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BackgroundAlthough use of inpatient crisis hospital intervention for suicide risk is common, the evidence for inpatient treatments that reduce suicidal thoughts and behaviors is remarkably limited. To address this need, this novel feasibility pilot randomized controlled trial compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced treatment as usual (E-TAU) within a standard acute inpatient mental health care setting.ObjectivesWe hypothesized that CAMS would be more effective than E-TAU in reducing suicidal thoughts and behaviors. As secondary outcomes we also investigated depressive symptoms, general symptom burden, reasons for living, and quality of the therapeutic relationship.MethodsAll patients were admitted due to acute suicidal thoughts or behaviors. They were randomly assigned to CAMS (n = 43) or E-TAU (n = 45) and assessed at four time points (admission, discharge, 1 month and 5 months after discharge). We used mixed-effects models, effect sizes, and reliable change analyses to compare improvements across and between treatment groups over time.ResultsIntent-to-treat analyses of 88 participants [mean age 32.1, SD = 13.5; n = 47 (53%) females] showed that both groups improved over time across all outcome measures with no significant between-group differences in terms of change in suicidal ideation, depression, reasons for living, and distress. However, CAMS showed larger effect sizes across all measures; for treatment completers CAMS patients showed significant improvement in suicidal ideation (p = 0.01) in comparison to control patients. CAMS patients rated the therapeutic relationship significantly better (p = 0.02) than E-TAU patients and were less likely to attempt suicide within 4 weeks after discharge (p = 0.05).ConclusionsCAMS and E-TAU were both effective in reducing suicidal thoughts and symptom distress. Within this feasibility RCT the pattern of results was generally supportive of CAMS suggesting that inpatient use of CAMS is both feasible and promising. However, our preliminary results need further replication within well-powered multi-site randomized controlled trials.Trial registrationDRKS-ID/ICTRP-ID: DRKS00013727. The trial was retrospectively registered in the German Clinical Trials Register, registration code/ DRKS-ID: DRKS00013727 on 12.01.2018 and also in the International Clinical Trials Registry Platform of the World Health Organization (identical registration code).

A large proportion of refugees show symptoms of mental health problems that require psychotherapy as first-line treatment. However, even in countries with a well-established psychotherapy system, refugees still encounter barriers to care. In a survey of 2002 outpatient psychotherapists in Germany, we collected data on treatment barriers and on the integration of refugees into regular psychotherapeutic practice.

Only a small proportion of refugees requiring treatment actually receive psychotherapy. Alongside structural barriers, it has been hypothesized that causal attributions for mental health problems that deviate from Western explanatory models may reduce refugees’ help-seeking behavior. Prevailing assumptions suggest that refugees predominantly hold causal beliefs that are incompatible with the rationales of psychotherapy. Testing these assumptions requires a reliable assessment tool to evaluate refugees’ causal beliefs. Therefore, we developed the Causal Attributions for Mental Health Problems Scale (MH-CAUSE) and validated it in a sample of Middle Eastern refugees living in Germany (N = 429). This OSF page contains the data used for the psychometric evaluation of the questionnaire.

Current theories of psychological trauma assume that posttraumatic symptoms originate from stress reactions caused by extremely adverse life experiences. Since the diagnosis of PTSD is restricted to events that involve threats to the physical or sexual integrity of a person, such as accidents and physical and sexual violence, these theories are not well suited to explain the psychopathological consequences of severe violations of one's social integrity, such as emotional abuse and bullying. However, it is evident that social threats contribute to a broad range of mental disorders and increase symptom severity in patients with posttraumatic stress disorder. The aim of the Physical and Social Trauma (PAST) framework is to extend current memory theories of psychological trauma to incorporate threats to a person's social integrity. Within this perspective, the harmful effects of events that involve social threats result from violations of core social motives such as the need for status and belonging that bring about intense affective reactions, including despair and defeat. Within associative threat structures, these emotions are tied to the stimulus characteristics of the experiences and can be re-activated in social situations. The resulting psychopathology transcends PTSD criteria and other current classifications and suggests a transdiagnostic perspective of psychological trauma. Implications for treatment and further directions for research are discussed.

**Background** Different types of maltreatment (emotional, physical, and sexual) lead to distortions in emotion and attention processing. The present study investigated whether the experience of peer victimization in childhood and adolescence has an additional influence on attention processing in adulthood. **Methods** Two non-clinical samples consisting of individuals with different levels of experiences of maltreatment were recruited. In an evaluative conditioning task, images of faces with neutral emotional expression were either associated with short videos of intense negative statements, or associated with neutral videos. Subsequently, these faces were used as stimuli in an emotional Stroop task as well as a dot-probe task. **Results** In both tasks, hierarchical regression analyses revealed that retrospective reports of relational peer victimization made an incremental contribution to the prediction of attentional biases beyond child maltreatment. In the emotional Stroop task, emotional abuse was the strongest predictor for an attentional bias showing delayed responses to negatively associated faces, while peer victimization was associated with faster responses to negatively associated faces. In the dot-probe task, relational peer victimization was the strongest predictor for an attentional bias. When the attentional bias was examined in more detail, though, peer victimization did not show incremental contributions although emotional abuse remained the strongest predictor for facilitated attention toward negatively associated neutral faces. **Conclusion** Experiences of peer victimization leave additional cognitive scars beyond effects of childhood maltreatment by caregivers. It is likely that attentional biases in the aftermath of victimization put individuals at risk for the development of psychopathology.

Additional File 2. Results of the qualitative interviews on the Treatment Camp and the rehabilitation process afterwards is providing information on the procedures and results of the qualitative analysis concerning the research questions: a) What elements of the Treatment Camp were perceived as helpful / not helpful by the participants concerning their aim to quit drinking, b) What elements were perceived as helpful / not helpful after the inpatient phase and c) What factors were perceived as causing a relapse into drinking or successful abstinence or harmless intake respectively.

Additional File 1. Partners��� and children���s reports of relationship quality and family violence is providing information on assessment instruments and results of the pre-, and follow-up data provided by the participants��� partners and children.

Additional file 7:. Appendix 5b Ethikkommission; Consulting and Evaluation – Consent of the Ethical Committee: English translation

Additional file 1. Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Checklist: recommended items to address in a clinical trial protocol and related documents*

Additional file 1:. Appendix 1 Fragebögen zur CAMS-Studie zur Behandlung suizidaler Krisenpatienten – Complete questionnaires for the CAMS study

Additional file 6:. Appendix 5a Ethikkommission; Beratung und Bewertung – Consent of the Ethical Committee: Original Document in German

Additional file 2:. Appendix 2 Suicide Status Forms – Complete CAMS Material

Additional file 3:. Appendix 3a Einverständniserklärung zur Teilnahme an der Studie – Informed Consent Form

Additional file 5:. Appendix 4 SPIRIT checklist – SPIRIT checklist

Additional file 4:. Appendix 3b Informationen zur Studie – Patient information

The formulation of life perspectives is one of the developmental tasks of adolescence. Expectations regarding one’s own future are shaped by cultural and contextual factors. However, there is little cross-cultural research that includes countries affected by war and turmoil. A Ugandan version of the Future Expectations Scale for Adolescents (FESA) was developed and evaluated with a sample of 279 Ugandan adolescents with low socioeconomic status living in rural communities affected by the Ugandan civil war (1986–2006). The Ugandan FESA was constructed on the basis of a combined item pool of the original Chilean and an adapted Brazilian FESA. Confirmatory factor analysis revealed that the factor structure of the original FESA did not fit the Ugandan data. Principal component analysis revealed a 3-factor solution, including the domains of children and family, work and education, and general future optimism. The final version consists of 19 items, which were deemed culturally appropriate by local focus groups. Overall, the item pool of the FESA was found useful for further studies in post-conflict societies.

Additional file 1. A: Management of missing data. B: Preliminary analysis on minimization/denial. C: Intercorrelations across demographic characteristics and childhood adversities. D: Frequencies and severities of child maltreatment assessed with the CTQ in other studies. E: Means and standard deviations of childhood adversity severities across groups

Table S1. Skewness and kurtosis for dependent and independent variables. Table S2. Intercorrelation between PTSD, depression, and traumatic events with demographic variables. (DOCX 25 kb)

Background and Aims: Since alcohol use disorders are among the most prevalent and destructive mental disorders, it is critical to address factors contributing to their development and maintenance. Drinking motives are relevant driving factors for consumption. Identifying groups of drinkers with similar motivations may help to specialize intervention components and make treatment more effective and efficient. We aimed to identify and describe distinct motive types of drinkers in dependent males from two diverse cultures (Uganda and Germany) and to explore potential differences and similarities in addiction-related measures. Moreover, we investigated specific links between motive types and childhood maltreatment, traumatic experiences, and symptoms of comorbid psychopathologies. Methods: To determine distinct drinking motive types, we conducted latent class analyses concerning drinking motives (Drinking Motive Scale) in samples of treatment-seeking alcohol-dependent men (N = 75). Subsequently we compared the identified motive types concerning their alcohol consumption and alcohol-related symptoms (Alcohol Use Disorders Identification Test), history of childhood maltreatment (Childhood Trauma Questionnaire), trauma exposure (Violence, War and Abduction Exposure Scale), psychopathology (Posttraumatic Stress Diagnostic Scale, Depression-section of the Hopkins Symptom Checklist, and Brief Symptom Inventory) and deficits in emotion regulation (Difficulties in Emotion Regulation Scale). Results: We found two congruent drinking motive types in both contexts. Reward-oriented drinking motives like the generation of positive feelings and enhancing performance were endorsed almost equally by both motive types, whereas high relief motive endorsement characterized one group, but not the other. The relief motive type drank to overcome aversive feelings, withdrawal, and daily hassles and was characterized by higher adversity in general. Emotional maltreatment in childhood and psychopathological symptoms were reported to a significantly greater extent by relief drinkers (effect sizes of comparisons ranging from r = 0.25 to r = 0.48). However, the motive types did not differ significantly on alcohol consumption or alcohol-related symptoms and traumatic experiences apart from childhood maltreatment. Conclusion: The chronology of addiction development and patterns of drinking motivation seem to be similar across cultures, i.e., that motive targeting interventions might be applicable cross-culturally. Addressing comorbid symptomatology should be a key treatment component for relief drinkers, whereas finding alternatives for the creation of positive feelings and ways to counteract boredom and inactivity should be a general treatment element. Introduction

Background: Trained local screeners assessed the mental-health status of male and female students in Northern Ugandan schools. The study aimed to disclose potential differences in mental health-related impairment in two groups, former child soldiers (n = 354) and other war-affected youth (n = 489), as well as to separate factors predicting mental suffering in learners.Methods: Participants were randomly selected. We used the Post-Traumatic Diagnostic Scale to assess symptoms of post-traumatic stress disorder (PTSD) and for potential depression the respective section of the Hopkins Symptom Checklist with a locally validated cut-off.Results: Almost all respondents had been displaced at least once in their life. 30% of girls and 50% of the boys in the study reported past abduction history. Trauma exposure was notably higher in the group of abductees. In former child soldiers, a PTSD rate of 32% was remarkably higher than that for non-abductees (12%). Especially in girls rates of potential depression were double those in the group of former abductees (17%) than in the group of non-abductees (8%). In all groups, trauma exposure increased the risk of developing PTSD. A path-analytic model for developing PTSD and potential depression revealed both previous trauma exposure as well as duration of abduction to have significant influences on trauma-related mental suffering. Findings also suggest that in Northern Ugandan schools trauma spectrum disorders are common among war-affected learners.Conclusions: Therefore, it is suggested the school context should be used to provide mental-health support structures within the education system for war-affected youth at likely risk of developing war-related mental distress.

The study investigated the role of an associative information network as a mechanism underlying the relation of peer victimization and social anxiety disorder (SAD). A sample of N = 80 was divided according to diagnosis (SAD vs. no diagnosis) and amount of peer victimization (low vs. high). Responses to memory of a personally experienced aversive social situation and to imagining a standardized negative social situation were assessed. In terms of skin conductance level, subjects with SAD and peer victimization were more reactive to the memory script than the other three groups while responses to the standardized script did not vary. As to heart rate, there were no differences between the groups. Emotional responses presented with an inconsistent pattern. The results provide a first indication that associative memory structures resulting from aversive social experiences might play a role in the development and maintenance of SAD, but further research is needed.

The authors examined the effectiveness of narrative exposure therapy for children (KIDNET) in treating posttraumatic stress disorder (PTSD) in refugee children living in exile. Twenty-six children traumatized by organized violence were randomly assigned to KIDNET or to a waiting list. Significant treatment by time interactions on all PTSD-relevant variables indicated that the KIDNET group, but not the controls, showed a clinically significant improvement in symptoms and functioning. Success of the KIDNET group remained stable at 12-month follow-up. This study confirms previous findings that, if left untreated, PTSD in children may persist for an extended period. However, it also shows that it is possible to effectively treat chronic PTSD and restore functioning in traumatized refugee children in only 8 treatment sessions.

This study examines the impact of children's exposure to natural disaster against the backdrop of exposure to other traumatic events and psychosocial risks. One thousand three hundred ninety-eight Sri Lankan children aged 9-15 years were interviewed in 4 cross-sectional studies about exposure to traumatic life events related to the war, the tsunami experience, and family violence. Symptoms of posttraumatic stress disorder, somatic complaints, psychosocial functioning, and teacher reports of school grades served as outcome measures. A global outcome variable of "positive adaptation" was created from a combination of these measures. Data showed extensive exposure to adversity and traumatic events among children in Sri Lanka. Findings of regression analyses indicated that all 3 event types--tsunami and disaster, war, and family violence--significantly contributed to poorer child adaptation.

The extent of cumulative adverse childhood experiences such as war, family violence, child labor, and poverty were assessed in a sample of school children (122 girls, 165 boys) in Kabul, Afghanistan. Strong gender differences were found with respect to both the frequency of such experiences and the association of different types of stressors with posttraumatic stress disorder (PTSD) symptoms. Boys reported higher overall amounts of traumatic events, specifically experiences of violence at home. This was reflected in a 26% prevalence of probable PTSD in boys compared to 14% in girls. Child labor emerged as a common phenomenon in the examined sample and was furthermore associated with an increased likelihood of experiencing family violence for girls. The results suggest that the interplay of multilevel stressors in Afghan children contributes to a higher vulnerability for the development of PTSD.

Background: The aim of the present study was to evaluate the efficacy of treatment modules for trauma spectrum disorders in a sample of Rwandan genocide orphans. Methods: Twenty-six orphans (originally 27) who presented with post-traumatic stress disorder (PTSD) at first assessment continued to meet a PTSD DSM-IV diagnosis 6 months after their initial assessment. They were offered participation in a controlled treatment trial. A group adaptation of interpersonal psychotherapy (IPT, n = 14) was compared to individual narrative exposure therapy (NET, n = 12). The last NET session involved guided mourning. Each treatment program consisted of 4 weekly sessions. Main outcome measures were diagnostic status and symptoms of PTSD and depression assessed before treatment, at 3 months post-test and at 6 months follow-up using the Clinician-Administered PTSD Scale, Mini-International Neuropsychiatric Interview, and Hamilton Rating Scale. Results: At post-test, there were no significant group differences between NET and IPT on any of the examined outcome measures. At 6-month follow-up, only 25% of NET, but 71% of IPT participants still fulfilled PTSD criteria. There was a significant time ! treatment interaction in the severity of PTSD [Wilks' Lambda = 0.75, F(2,23) = 3.93; p < 0.05] and depression symptoms [Wilks' Lambda = 0.23, F(2,23) = 3.40; p = 0.05]. At follow-up, NET participants were significantly more improved than IPT participants with respect to both the severity of symptoms of PTSD and depression. Conclusions: Individual NET in combination with group-based mourning comprises an effective treatment for traumatized survivors who have to bear the loss of loved ones and have been suffering from symptoms of PTSD and depression. Copyright (C) 2009 S. Karger AG, Basel