Search

Background Military personnel are at a heightened risk of being exposed to potentially traumatic incidents in the line of duty. Evidence would suggest that the risk of developing psychological trauma and/or PTSD after a traumatic event is predicted by the interaction of pre-trauma, peri-trauma and post-trauma risk and protective factors. Objective This research will explore military personnels' experience of potentially traumatic events while deployed. In particular, the research aims to gain an understanding of both protective and risk factors which influence personnels' experience of potentially traumatic events. Method One to one, semi-structured interviews were conducted with 12 members of the Irish Defence Forces. We conducted a thematic analysis in line with the recommendations provided by Braun & Clarke 2006. Results There was a wide variety of potentially traumatic events experienced by participants, ranging from stressful naval migrant rescues to armed standoffs. Aside from more pointed events, chronic stress was reported to negatively affect personal resilience while factors such as positive mindset and a belief in the mission had a galvanizing effect. Both the family back home and the "military family" were reported to provide sources of comfort and support, while at times being a source of significant stress. The organisational context of the military, including training and formal psychological supports was viewed with mixed opinions by our participants. Conclusions The findings of this research illuminate the unique stress and strains faced by Irish military personnel at pre, peri and post deployment. The results highlight the need for effective predeployment resilience building programmes to equip personnel with the tools to deal with traumatic events. This foundational work provides the basis for further research into the military peacekeeper and humanitarian domain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective Posttraumatic stress disorder (PTSD) is a common problem for veterans. Resilience, the tendency to bounce back from difficult circumstances, is negatively associated with posttraumatic cognitions (PTCs) among individuals with a history of trauma, and it may be important to understand responses to trauma reminders. Method Using a quasi-experimental design, we examined the association between trait resilience and state PTCs in veterans with PTSD (n = 47, Mage = 48.60, 91.8% male) at two points: following a written trauma narrative exposure (Time 1 [T1]), and following a subsequent positive distraction task (i.e., brief, positive video; Time 2 [T2]). Results After controlling for PTSD symptom severity and combat exposure, resilience was negatively associated with PTCs at T1 (ΔR2 = .19) and T2 (ΔR2 = .13). However, resilience was a poor predictor of change in PTCs from T1 to T2. We also examined the relationship between resilience and subtypes of PTCs: resilience was associated with negative views of the self (T1, ΔR2 = .24) but not negative views of the world or self-blame (T1, ΔR2s ≤ .07); these results were consistent at T2. Conclusions Thus, resilience may attenuate negative trauma-related cognitions after trauma recall; however, this study was not designed to test causal pathways. Future research could examine whether resilience-building exercises reduce negative PTCs after trauma reminders among veterans. Additional research is needed to generalize to other trauma-exposed populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVE Embitterment can occur as a reaction to unjust life events which damage the person's life values. It can lead to impairment of work ability and participation in life generally. Methods to reduce embitterment have been developed and tested in clinical samples. Perspective-change is a core method which can be trained in order to get distance from a hurting event and reduce embitterment. METHOD This experimental study investigates whether perspective-change can be used as a 1-shot mini-intervention to reduce subclinical embitterment. People (N = 155) from the general population completed the experiment. They were first asked about their life values, whether they had experienced and were still affected by a hurting event, and their degree of embitterment. Then a fictive unjust situation (downgrading at work) was presented, and the person was asked to project his or her thoughts into the described situation. Randomly, one half of the participants were given instructions for a perspective change in order to relativize the meaning of the hurting event. Degree of embitterment was again assessed after exposure to the fictive situation. RESULTS Embitterment was not significantly reduced after in comparison to before the fictive situation. There were no differences between the group that received instructions for perspective-change and the group which did not. CONCLUSION An ultrashort intervention by means of exposure to a fictive unjust situation and perspective-change did not result in the reduction of individual embitterment. Relevant reduction of individual embitterment may require exposure to the own individual unjust event, and several or repeated trainings of perspective-change. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Individuals with Post-Traumatic Stress Disorder (PTSD) smoke cigarettes at much higher prevalences than the general population. Less is known about PTSD and other smoking behaviors (e.g., smoking quantity and frequency) or about smoking among individuals who experience trauma. Objective To examine differences in cigarette smoking behaviors among adults in the United States (a) with no exposure to trauma or PTSD, (b) with trauma but no PTSD, and (c) with PTSD. Methods Data came from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions-II (NESARC-II, 2004-2005) and included demographics, PTSD diagnoses, traumatic events, and smoking behaviors. Odds ratios and group differences in smoking prevalence and behaviors based on PTSD diagnoses and exposure to traumatic experiences were calculated. Results Traumatic events and PTSD diagnoses were both associated with greater smoking prevalences than persons without trauma or PTSD. Individuals with PTSD who smoke were more likely to report daily smoking than those without PTSD who smoke (Cohen's d = 0.19). Cigarette users with either trauma or PTSD smoked more cigarettes per day than cigarette users without trauma or PTSD (Cohen's d = 0.35). US adults with trauma exposure or PTSD have higher smoking prevalences and more intense smoking behaviors than those without PTSD or trauma. Conclusion Trauma or PTSD may each serve as a clinical indicator of increased risk of cigarette smoking-related health problems and prompt the implementation of targeted interventions to reduce the harms of smoking. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Most mental health practitioners receive minimal trauma training in their degree curriculum and rely on supplemental training to build additional skills. Since 2016, the Core Curriculum on Childhood Trauma (CCCT) has been used for brief in-service training of more than 2,000 mental health practitioners. Prior evaluation showed statistically significant learning outcomes posttraining, yet little was known about retention of learning or impact on clinical practice. Method: We collected 100 mixed-method follow-up surveys from participants completing CCCT training between October 2016 and August 2019. Results: Statistically significant increases were seen between pretraining and follow-up self-report (6-24 months later) for four child trauma skills (effect sizes: 0.90-1.07). Qualitative data identified four key impacts on clinical practice: increased empathy, understanding of trauma complexity, systematic approach to case conceptualization, and catalyzing further trauma learning. Conclusions: Positive learning outcomes 6-24 months posttraining suggest that the CCCT is an effective tool for in-service training and that retained learning can translate into improved trauma-informed clinical practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective There is little evidence that posttraumatic stress disorder (PTSD) is more likely to follow traumatic events defined by Criterion A than non-Criterion A stressors. Criterion A events might have greater predictive validity for International Classification of Diseases (ICD)-11 PTSD, which is a condition more narrowly defined by core features. We evaluated the impact of using Criterion A, an expanded trauma definition in line with ICD-11 guidelines, and no exposure criterion on rates of ICD-11 PTSD and Complex PTSD (CPTSD). We also assessed whether 5 psychologically threatening events included in the expanded definition were as strongly associated with PTSD and CPTSD as standard Criterion A events. Method A nationally representative sample from Ireland (N = 1,020) completed self-report measures. Results Most participants were trauma-exposed based on Criterion A (82%) and the expanded (88%) criterion. When no exposure criterion was used, 13.7% met diagnostic requirements for PTSD or CPTSD, 13.2% when the expanded criterion was used, and 13.2% when Criterion A was used. The 5 psychologically threatening events were as strongly associated with PTSD and CPTSD as the Criterion A events. In a multivariate analysis, only the psychologically threatening events were significantly associated with PTSD (stalking) and CPTSD (bullying, emotional abuse, and neglect). Conclusions Certain non-Criterion A events involving extreme fear and horror should be considered traumatic. The ICD-11 approach of providing clinical guidance rather than a formal definition offers a viable solution to some of the problems associated with the current and previous attempts to define traumatic exposure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective Exposure to traumatic life events is associated with increased risk of posttraumatic stress disorder (PTSD) and other mental health problems such as suicidal ideation (SI), alcohol use disorder (AUD), and decreased quality of life (QOL). Mindfulness, which involves attending to the present moment, may help individuals cope with traumatic events by increasing acceptance of trauma-related experiences and decreasing trauma-related negative affect and avoidance of trauma reminders. The current study evaluated whether mindful attention to the present moment mediated the association between number of lifetime traumas and mental health. Method The sample consisted of 1,268 trauma-exposed U.S. veterans who participated in the National Health and Resilience in Veterans Study, a nationally representative study of U.S. veterans. On average, the sample was 60.6 years of age (SD = 15.2, range = 20-94), predominantly male (89.8%), Caucasian (75.0%), and noncombat veterans (59.2%). Results Path analyses revealed that mindfulness partially mediated the relation between number of lifetime traumas and PTSD symptoms (β = -.55), AUD (β = -.17), and QOL (β = .38), and fully mediated the relation between number of lifetime traumas and SI (β = -.36). Conclusions The relationship between lifetime trauma burden and various mental health issues of relevance to U.S. veterans may be mediated by mindfulness, or the ability to pay attention to the present moment. Interventions that bolster mindfulness may help mitigate the negative impact of cumulative traumas in this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: The present study, conducted after the 2014 Israel-Gaza conflict, was aimed to investigate 2 resources (i.e., personal mastery and community dedication) hypothesized to have a mediating effect on the relationship between trauma exposure and PTSS (posttraumatic stress symptoms) and PTG (posttraumatic growth) in the aftermath of a traumatic event. Method: Israeli civilians (N = 1,014) completed a questionnaire assessing levels of trauma exposure (the predictors), sense of mastery and community dedication (the mediators), and PTSS and PTG (the outcomes). Results: PTSS and PTG were positively related. Sense of mastery mediated the association between trauma exposure and PTSS symptoms and was negatively associated with PTSS and PTG. Community dedication was positively related to PTG and mediated the association of trauma with PTG. Conclusions: People higher in mastery may not need to search for a "silver lining" in coping with psychological consequences of trauma as they believe they are capable of handling it. Conversely, persons with higher levels of coping self-confidence may be denied the benefits of posttraumatic growth in coping with trauma. People's connections to the community in times of coping with collective upheavals may not protect them against PTSS yet community orientation may bring postevent benefits of posttraumatic growth. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: Memory problems are a frequent complaint in neuropsychological settings, particularly among individuals in mid-to-late adulthood and those who have experienced neurological insult (e.g., head trauma; Bay et al., 2012; Lezak et al., 2004; Wammes et al., 2017). Neuropsychiatric comorbidities that influence cognitive functioning (e.g., depression, anxiety, posttraumatic stress) are also common among neuropsychological patients, which can challenge interpreting etiology and predicting prognosis (Campbell et al., 2009; Reischies & Neu, 2000). Prolonged trauma exposure is associated with brain abnormalities in regions that subserve memory and executive functions (Daniels et al., 2016; Woon et al., 2010). Furthermore, a subgroup of individuals with trauma exposure experience dissociative symptoms, which can also interfere with memory and performing goal-directed behaviors (Bergouignan et al., 2014; Brewin et al., 2013; Ozdemir et al., 2015). Method: In this article, we focus on symptoms that are consistent with dissociation and present three case studies of trauma-exposed women who were referred for neuropsychological testing following complaints of memory decline. Results: Formal neuropsychological testing did not fully support the degree of amnestic symptoms reported. Based upon the complex pattern of results, we propose a potential hypothesis for consideration: the dissociative interference hypothesis. Conclusions: For all three women presented, dissociation was a common symptom that may have contributed to an exacerbation of memory failures and amnestic experiences. Thus, interventions targeted at increasing awareness, rather than withdrawal, during times of stress may lead to a reduction in their memory complaints. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective The relationship between posttraumatic stress disorder (PTSD) and anger is well established. However, further investigation into the underlying mechanisms of this PTSD-anger relationship is needed. Rumination, a construct with a known association to PTSD symptoms, theoretically may mediate this PTSD-anger relationship. Design We conducted a mediational model using self-report measures of PTSD symptoms, rumination, and anger reactions from a nonclinical, trauma-exposed sample (N = 339) through Amazon's Mechanical Turk. Results Rumination mediated overall PTSD symptoms and anger reactions, controlling for age and gender identity. Further analyses examined this mediating role between PTSD subscale scores and anger. Rumination mediated all PTSD subscales and anger when modeled separately. After adjusting for other PTSD symptoms, only 2 subscales' relationship with anger remained mediated by rumination: negative alterations in cognitions/mood and physiological arousal. Conclusions Rumination should be assessed in the context of PTSD and anger symptoms, specifically physiological arousal and negative moods/cognitions symptoms in PTSD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

OBJECTIVE The present study aimed to explore the lived experience of the spontaneous creation in art by Holocaust survivor artists, and to gain new insight into the way creative engagement may relate to survivors' traumatic past. METHOD Following the phenomenological paradigm of qualitative research, semistructured interviews were conducted with 30 Holocaust survivor visual artists residing in Israel (Mage = 80.6, SD = 5.5). Data were analyzed enabling the capture of various "lived experiences," aiming to establish an insider's conceptualization, understanding the essence of the phenomenon and identification of multiple meanings. RESULTS Expressions clustered around two major themes. The first-Turning outward: from a world of threat to a world at which to wonder-that describes how, beyond the enduring inner world of abandonment and threat, enhanced through art is a realm of wonderment at the world beyond the self. The second-Connecting with the world and others through creative experience-relating to modes of moving outward in art toward an emotional experience of connection. CONCLUSIONS Discussion of these themes pointed to the emotional state of self-transcendence as fundamental to survivors' artistic experience, and suggests how this may relate to their enduring struggle with trauma; thus, shedding new light on the redeeming potential of art in the face of trauma. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

In the wake of the 2019 novel coronavirus (COVID-19) pandemic and the psychological consequences that will follow, it is critical to acknowledge and understand the unique vulnerabilities of lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) populations in order to provide equitable mental health intervention that reaches these highly at-risk groups. It is well established that LGBTQ persons face social disadvantages and mental health disparities, which may be exacerbated as a result of COVID-19 pandemic trauma and social isolation measures. This commentary highlights structural, social, and individual-level challenges among LGBTQ populations in the context of COVID-19 and proposes prevention recommendations to mitigate the psychological ramifications of COVID-19 pandemic-related trauma among LGBTQ persons. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

There is growing concern about the mental health and social impact of COVID-19 on underresourced children, youth, and families given widespread social disruption, school closures, economic impact, and loss of lives. In this commentary we describe how an existing public-public partnership between a large county mental health department and a state university responded to COVID-19. This partnership, originally designed to address workforce needs, rapidly pivoted to support providers through a trauma- and resilience-informed approach to mitigating adverse mental health effects among youth and families in Los Angeles County. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The COVID-19 pandemic is linked to a rise in stigma and discrimination against Chinese and other Asians, which is likely to have a negative impact on mental health, especially when combined with additional outbreak-related stressors. We discuss the need to consider the potential harms of these anti-Asian sentiments during both the height of the pandemic and longer-term recovery through (a) research-examining how it affects mental health and recovery; (b) practice-implementing evidence-based stigma reduction initiatives; and (c) policy-coordinating federal response to anti-Asian racism including investment in mental health services and community-based efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The present commentary offers a timely exploration of the racial trauma experienced by Asian, Black, and Latinx communities as it relates to COVID-19. Instances of individual, cultural, and structural racism and implications for mental health are discussed. Evidence-based strategies are identified for mental health professionals in order to support healing and mitigate the risk of further racial traumas. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

THE ISSUE: Coronavirus-19 (COVID-19) is transforming every aspect of our lives. Identified in late 2019, COVID-19 quickly became characterized as a global pandemic by March of 2020. Given the rapid acceleration of transmission, and the lack of preparedness to prevent and treat this virus, the negative impacts of COVID-19 are rippling through every facet of society. Although large numbers of people throughout the world will show resilience to the profound loss, stress, and fear associated with COVID-19, the virus will likely exacerbate existing mental health disorders and contribute to the onset of new stress-related disorders for many. RECOMMENDATIONS: The field of traumatic stress should address the serious needs that will emerge now and well into the future. However, we propose that these efforts may be limited, in part, by ongoing gaps that exist within our research and clinical care. In particular, we suggest that COVID-19 requires us to prioritize and mobilize as a research and clinical community around several key areas: (a) diagnostics, (b) prevention, (c) public outreach and communication, (d) working with medical staff and mainstreaming into nonmental health services, and (e) COVID-19-specific trauma research. As members of our community begin to rapidly develop and test interventions for COVID-19-related distress, we hope that those in positions of leadership in the field of traumatic stress consider limits of our current approaches, and invest the intellectual and financial resources urgently needed in order to innovate, forge partnerships, and develop the technologies to support those in greatest need. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

OBJECTIVE Exposure to violence during childhood can have severe long-term consequences for social relationships. In the current study, we sought to disentangle some of the phenomena involved by utilizing a network approach to study the perceptions of aspects of social landscapes in young adulthood of victims of childhood violence. METHOD We used network analysis to describe the connections between perceived positive social support, barriers to social support, violence-related shame, childhood family cohesion, and perceived negative responses from others for 443 individuals exposed to childhood violence. RESULTS Respondents' enjoyment of spending time with family in childhood was strongly connected to many other aspects of their social landscapes. The highest values for expected influence were found for worrying about what others thought and experiencing support from others. Finding that other people withdrew from them after the violence had occurred had both high strength centrality and a high value of expected influence and was associated with shame and barriers to social support. CONCLUSIONS The results suggest that these elements can play important roles in the social landscapes of victims of childhood violence. Further research specifying the directionality between these elements is necessary. It may be helpful for clinicians working with victims of childhood violence to explore their perceptions of their social landscapes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital. Method The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother-child dyads. Results Overall, 98% reported trauma exposure, approximately one third met criteria for probable current PTSD, and one third endorsed moderate-or-severe depression based on self-report measures. Similar levels were found based on clinical assessments in the subsample. While 18% endorsed depression treatment, only 6% received treatment for PTSD. In a subsample of women with whom chart reviews were conducted (n = 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider. Conclusion Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Objective While high betrayal (HB) traumas (i.e., traumas perpetrated by close others) are associated with reduced maternal and child well-being compared to low betrayal (LB) traumas (i.e., traumas that are noninterpersonal or perpetrated by nonclose others), moderators of these relationships have not yet been examined. The aim of the present study was to examine the associations between maternal lifetime betrayal trauma and parent and child well-being while also examining attachment style and emotion regulation as potential moderators. Method Australian mothers (N = 174) of school-age children (5-12 years) completed online self-report measures assessing betrayal trauma, well-being, attachment style, and emotion regulation strategies. Results HB traumas were significantly associated with greater maternal distress and trauma symptoms, reduced child well-being, greater attachment anxiety, and greater difficulties with emotion regulation but were not significantly different with regard to parenting stress, social support satisfaction, or attachment avoidance when compared with LB traumas. Emotion regulation difficulties moderated the relationship between betrayal trauma history and maternal distress. Conclusions These results indicate that mothers with HB trauma histories who also have difficulties with emotion regulation may experience greater levels of distress compared to mothers with HB trauma histories who use more adaptive emotion regulation strategies. Accordingly, it may be especially important for victims of HB traumas to address trauma-related misappraisals regarding the self and others while strengthening the use of adaptive emotion regulation strategies. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

OBJECTIVE Childhood trauma is associated with greater psychological problems and poorer quality of life (QOL). This study evaluates the effect of multiple types of childhood trauma on posttraumatic stress disorder (PTSD) and QOL following cognitive processing therapy (CPT). Understanding how the breadth of traumatic experiences in childhood can influence psychosocial treatment outcomes may help to identify the unique needs of this population. METHOD This secondary data analysis of a randomized controlled trial delivering CPT to civilian (n = 105) and veteran women (n = 21) with PTSD used linear regressions to examine relationships between the number of unique types of childhood trauma, PTSD, and QOL before and after treatment. Models controlled for demographic information, adult trauma, and pretreatment PTSD, depression, and QOL scores. RESULTS More types of childhood trauma predicted pretreatment PTSD symptoms (B = 1.98, p = .02) but not QOL (B = -.018, p = .18). Significant reductions in Clinician-Administered PTSD Scale for DSM-IV-TR score, t(302) = 10.32, p < .001, and QOL, t(309) = -4.06, p < .001, were reported after treatment; number of traumatic event types was not predictive of QOL change (B = .01, p = .957). Women with more types of trauma reported significantly less PTSD symptom reduction when compared with those with one type (B = 3.12, p = .042). CONCLUSION Women who experienced a broader range of childhood trauma may experience diminished PTSD symptom reduction following CPT in comparison with women with less exposure. On average, all women, regardless of trauma history, reported small improvements in QOL. Clinical considerations are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

OBJECTIVE Posttraumatic stress disorder (PTSD) is a severe psychiatric condition that can manifest as a combination of debilitating symptoms, one of which is a distorted sense of responsibility for the traumatic event. The inclusion of DSM-5's PTSD D3 criterion (blaming self or others for the stressful experience) has received little research attention in regard to its relation to post-trauma mental health outcomes. To address this gap in literature, we examined the relevance of the clinical endorsement of the D3 criterion to PTSD symptomology and other posttrauma mental health outcomes. METHOD Participants were 123 trauma-exposed, treatment-seeking individuals (Mage = 35.70, 68.3% female) who completed a series of self-report questionnaires assessing PTSD symptomology, depression severity, distress intolerance, rumination, and anger reactions. RESULTS Independent t tests comparing those that clinically endorsed the D3 criterion (vs. those that did not) revealed that the clinical endorsement of blame was significantly associated with PTSD severity, depression, distress intolerance, and rumination. CONCLUSIONS Our findings support the significance of PTSD's D3 criterion, and further emphasize the importance of addressing blame in posttrauma mental health outcomes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Objective Previous studies have found evidence of an attentional bias for trauma-related stimuli in posttraumatic stress disorder (PTSD) using eye-tracking (ET) technlogy. However, it is unclear whether findings for PTSD after traumatic events in adulthood can be transferred to PTSD after interpersonal trauma in childhood. The latter is often accompanied by more complex symptom features, including, for example, affective dysregulation and has not yet been studied using ET. The aim of this study was to explore which components of attention are biased in adult victims of childhood trauma with PTSD compared to those without PTSD. Method Female participants with (n = 27) or without (n = 27) PTSD who had experienced interpersonal violence in childhood or adolescence watched different trauma-related stimuli (Experiment 1: words, Experiment 2: facial expressions). We analyzed whether trauma-related stimuli were primarily detected (vigilance bias) and/or dwelled on longer (maintenance bias) compared to stimuli of other emotional qualities. Results For trauma-related words, there was evidence of a maintenance bias but not of a vigilance bias. For trauma-related facial expressions, there was no evidence of any bias. Conclusions At present, an attentional bias to trauma-related stimuli cannot be considered as robust in PTSD following trauma in childhood compared to that of PTSD following trauma in adulthood. The findings are discussed with respect to difficulties attributing effects specifically to PTSD in this highly comorbid though understudied population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Objective Although previous research has demonstrated a link between posttraumatic stress disorder (PTSD) and self-rated health, the role of regulatory processes within this relationship has yet to be fully understood for African American urban populations. The goal of the present study was to determine whether emotion dysregulation mediated the relationship between PTSD diagnosis and self-rated health problems. Method Data were collected from 446 adult participants (92% female, 97% African American) between the ages of 18 and 65 years who were recruited as part of the Grady Trauma Project, a National Institutes of Health-funded study of risk and resilience factors related to PTSD. Participants were recruited from a public hospital, and interviews included demographic characteristics, self-rating of health, assessment of emotion dysregulation using the Difficulties in Emotion Regulation Scale, and PTSD diagnosis using the Modified PTSD Symptom Scale. Results Results revealed that emotion dysregulation significantly mediated the relationship between PTSD and self-rated health. Exploratory analyses revealed that specific dimensions of emotion regulation were significant mediators in this relationship. Age, sex, education, marital status, income, and total number of lifetime traumas experienced were controlled for in all analyses. Conclusions Our findings suggest that emotion dysregulation may play a significant role in the PTSD-health relationship for African Americans. Future research investigating culturally relevant emotion regulation strategies are warranted given likely consequences for both physical and mental health outcomes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

During the COVID-19, psychotherapists are often exposed to traumatic material in their sessions, potentially leading to vicarious traumatization. We surveyed 339 therapists about their professional practices and experiences during the pandemic. Results showed that on average therapists experienced moderate levels of vicarious trauma, whereas about 15% experienced high levels of vicarious trauma. A higher level of vicarious trauma was associated with younger age, less clinical experience, and negative online treatment experiences. The results imply a need for personal and professional support for therapists working remotely amid a global health crisis. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Demand for telehealth services with psychologists and other health professionals has increased during the COVID-19 pandemic, and as a result some members of the community are unable to access face-to-face assistance for trauma-related mental health issues. This has led to an increase in usage of alternative digital mental health options such as smartphone apps and other Internet-enabled assistance. The Australian Federal Government has promoted digital mental health options for many years, and it has a comprehensive architecture of digital resources in place, but will it be enough to deal with the expected rise in symptoms of trauma among the general population in the wake of COVID-19? (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Instability in the global economy in the wake of COVID-19 has resulted in millions of people losing access to employment. As a result, these same individuals will be faced with the pain of job loss in the present and the stress of the job search process in the future. This commentary seeks to draw attention to the psychological trauma that can result from job loss and job search and motivate psychologists to consider issues of work-life spillover in the aftermath of the pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Integrated primary care settings are ideal locations for treatment of posttraumatic stress concerns as primary care is the principal access point for mental health treatment in the United States. The COVID-19 global pandemic will increase the necessity of posttraumatic stress-related psychological care for vulnerable populations and frontline providers through traditional and virtual methods; integrated primary care settings are rapidly adapting to meet this need. Integrating more behavioral health clinicians into primary care clinics will provide better access to whole-person care when it is needed most. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The present article assesses the effects of shattered social identity and moral injuries experienced by health care professionals (HCPs) due to the COVID-19 pandemic. Professional expertise and emotional-cognitive demands as key aspects of HCPs' social identity are introduced, and the effects of moral injuries-in terms of violation of medical-ethical and social-ethical norms-on the mental health of HCPs are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The mental health consequences of the COVID-19 pandemic are particularly relevant in African-American communities because African-Americans have been disproportionately impacted by the disease, yet they are traditionally less engaged in mental health treatment compared with other racial groups. Using the state of Michigan as an example, we describe the social and psychological consequences of the pandemic on African-American communities in the United States, highlighting community members' concerns about contracting the disease, fears of racial bias in testing and treatment, experiences of sustained grief and loss, and retraumatization of already-traumatized communities. Furthermore, we describe the multilevel, community-wide approaches that have been used thus far to mitigate adverse mental health outcomes within our local African-American communities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective Repeated exposure to traumatic events has consistently been shown to negatively impact mental health functioning; however, the role of timing of such events has received less attention. The present study evaluated the role of trauma that has occurred prior to military service, during service, and across both points in contributing to the most common and deleterious mental health concerns experienced by military personnel: posttraumatic stress, depression, suicide ideation, and suicide attempts. Method Utah and Idaho National Guard personnel (n = 997) completed online self-report questionnaires of their current posttraumatic stress and depression symptoms, as well as history of potentially traumatic experiences, suicidal thoughts, and actions. Results Results indicated that history of trauma across time points is associated with negative outcomes across each of these outcomes, with the exception of suicide attempts. Exploratory analyses further revealed that unwanted or uncomfortable sexual experiences (not sexual assault) is the most robust predictor of negative outcomes, with approximately 2 to 7.5 times increased risk for PTSD, depression, suicide ideation, and suicide attempts. Conclusions The present findings suggest that individuals with history of trauma prior to military service are at increased risk for developing clinically significant mental health problems if exposed to additional potentially traumatic experiences. Further, other unwanted sexual experiences appear to be particularly detrimental to mental health functioning. Potential implications for military recruitment and conceptualization of traumatic events are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

OBJECTIVE Undergraduate psychology textbooks often present trauma, particularly child maltreatment (CM) and its consequences, inadequately or inaccurately. Adequate education about CM and adult trauma (AT) is crucial because they are prevalent and their health impacts are widespread and enduring. Furthermore, mental health professionals are called upon to treat disorders and problematic behaviors associated with trauma yet have often not received adequate knowledge and training about trauma and its treatment. This is the first study to investigate the adequacy and accuracy of the coverage of CM and AT in graduate psychology psychopathology textbooks. METHOD To address this gap, we reviewed and scored 10 graduate psychology psychopathology textbooks to determine the adequacy, completeness, and balance in their coverage of CM and AT. RESULTS There was a surprisingly wide range of scores, with some textbooks presenting little research on trauma or unbalanced coverage of trauma-related debates. Even the texts that earned the highest scores could more fully address trauma and/or provide more balanced discussion of debates. CONCLUSIONS Graduate textbooks would benefit from increased attention to, and more balanced coverage of, CM and AT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective The primary objective of the current study was to examine preliminary psychometric characteristics of the Structured Trauma-Related Experiences and Symptoms Screener for Adults (STRESS-A), a novel self-report instrument that inventories childhood and adulthood trauma-related experiences and assesses symptoms of posttraumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual for Mental Disorders (5th ed.; [DSM-5] American Psychiatric Association, 2013). Designed for efficient administration and interpretation by nonclinically trained professionals, the STRESS-A is a promising tool for use in settings where mental health professionals are lacking. Method A sample of 170 women in their third trimester of pregnancy and receiving services at an urban prenatal health care clinic completed the STRESS-A and a battery of instruments measuring mental health functioning, perceived stress, and emotion dysregulation. Tests of reliability and validity were conducted, including confirmatory factor analysis to examine the fit of STRESS-A symptom criteria relative to PTSD symptom structures supported in the literature. Results Results provide initial support for internal consistency, reliability, and convergent and construct validity in a largely Hispanic pregnancy sample. The STRESS-A symptom structure fit well with several that have been supported in the literature, including the 4-factor model of the DSM-5. Conclusion The STRESS-A is a promising tool for assessing risk associated with trauma exposure and probable DSM-5-based PTSD. Findings support its utility in a high-risk pregnancy cohort, a population that is underserved, yet shows high rates of trauma exposure and associated symptoms. Addressing maternal trauma-related impairment may have important implications for healthy fetal and child development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective Previous findings have demonstrated that torture survivors exhibit chronic pain and alterations in pain perception. However, not much is known regarding the characteristics of the torture experience and its contribution to these long-term ramifications. The current study examined the unique role of objective severity and subjective suffering in torture in predicting chronic pain and acute pain perception and pain modulation. Method Eighteen years after war, 59 former prisoners of war who were subjected to severe torture in captivity were assessed for subjective suffering in torture and estimated weight loss during captivity (an indication of torture severity) using self-administered questionnaires. Thirty-five years after captivity, systemic quantitative somatosensory testing was conducted, which included the measurement of pain threshold, pain tolerance, conditioned pain modulation, and perceived suprathreshold stimuli. Self-administered questionnaires were also used to evaluate chronic pain and posttraumatic stress disorder. Results The findings indicated that subjective suffering was associated with pain threshold, conditioned pain modulation, perceived suprathreshold stimuli, and chronic pain while controlling for posttraumatic stress symptoms. Estimated weight loss was associated only with pain threshold. Conclusion The findings demonstrate that the experience of chronic and acute pain is rooted in the subjective perception of traumatic experiences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective Gendered racial microaggression (GRM) experienced by Black women living with HIV (BWLWH) is a potentially important variable for posttraumatic stress disorder (PTSD) symptomatology in this population. GRM refers to everyday insults experienced by Black women on the basis of being both Black and female (e.g., comments about Black women's hair and body). We investigated the associations between GRM, race- and HIV-related discrimination, and trauma symptoms among BWLWH and explored whether gendered racial microaggressions contributed uniquely to trauma symptoms above the contribution of race- and HIV-related discrimination. Method One-hundred BWLWH in the U.S. completed baseline measures on GRM (frequency and appraisal), racial discrimination, HIV-related discrimination, PTSD symptoms, and posttraumatic cognitions. Results Hierarchical multiple linear regressions controlling for age, education, and income indicated that higher GRM and HIV-related discrimination predicted higher total PTSD symptoms, and higher GRM and racial discrimination predicted higher posttraumatic cognitions. Hierarchical multiple linear regressions with all predictors entered together revealed that only GRM contributed uniquely to both total PTSD symptoms and total posttraumatic cognitions. Analyses between GRM subscales and subscales of PTSD symptoms and posttraumatic cognitions indicated that GRM about beauty/sexual objectification and the strong Black women stereotype contributed uniquely and in interesting ways to PTSD symptoms and posttraumatic cognitions. Conclusions Our findings highlight the importance of addressing intersectional adversities such as GRM for BWLWH, as well as recognizing the role that GRM may play in mental health symptoms for Black women. Future research and intervention efforts aimed at improving the well-being of BWLWH should address GRM. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background Highly efficacious evidence-based psychotherapies (EBPs) exist for children and youth exposed to trauma, yet very few who need the treatments in the community receive them. Research within real-world settings is needed to better understand what is required to translate treatments into the community. Purpose We aimed to examine the implementation and clinical outcomes of a multiyear project installing 2 EBPs for trauma-exposed youth in community agencies across the state of New Hampshire. Method We invited clinicians to 2 days of training plus weekly group consultation calls for 9 or 12 months in Trauma-Focused Cognitive Behavioral Therapy or Child Parent Psychotherapy. Implementation metrics included clinician adherence to training, consultation, and treatment delivery expectations. Clinical outcomes included treatment dropout, as well as posttraumatic stress (PTS) symptoms. Results Of the 292 clinicians meeting eligibility and agreeing to participate, 243 (83%) attended trainings, 168 (58%) began consultation calls, and 70 (24%) adhered to implementation expectations by attending 80% of consultation calls and beginning the treatment with 2 youths. According to (completing) clinicians' reports, of the 363 youths tracked over the 9 to 12 month consultation periods, 47% dropped out of treatment and 44% were ongoing. Pre-post PTS scores (n = 82) demonstrated clinically meaningful reductions for 59% of youth. Conclusions Clinical outcomes were robust for those who completed treatment, rivaling those of highly controlled trials. However, implementation outcomes indicate an uphill battle in reaching youth who need the treatment. Implementation outcomes were mixed compared with those of more resource-intensive implementation models. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background Childhood trauma is associated with the development of depression during adolescence. Prior research suggests that traumatic experiences may result in differential acute treatment outcomes for depressed adolescents. However, the long-term effects of trauma on treatment response remain unclear. Method Participants (N = 318) with a primary diagnosis of major depressive disorder were randomly assigned to 1 of 3 treatment groups: cognitive-behavioral therapy (CBT), fluoxetine (FLX), or their combination (COMB). All participants received 36 weeks of active treatment followed by 1 year of open follow-up. We hypothesized that (a) adolescents without a trauma history would have greater symptom reduction over the course of treatment compared to those with a trauma history and (b) there would be an interaction between trauma history, treatment arm, and time such that adolescents without trauma histories in combination treatment would improve the most rapidly. Linear mixed effects modeling, factorial ANOVAs, and log-linear analyses were used to test these hypotheses. Results The linear mixed effect model revealed a significant 3-way interaction of time, trauma, and treatment type. In the CBT and COMB groups, adolescents without trauma histories improved more rapidly than traumatized adolescents. In the single-time-point analyses, there were no significant differences between adolescents with trauma histories and those without trauma histories. Conclusions Whereas all treatment groups experienced significant reductions in depression regardless of trauma history, adolescents without trauma histories receiving psychotherapy demonstrated more rapid improvements in depression symptom severity. Treatment response did not differ between traumatized and nontraumatized youth at long-term follow-up. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

OBJECTIVE Previous research has established associations among childhood trauma exposure, posttraumatic stress symptoms (PTSSs), and adolescent nonsuicidal self-injury (NSSI). In fact, numerous studies have suggested that PTSSs may serve as a mechanism linking trauma exposure and NSSI. However, studies to date have not utilized newer models of PTSSs that differentiate between symptoms of overmodulation and undermodulation. This study investigated associations among interpersonal and noninterpersonal trauma exposure, posttraumatic overmodulation and undermodulation, and NSSI in a sample of justice-involved youth. METHOD Participants were 566 youth (2 transgender youth, 142 girls, and 422 boys). On average, youth were 16 years old (SD = 1.27), and approximately half self-identified as an ethnic minority. Participants completed measures of lifetime trauma exposure and NSSI, and past-month PTSSs. RESULTS Structural equation modeling demonstrated that interpersonal trauma exposure was associated with symptoms of overmodulation (95% confidence interval [CI] [.180, .340]) and undermodulation (95% CI [.179, .338]) as well as NSSI (95% CI [.156, .572]). Additionally, symptoms of overmodulation were differentially associated with NSSI (95% CI [.158, .720]), and there was a significant indirect effect between interpersonal trauma exposure and NSSI via overmodulation (95% CI [.015, .095]). CONCLUSIONS This study highlights the utility of conceptualizing posttraumatic stress disorder as a disorder of emotion regulation characterized by symptoms of overmodulation and undermodulation, and has clinical implications for mental health professionals who interact with youth in the justice system. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective LGBT veterans experience high rates of trauma, discrimination, and minority stress. However, guidelines for case conceptualization and treatment remain limited. The aim of the current study was to examine the experiences of trauma and other high impact experiences among LGBT veterans to inform case conceptualization and treatment. Method We recruited 47 LGBT veterans with a history of exposure to LGBT-related Criterion A trauma and performed semistructured interviews about their experiences in trauma treatment, barriers to engagement, and treatment needs and preferences. We used thematic analysis of qualitative codes guided by inductive and deductive approaches to characterize the variety of trauma and high impact experiences reported. Results LGBT veterans disclosed a range of clinically relevant stressors, including Criterion A traumatic events, minority stress, and microaggression experiences, including interpersonal and institutional discrimination perpetrated by fellow service members/veterans, citizens, therapy group members, and health care providers. Conclusion These data provide a unique account of LGBT veteran's identity-related trauma and concomitant interpersonal and institutional discrimination, microaggression experiences, minority stress, and traumatic stress symptoms. Findings highlight existing service gaps regarding evidence-based treatments for the sequalae of trauma, discrimination, microaggressions, and minority stress. In addition, we noted past and present issues in military and health care settings that may lead to or exacerbate trauma-related distress and discourage treatment seeking among LGBT veterans. We provide suggestions for clinical work with LGBT veterans and encourage ongoing research and development to eliminate remaining service gaps. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exposure to potentially traumatic events (PTEs) has been identified as a risk factor for various psychological problems in adolescents generally and in young refugees. The aim of this study was to examine whether individual resilience (assessed as a personality characteristic) can protect adolescents in diverse contexts from negative effects of trauma exposure.A path model was used to assess whether individual resilience buffered the negative effects of exposure to PTEs in a cross-sectional study of adolescent refugees (aged 12-17 years; n = 117) and their Dutch peers (n = 148). Measurements included the Children's Revised Impact of Event Scale, Strengths and Difficulties Questionnaire, Satisfaction with Life Scale and the Resilience Scale.The moderating effects of individual resilience on the relationship between PTEs and mental health problems and life satisfaction were mixed: In the nonrefugee group, but not in the refugee group most moderation effects reached significance.Findings suggest that not all groups benefit similarly from individual-level resilience. Consequently, adolescents, who differ with regard to the risks to which they are exposed, may need different forms of support. This study points to the interplay of factors that contributes to demonstration of individual resilience. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

This special section in Psychological Trauma: Theory, Research, Practice, and Policy: "Religion and Spirituality in the Context of Disaster," demonstrates the heterogeneity and complexities of religion as a variable of psychological resilience in response to disaster. Research from hurricane, flood, and mass shooting disasters are reported. So too is the development of a new measure of disaster response. The section ends with a review of 51 empirical resilience studies of religion/spirituality and disaster. There are both ethnic and age differences in how salient a factor religion is after disasters. These papers demonstrate that to engage this complexity will require the expertise and effort-as with all cultural competence-to understand the "made meaning" of the lived experience of religion across one's life span. Religion is shown to be a robust objective for public health policy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective Prior research suggests that there is a relationship between traumatic experiences and poor health. When considered through the lens of betrayal trauma (i.e., the perpetrator and the victim have a close interpersonal relationship), traumatic experiences predict greater posttraumatic difficulty and higher levels of depression. Betrayal trauma has been associated with poorer interpersonal relationships and less trust in individuals and systems that may be important for a person's wellbeing, such as health care systems. In turn, trauma survivors are less likely to adhere to medical treatment, which may ultimately affect their overall health. The current study examined the complex relationship between experiences of betrayal trauma and poor health, while accounting for demographics, mental health symptoms, trust in physicians and the medical system, attachment style, and nonadherence to medical treatment. Method A demographically representative sample of 312 Canadian participants was surveyed online. Participants completed measures that assessed symptoms of mental health (PTSD, depression), trauma, attachment style, trust, and nonadherence to medical treatment. Results Hierarchical regression models were used to examine the relationship between betrayal trauma and health. Betrayal trauma significantly predicted nonadherence to treatment, while trust in physicians was explained by trauma, attachment style, and mental health symptoms. All of these factors significantly explained poor health status. Conclusions Results suggest the importance of implementing trauma-informed care in health care systems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective This article explores the universal concept of time with the aim of enhancing our ability to help those affected by loss and trauma as well as those who study and treat them. The help comes in the form of a new framework that focuses on how we think about, and represent, time in scholarship and practice. Method In this conceptual article, I outline traditional approaches to incorporating time in psychological research and discuss the many related concepts, such as anniversary reactions. The main aim of the article is to introduce a reconceptualized framework of time, including the assertion of meaningful time and markers in time. The premise of this framework is that social behavioral sciences should consider time as an uneven, meaningful, and overt force that influences trajectories of adaptation in the context of traumatic loss. Results This article describes the ways in which markers in time push our current representations of time forward and, in doing so, alter the narrative around pathological grief by removing the time limitation on grief and mourning. This framework recognizes grief as a cyclical process that unfolds in the context of meaningful, rather than chronological, time. Conclusion The article concludes by addressing the practical implications of this reconceptualization and the potential to greatly impact scholarship and clinical approaches to addressing the needs of clients coping with traumatic loss. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Reports an error in "The effects of web-prolonged exposure among military personnel and veterans with posttraumatic stress disorder" by Carmen P. McLean, Edna B. Foa, Katherine A. Dondanville, Christopher K. Haddock, Madeleine L. Miller, Sheila A. M. Rauch, Jeffery S. Yarvis, Edward C. Wright, Brittany N. Hall-Clark, Brooke A. Fina, Brett T. Litz, Jim Mintz, Stacey Young-McCaughan and Alan L. Peterson (Web-based treatments address many of the logistical and stigma-related barriers to in-person behavioral health care. Prior studies of web-based treatments for posttraumatic stress disorder (PTSD) did not employ gold-standard treatments and have not compared to in-person therapy.We compared a web version of Prolonged Exposure Therapy, "Web-PE," to in-person Present-Centered Therapy (PCT) in a randomized controlled trial (RCT) with 40 military personnel with PTSD seeking treatment at Fort Hood, Texas. Due to recruitment challenges, we terminated the RCT and subsequently examined the effects of Web-PE in an uncontrolled open trial with 34 service members and veterans recruited nationwide. Both studies assessed PTSD, depressive symptoms, and health functioning at baseline and 1 and 3 months posttreatment; the RCT also included a 6-month assessment.Results of the RCT showed no differential impact for Web-PE and PCT, although more PCT participants achieved clinically significant change at one of the follow-up assessments. Both treatment conditions significantly reduced self-reported and blind independent interviewer-assessed symptoms of PTSD. Results of the open trial showed that Web-PE was associated with significant reductions in self-reported PTSD symptoms, with a much larger effect size than in the RCT.Web-PE significantly reduced PTSD symptoms in both studies, although the reductions in PTSD symptoms were greater among open trial participants, who were specifically seeking a web-based treatment. Future research should evaluate Web-PE relative to another web-based treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Individuals with elevated symptoms of posttraumatic stress disorder (PTSD) or a PTSD diagnosis are at increased risk of thinking about, attempting, and dying by suicide. Yet, there remain key gaps in the field’s understanding of the relation between PTSD and suicidal thoughts and behaviors. In response, Psychological Trauma: Theory, Research, Practice, and Policy organized this Special Section on PTSD and Suicide Risk. The articles included in this Special Section represent innovations in the understanding of the link between PTSD and suicidality across various at-risk populations and units of analysis. This Special Section additionally contains articles that address key data analytic and assessment considerations, paving the way for methodologically rigorous future research. Ultimately, it is my hope and belief that advancements in the scientific understanding of PTSD and suicide risk will contribute to decreases in suffering and decreases in suicide deaths.

Objective: COVID-19 is the current viral pandemic. Its consequences are multifaceted and refer to individual and public physical, mental, and economic states. Therefore, viral outbreaks raise many fears and concerns, both among policymakers and individuals. In light of these fears, we explore the central aspects of viral victimization, compared to another significant threat of this century: terrorism. Analysis: There are many similarities between terrorism and the current pandemic which manifest within the physical, economic, social, and psychological aspects of victimization. To address the multidimensional nature of the pandemic's impact we coined the term viruism. Though terrorism and viruism are not the deadliest of threats, they evoke high levels of fear and cause enormous financial, social, and psychological effects. Conclusion: We recommend exploring the psychosocial mechanisms that account for public reaction to viruism. Identifying such mechanisms will contribute to developing more effective practices in managing the fear of viruism and in decreasing its emotional toll. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

India enforced one of the world's largest lockdowns in the last quarter of March 2020 to minimize the impact of the COVID-19 pandemic. This commentary focuses on the mental health implications of the ongoing pandemic as well as the lockdown that lasted for more than two months and is still in place in certain areas. Whereas loneliness, stress, anxiety, and depression have been widespread, vulnerable sections of the population, including daily wage workers, migrant laborers, religious minorities, women and children, and the elderly, have been facing various forms of economic, sociopolitical, and familial stigma, racism, and violence. By and large, the COVID-19 pandemic has widened all forms of societal disparities in India. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Prior wartime trauma likely acts as a double-edged sword that promotes both aging veterans' vulnerability and resilience in the context of the current COVID-19 pandemic. During this stressful time, aging veterans may benefit from having an array of socially supportive network ties. We therefore suggest that clinicians working with veterans encourage veterans to (a) create or sustain positive social connections while maintaining physical distance and (b) call upon coping strategies that helped them manage past difficulties. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

During the COVID-19 pandemic, trauma-exposed individuals may have heightened risk for substance use. Using substances to cope may contribute to the development of problematic substance use over time. It is imperative to initiate conversations about substance use with clients during this time and motivational interviewing offers an ideal framework for doing so. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The current COVID-19 pandemic places maternity staff at risk of engaging in clinical practice that may be in direct contravention with evidence; professional recommendations; or, more profoundly, deeply held ethical or moral beliefs and values, as services attempt to control the risk of cross-infection. Practice changes in some settings include reduction in personal contacts for tests, treatments and antenatal and postnatal care, exclusion of birth partners for labor and birth, separation of mother and baby in the immediate postnatal period, restrictions on breastfeeding, and reduced capacity for hands-on professional labor support through social distancing and use of personal protective equipment. These enforced changes may result in increasing levels of occupational moral injury that need to be addressed at both an organizational and a personal level. (PsycInfo Database Record (c) 2020 APA, all rights reserved).