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Aggression after military deployment is a common occurrence in veterans. Neurobiological research has shown that aggression is associated with a dysfunction in a network connecting brain regions implicated in threat processing and emotion regulation. However, aggression may also be related to deficits in networks underlying communication and social cognition. The uncinate and arcuate fasciculi are integral to these networks, thus studying potential abnormalities in these white matter connections can further our understanding of anger and aggression problems in military veterans. Here, we use diffusion tensor imaging tractography to investigate white matter microstructural properties of the uncinate fasciculus and the arcuate fasciculus in veterans with and without anger and aggression problems. A control tract, the parahippocampal cingulum was also included in the analyses. More specifically, fractional anisotropy (FA) estimates are derived along the trajectory from all fiber pathways and compared between both groups. No between-group FA differences are observed for the uncinate fasciculus and the cingulum, however parts of the arcuate fasciculus show a significantly lower FA in the group of veterans with aggression and anger problems. Our data suggest that abnormalities in arcuate fasciculus white matter connectivity that are related to self-regulation may play an important role in the etiology of anger and aggression in military veterans. Electronic supplementary material The online version of this article (10.1007/s00429-019-02016-2) contains supplementary material, which is available to authorized users.

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).

AimTo evaluate the feasibility and effect of a 10-session creative arts in psychotherapy group programme on posttraumatic stress symptoms, behavioural problems, and posttraumatic growth, in children who experienced a traumatic event.DesignA multicentre non-randomized controlled trial with a treatment and a control condition conducted in South Africa (4 sites).Methods125 children aged 7 to 13 years were assigned either to the treatment condition receiving creative arts in psychotherapy or a control condition with a low-level supportive programme without treatment. Attrition rates were 63.4% and in total 47 children completed the programme and questionnaires assessing posttraumatic stress, posttraumatic growth and behaviour problems both at baseline and follow-up; 23 in the treatment group and 24 in the control group. Adjusted mean differences were analysed using ANCOVA with bootstrapping.ResultsResults showed that both hyperarousal symptoms (d = 0.61) and avoidance symptoms (d = 0.41) decreased more in the treatment group compared to the control group. There was no significant effect of the intervention found for reported levels of behavioural problems and posttraumatic growth.ConclusionIn spite of severe challenges implementing and executing this pioneering study in underprivileged areas of South Africa, support was found for creative arts in psychotherapy reducing hyperarousal and avoidance symptoms, but not for other symptoms. Valuable lessons were learned on feasibility of implementing this intervention in a developing context.

Contains fulltext : 199253.pdf (Publisher’s version ) (Closed access) Research showed that more than 30% of patients with Posttraumatic Stress Disorder (PTSD) do not benefit from evidence-based treatments: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Eye Movement Desensitization and Reprocessing (EMDR). These are patients with prolonged and multiple traumatization, with poor verbal memory, and patients with emotional over-modulation. Retelling traumatic experiences in detail is poorly tolerated by these patients and might be a reason for not starting or not completing the recommended treatments. Due to lack of evidence, no alternative treatments are recommended yet. Art therapy may offer an alternative and suitable treatment, because the nonverbal and experiential character of art therapy appears to be an appropriate approach to the often wordless and visual nature of traumatic memories. The objective of this pilot study was to test the acceptability, feasibility, and applicability of trauma-focused art therapy for adults with PTSD due to multiple and prolonged traumatization (patients with early childhood traumatization and refugees from different cultures). Another objective was to identify the preliminary effectiveness of art therapy. Results showed willingness to participate and adherence to treatment of patients. Therapists considered trauma-focused art therapy feasible and applicable and patients reported beneficial effects, such as more relaxation, externalization of memories and emotions into artwork, less intrusive thoughts of traumatic experiences and more confidence in the future. The preliminary findings on PTSD symptom severity showed a decrease of symptoms in some participants, and an increase of symptoms in other participants. Further research into the effectiveness of art therapy and PTSD is needed. 17 p.

Background Previous research has indicated that one out of ten naturally bereaved individuals develops prolonged grief disorder (PGD). Less is known about the prevalence of PGD following unnatural deaths, such as accidents, disasters, suicides, or homicides. The aim of this study was to compute the pooled prevalence of PGD and to determine possible causes of its varied estimates. Methods A literature search was conducted in PsycINFO, Ovid Medline, PILOTS, Embase, Web of Science, and CINAHL. A meta-analysis using random effects models was performed to calculate the pooled prevalence rate of PGD. Multivariate meta-regression was used to explore heterogeneity among the studies. Results Twenty-five articles met eligibility criteria. The random-effects pooled prevalence was 49%, 95% CI [33.6, 65.4]. Death of only child, violent killings and non-western study location were associated with a higher PGD prevalence. A longer time since loss and a loss in a natural disaster were associated with a lower PGD prevalence. Limitations These findings should be interpreted with caution, because of the heterogeneity in study methodology. Conclusions This first meta-analysis of PGD following unnatural losses indicated that nearly half of the bereaved adults experienced PGD. This illustrates the importance of assessing PGD in individuals affected by loss and trauma.

Background: To explore cognitive recovery during and after Narrative Exposure Therapy from the patient’s perspective, autobiographical material and interview responses were qualitatively analyzed. Method: Using a framework of cognitive development, patient-reported outcomes from four senior Dutch citizens (57–81 years of age) were examined. All participants reported multiple traumatic experiences, including adverse childhood experiences. Results: During and after treatment, the participants reported gradual changes in posttraumatic feelings, cognitions, and treatment-related perceptions toward increased self-awareness and self-esteem. Conclusions: A framework of cognitive development provides a comprehensive understanding of how older adults deal with childhood trauma and its consequences.

In this article we introduce a Creative Arts in Psychotherapy (CAP) treatment protocol for children who have been traumatized, aiming to enhance their psychological wellbeing and strengthening positive development. The protocol combines principles of group dynamics and multimodal arts activities in order to facilitate healing through the three stages of the trauma recovery model; creating a safe space, telling the trauma story, and preparing the children to return to the community. The programme takes place over a period often 90-minute sessions. The CAP therapeutic process is designed to be run in groups of six to eight participants in the age between 8 to 12 years. The described protocol aims to bring more uniformity in the management of child trauma in multicultural and under-resourced communities. It can be carried out by any qualified health care professional, where clients are seeking help and relief.

BackgroundEvidence-based treatment and age-specific services are required to address the needs of trauma-affected older populations. Narrative exposure therapy (NET) may present an appropriate treatment approach for this population since it provides prolonged exposure in a lifespan perspective. As yet, however, no trial on this intervention has been conducted with older adults from Western Europe.AimsExamining the efficacy of NET in a sample of older adults.MethodOut-patients with post-traumatic stress disorder (PTSD), aged 55 years and over, were randomly assigned to either 11 sessions of NET (n = 18) or 11 sessions of present-centred therapy (PCT) (n = 15) and assessed on the Clinician-Administered PTSD Scale (CAPS) pre-treatment, post-treatment and at follow-up. Total scores as well as symptom scores (re-experience, avoidance and hyperarousal) were evaluated.ResultsUsing a piecewise mixed-effects growth model, at post-treatment a medium between-treatment effect size for CAPS total score (Cohen's d = 0.44) was found, favouring PCT. At follow-up, however, the between-treatment differences were non-significant. Drop-out rates were low (NET 6.7%, PCT 14.3%) and no participant dropped out of the study because of increased distress.ConclusionsBoth NET and PCT appear to be safe and efficacious treatments with older adults: PCT is non-intrusive and NET allows for imaginal exposure in a lifespan perspective. By selectively providing these approaches in clinical practice, patient matching can be optimised.Declaration of interestNone.

Individuals diagnosed with posttraumatic stress disorder (PTSD) show remarkably different symptom presentations. Identification of diagnostic profiles of PTSD may contribute to knowledge about treatment modifications to enhance treatment effectiveness. The present study aimed to identify symptom severity classes among 236 Dutch veterans based on a broad range of psychopathology outcomes, including PTSD, using Latent Profile Analysis (LPA). Moreover, multinomial logistic regression was used to test whether class membership could be predicted by the number and characteristics of traumatic event types, coping and personality dimensions. LPA identified three classes of individuals, defined as average, severe, and highly severe symptom severity classes, respectively. No qualitative differences in the symptom dimensions emerged between classes. Veterans with higher amounts of traumatic experiences and specifically with regard to lack of basic human needs, as well as those using more avoidant and problem-focused coping strategies and with more dysfunctional personality characteristics regarding neuroticism and agreeableness were significantly more often in the severe and/or highly severe symptom classes. In conclusion, general symptom severity was found to be an important diagnostic characteristic in this population. Integrated treatments targeting the broad spectrum of mental health problems may be of importance in treating patients that show low therapeutic recovery.

Background Although bereavement is likely a common stressor among patients referred to a psychotrauma clinic, no study has yet examined the co-occurrence and relationships between symptoms of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder symptoms in this population. Method In a sample of patients seeking treatment following psychological trauma (n = 458), we used latent class analysis to identify classes of patients sharing the same profile of PGD, PTSD, and depression symptoms. We then used network analysis to investigate the relationships among these symptoms and with loss-related variables. Results Most participants (65%) were members of a class that exhibited elevated endorsement of PGD symptoms. PGD, PTSD, and depression symptoms hung together as highly overlapping but distinguishable communities of symptoms. Symptoms related to social isolation and diminished sense of self bridged these communities. Violent loss was associated with more difficulty accepting the loss. The loss of close kin was most strongly associated with difficulty moving on in life. Conclusions PGD symptoms are common in trauma-exposed bereaved adults and closely associated with symptoms of PTSD and depression, illustrating the importance of assessing bereavement and PGD symptoms in those seeking treatment following trauma.

Background Child maltreatment (CM) is associated with long-lasting poor health outcomes, as well as increased levels of disability and health-services consumption across the life-span. However, less is known about how CM consequences can be reduced during adulthood. We investigated professional opinions on how to mitigate long-term consequences of CM in a public health (PH) perspective. Methods Using the Delphi method in three rounds, we inquired 91 professionals, mostly European researchers and clinicians about potential PH actions to mitigate CM consequences during adulthood. Results Most experts agreed that PH actions are needed. Increasing community awareness and training emotional regulation in affected adults were prioritized strategies. Enlarging curricular knowledge about CM for professionals and developing evidence-based interventions were considered preferred methods. Reducing the barriers for access to interventions for adults, such as those provided by trauma-informed services were also suggested. Participants highlighted the possibility to reduce CM consequences across generations as a significant benefit. Conclusions PH programmes to reduce the burden of CM can be enhanced by specific actions to facilitate the recognition of difficulties in affected adults and to expand the availability of helpful resources. The application of these programmes could be assisted by the use of modern information-technology.

Relationships between the corticotropin-releasing hormone receptor 1 (CRHR1) [rs878886] and serotonin transporter promoter polymorphism (5-HTTLPR), with resilience and satisfaction with life were examined in 172 adolescents; 70 refugee adolescents living in the Netherlands and 102 non-refugee (Dutch) adolescents. Genetic variation in the CRHR1 was related with self-reported resilience and satisfaction with life, while the 5-HTTLPR polymorphism was not. These findings did not depend on being a refugee or a non-refugee (Dutch) adolescent and did hold after accounting for age, number of exposures to potentially traumatic events and gender. This implies that adolescents who are G-allele carriers of CRHR1 (rs878886) might be more susceptible to mental health problems following trauma, further suggesting innate differences in CRHR1 as a factor in resilience.

The 12-month and lifetime prevalence of posttraumatic stress disorder (PTSD) in different country populations has been assessed while using clinical interviews. Because this methodology is relatively time-consuming and resource-intensive, disaster health researchers adopted instruments, like the Trauma Screening Questionnaire (TSQ). This study (1) used the TSQ to estimate the lifetime prevalence of potentially traumatic events and other life events (PTE/OLEs) and the one-week prevalence of subsequent reactions indicative for PTSD (based on DSM-IV PTSD criteria) in The Netherlands and (2) investigated risk and protective factors for the development of PTSD to overcome the lack of baseline comparison data on general populations and subgroups. The data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a representative study in the Dutch general population aged 18 to 64 years (N = 6646), using face-to-face interviews. Logistic regression modeling was used to assess PTSD correlates. The lifetime PTE/OLE prevalence was 71.1%. Among exposed subjects, one-week PTSD prevalence was estimated at 2.0%. The correlates of PTSD were female gender, Moroccan, or Turkish ethnicity, and exposure to sexual abuse and exposure time less than four years ago. The results are discussed in relation to earlier 12-month and lifetime general population prevalence of PTSD in the Netherlands and other countries, and TSQ-based disaster studies. General population replications can provide additional TSQ baseline data, and shed light on exposure and PTSD prevalence assessed with different instruments.

Objectives Little is known about the 12-month prevalence of potentially traumatic events (PTEs) and to what extent the type of PTE is a risk factor for post-event lack of social support. In addition, it is largely unknown if pre-event mental health problems and loneliness, and demographics are risk factors for a lack of support. Aim of the present prospective study is to fill these gaps in evidence-based knowledge. Methods A survey was conducted among a large random sample of the Dutch adult population (i.e. the longitudinal LISS panel) in March-April 2018, and linked with pre-event mental health and loneliness data from surveys conducted in 2016 (n = 5,879). We distinguished four forms of perceived social support: emotional and esteem support, and social recognition and general disapproval. Results Loss of a significant other and/or colleague (28%) was the most prevalent 12-month PTE. The 12-month prevalence of violence, accidents and/or, and theft-related events was 13%. Multivariate logistic regression analyses revealed no differences in lack of emotional and esteem support, or in lack of recognition across non-death PTEs and death-related PTEs. However, victims of threat and physical (sexual) violence more often faced disapproval than those affected by burglary and accidents. Results furthermore showed that pre-event mental health problems, pre-event loneliness and stress during the PTE were important independent predictors of forms of support and acknowledgment. Affected individuals with a non-Western background more often lacked support and acknowledgment. Conclusions Many adults are confronted with a PTE during a year. In general, pre-event factors and stress during the event are better predictors of a perceived lack of support and acknowledgment than type of event. Early screening programs should especially assess pre-event mental health and loneliness, besides levels of stress during the event, to identify affected people who are at risk for a lack of social support and acknowledgment.

Background: To date, most studies on the mental health of refugees in Europe have focused on the prevalence and treatment of psychopathology. Little is known about those who illegally reside in the host country, referred to, in the Netherlands, as undocumented asylum seekers. There are indications that mental health and psychosocial problems are more prevalent in this group than among refugees in general, with unsatisfactory treatment outcomes. Objective: To describe characteristics and mental health and psychosocial problems of undocumented asylum seekers, and to establish the need for, and feasibility of, a tailored treatment approach. Method: Based on a literature review and extensive clinical experience, common mental health and psychosocial problems and accessibility of care for undocumented asylum seekers are established, as well as the common treatment approach in the Netherlands. A tailored treatment programme and experiences with its implementation are described. Results: Mental health and psychosocial problems are highly prevalent among undocumented asylum seekers, and access to care is limited. In addition, treatment in the Netherlands, if provided, is mostly insufficient yet prolonged. Given the specific psychosocial problems and living conditions of undocumented asylum seekers, a necessary criterion to enable adequate and evidence-based treatment provision is acknowledgement of their distinct needs. A tailored treatment programme as currently implemented in the Netherlands appears to meet this criterion and be feasible under certain conditions. Collaboration between mental health care providers and involved social service and governmental parties by regular meetings, though complicated, is a relevant element. Conclusions: Even though undocumented asylum seekers are illegally residing in a country, medical ethics and the human rights perspective necessitate for adequate and evidence-based treatment for those among them with mental health problems. The tailored treatment approach presented here suggests that, notwithstanding factors complicating care provision which require specific attention, this is feasible.

Although the literature on positive adjustment following traumatic events is growing, only a few studies have examined this phenomenon in young refugees. Using the social-ecological framework, the aim of this study was to identify factors and processes that according to young refugees promote their resilience. A total of 16 treatment-seeking refugees aged 13–21 years, living in the Netherlands, were interviewed. Data analysis revealed four resilience strategies: (1) acting autonomously, (2) performing at school, (3) perceiving support from peers and parents, and (4) participating in the new society. These strategies interacted with one another and demonstrated the interrelatedness between individuals and their social context. Having to wait long for a residence permit and being older appeared to negatively influence participants’ resilience strategies. These findings suggest that resilience refers to a dynamic process that is context and time specific.

Introduction Prehospital providers are at increased risk for psychological distress. Support at work after critical incidents is believed to be important for providers, but current guidelines are in need of more scientific evidence. This study aimed to investigate: (1) to what extent prehospital providers experience support at work; (2) whether support at work is directly associated with lower distress and (3) whether availability of a formal peer support system is related to lower distress via perceived colleague support. Methods This cross-sectional study surveyed prehospital providers from eight western industrialised countries between June and November 2014. A supportive work environment was operationalised as perceived management and colleague support (Job Content Questionnaire), availability of a formal peer support system and having enough time to recover after critical incidents. The outcome variable was psychological distress (Kessler 10). We conducted multiple linear regression analyses and mediation analysis. Results Of the 813 respondents, more than half (56.2%) were at moderate to high risk of psychological distress. Participants did not consistently report support at work (eg, 39.4% were not aware of formal peer support). Perceived management support (b (unstandardised regression coefficient)=−0.01, 95% CI −0.01 to 0.00), having enough time to recover after critical incidents (b=−0.07, 95% CI −0.09 to −0.04) and perceived colleague support (b=−0.01, 95% CI −0.01 to 0.00) were related to lower distress. Availability of formal peer support was indirectly related to lower distress via increased perceived colleague support (β=−0.04, 95% CI −0.02 to −0.01). Conclusions Prehospital providers at risk of psychological distress may benefit from support from colleagues and management and from having time to recover after critical incidents. Formal peer support may assist providers by increasing their sense of support from colleagues. These findings need to be verified in a longitudinal design.

Disasters are associated with a substantial psychosocial burden for affected individuals (including first responders) and communities. Knowledge about how to address these risks and problems is valuable for societies worldwide. Decades of research into post-disaster psychosocial care has resulted in various recommendations and general guidelines. However, as CBRN (chemical, biological, radiological, nuclear) events form a distinctive theme in emergency planning and disaster preparedness, it is important to systematically explore their implications for psychosocial care. The aim of this study is to answer two questions: 1). To what extent does psychosocial care in the case of CBRN events differ from other types of events? 2). How strong is the scientific evidence for the effectiveness of psychosocial care interventions in the context of a CBRN event? A systematic literature review was conducted. Searches were performed in Medline, PsychINFO, Embase and PILOTS. Studies since January 2000 were included and evaluated by independent reviewers. The 39 included studies contain recommendations, primarily based on unsystematic literature reviews, qualitative research and expert opinions. Recommendations address: 1) public risk- and crisis communication, 2) training, education and exercise of responders, 3) support, and 4) psychosocial counselling and care to citizens and responders. Although none of the studies meet the design criteria for effectiveness research, a substantial amount of consensus exists on aspects relevant to CBRN related psychosocial care. Recommendations are similar or complementary to general post-disaster psychosocial care guidelines. Notable differences are the emphasis on risk communication and specific preparation needs. Relevant recurring topics are uncertainty about contamination and health effects, how people will overwhelm health care systems, and the possibility that professionals are less likely to respond. However, the lack of evidence on effectiveness makes it necessary to be careful with recommendations. More evaluation research is absolutely needed. Keywords: Psychosocial care, CBRN events, Guidelines, Systematic review, Disasters, Mental health

Background: In 2009, an aeroplane crashed near Amsterdam. To remedy unmet mental health needs, active outreach was used to identify victims at risk for post-traumatic stress disorder (PTSD) and depression. Objective: The active outreach strategy was evaluated by examining the accuracy of screening methods in predicting PTSD and depression, self-reported treatment needs, and the extent to which perceived treatment needs predict trajectories of PTSD. Method: In 112 adult survivors, semi-structured telephone interviews were held at 2 (T1, n = 76), 9 (T2, n = 77) and 44 months (T3, n = 55) after the crash. The Trauma Screening Questionnaire (TSQ) and the Patient Health Questionnaire-2 (PHQ-2) measured symptoms of PTSD and depression, respectively. At T3, a clinical interview assessed PTSD and depression diagnoses. Based on the TSQ scores at the three time-points, participants were grouped into five 'trajectories': resilient (n = 38), chronic (n = 30), recovery (n = 9), delayed onset (n = 9) and relapse (n = 3). Results: The TSQ accurately predicted PTSD at T3 (sensitivity: .75-1.00; specificity: .79-.90). The PHQ-2 showed modest accuracy (sensitivity: .38-.89; specificity: .67-.90). Both measures provided low positive predictive values (TSQ: 0.57; PHQ-2: .50 at T3). A number of participants reported unmet treatment needs (T1: 32.9%; T2: 19.5%; T3: 10.9%). Reporting unmet needs at T2 was more often assigned to a chronic PTSD trajectory compared to reporting no needs (p < .01). Conclusions: The prevalence of unmet needs at 44 months after the crash within a chronic PTSD trajectory indicated that active outreach may be warranted. Nevertheless, although the TSQ was accurate, many participants screening positive did not develop PTSD. This implies that, although active outreach may benefit those with unmet needs, it also has its costs in terms of possible unnecessary clinical assessments.Spanish abstract:Antecedentes: En 2009 ocurrió un accidente aéreo cerca de Amsterdam. Para subsanar las necesidades de salud mental insatisfechas, se usó contacto activo para identificar víctimas en riesgo de trastorno de estrés postraumático (TEPT) y depresión.Objetivo: Evaluar esta estrategia examinando: 1) la precisión de los métodos de tamizaje para predecir TEPT Y depresión, 2) necesidades de tratamiento auto-reportadas, y 3) el grado en que las necesidades de tratamiento percibidas predicen las trayectorias de TEPT.Métodos: En 112 adultos sobrevivientes, se realizaron entrevistas telefónicas semi-estructuradas a los 2 (T1, n=76), 9 (T2, n=77) y 44 meses (T3, n=55) posteriores al accidente. El Cuestionario de Tamizaje de Trauma (TSQ por sus siglas en inglés) y el Cuestionario de Salud de los Pacientes-2 (PHQ-2 por sus siglas en inglés) midieron síntomas de TEPT y depresión, respectivamente. En T3, se evaluó con una entrevista clínica los diagnósticos de TEPT y depresión. En base a los puntajes de TSQ en los 3 puntos de tiempo, los participantes fueron agrupados en 5 ‘trayectorias’: resiliente (n=38), crónico (n=30), recuperación (n=9), inicio demorado (n=9) y recaída (n=3).Resultados: la TSQ predijo TEPT en forma precisa al T3 (sensibilidad: .75 a 1.00, especificidad: .79 a .90). El PHQ-2 mostró modesta precisión (sensibilidad: .38 a .89, especificidad: .67 a .90). Ambas medidas entregaron bajos valores predictivos positivos (TSQ: .57, PHQ-2: .50 en T3). Un número de participantes reportaron necesidades de tratamiento insatisfechas (T1: 32.9%, T2: 19.5%, T3: 10.9%). El reportar necesidades insatisfechas en T2 fue más frecuentemente asignado a una trayectoria crónica de TEPT comparado a no reportar necesidades (pConclusiones: La prevalencia de necesidades insatisfechas 44 meses después del accidente dentro de una trayectoria crónica de TEPT indicó que el contacto activo puede estar justificado. Sin embargo, aunque la TSQ fue precisa, muchos participantes detectados como positivos no desarrollaron TEPT. Esto implica que, aunque el contacto activo puede beneficiar a aquellos con necesidades insatisfechas, tiene también sus costos en términos de posibles evaluaciones clínicas innecesarias.Chinese abstract:背景：2009年，一架飞机在阿姆斯特丹坠毁。通过积极联系（Active Outreach）策略识别有创伤后应激障碍（PTSD）和抑郁症风险的受害者，以解决其未满足的心理健康护理需求。目的：通过检查以下方面对该策略进行：1）PTSD和抑郁症的筛查方法的预测准确性，2）自我报告的治疗需求，以及3）感知到的治疗需求对PTSD轨迹的预测程度。方法：在112名成年幸存者中，在坠机后第2（T1，n = 76），9（T2，n = 77）和44个月（T3，n = 55）进行半结构化电话访谈。创伤筛查问卷（TSQ）和患者健康问卷-2（PHQ-2）分别测量了创伤后应激障碍和抑郁症的症状。在T3，临床访谈评估PTSD和抑郁症诊断。基于3个时间点的TSQ评分，参与者被分为5个症状‘轨迹’组：韧性（n = 38），慢性（n = 30），恢复（n = 9），延迟发作（n = 9）和复发（ n = 3）。结果：TSQ准确预测T3时的PTSD（灵敏度：.75至1.00，特异性：.79至.90）。 PHQ-2显示适度的准确度（灵敏度：.38至.89，特异性：.67至.90）。 两种测量均提供低阳性预测值（TSQ：.57，PHQ-2：在T3时为.50）。 一些参与者报告了未满足的治疗需求（T1：32.9％，T2：19.5％，T3：10.9％）。 在T2报告有未满足的需求的参与者，与报告没有需求的相比，更常被分到慢性PTSD的轨迹组（p 结论：在事故发生后44个月在慢性创伤后应激障碍轨迹组中普遍存在未满足需求，这表明积极联系策略可能是必要的。但尽管TSQ是准确的，许多参与筛查阳性的患者并未出现创伤后应激障碍。这意味着，虽然积极联系可能会使那些有未满足需求的人受益，但在可能的不需要的临床评估方面付出代价。

Exposure to war and violence has major consequences for society at large, detrimental impact on people's individual lives, and may also have intergenerational consequences. To gain more insight into these intergenerational consequences, research addressing the impact of the Holocaust on offspring is an important source of information. The aim of the current study was to systematically review the mechanisms of intergenerational consequences by summarizing characteristics in Holocaust survivors and their offspring suggested to impact the offspring's mental health. We focused on: 1) parental mental health problems, 2) (perceived) parenting and attachment quality, 3) family structure, especially parental Holocaust history, 4) additional stress and life events, and 5) psychophysiological processes of transmission. We identified 23 eligible studies published between 2000 and 2018. Only Holocaust survivor studies met the inclusion criteria. Various parent and child characteristics and their interaction were found to contribute to the development of psychological symptoms and biological and epigenetic variations. Parental mental health problems, perceived parenting, attachment quality, and parental gender appeared to be influential for the mental well-being of their offspring. In addition, having two survivor parents resulted in higher mental health problems compared to having one survivor parent. Also, there was evidence suggesting that Holocaust survivor offspring show a heightened vulnerability for stress, although this was only evident in the face of actual danger. Finally, the results also indicate intergenerational effects on offspring cortisol levels. Clinical and treatment implications are discussed.La exposición a la guerra y la violencia tiene consecuencias importantes para la sociedad en general, un impacto perjudicial en la vida individual de las personas, y también puede tener consecuencias intergeneracionales. Para obtener más información sobre estas consecuencias intergeneracionales, la investigación que aborda el impacto del Holocausto en la descendencia es una fuente importante de información. El objetivo del presente estudio fue revisar sistemáticamente los mecanismos de las consecuencias intergeneracionales resumiendo las características de los sobrevivientes del Holocausto y sus descendientes, que podrían impactar la salud mental de la descendencia. Nos centramos en: 1) los problemas de salud mental de los padres, 2) la calidad (percibida) de la crianza y el apego, 3) la estructura familiar, especialmente antecedentes del Holocausto de los padres, 4) el estrés y los eventos de la vida adicionales, y 5) los procesos psicofisiológicos de la transmisión. Identificamos 23 estudios elegibles publicados entre 2000 y 2018. Solo los estudios de sobrevivientes del Holocausto cumplieron con los criterios de inclusión. Se descubrió que diversas características de los padres y de los hijos y su interacción contribuyen al desarrollo de los síntomas psicológicos y las variaciones biológicas y epigenéticas. Los problemas de salud mental de los padres, la crianza percibida, la calidad del apego, y el género parental parecieron influir en el bienestar mental de sus hijos. Además, tener dos padres sobrevivientes resultó en mayores problemas de salud mental en comparación con tener uno de los padres sobrevivientes. Además, hubo evidencia que sugiere que los descendientes de los sobrevivientes del Holocausto muestran una mayor vulnerabilidad al estrés, aunque esto fue solo evidente ante el peligro real. Finalmente, los resultados también indican los efectos intergeneracionales en los niveles de cortisol de la descendencia. Se discuten las implicaciones clínicas y de tratamiento.暴露于战争和暴力会对整个社会产生重大影响，会对人们的个人生活造成不利影响，并也可能产生代际影响。为了更深入地了解这些代际影响，探讨大屠杀对后代影响的研究是一个重要的信息来源。本研究的目的是通过总结大屠杀幸存者及其后代中暗示会影响后代心理健康的特征来系统地回顾代际影响的机制。我们重点关注：1）父母的心理健康问题，2）（感知到的）父母养育和依恋质量，3）家庭结构，尤其是父母的大屠杀史，4）额外的应激和生活事件，以及5）传递的心理生理过程。我们确定出23项发表于2000年至2018年间符合条件的研究。只有大屠杀幸存者的研究符合纳入标准。多种亲子特征及其互动方式被发现会促进心理症状的发展、生物及表观遗传变异。父母的心理健康问题、感知到的养育、依恋质量和父母的性别似乎对他们后代的心理健康有影响。此外，有两名幸存者父母相较于有一名幸存者父母的后代会出现更多的心理健康问题。另外有证据表明，大屠杀幸存者后代会表现出更高的应激脆弱性，尽管只是在面对实际危险时才明显。最后，结果也表明了在后代皮质醇水平上的代际影响。文中还讨论了临床和治疗意义。.

This article reports on the suitability of implementing a trauma-focused creative arts therapy intervention for severely abused children in South Africa. The study aimed to explore implementation processes and outcomes associated with the delivery of this therapy. The intervention was implemented in a child trauma clinic situated within communities in and around Johannesburg, South Africa. The challenges of implementing and evaluating a new intervention programme within routine clinical practice in a developing context have been significant. We outlined three major challenges referring to high dropout rates, the lack of facilitator’s skills and commitment, and the suitability of the evaluation methods used. Finally, we discuss how these challenges can inform us about the suitability of community-based and trauma-focused treatment in a developing context and make recommendations based on pivotal lessons learned.

Background Western countries are facing many challenges hosting refugees from several regions in the world. Many of them are severely traumatized and suffer from a variety of mental health symptoms, which complicates the identification and treatment of refugees at risk. This study examined subgroups based on a broad range of psychopathology, and several predictors, including trauma characteristics and gender. Methods Participants were 1147 treatment-seeking, traumatized refugees. Latent profile analysis was conducted to identify different subgroups based on levels of posttraumatic stress disorder (PTSD), depression, anxiety, and somatic symptoms. Multinomial logistic regression was used to identify predictors of subgroup membership. Results Three distinct subgroups were identified, reflecting Moderate (10.2%), Severe (43.0%), and Highly Severe (45.9%) symptom severity levels, respectively. Symptom severity of all psychopathology dimensions was distributed equally between the subgroups. Participants in the Severe and Highly Severe Symptoms subgroups reported more types of traumatic events compared to the Moderate subgroup. In particular, traumatic events associated with human right abuses, lack of human needs and separation from others predicted subgroup membership, as did gender. Limitations The results are confined to treatment-seeking, traumatized refugee populations. Conclusions Distinguishable symptom severity profiles of PTSD, depression, anxiety and somatic complaints could be identified in this large treatment-seeking refugee population, without qualitative differences in symptom distribution. Instead of focusing on specific mental disorders, classification based on overall symptom severity is of interest in severely traumatized patients. This knowledge will help to identify individuals at risk and to enhance existing treatment programs for specific patient groups.

Mitigar - Research initiative Public Health Actions to Reduce the Consequences of Childhood Maltreatment among Adults in the Community Introduction Childhood maltreatment has been linked to poor long-term health outcomes. Therapeutic protocols are available for affected children, adolescents and adults. However, preventive programs are scarcely implemented. We lack knowledge about cost-effective actions to mitigate the consequences of childhood maltreatment among adults in the community. The increased risk for illness and the large economical costs related with childhood maltreatment justifies a Public Health approach. Goals To study the need and adequacy of public health actions for adults in the community exposed to childhood maltreatment. Discuss assessment and disease prevention strategies, that may be applied in a cost-benefit effective perspective. Method We will ask the opinion of at least 50 professionals working in the field of childhood maltreatment consequences in adults or related issues, based on the Delphi method. Expected results To obtain consensual opinions about the need of a public health approach to diminish the consequences of childhood maltreatment in adults. Develop a set of guidelines for the assessment and intervention in a public health perspective based on the results of the professional and expert opinions.

Refugees in the Western world are a very diverse group of people. In the Netherlands they originate from over more than a hundred different countries. Most refugees suffer from mental disorders, most notably PTSD and depression. Four general rubrics of stressors and supports have been distinguished: migration and loss, acculturation, traumatization and social marginalization. When refugees are referred to mental health care, the challenge will be to have a consensus about the goals of and expectations from the treatment. Furthermore, a proper diagnosis has to be made, in order to start treatment. In the present study, we have assessed the content, the development, and the experience of a cultural interview in the first meeting with a refugee. This cultural interview is an operationalization of the Outline for a Cultural Formulation (OCF), which was published in the Diagnostic and Statistical manual of Mental Disorders, fourth edition (DSM-IV). For DSM-5, we constructed a new interview, the so-called Cultural Formulation Interview (CFI), and collaborated in an international field trial. Psychodiagnostic assessment with refugees is about the construction of the cultural interviews, and about the evaluation of the latest interview. In addition, the challenge of building a good patient-clinician relationship is described here. Another important issue is the syndrome of somatization. It is a complex construct, and in refugees it has a connection with traumatization. Of traumatic experiences, being tortured is studied here. Suggestions on how to cope with somatization are mentioned.

Objectives Dissociation is a prevalent phenomenon among veterans with post-traumatic stress disorder (PTSD) that may interfere with the effectiveness of treatment. This study aimed to replicate findings of a dissociative PTSD subtype, to identify corresponding patterns in coping style, symptom type, and symptom severity, and to investigate its impact on post-traumatic symptom improvement. Methods Latent profile analysis (LPA) was applied to baseline data from 330 predominantly (97%) male treatment-seeking veterans (mean age 39.5 years) with a probable PTSD. Multinomial logistic models were used to identify predictors of dissociative PTSD. Eighty veterans with PTSD that commenced with psychotherapy were invited for a follow-up measure after 6 months. The majority (n = 64, 80% response rate) completed the follow-up measure. Changes in post-traumatic stress between baseline and follow-up were explored as a continuous distal outcome. Results Latent profile analysis revealed four distinct patient profiles: 'low' (12.9%), 'moderate' (33.2%), 'severe' (45.1%), and 'dissociative' (8.8%) PTSD. The dissociative PTSD profile was characterized by more severe pathology levels, though not post-traumatic reactions symptom severity. Veterans with dissociative PTSD benefitted equally from PTSD treatment as veterans with non-dissociative PTSD with similar symptom severity. Conclusions Within a sample of veterans with PTSD, a subsample of severely dissociative veterans was identified, characterized by elevated severity levels on pathology dimensions. The dissociative PTSD subtype did not negatively impact PTSD treatment. Practitioner points The present findings confirmed the existence of a distinct subgroup veterans that fit the description of dissociative PTSD. Patients with dissociative PTSD subtype symptoms uniquely differed from patients with non-dissociative PTSD in the severity of several psychopathology dimensions. Dissociative and non-dissociative PTSD patients with similar post-traumatic severity levels showed similar levels of improvement after PTSD treatment. The observational design and small sample size caution interpretation of the treatment outcome data. The IES-R questionnaire does not assess all PTSD DSM-IV diagnostic criteria (14 of 17), although it is considered a valid measure for an indication of PTSD.

OBJECTIVES: Given the recent peak in refugee numbers and refugees' high odds of developing post-traumatic stress disorder (PTSD), finding ways to alleviate PTSD in refugees is of vital importance. However, there are major differences in PTSD treatment response between refugees, the determinants of which are largely unknown. This study aimed at improving PTSD treatment for adult refugees by identifying PTSD treatment response predictors. DESIGN: A prospective longitudinal multilevel modelling design was used to predict PTSD severity scores over time. We analysed data from a randomized controlled trial with pre-, post-, and follow-up measurements of the safety and efficacy of eye movement desensitization and reprocessing and stabilization in asylum seekers and refugees suffering from PTSD. METHODS: Lack of refugee status, comorbid depression, demographic, trauma-related and treatment-related variables were analysed as potential predictors of PTSD treatment outcome. Treatment outcome data from 72 participants were used. RESULTS: The presence (B = 6.5, p = .03) and severity (B = 6.3, p < .01) of a pre-treatment depressive disorder predicted poor treatment response and explained 39% of the variance between individuals. CONCLUSIONS: Refugee patients who suffer from PTSD and severe comorbid depression benefit less from treatment aimed at alleviating PTSD. Results highlight the need for treatment adaptations for PTSD and comorbid severe depression in traumatized refugees, including testing whether initial targeting of severe depressive symptoms increases PTSD treatment effectiveness. PRACTITIONER POINTS: There are differences in post-traumatic stress disorder (PTSD) treatment response between traumatized refugees. Comorbid depressive disorder and depression severity predict poor PTSD response. Refugees with PTSD and severe depression may not benefit from PTSD treatment. Targeting comorbid severe depression before PTSD treatment is warranted. This study did not correct for multiple hypothesis testing. Comorbid depression may differentially impact alternative PTSD treatments.

Contains fulltext : 199183.pdf (Publisher’s version ) (Closed access) It has been hypothesized that adult attachment representations guide caregiving behavior and influence parental sensitivity, and thus affect the child's socio-emotional development. Several studies have shown a link between posttraumatic stress disorder (PTSD) and reduced parental sensitivity, so it is possible that PTSD moderates the relationship between insecure attachment representations and insensitivity. In this study symptoms of PTSD (Harvard Trauma Questionnaire), parental sensitivity (Emotional Availability Scales), and attachment representations (Attachment Script Assessment) were assessed in 53 parents who were asylum seekers or refugees. Results showed that when parents were less able to draw on secure attachment representations, symptoms of PTSD increased the risk of insensitive parenting. These findings suggest that parental sensitivity is affected not just by attachment representations, but by a conjunction of risk factors including symptoms of PTSD and insecure attachment representations. These parents should therefore be supported to establish or confirm secure models of attachment experiences, to facilitate their ability interact sensitively and form a secure relationship with their children. 12 p.