Search

Die aktualisierte 11. Version der Internationalen statistischen Klassifikation der Krankheiten (ICD-11) brachte eine Reihe bedeutender Änderungen in der Konzeptualisierung der belastungsbezogenen psychischen Störungen mit sich. Dieser Beitrag benennt die wichtigsten Unterschiede zwischen den Belastungsfolgestörungen des Erwachsenenalters in ICD-11 und DSM-5 und leitet zentrale klinische Implikationen der ICD-11 Konzepte ab.

Childhood maltreatment (CM) is thought to be associated with altered responses to socialstimuli and interpersonal signals. Correspondingly, first studies found that CM is linked tolarger comfortable interpersonal distance (CID). However, studies were limited in statisticalpower and only examined individuals from the European region. Moreover, little is knownabout the effects of CM on CID towards different interaction partners and whether CID islinked to social functioning and attachment. To address these outstanding issues, adults(N=2986) from diverse cultures and socio-economic strata completed an online task evaluating CID. Higher CM was linked to larger CID towards both friends and strangers. Moreover,insecure attachment styles and less social support were associated with a larger CID. Giventhe importance of social relationships for mental health, our findings suggest that maltreatedindividuals should be supported in CID regulation (e.g., by means of tailored interventions).

Posttraumatisches Wachstum beschreibt positive psychologische Veranderungen, die aus dem Umgang mit hoch belastenden Erlebnissen resultieren. Da Grund zur Annahme besteht, dass sich Posttraumatisches Wachstum uber die Zeit hinweg verandert, gibt dieser Beitrag einen Uberblick uber die internationale Literatur zum posttraumatischen Wachstum aus einer Lebensspannenperspektive. Aus den gesichteten Studien geht hervor, dass posttraumatisches Wachstum im fruhen Erwachsenenalter am wahrscheinlichsten ist. Daruber hinaus weisen Langzeitstudien in der Anfangsphase nach dem Trauma auf stabile oder zunehmende Verlaufe hin, wahrend Posttraumatisches Wachstum in spateren Jahren zu Stabilitat oder Abnahme tendiert. Werden die verschiedenen Domanen posttraumatischen Wachstums einzeln untersucht, wird klar, dass uber langere Zeitraume hinweg wenig Stabilitat besteht. In ihrer Gesamtheit weisen diese Befunde darauf hin, dass Personen mit gewissen demografischen Merkmalen im Zuge von traumatischen Erfahrungen Unterstutzung in der Entwicklung von Posttraumatischem Wachstum benotigen konnten und dass Posttraumatisches Wachstum domanenspezifisch gefordert werden sollte. The Development of Posttraumatic Growth across Time – Taking a Lifespan Perspective Posttraumatic growth refers to positive psychological changes which originate from handling highly stressful life events. As there is reason to assume that posttraumatic growth changes over time, this article reviews the international literature on posttraumatic growth from a lifespan perspective. The literature shows that posttraumatic growth is most likely to develop in early adulthood. In addition, longitudinal studies suggest that in the early stages after trauma, posttraumatic growth follows a stable or increasing trajectory while later years are characterized by stability or decline. If domains of posttraumatic growth are investigated individually, it becomes clear that little stability exists across longer periods of time. In summary, these findings suggest that individuals with certain demographic characteristics may need support in the development of posttraumatic growth and that domain-specific fostering of posttraumatic growth may be most effective.

Despite increasing interest in the mental health of aging veterans, the pathogenic and salutogenic ramifications of war have not been investigated among aging veterans who received decorations of v...

The outbreak of the COVID-19 pandemic has confronted humanity with an ongoing biopsychosocial stressor, imposing multifaceted challenges to individuals and societies. Particularly, the pandemic reflects an ongoing, potentially life-threatening danger to self and others, which may instigate acute stress symptoms (ASS). This study utilized a network framework to assess cross-national ASS a short time following the initial COVID-19 outbreak. Three samples of adult participants from China, Israel, and Switzerland completed a self-report assessment of acute stress symptoms. Network analyses were utilized to uncover the phenotype and dynamics of different ASS in these three countries. The ASS network analyses revealed extensive connections in all networks and reflected the structure of ASS. The centrality indexes in all networks were from the hyperarousal cluster. “Feeling jumpy” was the node with the highest strength centrality in the Israeli sample and “physiological reactivity” was the item with the highest centrality in the Swiss sample. In the Chinese sample, the item with the highest centrality was “feeling alert to danger." The findings reveal that despite some variations, the overall clinical picture of ASS in response to the COVID-19 pandemic is universal. These findings highlight the centrality of hyperarousal symptoms, presumably reflecting its significance for clinical interventions.

Zusammenfassung Ziel Es ist davon auszugehen, dass eine komplexe Posttraumatische Belastungsstörung (kPTBS) nach ICD-11 die Betroffenen auch im beruflichen Bereich beeinträchtigt. Die vorliegende Arbeit untersucht daher, ob zwischen Patienten mit positivem Screening auf eine kPTBS, Patienten mit positivem Screening auf eine PTBS und Patienten mit negativem Screening auf Traumafolgestörungen Unterschiede bezüglich ihrer arbeitsbezogenen Verhaltens- und Erlebensmuster (AVEM) bestehen. Methodik Teilnehmer waren 566 Patienten einer psychosomatischen Rehabilitationsklinik (Alter M=50,96, SD 8,73 Jahre; 70,3% weiblich). Die Teilnehmer bearbeiteten zu Beginn ihres stationären Aufenthalts Selbstbeurteilungs-/ Screeninginstrumente. Univariate Varianzanalysen wurden eingesetzt, um Gruppenunterschiede in den arbeitsbezogenen Verhaltens- und Erlebensmustern zu beurteilen. Der AVEM erfasst auf 11 Dimensionen gesundheitsförderliche bzw. -gefährdende Verhaltens- und Erlebensweisen bei der Bewältigung von Arbeits- und Berufsanforderungen. Ergebnisse Auf 8 von 11 AVEM-Dimensionen zeigten sich signifikante Unterschiede zwischen den Gruppen „kein Verdacht“ und „kPTBS“. Die Gruppen „PTBS“ und „kPTBS“ unterscheiden sich signifikant auf den Dimensionen „Resignationstendenzen“, „Offensive Problembewältigung“ und „Lebenszufriedenheit“. Die Gruppen „kein Verdacht“ und „PTBS“ unterschieden sich hingegen nicht signifikant. Diskussion Patienten mit Verdacht auf kPTBS stellen im Arbeitskontext eine besonders belastete Patientengruppe dar. Es erscheint inhaltlich plausibel, dass die in der ICD-11 für die kPTBS formulierten Probleme im Bereich der Selbstorganisation zu den gefundenen problematischen Verhaltens- und Erlebensmuster führen können. Schlussfolgerung Dies spricht dafür, dass für Patienten mit kPTBS spezielle Interventionen im Rahmen der medizinisch-beruflich orientierten Rehabilitation sinnvoll sind, um diese Defizite zu kompensieren und die Teilhabe am Erwerbsleben zu erhalten.

Childhood maltreatment (CM) is linked to impairments in various domains of social functioning. Here, we argue that it is critical to identify factors that underlie impaired social functioning as well as processes that mediate the beneficial health effects of positive relationships in individuals exposed to CM. Key research recommendations are presented, focusing on: (1) identifying attachment-related alterations in specific inter- and intrapersonal processes (e.g., regulation of closeness and distance) that underlie problems in broader domains of social functioning (e.g., lack of perceived social support) in individuals affected by CM; (2) identifying internal (e.g., current emotional state) and external situational factors (e.g., cultural factors, presence of close others) that modulate alterations in specific social processes; and (3) identifying mechanisms that explain the positive health effects of intact social functioning. Methodological recommendations include: (1) assessing social processes through interactive and (close to) real-life assessments inside and outside the laboratory; (2) adopting an interdisciplinary, lifespan perspective to assess social processes, using multi-method assessments; (3) establishing global research collaborations to account for cultural influences on social processes and enable replications across laboratories and countries. The proposed line of research will contribute to globally develop and refine interventions that prevent CM and further positive relationships, which – likely through buffering the effects of chronic stress and corresponding allostatic load – foster resilience and improve mental and physical health, thereby reducing personal suffering and the societal and economic costs of CM and its consequences. Interventions targeting euthymia and psychological well-being are promising therapeutic concepts in this context.

Die Anpassungsstörung gilt als Verlegenheitsdiagnose und wurde aufgrund diverser Validitätsprobleme lange Zeit kontrovers diskutiert. Ein neues Störungskonzept im ICD-11 soll den bekannten Schwierigkeiten entgegentreten. Zum ersten Mal werden spezifische Symptome für die Anpassungsstörung definiert.

Wenn ein nahestehender Mensch ein Trauma erlebt, ist dies auch für Angehörige oft schwer zu ertragen. Durch den ständigen Kontakt mit der posttraumatischen Symptomatik können sich psychische Symptome entwickeln, die jenen der Betroffenen selbst sehr ähnlich sind: Alpträume, erhöhte Wachsamkeit, sowie Vermeidung von Trigger, die Erinnerungen an das Trauma wachrufen. Ein Überblick anhand einer Studie zu den Langzeitfolgen von Kriegsgefangenschaft.

The present study investigates whether secondary traumatization (i.e., family history of Holocaust survival and secondary exposure to captivity) is implicated in subjective age. Women exposed to different levels of secondary traumatization (N = 177) were assessed. Analyses of variance (ANOVAs) revealed that a Holocaust background and husband's captivity had a marginally significant positive effect on age appearance. Women with a Holocaust background whose husbands were held captive reported older interest age, indicating double jeopardy for older subjective age when two sources of secondary traumatization are present. A similar trend existed for behavior age. Possible explanations for these complex findings of risk and resilience are discussed.

BackgroundThe Kessler Psychological Distress Scale (K-6) has been used worldwide in community epidemiological surveys and served as a screening measure for serious mental illness in the general population. We take a novel approach by examining the symptoms network of the K-6 and the exploration of differences between three types of disasters: Nature related, Terror attacks, and COVID-19.AimsTo explore the K-6 symptoms network and its structure replication across the three types of disasters.MethodsA network analysis of psychological distress symptoms as assessed by the K-6 was conducted using data from 9,271 participants from different disaster samples: Terror (n = 5842), COVID-19 (n = 2428), and Nature related (n = 1001).ResultsWhile there were extensive connections between items across all disaster samples, network structure differed across the disaster types. While after a nature related disaster and the COVID-19 pandemic depression- and anxiety-items were interconnected, a terror attack resulted in more separated manifestations of anxiety and depression. Centrality analysis showed “depressed/no cheering up” to be the node with the highest strength centrality in all networks; in the Nature-related network, “restless or fidgety” was also highly central.ConclusionsResults provide evidence of different psychological distress structures in different disasters. Depending on the type of disaster, trauma-focused interventions may need to be augmented, with specific components directed at depression and/or anxiety.

This study examined differences in work-related behavioral and experiential patterns between patients with positive screening for complex PTSD (CPTSD), patients with positive screening for PTSD and patients with negative screening for trauma sequelae.Participants were 566 patients (mean age 50.96 +/- 8.73 years; 70.3 % female) of a psychosomatic rehabilitation clinic. Self-reported screening instruments were administered to participants at the beginning of their inpatient psychotherapy. Univariate analyses of variance were used to assess group differences in work-related experience- and behavioral patterns. The instrument identifies 11 dimensions of health-promoting or -endangering behavior and experiences in coping with work and occupational demands.On 8 of 11 work-related dimensions, significant differences were found between the groups "without PTSD" and "CPTSD". The "PTSD" and "CPTSD" groups differed significantly on the dimensions of "resignation tendencies", "offensive coping" and "life satisfaction". The groups "without PTSD" and "PTSD" did not differ significantly.Patients with a positive CPTSD screening represent a particularly burdened patient group in the working context. They reported problematic behavior and experience patterns that correspond to the problem areas of self-organization described in the diagnostic criteria of the ICD-11.This suggests that for patients with CPTSD special interventions within the context of medical-professional oriented rehabilitation are useful to compensate these deficits and maintain participation in working life.ZIEL: Es ist davon auszugehen, dass eine komplexe Posttraumatische Belastungsstörung (kPTBS) nach ICD-11 die Betroffenen auch im beruflichen Bereich beeinträchtigt. Die vorliegende Arbeit untersucht daher, ob zwischen Patienten mit positivem Screening auf eine kPTBS, Patienten mit positivem Screening auf eine PTBS und Patienten mit negativem Screening auf Traumafolgestörungen Unterschiede bezüglich ihrer arbeitsbezogenen Verhaltens- und Erlebensmuster (AVEM) bestehen.Teilnehmer waren 566 Patienten einer psychosomatischen Rehabilitationsklinik (AlterAuf 8 von 11 AVEM-Dimensionen zeigten sich signifikante Unterschiede zwischen den Gruppen „kein Verdacht“ und „kPTBS“. Die Gruppen „PTBS“ und „kPTBS“ unterscheiden sich signifikant auf den Dimensionen „Resignationstendenzen“, „Offensive Problembewältigung“ und „Lebenszufriedenheit“. Die Gruppen „kein Verdacht“ und „PTBS“ unterschieden sich hingegen nicht signifikant.Patienten mit Verdacht auf kPTBS stellen im Arbeitskontext eine besonders belastete Patientengruppe dar. Es erscheint inhaltlich plausibel, dass die in der ICD-11 für die kPTBS formulierten Probleme im Bereich der Selbstorganisation zu den gefundenen problematischen Verhaltens- und Erlebensmuster führen können.Dies spricht dafür, dass für Patienten mit kPTBS spezielle Interventionen im Rahmen der medizinisch-beruflich orientierten Rehabilitation sinnvoll sind, um diese Defizite zu kompensieren und die Teilhabe am Erwerbsleben zu erhalten.

OBJECTIVES: Depression is a prevalent outcome of traumatic experiences, such as combat and war captivity. This study explores the heterogeneity of changes over time and assesses the contribution of trauma exposure (combat vs. war captivity), hardiness, and social support for depression trajectories. METHODS: Two groups of Israeli veterans were assessed in 1991, 2003, 2008, and 2015: 149 former prisoners-of-war (ex-POWs) and 107 combat veterans. Protective factors were evaluated in 1991. Group-based trajectory modeling was conducted to identify latent trajectories of change. RESULTS: Four trajectories of "resiliency" (62.8%), "delayed onset" (25.1%), "exacerbation" (6.2%), and "chronicity" (5.9%) were found. The majority of the resilient group were combat veterans whereas the clinical groups consisted primarily of ex-POWs. Lower hardiness and social support were related to more deleterious trajectories. CONCLUSIONS: Spirals of loss involving hardiness and social support, normative experiences, and contextual factors may present explanations for the various depression trajectories.

Background Symptom network analysis has become an essential tool for researchers and clinicians investigating the structure of mental disorders. Two methods have been used; one relies on partial correlations, and the second relies on zero order correlations with forced-directed algorithm. This combination was used to examine symptom connections for ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) as the symptoms for these disorders have been known to be organized in a multi-dimensional and hierarchical fashion. We aimed to examine whether networks of ICD-11 CPTSD symptoms reproduced across samples from three African countries. Methods We produced network models based on data from 2524 participants in Nigeria (n = 1018), Kenya (n = 1006), and Ghana (n = 500). PTSD and CPTSD symptoms were measured using the International Trauma Questionnaire (Cloitre et al., 2018). Results The CPTSD network analysis using force-directed method alongside partial correlations based on Gaussian Graphical Models (GGM) revealed the multidimensional-hierarchal structure of CPTSD. The within-cluster symptoms of Disturbances in Self Organization (DSO) and PTSD were strongly correlated with each other in all networks, and the cross-cluster symptoms were lower. The most central symptom was ‘feelings of worthlessness’, a symptom of Negative Self-Concept that is part of the CPTSD cluster. The networks were very similar across the three countries. Conclusions Findings support the ICD-11 model of PTSD and CPTSD in three African countries.

Background In the aftermath of trauma not only the primary traumatized survivors’ mental health is affected but often also their significant others. The current study explores the specific associations of ICD-11 symptoms of posttraumatic stress disorder (PTSD) and disturbances in self organization (DSO) for secondary traumatic stress and dyadic adjustment among both spouses. Methods Male Israeli veterans and their wives (N = 216) were assessed 30 years after the war. Primary PTSD/DSO symptoms of the veterans and secondary posttraumatic stress symptoms (secondary PTSS)/DSO of the wives were assessed. Actor Partner Independence Modelling (APIM) evaluated the differential effects of PTSD and DSO for trauma transmission and dyadic adjustment. Results While veterans’ primary PTSD only related to secondary PTSS of the wives, the veterans’ DSO predicted the wives’ secondary PTSS as well as DSO. Moreover, the APIM revealed that the primary and secondary DSO of both partners were associated with dyadic adjustment while their PTSD symptoms were not. Limitations The cross-sectional data did not allow to identify directional or causal effects and DSO symptoms were not assessed with an ICD-specific instrument as such scales did not exist at the time of data collection. Conclusions ICD-11 DSO symptoms seem to drive the transmission of posttraumatic stress among spouses to a more significant extent than PTSD symptoms. As DSO are also strongly implicated in decreased dyadic adjustment, they are valuable targets for couple therapy after one spouse experienced severe trauma, both in order to prevent interpersonal trauma transfer as well as to enhance dyadic adjustment.

Background Existing research on post-traumatic sequelae suggests a positive association between fatalism and symptoms of post-traumatic stress disorder (PTSD). However, the associations between fatalism and the new ICD-11 diagnosis of complex PTSD (CPTSD) have never been explored before. Objective The current study explored the association between fatalism and PTSD and CPTSD in samples from three African countries. Methods A total of 2,524 participants from Nigeria (n = 1018), Kenya (n = 1006), and Ghana (n = 500) completed measures of fatalism (non-judgemental fatalism, current fatalism, pessimistic fatalism, prospective fatalism) and the International Trauma Questionnaire (ITQ). A combination of a multinomial regression and path analysis was used to identify fatalism predictors of PTSD and CPTSD versus no diagnosis, and CPTSD versus PTSD, adjusted for demographic variables and trauma exposure. Results While PTSD was not predicted by any of the fatalism types, compared to no diagnosis, CPTSD was significantly predicted by pessimistic, non-judgemental and current fatalism, both compared to no diagnosis and PTSD. Conclusions The results broaden the knowledge on potential correlates of the new diagnosis of CPTSD. Addressing fatalistic beliefs by empowering people to think that they can choose their fate should be further explored as a possible target for intervention in the treatment of CPTSD., HIGHLIGHTS The study explored the association between fatalism and PTSD and CPTSD according to ICD-11 definition in samples from three African countries.The results broaden the knowledge beyond Western population on potential correlates of the new diagnosis of CPTSD.

Latinx immigrants are exposed to multiple stressors before, during, and after migration. However, most past research has assumed the effects of these stressors are uniform across Latinx groups despite considerable within-group variation. The purpose of this study was to (a) assess the moderating effects of several risk and protective factors on the association between cumulative lifetime adversity and depression among U.S. Latinx immigrants and (b) examine the extent to which risk and protective processes differed between Latinx subgroups.Data came from a cross-sectional secondary dataset, called the HCHS/SOL Sociocultural Ancillary Study. The sample (Results from multi-group regression analyses suggested that social support moderated the association between cumulative lifetime adversity and depression. However, further subgroup analyses showed the moderation effect was only present for Cuban and Dominican immigrants. We also found that perceived discrimination moderated the association between lifetime adversity and depression for Cuban immigrants and ethnic identity moderated the relationship between lifetime adversity and depression for Dominican immigrants.Our results provide preliminary evidence for the presence of within-group differences in responses to adverse events among Latinx immigrant groups. Results can be used to inform the development of mental health interventions tailored to the specific needs of various Latinx immigrant populations.Los inmigrantes Latinx están expuestos a varios factores que les causan estrés antes, durante, y después de migrar. Sin embargo, casi todas las investigaciones previas han asumido que los efectos de estos factores que causan estrés son uniformes entre todos los grupos inmigrantes Latinx, a pesar de variación considerable dentro del grupo. El propósito de esta investigación fue (a) evaluar los efectos moderativos de los varios factores riesgosos y protectores en la relación entre la adversidad acumulativa de la vida y la depresión entre los inmigrantes Latinx en los estados unidos y (b) examinar hasta qué punto los procesos riesgosos y protectores se distinguían entre los subgrupos Latinx.Los datos vinieron de un conjunto de datos secundarios transversales llamados el HCHS/SOL Estudio Sociocultural Ancilar. La muestra de personas (N = 2893) fue identificada usando un muestreo aleatorio proporcionalmente estratificado en cuatro de las áreas metropolitanas más grandes de gente Latinx: El Bronx en New York, San Diego, California, Chicago, Illinois, y Miami, Florida. Hemos incluyendo cuatro subgrupos Latinx en nuestra investigación: puertorriqueños, cubanos, mexicanos, y dominicanos.Resultados del análisis de regresión multi-grupo sugirieron que el apoyo social moderó la relación entre la adversidad acumulativa de la vida y la depresión. Sin embargo, análisis más a fondo de subgrupos demostraron que el efecto de moderación solo estaba presente para los inmigrantes cubanos y dominicanos. También descubrimos que la discriminación moderó la relación entre la adversidad acumulativa de la vida y la depresión para los inmigrantes cubanos y que la identidad étnica moderó la relación entre la adversidad acumulativa de la vida y la depresión para los inmigrantes dominicanos.Nuestros resultados proveen evidencia preliminar de la presencia de diferencias dentro del grupo en las repuestas a los eventos adversos entre los subgrupos de inmigrantes Latinx. Los resultados pueden informar el desarrollo de intervenciones de salud mental personalizadas para las necesidades específicas de varias poblaciones de inmigrantes Latinx.

Background: Adjustment disorder (AjD) is one of the most frequently used diagnoses in psychiatry but a diagnostic definition for AjD was only introduced in release of the ICD-11. This study sought to develop and validate a new measure operationalizing the ICD-11's narrative description of AjD, and to determine the current rate of people meeting the symptoms indicative of AjD in the general population of the Republic of Ireland. Methods: The International Adjustment Disorder Questionnaire (IADQ) was constructed to measure the core diagnostic criteria of ICD-11 AjD: stressor exposure, preoccupations with, and failure to adapt to, the stressor, timing of symptom onset, and functional impairment. A nationally representative sample (N = 1,020) of adults from Ireland completed the IADQ. Results: Confirmatory factor analysis supported construct validity and the reliability estimates were excellent. The IADQ correlated strongly with depression, anxiety, and posttraumatic stress. The criteria were met by 7.0% of the sample, adjusted for other exclusionary disorders. Discussion: The IADQ is a measure based on the ICD-11's description and produces reliable scores, however it should not be used for clinical assessment until validated with clinical interviews.

Avoidant attachment is associated with numerous negative interpersonal outcomes. The current study tested whether self-perceptions of impostorism intensify negative interpersonal outcomes of attachment-related avoidance. One hundred and twenty-nine male Israeli veterans of the 1973 Yom Kippur War were assessed using self-report measures of attachment orientations (avoidance, anxiety), impostorism, beliefs about others' benevolence, marital quality, and loneliness. As hypothesized, hierarchical regressions revealed significant interactions of impostorism and attachment avoidance after accounting for main effects, showing that impostorism intensified the association between avoidant attachment, on the one hand, and more negative beliefs about others’ benevolence, lower marital quality, and heightened loneliness, on the other hand. The current study is among the first to systematically assess the relational implications of impostorism and suggests that high impostorism is a risk factor for aversive outcomes in the interpersonal realm, especially among highly attachment-avoidant people.

This study explored trajectories of marital adjustment, including overall, affection, satisfaction, cohesion and consensus, in 197 middle-aged Israeli spouses who had been married for an average of 34 years. As military conscription in Israel is mandatory, all men in this study are military veterans. The main aims of the study were to explore the trajectories of marital adjustment over time and to describe similarities and differences in the marital adjustment of husbands and wives. Assessments were done at three time points over 12 years and were analyzed using a latent growth mixture model. Findings showed that overall husbands and wives reported being generally satisfied in their marriage. Different trajectories for husbands and wives were found in most domains of marital adjustment. The majority of wives reported a sharper decline in satisfaction over time, while more husbands reported an increase in affection. The wives reported more variability, as well as higher levels of consensus than their husbands across the 12 years of the study and the three data collection points. The spouses’ high level of cohesion served to support their high levels of marital adjustment. Implications of these findings are discussed.

Among the most prevalent and adverse sequalae of traumatic experiences are negative world assumptions (WAs), which describe trauma-related negative cognitions regarding the self, the world, and others. Even though a wealth of studies has shown intrapersonal associations between negative WAs and posttraumatic stress symptoms (PTSS), there has been little research on how WAs may affect family systems. This study examined the intergenerational associations between parental WAs, paternal PTSS, and maternal secondary traumatic stress (STS) on adult–children’s STS in veterans’ families. It was hypothesized that negative paternal WAs would mediate the association between parental PTSS/STS and adult–children’s STS. Three domains of WAs (benevolence of the world, meaningfulness of the world, and self-worth) and PTSS were prospectively assessed in 123 father–mother–offspring triads of former Israeli veterans of the 1973 Yom Kippur War, their wives and adult offspring. Data were collected in 2003, 2008, and 2014, and analyzed using triadic path modeling. Mothers’ STS was associated with children’s STS via negative maternal WAs on world benevolence. Fathers’ PTSS was related to children’s STS via fathers’ WAs on world benevolence and self-worth. Moreover, fathers’ WAs on world benevolence and self-worth mediated the intergenerational transmission of STS from mothers to offspring. No effects were found for meaningfulness WAs. Findings suggest that parental WAs related to world benevolence and paternal self-worth contribute to intergenerational trauma transmission. Clinical implications favor cognitive and systemic approaches to therapy that address negative benevolence and self-worth assumptions and involve the entire family system.

Background: Adjustment disorder (AjD) is a transient mental health condition emerging after stressful life events. Its diagnostic criteria have recently been under revision which led to the development of the Adjustment Disorder–New Module 20 (ADNM-20) as a self-report assessment. Objective: To identify a threshold value for people at high risk for AjD. Methods: As part of a randomized controlled trial evaluating a self-help manual for burglary victims, the baseline data of all participants (n=80) were analyzed. Besides the ADNM-20, participants answered self-report questionnaires regarding the external variables post-traumatic stress disorder symptomatology, depression, anxiety, and stress levels. We used cluster analysis and ROC analysis to identify the most appropriate cut-off value. Results: The cluster analysis identified three different subgroups. They differed in their level of AjD symptomatology from low to high symptom severity. The same pattern of impairment was found for the external variables. The ROC analysis testing the ADNM-20 sum score against the theory-based diagnostic algorithm, revealed an optimal cut-off score at 47.5 to distinguish between people at high risk for AjD and people at low risk. Conclusion: The ADNM-20 distinguishes between people with low, moderate, and high symptomatology. The recommendation for a cut-off score at 47.5 facilitates the use of the ADNM-20 in research and practice.

Adjustment disorders (AjD) are among the most frequent mental disorders yet often remain untreated. The high prevalence, comparatively mild symptom impairment, and transient nature make AjD a promising target for low-threshold self-help interventions. Bibliotherapy represents a potential treatment for AjD problems. This study investigates the effectiveness of a cognitive behavioral self-help manual specifically directed at alleviating AjD symptoms in a homogenous sample of burglary victims. Participants with clinical or subclinical AjD symptoms following experience of burglary were randomized to an intervention group (n = 30) or waiting-list control group (n = 24). The new explicit stress response syndrome model for diagnosing AjD was applied. Participants received no therapist support and assessments took place at baseline, after the one-month intervention, and at three-month follow-up. Based on completer analyses, group by time interactions indicated that the intervention group showed more improvement in AjD symptoms of preoccupation and in post-traumatic stress symptoms. Post-intervention between-group effect sizes ranged from Cohen's d = .17 to .67 and the proportion of participants showing reliable change was consistently higher in the intervention group than in the control group. Engagement with the self-help manual was high: 87% of participants had worked through at least half the manual. This is the first published RCT of a bibliotherapeutic self-help intervention for AjD problems. The findings provide evidence that a low-threshold self-help intervention without therapist contact is a feasible and effective treatment for symptoms of AjD.

Adjustment disorder (AD) is one of the most frequent mental health conditions after stressful life experiences in the medical setting. The diagnosis has been conceptually redefined in International Classification of Diseases (ICD-11) and now includes specific symptoms of preoccupations and failure to adapt. The current study assesses the prevalence of self-reported ICD-11 AD among organ transplantation patients and their relatives, explores the association of patients&rsquo, demographic-, transplant-, and health-related characteristics and ICD-11 AD symptoms, and evaluates the role of social support in the post- transplant context. A total of N = 140 patient-relative dyads were examined cross-sectionally. Hierarchical linear regression analyses were conducted to explore potential predictive factors of AD. The results revealed an AD prevalence of 10.7% among patients and 16.4% among relatives at an average of 13.5 years after the transplantation. The time that had passed since the transplantation was unrelated to AD symptom severity. Women tended to be at a higher risk in both groups. Somatic issues were predictive for AD only among patients and social support was predictive mainly among relatives. The results suggest that ICD-11 AD is a relevant diagnosis after organ transplantations for patients and relatives and its specific symptom clusters may provide important information for developing intervention strategies.

Objective: Long-term trajectories of posttraumatic stress disorder (PTSD) may fluctuate over time and typically conform to four heterogeneous patterns: resilience, recovery, delayed-onset, and chro...

Abstract. The present study introduces a revised Sense of Coherence (SOC) scale, a new conceptualization and operationalization of the resilience indicator SOC. It outlines the scale development and aims for testing its reliability, factor structure, and validity. Literature on Antonovsky’s SOC (SOC-A) was critically reviewed to identify needs for improving the scale. The scale was investigated in two samples. Sample 1 consisted of 334 bereaved participants, Sample 2 of 157 healthy controls. The revised SOC Scale, SOC-A, and theoretically relevant questionnaires were applied. Explorative and confirmatory factor analyses established a three-factor structure in both samples. The revised SOC Scale showed significant but discriminative associations with related constructs, including self-efficacy, posttraumatic growth, and neuroticism. The revised measure was significantly associated with psychological health indicators, including persistent grief, depression, and anxiety, but not to the extent as the previous SOC-A. Stability over time was sufficient. The study provides psychometric support for the revised SOC conceptualization and scale. It has several advantages over the previous SOC-A scale (unique variance, distinct factor structure, stability). The scale could be used for clinical and health psychological testing or research into the growing field of studies on resilience over the life span.

Background Adjustment disorder is among the most frequently diagnosed mental disorders in clinical practice although it has received little academic attention and been the subject of substantial criticism over the past decades. While those suffering with adjustment disorders are often treated by mental health professionals, research interest in the origin of the disorder or the effectiveness of psychotherapeutic and medical interventions has only recently begun to emerge. This article summarizes the empirical literature published on adjustment disorder and points out current diagnostic developments in DSM-5 and ICD-11. Methods Literature for this review was identified through established online search tools, including publications in English, German, and Spanish. Results This paper reviews literature on the evolution of adjustment disorder, and highlights the current state of research with regard to genesis and treatment. Importantly, for the first time ICD-11 intends to define adjustment disorder by explicit symptom groups, unlike DSM-5. Limitations Publications without an English abstract were not included. Conclusions Key directions for future research include investigating the concordance of the ICD-11 and DSM-5 concepts and the effect that the diverging conceptualizations may have. Risk and protective factors specific to AD should be identified and the biological underpinnings of the disorder should be explored. Finally, given the high prevalence of AD in certain clinical settings effective disorder-specific interventions should be developed and evaluated.

Research indicates that posttraumatic stress symptoms (PTSS) induced by war trauma may be transmitted to veterans’ wives and offspring (secondary traumatic stress; STS). However, the interplay between family members’ characteristics has not been accounted for in such processes. Taking a family systems perspective, we examine the contributions of fathers’ PTSS, mothers’ STS, marital adjustment, and self-disclosure of both parents to offspring's STS and test whether marital quality applies as a mechanism of parent–child transmission. Combat veterans and former prisoners of war (N = 123), their spouses, and adult offspring were investigated in a multiple-step mediation analysis. The results highlight the mother's crucial role in trauma transmission and suggest that strengthening the marital relationship may buffer the transmission of fathers’ PTSS to offspring.

Despite considerable research on secondary traumatization, the ramifications of veterans' and their wives' posttraumatic stress symptoms (PTSS) for the family system remain largely uninvestigated. Beginning to fill this gap, the current study aims to investigate the reciprocal relations between both spouses' PTSS and marital adjustment, and the implications these bear for their parental functioning. Two hundred and twenty-five Israeli veterans (mean age = 58.62, SD = 7.6) from the 1973 Yom Kippur War and their wives (mean age = 58.28, SD = 5.79) were examined at two points in time: 30 (T1) and 35-37 years after the war (T2). Analysis included longitudinal actor-partner interdependence modeling and sequential mediation analyses. The results show that higher PTSS among the wives at T1 predicted higher PTSS among husbands at T2, and vice versa, and predicted their husbands' marital adjustment at T2. Moreover, wives' PTSS at T1 had a significant effect on parental overinvolvement of both parents at T2, but neither their PTSS nor their husbands' PTSS had an impact on positive parenting. In the intrapersonal domain, better marital adjustment at T1 predicted positive parenting among both spouses in subsequent measurement. Interpersonally, wives' lower marital adjustment at T1 predicted husbands' higher parental functioning, but not vice versa. Furthermore, marital adjustment mediated the association between PTSS and positive parenting for both spouses. The results emphasize the detrimental ramifications of war trauma on the interpersonal domains in veterans' families. Hence, both marital and parental consequences of trauma should be considered in clinical family interventions.© 2016 Family Process Institute. Language: en

The purpose of this study was to quantify the association between childhood traumatic experiences and geriatric depression (GDS) in a population of elderly who were exposed to severe childhood trauma. We aimed to identify the role of childhood maltreatment exposure in geriatric depression and the developmental and contextual factors that exacerbate this relationship. We interviewed 141 former indentured child laborers (58 females) about their experiences as children and their current depressive symptoms (Mage=77, SD=6.8). Participants provided their age, the year they were first indentured, duration indentured, current physical health, completed the Childhood Trauma Questionnaire (CTQ) and the Geriatric Depression Scale (GDS). Child maltreatment, specifically emotional abuse, was strongly associated with geriatric depression symptoms. These effects were specific to individuals who were removed from their biological families between the ages of 3 and 9 years, and for children who were indentured for 6-12 years. Finally, depression partially mediated the association between medical conditions and daily health impairment, but not for individuals "at risk" for depression by virtue of their maltreatment experiences. This study was conducted with a specific subpopulation of elderly and therefore may not generalize to all geriatric depression, nor to all generations or populations with exposure to childhood adversity. This study demonstrates the importance of using a developmental framework to understand how childhood maltreatment facilitates increased risk for the development of depression in late life.