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The goal of this study was to assess students' responses to a potentially triggering passage from literature using differing trigger warnings. 123 undergraduates read a passage which contained depictions of physical and sexual assault. Students were randomly assigned to differing trigger warning conditions prior to reading the passage that anticipated either neutral, positive, or negative emotional reactions. Measures of PTSD symptoms and distress were taken on Day 1, Day 2, and Day 14. Distress to the triggering passage did not vary as a function of either trauma history or trigger warning type. Those with higher PTSD scores to start did not experience more distress over time. The data suggest that instructors can assign challenging passages with the expectation that those with related traumas will not be disproportionately affected. In addition, the type of warning is not likely to impact on student emotional responses. [ABSTRACT FROM AUTHOR]

Historical, cultural, and social trauma, along with social determinants of health (SDOH), shape health outcomes, attitudes toward medicine, government, and health behaviors among communities of color in the United States (U.S.). This study explores how trauma and fear influence COVID-19 testing and vaccination among Black/African American, Latinx/Indigenous Latin American, and Native American/Indigenous communities. Leveraging community-based participatory research methods, we conducted 11 virtual focus groups from January to March of 2021 with Black/African American (n = 4), Latinx/Indigenous Latin American (n = 4), and Native American/Indigenous (n = 3) identifying community members in Inland Southern California. Our team employed rapid analytic approaches (e.g., template and matrix analysis) to summarize data and identify themes across focus groups and used theories of intersectionality and trauma to meaningfully interpret study findings. Historical, cultural, and social trauma induce fear and mistrust in public health and medical institutions influencing COVID-19 testing and vaccination decisions in communities of color in Inland Southern California. This work showcases the need for culturally and structurally sensitive community-based health interventions that attend to the historical, cultural, and social traumas unique to racial/ethnic minority populations in the U.S. that underlie fear and mistrust of medical, scientific, and governmental institutions. [ABSTRACT FROM AUTHOR]

Suicide and PTSD are pressing public health issues in the US, with discrimination and potentially traumatic experiences (PTEs) influencing mental health. However, the unique effects of these factors on Multiracial/ethnic adults' PTSD and suicidal thoughts/behaviors (STB) are not thoroughly researched. Using a cross-sectional design, an online survey was conducted (N = 1012) from October to December 2022. Multivariable logistic regression models analyzed relationships between PTEs, discriminatory events, and mental health outcomes, accounting for sociodemographics. After adjusting for demographics, exposure to PTEs and discrimination correlated with heightened odds of PTSD and STB. Individual lifetime discrimination experiences and specific PTEs demonstrated varying associations with STB and PTSD. The study underscores discrimination's relevance as a risk factor. The study's cross-sectional nature restricts causality or temporality interpretations. Moreover, the convenience sample of English-speaking online participants might not be reflective of all Multiracial/ethnic US adults. Findings underscore PTEs and discrimination's interconnectedness in Multiracial/ethnic mental health outcomes. Discrimination might pose similar risks to PTEs. Acknowledging discrimination as potential precursors for PTSD and STB aids accurate diagnosis and effective treatment planning. Incorporating racial/ethnic discrimination and traumatic experiences into PTSD conceptualization and assessment is pivotal. This knowledge informs tailored interventions and mental health education for this population. • Potentially Traumatic Experiences (PTE) are events that meet qualifying criteria for PTSD. • Discrimination is not currently included as a qualifying PTE. • PTEs & discrimination linked to 5–34 % higher odds of STB and PTSD in Multiracial/ethnic adults. • Discrimination may pose similar STB/PTSD risks as traditionally noted PTEs. • Consider including assessment of exposure to discrimination as risk factor for STB and PTSD. [ABSTRACT FROM AUTHOR]

In this observational study, we assessed the extent to which a community-created pilot intervention, providing trauma-informed care for persons with HIV (PWH), affected HIV care retention and viral suppression among PWH attending an HIV Services Organization in the Southern US. PWH with trauma exposure and/or trauma symptoms (N = 166) were offered a screening and referral to treatment (SBIRT) session. Per self-selection, 30 opted-out, 29 received SBIRT-Only, 25 received SBIRT-only but reported receiving other behavioral health care elsewhere, and 82 participated in the Safety and Stabilization (S&S) Intervention. Estimates from multivariable logistic regression analyses indicated S&S Intervention participants had increased retention in HIV care (adjusted odds ratio [aOR] 5.46, 95% CI 1.70–17.50) and viral suppression (aOR 17.74, 95% CI 1.83–172), compared to opt-out participants. Some evidence suggested that PTSD symptoms decreased for intervention participants. A randomized controlled trial is needed to confirm findings. [ABSTRACT FROM AUTHOR]

Although not widely known, public works employees in the United States were designated as emergency providers during critical incidents in 2003 and have provided these public works services, when activated. These public works employees may be either employees of a specific government entity or, more recently, privately contracted employees who provide similar services for a government entity. First responders working critical incidents are at risk for psychological trauma and posttraumatic stress disorder (PTSD). It is less clear, however, whether government/contracted public works employees working the same critical incidents are subject to the same risk of onset. This paper reviewed 24 empirical studies assessing this possible association from 1980 to 2020. These studies included 94,302 government/contracted employees. Psychological trauma/PTSD was reported in all 24 manuscripts assessing PTSD. Three of these studies additionally reporting serious somatic health problems. Public works employees are at risk for onset and this is a worldwide issue. Study findings and treatment implications are presented. [ABSTRACT FROM AUTHOR]

Objective: Sexual assault, child abuse, and combat have been linked to eating disorders (EDs). However, noninterpersonal trauma is relatively understudied, and therefore it is unknown whether noninterpersonal trauma is associated with EDs. Furthermore, most previous studies do not account for multiple trauma exposures, or the relative association of traumatic events with EDs in the same statistical model. Method: Multinomial regression was used to examine the association of lifetime ED diagnosis (anorexia nervosa [AN], bulimia nervosa [BN], binge eating disorder [BED]) with trauma type (sexual interpersonal, other interpersonal, war/combat, and noninterpersonal) in a nationally representative dataset of US adults in bivariate and multivariable (i.e., with all trauma types) models. Results: Sexual interpersonal trauma was significantly positively associated with AN and BED in bivariate and multivariable models. In the multivariable model, only BED was found to be equally associated with sexual interpersonal, other interpersonal, and noninterpersonal trauma. Discussion: These results indicate a strong positive association between sexual trauma and EDs, even when controlling for experiences of other trauma events. Future research should examine longitudinal mediators between trauma and EDs, especially sexual trauma, to identify what factors may explain this relationship. Public significance statement: Individuals with eating disorders often experience traumatic events but it is unclear whether specific trauma types are more or less common in this population. This study found that only events such as rape and sexual assault are associated with anorexia nervosa, but that most trauma types are associated with binge eating disorder. Therefore, the relationship between trauma and binge eating disorder may function differently than other eating disorders. [ABSTRACT FROM AUTHOR]

Situations involving active firearm shooters in schools have increased exponentially in recent years, especially in the United States. These events result in death and psychological traumatization, not just to the involved school but also to the surrounding communities and to the rest of the population of the United States and other countries who observe these massacres in the media. This article will review the recent statistics of school shooting incidents in the United States, the psychological profiles of the perpetrators, the pattern of circumstances that contribute to the buildup until the point the act if committed, the effectiveness of the responses by authorities, the possible risk factors and precipitating factors for these attacks, the psychological sequelae to individuals, families, and the communities, and the evidence‑based preventive interventions. [ABSTRACT FROM AUTHOR]

Background: Each year, nearly 790.000 new cases of myocardial infarction (MI) are recorded in the United States. Better knowledge of the modifiable risk factors for this cardiovascular disease remains a major public health issue. In this perspective, the aim of this systematic review and meta-analysis was to estimate the relationship between post-traumatic stress disorder (PTSD) and risk of subsequent myocardial infarction (MI).Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines was performed by searching four bibliographic databases (PubMed/Medline, PsycINFO, Science Direct and Proquest Dissertations and Theses).Results: A total of 14 articles were included. Nine of these included depression as a covariate. Among 13 studies (N = 848.903), the pooled HR for the magnitude of the relationship between PTSD and MI was 1.49 (95% CI 1.31-1.69) before adjustment for depression. The pooled HR estimate for the 9 depression-adjusted estimates (N = 814.441) was 1.32 (95% CI 1.12-1.56).Limitations: These results should be considered with caution because there is high heterogeneity between studies and possible publication bias; thus, further research is required to support these results.Conclusions: Further research is still needed to identify in more precise terms the mediating factors involved in the direct association between PTSD and the subsequent occurrence of ischemic heart disease. [ABSTRACT FROM AUTHOR]

The United States has long been the leading destination for Latin Americans seeking refuge. However, in the last 7 years, many children from Mexico and northern Central America, composed of El Salvador, Honduras, and Guatemala, have joined this migratory flow. The experience of forced migration is intense, chronic, and complex for children in their home countries, during their journey, and on arrival in the United States. Their stories can inform clinical practices, such as Psychological First Aid and Trauma-Focused Cognitive Behavioral Therapy, to promote resilience in children in vulnerable conditions., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Psychological trauma refers to long-lasting adverse effects on well-being precipitated by the experience of a distressing event or a combination of events. High rates of psychological birth trauma in patients contribute to secondary traumatic stress (STS) in perinatal nurses, creating workplace challenges and resulting in dissatisfaction, apathy, and attrition. Perinatal nurses experience high rates of STS, and researchers have called for a universal standard of trauma-informed care (TIC). However, there is a lack of published results on effectively creating TIC education in this nurse population., Methods: A pre/posttest design evaluated an online pilot evidence-based practice project addressing a perinatal nurse education initiative on STS and its correlation with nurse attitudes toward TIC. Participants include perinatal nurses in the United States (n = 29). Two scales measured the program's effect on nurses: the Secondary Traumatic Stress Scale (STSS) and the Attitudes Related to Trauma-Informed Care (ARTIC) scale., Results: A paired t test evaluating pre- and postprogram levels of the STSS showed a decrease in STS (t28 = -3.28, P = .003, Cohen's d = 0.609), the ARTIC scale results showed an increased receptiveness to TIC (t28 = 3.8, P < .001, Cohen's d = 0.706], and a not significant correlation was found between pretest STS and ARTIC scores (Spearman' ρ = -0.248, P = .194)., Conclusion: This program supported a significant reduction in nurses' identification of STS. Future perinatal nurse education can expand to build a standard of TIC that is patient-centered and reduces nurse STS., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Trauma-informed care (TIC) aims to create a safe and supportive healthcare environment that empowers patients and cultivates understanding of the role trauma plays in short-term and long-term health. TIC also has the potential to improve health outcomes and foster clinician wellness. Nurse educators must design evidence-based instruction to develop advanced practice registered nurses (APRNs) who deliver high-quality TIC while also protecting their own wellbeing., Objectives: To identify patterns in subjective viewpoints about TIC among APRN students and describe how those patterns influence their learning experience in an advanced health assessment course., Design: Q methodology was used to explore student perceptions of TIC., Setting: A virtual advanced health assessment course at a large, midwestern university in the United States., Participants: Ninety-five APRN students from six specialty APRN programs., Methods: Students completed an online Q-sort activity by ranking 32 TIC statements according to how well the statements aligned with their own perspectives. Q-sorts were analyzed using factor analysis and narrative responses to open-ended questions., Results: Four factors were extracted that revealed different student viewpoints on TIC and their learning experiences: Comfortable/Confident Learners, Uncomfortable/Apprehensive Learners, Empathetic/Hesitant Learners, and Inexperienced/Uncertain Learners., Conclusions: All students acknowledged the need to learn about TIC to implement it effectively in practice. It is important for faculty to understand the potential range of divergent student viewpoints about TIC and acknowledge, accept, and support students who have anxiety related to learning about TIC., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Hepatitis C Virus (HCV), a blood borne pathogen capable of causing severe liver disease, disproportionately affects veterans in the United States. While there are antiviral medications to treat HCV, stigma and trauma in this population may lead to avoidance of care. Those veterans who do undergo treatment have certain illness representations about HCV and its treatment. They undergo treatment even while facing stigma and trauma. The Common‐Sense Model may be useful in elucidating how such representations, when matched to an appropriate illness prototype, may inform an action plan of how to respond to HCV. An exploration of the illness representations among veterans with HCV, and the effects of stigma and trauma on these representations, may help to explain how they exercise the choice to undergo treatment and may inform interventions to encourage treatment in veterans who have yet to do so. [ABSTRACT FROM AUTHOR]

The lack of a precise and reliable definition of a concept has an impact on how well we can use it. The present study is an evolutionary concept analysis of psychological trauma. Review of all the 2015 publications from the main journals in the area. Our findings indicate that the concept is composed by the attributes death, serious injury, and sexual violence. The majority use is based on the American Psychological Association (APA) manuals, assessed through semistructured interviews and questionnaires. West European Countries and the United States produced almost every research, and this may create a cultural and sample bias. [ABSTRACT FROM AUTHOR]

Introduction: Post‐traumatic stress disorder (PTSD) is a chronic, disabling psychiatric disorder prevalent among civilian and military personnel in the United States (US) and United Kingdom (UK). Current trauma‐focused psychotherapies may place high emotional demands and lengthy treatment commitment that may hinder successful treatment completion for some patients. Accelerated resolution therapy (ART) is an emerging trauma‐focused psychotherapy that is briefer than most current treatments. Materials and Methods: This review describes the ART clinical protocol and theoretical underpinnings, its relationship to current treatments and formal established treatment guidelines and empirical research data. Also presented are new subgroup data for the use of ART among clients with PTSD and concomitant traumatic brain injury (TBI), and among US Special Operations Forces (SOF) personnel with extensive combat‐related trauma exposure. Treatment response was defined as ≥10‐point reduction on the 17‐item PCL‐M (PTSD Checklist). Results: In subgroup analyses, mean treatment with ART consisted of approximately four sessions. Among 202 US service members/veterans, intention‐to‐treat response rates (assuming no response for non‐completers) by TBI status were as follows: no TBI (58.1%, n = 105), mild TBI (60.4%, n = 48), moderate/severe TBI (46.9%, n = 49). Among 141 US service members/veterans, intention‐to‐treat response rates by SOF status were as follows: non‐SOF (54.3%, n = 116), SOF (60.0%, n = 25). Conclusion: The ART protocol aligns closely with established first‐line trauma‐focused psychotherapies and clinical guidelines. It appears to provide frequent clinical relief of symptoms of PTSD in an average of four sessions among military personnel with challenging clinical presentations, including concomitant TBI and extensive operational combat‐related trauma. [ABSTRACT FROM AUTHOR]

Objective: To review the literature regarding systemic lupus erythematosus (SLE) in American Indian/Alaska Native (AI/AN) people and relate prevalence and/or disease severity to our emerging understanding of the biology of trauma and toxic stress., Methods: We conducted a search and review of the literature using search terms "lupus and American Indians" "ACEs and disease outcome" "Biology of Adversity" "lupus and ACE scores," " lupus and childhood abuse." These search criteria were entered into Google Scholar and articles retrieved from PubMed, NBCI. This approach yielded a small numbers of papers used throughout this review. We excluded articles that were not published in a peer reviewed journals, as well as editorial commentaries., Results: In the AI/AN population, SLE shows high prevalence rates and severe disease manifestations, comparable to the African American population. AI/AN populations also have high rates of childhood trauma. Toxic stress and trauma such as those catalogued in the Adverse Childhood Experiences (ACE) study have broad-reaching immunologic and epigenetic effects that are likely to be relevant to our understanding of SLE in AI/AN people., Conclusions: AI/AN people have high rates of SLE. These high rates are likely to be driven by many complex factors, not all of which are genetic. Future research is needed to establish (or refute) a causal connection between the biology of adversity and SLE in socially marginalized and historically traumatized populations., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Posttraumatic stress disorder (PTSD) diagnostic criteria have been criticized for including symptoms that overlap with commonly comorbid disorders, which critics argue undermines the validity of the diagnosis and inflates psychiatric comorbidity rates. In response, the upcoming 11th edition of the International Classification of Diseases (ICD-11) will offer PTSD diagnostic criteria that are intended to promote diagnostic accuracy. However, diagnostic utility analyses have not yet assessed whether these criteria minimize diagnostic errors. The present study examined the diagnostic utility of each PTSD symptom in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for males and females.Methods: Participants were 1,347 individuals enrolled in a longitudinal national registry of returning veterans receiving care at a Department of Veterans Affairs (VA) facility. Doctoral level clinicians assessed all participants using the PTSD module of the Structured Clinical Interview for DSM.Results: Of the 20 symptoms examined, the majority performed in the fair to poor range on test quality indices. Although a few items did perform in the good (or better) range, only half were ICD-11 symptoms. None of the 20 symptoms demonstrated good quality of efficiency. Results demonstrated few sex differences across indices. There were no differences in the proportion of comorbid psychiatric disorders or functional impairment between DSM-5 and ICD-11 criteria.Conclusions: ICD-11 PTSD criteria demonstrate neither greater diagnostic specificity nor reduced rates of comorbidity relative to DSM-5 criteria and, as such, do not perform as intended. Modifications to existing symptoms or new symptoms may improve differential diagnosis. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has resulted in substantial changes in individual and socio-economic factors that may negatively impact sleep health. We examined associations between COVID-19 related distress and sleep among trauma-exposed South Asian adults in the United States. Since a health advantage among foreign-born individuals has been previously noted in the literature (the 'immigrant paradox'), we also explored if generational status (number of generations one's family has been in the U.S.) moderated associations between COVID-19 related distress and sleep health. Participants were 196 trauma-exposed South Asian adults residing in the U.S. (54% male, 63% U.S.-born citizens, average age = 34.51 years), who completed measures of generational status, COVID-19 related distress, trauma exposure, sleep-related impairment (SRI), and sleep disturbances. Greater COVID-19 distress was associated with more sleep disturbances (b = 0.15, p < 0.001) and SRI (b = 0.24, p < 0.001). Generational status was not associated with sleep, nor did it modify associations between COVID-19 distress and sleep. Findings highlight the potential importance of developing interventions to reduce stress and sleep difficulties during the pandemic. Our results did not support the immigration paradox. Future studies are needed to better understand the role of generational status on sleep health across immigrant subgroups., (© 2022 John Wiley & Sons Ltd.)

Experiences of racism occur across a continuum from denial of services to more subtle forms of discrimination and exact a significant toll. These multilevel systems of oppression accumulate as chronic stressors that cause psychological injury conceptualized as racism-based traumatic stress (RBTS). RBTS has overlapping symptoms with posttraumatic stress disorder (PTSD) with the added burden that threats are constantly present. Chronic pain is a public health crisis that is exacerbated by the intersection of racism and health inequities. However, the relationship between RBTS and pain has not yet been explored. To highlight how these phenomena are interlinked, we present Racism ExpoSure and Trauma AccumulatiOn PeRpetuate PAin InequiTIes-AdVocating for ChangE (RESTORATIVE); a novel conceptual model that integrates the models of racism and pain and demonstrates how the shared contribution of trauma symptoms (e.g., RBTS and PTSD) maintains and perpetuates chronic pain for racialized groups in the United States. Visualizing racism and pain as "two halves of the same coin," in which the accumulative effects of numerous events may moderate the severity of RBTS and pain, we emphasize the importance of within-group distinctiveness and intersectionality (overlapping identities). We call on psychologists to lead efforts in applying the RESTORATIVE model, acting as facilitators and advocates for the patient's lived experience with RBTS in clinical pain care teams. To assist with this goal, we offer suggestions for provider and researcher antiracism education, assessment of RBTS in pain populations, and discuss how cultural humility is a central component in implementing the RESTORATIVE model. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The author questions the conceptual basis of the unrepresented , a set of terms including: the unstructured unconscious, figurability, and reverie . Because this terminology proposes a profoundly different metapsychology than Freud developed, the author contextualizes the fate of Freud's metapsychology in America and how it was confused with the authority of the classical analyst. Then excerpts of texts by Howard B. Levine, one of the main proponents of the unrepresented, are analyzed to show that the decisive element in Levine's claim of creating meaning for patients is figurability . The author does a close reading and elaboration of French analyst Laurence Kahn's very thoughtful critique of figurability. Kahn's scholarship is brought to bear on Freud's metapsychology, showing how what is at stake are presentations not figures. Figuration and reverie are founded on the projection of referential and narrative coherence onto what is presented by the patient. But the unconscious does exactly the opposite, it presents to consciousness its noncoherent derivatives (presentations). Kahn illuminates Freud's mode of thinking using the critique of figurability as a springboard to show us what is essential in conceptualizing unconscious functioning.

The findings presented in this article come from a two-generation study exploring the psychological impact of trauma among American Indian/Alaskan Native (AI/AN) families and its perceived relationship to substance abuse across generations. Psychological traumas and stressors found to be pervasive across generations included physical and sexual abuse as well as persistent discrimination and racism, such as fear of having children removed from the home. A noteworthy finding was a decrease in reports of childhood traumas across the two generations within this sample. Implications and recommendations for clinicians and researchers working with AI populations are discussed in light of the findings. [ABSTRACT FROM PUBLISHER]

Reports an error in "Acculturation, coping, and PTSD in Hispanic 9/11 rescue and recovery workers" by Dianne Ciro, Robert H. Pietrzak, Rufina J. Lee, Janice Rodriguez, Ritika Singh, Ryan Salim, Clyde B. Schechter, Steven M. Southwick, Michael Crane, Denise J. Harrison, Benjamin J. Luft, Jacqueline M. Moline, Iris G. Udasin and Adriana Feder ( Psychological Trauma: Theory, Research, Practice, and Policy , 2021[Jan], Vol 13[1], 84-93). In the original article, the following acknowledgment of funding was missing in the author note: "This study was supported by the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (Research Contract 200-2011-41919). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC/NIOSH. This funding source had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication." The online version of this article has been corrected. (The following abstract of the original article appeared in record 2021-00489-003). Objective: Research examining the responders of the World Trade Center terrorist attacks of 9/11 has found that Hispanic responders are at greater risk for posttraumatic stress disorder (PTSD) than non-Hispanic White responders. However, no studies have examined how acculturation may influence the relationship between coping and PTSD in Hispanic 9/11 responders. This novel study is the first to examine differences in coping and PTSD among Hispanic responders by level of acculturation. Methods: The sample is composed of 845 Hispanic 9/11 responders who were seen at the World Trade Center Health Program and participated in a web-based survey. Using logistic and multiple linear regression, we examined how acculturation is related to their coping strategies and risk for PTSD. We also tested for interaction to examine whether level of acculturation moderated the relationship between coping and PTSD symptom severity. Results: Key findings revealed that higher acculturation is associated with the use of substances, venting, and humor to cope, while lower acculturation is associated with the use of active coping and self-distraction in this sample. We also found that less acculturated responders were more likely to experience more severe PTSD. Lastly, our findings revealed that Hispanics who are more acculturated and used substances to cope had more severe PTSD than less acculturated responders. Conclusion: These findings highlight the need to consider the role of acculturation in Hispanic responders' coping and PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

In this paper, I explore the kinds of psychological trauma experienced by polio patients in the mid-twentieth century in the United States. I argue that the trauma was the result of the experience of sudden paralysis, the conditions under which patients were treated, and the expectations for rehabilitation derived from the psychosocial context of the period. Psychiatric and psychological counseling in hospitals was only beginning to be offered in this period, and most polio patients received little or no counseling or assistance in dealing with their psychological problems. Contemporary psychological studies suggest that many polio patients suffered from psychological problems but that they were relatively mild. However, compared with the many studies of the physical problems of polio patients, there were relatively few studies of the psychological issues associated with the disease. The narratives and memoirs of polio survivors vividly testify to the psychological burden they experienced as patients during both the acute phase of the illness and during rehabilitation. [ABSTRACT FROM AUTHOR]

Following September 11 in the US and July 7 in the UK, the threat to civilians from terrorist attack has become real yet considerable disagreement exists about how people might respond. The effect of aerial bombing on the public's morale during the Second World War and the incidence of psychiatric casualties have been explored to provide reference points for the current terrorist threat. Systematic study of restricted government investigations and intelligence reports into the effect of air-raids on major British towns and contemporary medical publications have shown that panic was a rare phenomenon and arose in defined circumstances. Morale fluctuated according to the intensity of attacks, preparedness and popular perceptions of how successfully the war was being conducted. Resilience was in part a function of the active involvement of the public in its own defence but also reflected the inability of German bombers to deliver a concentrated attack over a wide area. Most civilians, by their very numbers, were likely to survive. Inappropriate or excessive precautionary measures may serve to weaken society's natural bonds and, in turn, create anxious and avoidant behaviour. Weapons that tap into contemporary health fears have the greatest psychological impact. Efforts by government to engage the public not only build trust but may also make an effective contribution to the campaign against terrorism. [ABSTRACT FROM AUTHOR]

Residents of urban American neighborhoods facing economic hardship often experience individual and collective adversities at high levels. This study explores how racially diverse adults experience stress, adversity, and trauma, and how they cope and heal in the context of their environment. Following a critical realist grounded theory methodology, four focus groups were conducted with African American, White and Latinx participants (N = 21) within an employment service program. Participants identified key stressors ranging from financial and job challenges, violence, and trauma. To cope with and heal from adversity, they practiced positivity, named trauma and its effects, sought social connection, envisioned community-based resources, and addressed structural and systemic barriers. The data generated a theory of "a mutual process of healing self and healing the community" through intrapersonal, interpersonal, and structural change. The results of this study indicate a need for peer-led, community-engaged initiatives and holistic, trauma-informed, healing-centered practices., (© 2021 Wiley Periodicals LLC.)

Background: Asylum seekers report exposure to human rights violations associated with a range of psychological and medical sequelae. Clinical evaluators can provide forensic evaluations that document evidence associated with their reports of persecution. The aim of this study was to characterize the forms of abuse experienced by asylum seekers, the psychological consequences of abuse, and the frequency with which clinician-evaluators found evidence that corroborated asylum seekers' reports., Method: We completed a retrospective chart review of 121 asylum seekers who received pro bono medical-legal evaluations through a human rights program and analyzed data using the constant comparative method., Results: Eighty-eight percent of the clients reported experiencing multiple human rights abuses. Ninety-one percent of the clients who received psychological evaluations presented with symptoms associated with depression, anxiety, or trauma and stressor-related disorders. Clinician-evaluators found physical or psychological evidence consistent with the clients' reports in 97% of cases. Forms, perpetrators, and psychological consequences of abuse varied significantly by gender and geographic region., Discussion: Asylum seekers report diverse forms of persecution in their countries of origin that differ by gender and geographic region. Clinician-evaluators overwhelmingly found physical and psychological evidence consistent with the asylum seekers' accounts of persecution.

Background Sexual assault is a risk factor for poor mental health, yet its relationship to cardiovascular disease risk is not understood. We tested whether women with a sexual assault history had greater carotid atherosclerosis levels and progression over midlife. Methods and Results A total of 169 non-smoking, cardiovascular disease-free women aged 40 to 60 years were assessed twice over 5 years. At each point, women completed questionnaires, physical measures, phlebotomy, and carotid ultrasounds. Associations between sexual assault and carotid plaque level (score 0, 1, ≥2) and progression (score change) were assessed in multinomial logistic and linear regression models, adjusted for age, race/ethnicity, education, body mass index, blood pressure, lipids, insulin resistance, and additionally depression/post-traumatic stress symptoms; 28% of the women reported a sexual assault history. Relative to non-exposed women, women with a sexual assault history had an over 4-fold odds of a plaque score of ≥2 at baseline (≥2, odds ratio [OR] [95% CI]=4.35 [1.48-12.79], P =0.008; 1, OR [95% CI]=0.49 [0.12-1.97], P =0.32, versus no plaque; multivariable); and an over 3-fold odds of plaque ≥2 at follow-up (≥2, OR [95% CI]=3.65 [1.40-9.51], P =0.008; 1, OR [95% CI]=1.52 [0.46-4.99], P =0.49, versus no plaque; multivariable). Women with a sexual assault history also had an over 3-folds greater odds of a plaque score progression of ≥2 (OR [95% CI]=3.48[1.11-10.93], P =0.033, multivariable). Neither depression nor post-traumatic symptoms were related to plaque. Conclusions Sexual assault is associated with greater carotid atherosclerosis level and progression over midlife. Associations were not explained by standard cardiovascular disease risk factors. Future work should consider whether sexual assault prevention reduces women's cardiovascular disease risk.

A traumatic life experience in childhood is a fundamental risk factor of numerous psychiatric disorders. Recently, studies try to evaluate the mental health consequences on victims' offspring, but few psychiatric disorders were examined, and whether these results apply to the general population remains unknown. In this study, we use the National Epidemiologic Survey on Alcohol and Related Conditions, a large representative sample of American population, in order to estimate the impact on the offspring of a traumatic experience in parents. Besides, we use a well-known risk factor for offspring's psychiatric disorder: a familial history of a psychiatric disorder, in order to compare and assess the importance of parental traumatism as a risk factor for the offspring. Our results show that the five psychiatric disorders studied, alcohol use disorder, substance use disorder, mood disorder, antisocial personality disorder and anxiety disorder, are more prevalent in the offspring, when at least one parent report a traumatic life event in his own childhood. Moreover, the magnitude of this risk factor is close to the magnitude of having a parental history of psychiatric disorder., Competing Interests: Declarations of competing interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

We present two datasets from a project about the relationship between traumatic life experiences and religiosity. These include data from 1,754 individuals in the United States (n = 322), Brazil (n = 205), China (n = 202), India (n = 205), Indonesia (n = 205), Russia (n = 205), Thailand (n = 205), and Turkey (n = 205). Surveys were consistent across samples: they include measures of traumatic life experiences, negative affective traits, existential security, life satisfaction, death anxiety, and various religious beliefs, attitudes, and behaviours. Psychometric evaluations of measures of supernatural belief and death anxiety were conducted.

People experiencing homelessness often have a history of trauma, and losing one's home is a traumatic event. The trauma of living in emergency shelters and on the streets uniquely impacts older adults, whose experiences of homelessness increase the likelihood of multiple health conditions and premature aging. This paper includes data from 18 men, aged 50 and older, who had experienced multiple instances of homelessness, as part of a larger study to understand the return path to homelessness from permanent housing. When participants spoke with us about their failure to be in housing, their inability to free themselves from reoccurring homelessness could not be discussed without talking about their trauma. Participants spoke of trauma in early life, perhaps precipitating homelessness, as well as traumatic experiences while homeless. The men discussed feeling imprisoned by the systemic issues around homelessness, facing mistreatment by service providers, and being exposed to external threats in their lives on the streets, including violence. Findings from this study lend themselves to the explicit need for trauma-informed care and supportive services that are sensitive to the urgency of homelessness as it is experienced by men in late life.

Introduction: The purpose of this qualitative meta-synthesis was to understand the labor and birth experiences of immigrant women in countries of resettlement who have a history of female genital cutting (FGC), also known as female genital mutilation or female circumcision., Methods: We used a meta-ethnography approach to synthesize the literature on this topic. We searched PubMed, Embase, Web of Science, CINAHL, PsycINFO, and Sociological Abstracts databases from inception to May 2016 using the search terms female genital cutting, female circumcision, clitorectomy, clitoridectomy, pharaonic circumcision, genital circumcision, female genital mutilation, infibulation, and deinfibulation. Our inclusion criteria were 1) peer-reviewed, original qualitative research; 2) focused on populations affected by FGC or their health care providers; 3) conducted in a country where FGC is not documented as an indigenous practice; 4) English language; and 5) included a description of postmigratory labor and birth experiences of women affected by FGC. Fourteen articles were included., Results: Two new syntheses emerged from our sample of studies including African immigrant women primarily resettled in Europe and the United States. First, birth after FGC in the context of resettlement included pain and anxiety, and has the potential to retraumatize. Second, while women experienced nostalgia for familiar traditions and perceived disrespect in their new setting, they questioned traditions, including the role of FGC, in their and their daughters' lives., Discussion: The negative birth experiences of women affected by FGC highlight the need to improve care for this population. Health care professionals can serve as a source of support for women affected by FGC by acknowledging and addressing FGC in their care and actively listening to their perspectives and concerns., (© 2018 by the American College of Nurse-Midwives.)

Background: Posttraumatic stress disorder (PTSD) is prevalent in both homeless and nonhomeless veterans., Purpose: To examine unique characteristics of being homeless that may influence PTSD treatment completion and clinical success., Methods: Twenty-three veterans who were homeless and residing in a homeless shelter, along with 94 veterans from the community, were enrolled to receive one to five sessions of Accelerated Resolution Therapy (ART), an emerging trauma-focused therapy for symptoms of PTSD. Rates of treatment completion with ART and acute and 6-month change in symptoms of PTSD were compared in an observational (nonrandomized) manner by housing status., Findings: Compared to veterans recruited from the community, veterans residing in the homeless shelter were older and presented with more extensive psychopathology yet had less combat exposure while being more likely to have experienced sexual assault. Rates of treatment completion were 52.2% (12 of 23) among homeless veterans compared to 81.9% (77 of 94) among veterans from the community (p = .005). Among treatment completers, both groups received an average of four sessions of ART. Reduction of symptoms of PTSD was substantial and nonsignificantly greater among homeless veterans vs. those treated from the community (p = .14), as were comorbidity reductions in depression, anxiety, sleep quality, pain, and improved quality of life. Results at 6-month posttreatment follow-up were similar., Conclusions: Although limited by small sample size and a nonrandomized design, ART appears to be an effective, brief treatment for symptoms of PTSD among veterans residing in a homeless shelter. However, development of effective strategies to maximize treatment completion among homeless veterans is needed., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: Little is known about the effect of cumulative psychological trauma on health outcomes in patients with cardiovascular disease. The objective of this study was to prospectively examine the association between lifetime trauma exposure and recurrent cardiovascular events or all-cause mortality in patients with existing cardiovascular disease., Methods: A total of 1021 men and women with cardiovascular disease were recruited in 2000 to 2002 and followed annually. Trauma history and psychiatric comorbidities were assessed at baseline using the Computerized Diagnostic Interview Schedule for DSM-IV. Health behaviors were assessed using standardized questionnaires. Outcome data were collected annually, and all medical records were reviewed by two independent, blinded physician adjudicators. We used Cox proportional hazards models to evaluate the association between lifetime trauma exposure and the composite outcome of cardiovascular events and all-cause mortality., Results: During an average of 7.5 years of follow-up, there were 503 cardiovascular events and deaths. Compared with the 251 participants in the lowest trauma exposure quartile, the 256 participants in the highest exposure quartile had a 38% greater risk of adverse outcomes (hazard ratio = 1.38, 95% confidence interval = 1.06-1.81), adjusted for age, sex, race, income, education, depression, posttraumatic stress disorder, generalized anxiety disorder, smoking, physical inactivity, and illicit drug abuse., Conclusions: Cumulative exposure to psychological trauma was associated with an increased risk of recurrent cardiovascular events and mortality, independent of psychiatric comorbidities and health behaviors. These data add to a growing literature showing enduring effects of repeated trauma exposure on health that are independent of trauma-related psychiatric disorders such as depression and posttraumatic stress disorder.