一事件發生後有較多數量的生命壓力源༌跟長遠症狀惡化有關。在第一波有較嚴重的過度激發症狀༈尤其是焦慮激發༉的樣本༌PTSS有較大機會長遠惡化(已調節勝算比(aOR) = 1.55)。在第一波的情感麻木症狀༈尤其是煩躁༉較輕༌跟其後的PTSS康復度有邊緣而顯著的關連(aOR = 0.75)。未來在如恐怖襲擊的集體創傷後༌提供針對過度激發及情感麻木症狀的干預治療༌有可能可緩和症狀惡化༌並幫助個人的創傷後康復過程。我們亦討論到結果的其他臨床貢獻。 Simplified Chinese 标题: 世界贸易中心生还者的创伤后压力轨迹:过度激发及情感麻木可预测症状改变 撮要: 我们对在如恐怖袭击等集体创伤后༌构成创伤后压力症状(PTSS)异质轨迹背后的症状学理解甚少。本研究采用潜在成长混合模型༌检视PTSS的纵贯轨迹。样本为2,355名于世界贸易中心(WTC)经历九一一袭击事件的生还者。样本在2001年9月11日的恐怖袭击平均2.5、5.5、10.5 年后༌接受世贸中心健康状况登记系统进行的调查。共变量包括:社会人口特征、WTC相关经历、及其他创伤/压力源。我们发现四种PTSS的曲线轨迹:低水平症状(74.9%)、康复中(8.0%)、恶化中(6.7%)、慢性(10.4%)。大多数WTC生还者(85.3%)都有稳定的症状轨迹༌而且PTSS的改变逐渐减弱。虽然༌WTC相关经历跟初期的PTSS严重度有关༌可是༌WTC相关经历跟慢性PTSS或PTSS的长远改变无关。性别为男性༌以及在九一一事件发生后有较多数量的生命压力源༌跟长远症状恶化有关。在第一波有较严重的过度激发症状༈尤其是焦虑激发༉的样本༌PTSS有较大机会长远恶化(已调节胜算比(aOR) = 1.55)。在第一波的情感麻木症状༈尤其是烦躁༉较轻༌跟其后的PTSS康复度有边缘而显著的关连(aOR = 0.75)。未来在如恐怖袭击的集体创伤后༌提供针对过度激发及情感麻木症状的干预治疗༌有可能可缓和症状恶化༌并帮助个人的创伤后康复过程。我们亦讨论到结果的其他临床贡献。.

Although the prevalence of exposure to potentially traumatic events and associated outcomes among children is well documented, widespread trauma screening remains limited. This study provides additional data supporting the psychometrics of the Child Trauma Screen (CTS), a free, brief, empirically derived measure that was intended as a trauma screen for use across child-serving systems. Participants were an ethnically diverse sample of 187 children aged 6-18 years recruited from an urban children's community mental health clinic. At intake, children and their caregivers completed the CTS and other standardized measures of posttraumatic stress disorder, externalizing behavior, anxiety, and depression. Results indicated that the CTS had strong properties on both child and caregiver reports, including internal consistency (Cronbach's α = .78 for both), convergent validity (r = .83 and r = .86), divergent validity (mean across measures and reporters, r = .31; range r = .01-.70), and criterion validity (sensitivity = 0.83 and 0.76; specificity = 0.95 and 0.79, correct classification 89.3% and 81.4%). Suggested cut points and recommendations for using the CTS as a trauma screen are provided. This study provides further empirical support for the use of the CTS as a brief trauma screening measure and provides recommendations for further research.

Based on emotional processing theory, preexisting negative cognitions may contribute to the development of posttraumatic stress disorder (PTSD) symptoms. The present study prospectively examined the association between preexisting PTSD-related cognitions and subsequent acute PTSD symptoms, and the potential mediators of this association. We also compared the effect of preexisting depressive cognitions and preexisting PTSD-related cognitions on PTSD symptoms. In the current study, 810 Taiwanese undergraduates completed a baseline survey (T1), of which 73.1% (n = 592) participated in a second survey two months later (T2). Of those who completed both surveys, 97 experienced a trauma at least one week before T2; this group comprised the final sample. Hierarchical regression showed that preexisting PTSD-related cognitions (β = .38, p.001, sr

Cognitive models of posttraumatic stress disorder (PTSD) place an emphasis on the role of negative appraisals of traumatic events. It is suggested that the way in which the event is appraised determines the extent to which posttraumatic stress symptoms will be experienced. Therefore, a strong relationship between trauma appraisals and symptoms of PTSD might be expected. However, this relationship is not as firmly established in the child and adolescent literature. A systematic literature review of this relationship returned 467 publications, of which 11 met full eligibility criteria. A random effects meta-analysis revealed a large effect size for the relationship between appraisals and PTSD symptoms in children and adolescents, r = .63, 95% CI [.58, .68], Z = 17.32, p.001, with significant heterogeneity present. A sensitivity analysis suggested that this relationship was not contingent on 1 specific measure of appraisals. Results were consistent with the cognitive behavioral theory of PTSD, demonstrating that appraisals of trauma are strongly related to posttraumatic stress in children and adolescents. However, this relationship was not observed in a sample of 4- to 6-year-olds, indicating that further research is required to explicate cognitive processing of trauma in very young children.

Research suggests that racial and ethnic minorities are more likely to attrit from longitudinal trauma studies than non-Hispanic Whites. Yet, little is known about how the loss of minority participants influences longitudinal findings as well as internal and external validity of study findings. Thus, the present study examined the effects of race/ethnicity on attrition in a longitudinal trauma study of women (minority = 223, non-Hispanic White or majority = 459) exposed to a campus shooting. Survival analyses were used to compare the attrition rates of minority participants to majority participants and assess the extent to which race/ethnicity, among other variables, predicted attrition. Minority participants were more likely to attrit than majority participants, hazard ratio (HR) = 0.69, 95% CI [0.48, 0.99], even after adjusting for study variables. A main effect was also found for age, HR = 1.06, 95% CI [1.01, 1.12]. Race/ethnicity did not interact with other study variables to influence attrition. The findings underscored the importance of assessing the effects of attrition on longitudinal findings and external validity.

Research suggests increases in substance use may be associated with symptoms of posttraumatic stress disorder (PTSD) following exposure to traumatic events (Boscarino, Adams, & Galea, 2006; Grieger, Fullerton, & Ursano, 2003; Pfefferbaum & Doughty, 2001; Stewart, Mitchell, Wright, & Loba, 2004). It has also been suggested that traumatic exposures may be a risk factor for future substance misuse (Chilcoat & Menard, 2003; Ouimette & Brown, 2003). Some evidence suggests that this association is due to the use of alcohol and other substances to ameliorate PTSD symptoms (Boscarino, Adams, & Galea, 2006; Chilcoat & Menard, 2003). Although studies of the association between substance use and exposure to psychological distress have a considerable history (Boscarino, 1981; Gottheil, Druley, Pashko, & Weinstein, 1987; Khantzian, 1990; Linsky, Colby, & Straus, 1991), these findings have not been consistent. For example, although experimental studies have linked alcohol use to psychological distress, findings from community-based studies have been less consistent (Castaneda, Lifshutz, Galanter, & Franco, 1994; Gottheil et al., 1987). There are studies that suggest that this relationship may include mediating factors (Cerda, Tracy, & Galea, 2011; Cerda, Vlahov, Tracy, & Galea, 2008; North, Ringwalt, Downs, Derzon, & Galvin, 2011), as well as some that suggest a direct association between PTSD and substance misuse (e.g., Kilpatrick et al., 2000). A recent large-scale national study of 34,635 adults, Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (Leeies, Pagura, Sareen, & Bolton, 2010), found that approximately 20% of individuals with PTSD may use alcohol and drugs to relieve their symptoms. Men were significantly more likely than women to engage in self-medication. In addition, another recent study suggested that fluctuation in PTSD symptoms are synchronized with alcohol-dependence symptoms and misuse of other substances (Ouimette, Read, Wade, & Tirone, 2010). Because alcohol is readily available in the US and it can be readily misused (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2000), an investigation of the degree to which alcohol problems are related to PTSD symptoms consequent to widespread traumatic exposure from terrorism is timely and potentially valuable. The present study examines the relationship between alcohol use before and following the World Trade Center (WTC) attacks in New York City and their relationship to PTSD and PTSD symptoms. Early postdisaster WTC studies documented an increased use of psychoactive substances, including alcohol, cigarettes, and marijuana and linked this use to PTSD (Vlahov et al., 2002, 2004). Previously we reported that greater exposure to the WTC attacks was associated with higher alcohol consumption at 1 year and 2 years after this event (Boscarino, Adams, & Galea, 2006) and we also reported that exposure to the attacks was associated with binge drinking at 1 year, but was not associated with binge drinking measured 2 years after the attacks. Alcohol misuse, as measured using a CAGE Questionnaire for alcohol, also was associated with greater exposure. After adjusting for exposure and other covariates, however, PTSD at Year 1 was not associated with alcohol use. This earlier report suggested that exposure to psychological trauma was associated with increases in problem drinking after exposure; absent was the longitudinal examination from predisaster to postdiaster of those with delayed onset PTSD. This a key focus of the present report. We expected that delayed-onset PTSD would be associated with both higher alcohol consumption and alcohol misuse up to 2 years after the attacks, independent of other factors such as demographics, history of traumatic exposures, recent stressful life events, and available psychosocial resources. To guide our analytical approach, we used a stress-process model (Adams & Boscarino, 2005). This model suggests that individuals subjected to stressors often respond physiologically through alterations in neuroendocrine functions (Boscarino, 1996), psychologically through alterations in cognitive status (Keane, Zimering, & Caddell, 1985), and behaviorally through, among other things, changes in use of psychoactive substances (Adams, Boscarino, & Galea, 2006a), as well as through help-seeking behaviors (Boscarino, Adams, & Figley, 2011). It is suggested that these stressor events could put individuals at risk for alcohol misuse because some persons may use psychoactive substances to help manage PTSD symptoms (e.g., hyperarousal or sleep disturbance), a phenomenon that has been conceptualized as a self-medication model of substance use (Bolton, Cox, Clara, & Sareen, 2006; Khantzian, 1990). Given recent reports (Cerda et al., 2008; Jacobson et al., 2008), and our previous work cited above describing the level of stress response (Adams, Boscarino, & Galea, 2006a), we did not expect the misuse of alcohol to rise to the level of symptoms of alcohol dependence (e.g., tolerance, withdrawal, etc.). Rather, we looked for the impact in greater frequency of binge drinking and increased alcohol consumption.

The present study used factor mixture modeling to explore empirically defined subgroups of psychological trauma victims based on confirmatory factor analysis (CFA) and latent class analysis of posttraumatic stress disorder (PTSD) symptoms. We sampled 310 medical patients with a history of trauma exposure. Confirmatory factor analysis revealed that the 4-factor emotional numbing PTSD model yielded the best model fit. Using latent factor means derived from this model and the 4-factor dysphoria PTSD model (indexing severity on PTSD factors), 3 latent classes of participants were identified using factor mixture modeling. The 3-class model fit the data very well and was validated against external measures of anxiety and rumination.

The Louisiana Rural Trauma Services Center was established to provide, improve, and enhance urgently needed assessment, treatment, crisis management, and consultation services for children and adolescents exposed to traumatic events in three rural southeastern Louisiana parishes. The purpose of this study is to describe the process of implementing the rural school-based trauma treatment program and to evaluate its effectiveness in 115 students. Through attention to process including the three-tiered approach of relationship building, trauma training, and trauma services, the school-based trauma treatment program proved effective in reducing trauma symptoms. This study is important to support the widespread implementation of school-based mental health services.

The hypothalamic–pituitary–adrenal axis (HPA axis) is a pathway through which childhood trauma may increase risk for negative health outcomes. The HPA axis is sensitive to stress throughout development; however, few studies have examined whether timing of exposure to childhood trauma is related to differences in later HPA axis functioning. Therefore, we examined the association between age of first trauma and HPA axis functioning among adolescents, and whether these associations varied by sex. Parents of 97 youth (aged 9–16 years) completed the Early Trauma Inventory (ETI), and youth completed the Socially-Evaluated Cold-Pressor Task (SECPT). We measured salivary cortisol response to the SECPT, the cortisol awakening response, and diurnal regulation at home across 2 consecutive weekdays. Exposure to trauma during infancy related to delayed cortisol recovery from peak responses to acute stress, d = 0.23 to 0.42. Timing of trauma exposure related to diverging patterns of diurnal cortisol regulation for males, d = 0.55, and females, d = 0.57. Therefore, the HPA axis may be susceptible to developing acute stress dysregulation when exposed to trauma during infancy, whereas the consequences within circadian cortisol regulation may occur in the context of later trauma exposure and vary by sex. Further investigations are warranted to characterize HPA axis sensitivity to exposure to childhood trauma across child development.

Increasing attention has been drawn to the symptom of emotional numbing in the phenomenology of posttraumatic stress disorder (PTSD), particularly regarding its implications for maladaptive outcomes in adolescence such as delinquent behavior. One change in the definition of emotional numbing according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) was the limitation to the numbing of positive emotions. Previous research with youth, however, has implicated general numbing or numbing of negative emotions in PTSD, whereas numbing of positive emotions may overlap with other disorders, particularly depression. Consequently, the goal of this study was to investigate whether numbing of positive emotions was associated with PTSD symptoms above and beyond numbing of negative emotions, general emotional numbing, or depressive symptoms among at-risk adolescents. In a sample of 221 detained youth (mean age = 15.98 years, SD = 1.25; 50.7% ethnic minority), results of hierarchical multiple regressions indicated that only general emotional numbing and numbing of anger accounted for significant variance in PTSD symptoms (total R(2) = .37). In contrast, numbing of sadness and positive emotions were statistical correlates of depressive symptoms (total R(2) = .24). Further tests using Hayes' Process macro showed that general numbing, 95% CI [.02, .45], and numbing of anger, 95% CI [.01, .42], demonstrated indirect effects on the association between trauma exposure and PTSD symptoms.

The longitudinal course of posttraumatic stress disorder (PTSD) over 8-9 years was examined among 16,488 rescue and recovery workers who responded to the events of September 11, 2001 (9/11) at the World Trade Center (WTC; New York, NY), and were enrolled in the World Trade Center Health Registry. Latent class growth analysis identified 5 groups of rescue and recovery workers with similar score trajectories at 3 administrations of the PTSD Checklist (PCL): low-stable (53.3%), moderate- stable (28.7%), moderate-increasing (6.4%), high-decreasing (7.7%), and high-stable (4.0%). Relative to the low-stable group, membership in higher risk groups was associated with 9/11-related exposures including duration of WTC work, with adjusted odds ratios ranging from 1.3 to 2.0, witnessing of horrific events (range = 1.3 to 2.1), being injured (range = 1.4 to 2.3), perceiving threat to life or safety (range = 2.2 to 5.2), bereavement (range = 1.6 to 4.8), and job loss due to 9/11 (range = 2.4 to 15.8). Within groups, higher PCL scores were associated with adverse social circumstances including lower social support, with B coefficients ranging from 0.2 to 0.6, divorce, separation, or widowhood (range = 0.4-0.7), and unemployment (range = 0.4-0.5). Given baseline, exposure-related, and contextual influences that affect divergent PTSD trajectories, screening for both PTSD and adverse circumstances should occur immediately, and at regular intervals postdisaster.

Positive adaptation to psychological trauma and wisdom both have a rich history in European literature and philosophy. Although the literature on posttraumatic growth has recognized the possibility of wisdom as an outcome of adaptation, its role in the process of adaptation has been neglected. A theoretical framework is presented that conceptualizes three dimensions of wisdom as crucial to an understanding of the role it can play in posttraumatic positive adaptation. These dimensions are the recognition and management of uncertainty; the integration of affect and cognition; and the recognition and acceptance of human limitation. The role of these dimensions in the process and outcome of traumatic adaptation is considered, together with limitations of the framework and directions for future research.

Multiple pathways have been suggested to account for the relationship of adverse childhood experiences (ACEs) and well-being in adulthood, including interpersonal difficulties, the underestimation of one's sense of mastery, and a greater propensity to experience stressors later in life. This study was conducted to examine the association between ACEs and mental health in Canadian Armed Forces (CAF) personnel, and the possible mediating roles of social support, mastery, and combat stressors in that relationship. The study consisted of a prospective analysis involving 3,319 CAF members upon their return from an overseas deployment. Results were that ACEs were associated with poorer mental health (β = -.14, p.001) and that approximately 42.6% of this relationship could be explained by the mediating effects of low social support, low mastery, and a greater number of combat stressors. The full model, including the covariates, ACEs, social support, mastery, and combat stressors as correlates of postdeployment mental health, was statistically significant with adjusted R(2) = .28, F(9, 3309) = 141.96, p.001. On the whole, results suggested that social support, mastery, and life stressors may be possible targets for interventions to minimize the impact of ACEs on later mental health in military personnel.

This study used a sample of 72 consecutive attendees to hospital following motor vehicle accidents. It aimed to assess the relationship between demographic variables, details of the accident and cognitions about the accident recorded soon afterward, and degree of psychological trauma 3 and 6 months later. Psychological trauma was assessed using the General Health Questionnaire, Impact of Event Scale, and Posttraumatic Stress Disorder Interview. A structured interview was used to gain information about demographic, accident, and accident cognition variables. Results showed that initial cognitions such as perceived threat to life, rather than demographic or accident variables, had the strongest relationships to subsequent trauma.

This paper presents an ecological view of psychological trauma and trauma recovery. Individual differences in posttraumatic response and recovery are the result of complex interactions among person, event, and environmental factors. These interactions define the interrelationship of individual and community and together may foster or impede individual recovery. The ecological model proposes a multidimensional definition of trauma recovery and suggests that the efficacy of trauma-focused interventions depends on the degree to which they enhance the person-community relationship and achieve “ecological fit” within individually varied recovery contexts. In attending to the social, cultural and political context of victimization and acknowledging that survivors of traumatic experiences may recover without benefit of clinical intervention, the model highlights the phenomenon of resiliency, and the relevance of community intervention efforts.

Studies concerning the development of a post-traumatic stress disorder related to severe illness are scarce. The confrontation with myocardial infarction may be a very stressful event. Twenty-three patients consecutively admitted for first myocardial infarction were studied. After two years 1 of 18 survivors had been suffering from a partial post-traumatic stress disorder. Similarities and differences in the psychological reactions following potential traumatic events are discussed.

The Criterion A problem in the field of traumatic stress refers to the stressor criterion for posttraumatic stress disorder (PTSD) and involves a number of fundamental issues regarding the definition and measurement of psychological trauma. These issues first emerged with the introduction of PTSD as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III; American Psychiatric Association, 1980) and continue to generate considerable controversy. In this article, the authors provide an update on the Criterion A problem, with particular emphasis on the evolution of the DSM definition of the stressor criterion and the ongoing debate regarding broad versus narrow conceptualizations of traumatic events.

Psychological trauma is associated with poor physical health. We examined whether specific trauma types (assaultive, sexual, any) are associated with specific medical illnesses and whether posttraumatic stress disorder (PTSD) mediated these relationships in 680 primary care patients. For men, trauma history was associated with arthritis and diabetes; PTSD mediated the association between trauma and arthritis but not diabetes. Among women, trauma was associated with digestive diseases and cancer; PTSD did not mediate these relationships. Awareness of the presence of the physical illnesses examined here may help with the identification and treatment of primary care patients with trauma histories.

The development of effective methods of screening for posttraumatic stress disorder (PTSD) is important in the context of mass trauma, the geographical dispersion of victims, and the restricted availability of specialists in psychological trauma. The review focused on published English-language screening instruments for civilian PTSD consisting of 30 items or fewer and validated against structured clinical interviews. Thirteen instruments were identified meeting these criteria, all consisting of symptoms of traumatic stress. The review concluded that the performance of some currently available instruments is near to their maximal potential effectiveness, and that instruments with fewer items, simpler response scales, and simpler scoring methods perform as well as if not better than longer and more complex measures.

To assess medication use in New York after the September 11th attacks, a telephone survey was conducted in October 2001 (N = 1,008). The prevalence of psychiatric medication use 30 days before the disaster was 8.9 and 11.6% 30 days after, a small but significant increase. The most important factor predicting postdisaster use was predisaster use--92% of those who used medications postdisaster used them predisaster. In addition, 3.3% used psychiatric medications 30 days postdisaster, but not 30 days before. Those who had panic attacks, posttraumatic stress disorder (PTSD), and insurance coverage, were the most likely medicated (26.5%). However, among those who used postdisaster medications (n = 129), new users tended to be those with panic attacks (44.1%) and those with panic attacks and PTSD (69.2%).