Elevated Posttraumatic Stress Research Articles

Are Differences Evident in the Ways Boys and Girls Appraise and Interpret Their Traumatic Experiences? A Qualitative Analysis of Youth Trauma Narratives.

The purpose of this study was to explore potential similarities and differences in the ways boys and girls appraise and interpret their traumatic experiences, and better understand how gender roles, performance, and socialization processes may impact trauma experiences, appraisals, and narratives within the context of trauma-focused treatment. We used thematic analysis to analyze the trauma narratives of youth (N = 16) ages 8-16 who had experienced multiple types (M = 5.38) of child maltreatment and who were receiving Trauma-focused Cognitive Behavioral Therapy to address clinically elevated posttraumatic stress symptoms. Four themes emerged: variations in the content of negative cognitions, differences in relational emotion, adoption of socially prescribed gender roles, and symptom differences. Although many similarities existed in youth's trauma narratives, differences emerged that point to the importance of social context and the ways gender role expectations and socialization processes influence youth's appraisal of and responses to traumatic events. Findings indicate the importance of considering distress tolerance, relational emotion, gender identity development, and role socialization within the treatment milieu.

The influence of pretreatment respiratory sinus arrhythmia dimensions on trauma-focused cognitive behavioral therapy outcomes: Findings from a randomized controlled feasibility trial.

Child maltreatment is associated with respiratory sinus arrhythmia (RSA) dysregulation, a physiological indicator of emotion regulation that predicts elevated posttraumatic stress disorder (PTSD) symptoms and may be a mechanism of action for exposure-based therapies, such as trauma-focused cognitive behavioral therapy (TF-CBT). Animal-assisted therapy (AAT) has been proposed as an adjunct to TF-CBT for improving emotion regulation following maltreatment. The current study reports findings from a randomized controlled feasibility trial (N = 33; Mage = 11.79 years, SD = 3.08; 63.6% White; 66.7% female) that measured youths' resting RSA, RSA reactivity, and RSA recovery in response to a pretreatment laboratory challenge. We tested whether (a) lower pretreatment resting RSA was associated with blunted RSA during the challenge; (b) either of the pretreatment RSA dimensions predicted more severe pretreatment PTSD symptoms; and (c) either of the pretreatment RSA dimensions predicted less severe posttreatment PTSD symptoms and, as an exploratory aim, whether this was moderated by treatment group (i.e., TF-CBT vs. TF-CBT + AAT). Results from multiple linear regression indicated that, after controlling for pretreatment symptom severity, there was a large effect size for higher resting RSA predicting less severe caregiver-reported posttreatment PTSD symptoms, β = -.52, p =.058, and higher RSA during recovery predicting less severe child-reported posttreatment PTSD symptoms, β = -.70, p =.056, although these findings were not significant. These preliminary results offer important insights for future studies to investigate how the ability to regulate RSA informs which children need additional support to benefit from psychotherapeutic treatment.

Development of a brief bedside tool to screen women sexual assault survivors for risk of persistent posttraumatic stress six months after sexual assault

This study aims to develop and validate a brief bedside tool to screen women survivors presenting for emergency care following sexual assault for risk of persistent elevated posttraumatic stress symptoms (PTSS) six months after assault. Participants were 547 cisgender women sexual assault survivors who presented to one of 13 sexual assault nurse examiner (SANE) programs for medical care within 72 h of a sexual assault and completed surveys one week and six months after the assault. Data on 222 potential predictors from the SANE visit and the week one survey spanning seven broadly-defined risk factor domains were candidates for inclusion in the screening tool. Elevated PTSS six months after assault were defined as PCL-5 > 38. LASSO logistic regression was applied to 20 randomly selected bootstrapped samples to evaluate variable importance. Logistic regression models comprised of the top 10, 20, and 30 candidate predictors were tested in 10 cross-validation samples drawn from 80% of the sample. The resulting instrument was validated in the remaining 20% of the sample. AUC of the finalized eight-item prediction tool was 0.77 and the Brier Score was 0.19. A raw score of 41 on the screener corresponds to a 70% risk of elevated PTSS at 6 months. Similar performance was observed for elevated PTSS at one year. This brief, eight-item risk stratification tool consists of easy-to-collect information and, if validated, may be useful for clinical trial enrichment and/or patient screening.

Does cognitive load influence expressive flexibility? Comparing civilian and veteran populations

ABSTRACT Expressive flexibility (EF) is a component of emotion regulation flexibility repertoire that constitutes the ability to enhance or suppress the expression of emotion in accordance with a given situational context. Previous research has associated EF with healthy adjustment to adversity. This association has also been observed in combat veterans with elevated post-traumatic stress. EF and other elements of regulatory flexibility are believed to rely on functions of cognitive control, such as working memory. However, previous research has yet to investigate this link. Accordingly, we examined performance in veterans (N = 42) and non-veterans (N = 75) on an EF Task with and without the inclusion of a numerical cognitive load task. Results indicate an interaction between cognitive load and expressive condition. Specifically, suppression abilities were weaker in cognitive load conditions. These findings did not vary in veteran and non-veteran samples. These results add to a growing body of work indicating a relationship between cognitive control and regulatory flexibility, and suggest similar mechanisms between veteran and non-veteran populations.

The mental health of officials who regularly examine child sexual abuse material: strategies for harm mitigation

BackgroundThe current study aims to better understand the mental health and subjective well-being of investigators and forensic examiners exposed to child sexual abuse material (CSAM) by examining which components of this work are associated with elevated mental health conditions and decreased well-being, as well as the intra-personal and organizational variables that may mitigate harm and improve well-being.MethodsPolice investigators, forensic examiners, and others connected with the criminal justice system from across the United States who were exposed to CSAM as part of their professions (N = 500) completed an anonymous online survey. Participants were recruited through connections with the National Criminal Justice Training Center.ResultsDuration, frequency, amount, and content of CSAM exposure was not related to poorer mental health with the exception of exposure to violent CSAM which was related to elevated post-traumatic stress symptoms. Several agency-level practices and policies, such as the availability of an Officer Wellness Program and more frequently knowing the final case resolution, were related to better mental health and well-being. Harm mitigation strategies, such as talking to other officers investigating the case and taking breaks from the material being viewed, were also related to better mental health.ConclusionsFindings indicate that police agencies have options for implementing agency-level procedures and practices that have the potential to reduce the negative impact of CSAM investigations. Additionally, many investigators use strategies that are correlated with greater well-being, suggesting opportunities for improving training programs.

Changes in fear-associated learning task brain activation over the COVID-19 pandemic period: a preliminary longitudinal analysis

BackgroundThe COVID-19 pandemic has had profound impacts on people worldwide. Previous studies have shown that fear learning, extinction, recall, and contextual information processing involve the activation of emotion and sensory brain systems, which can be modified. However, it remains unclear whether brain functions associated with these processes have been altered over the pandemic period.MethodsWe compared pre- and peri-pandemic brain activation during a fear-associated learning task (FALT) using previously collected data. The participants were divided into two groups: the pandemic group (n = 16), who completed a baseline FALT before the pandemic and repeated the task during the pandemic, and the non-pandemic group (n = 77), who completed both sessions before the pandemic began.ResultsCompared with the non-pandemic group, the pandemic group exhibited significant decreases in brain activation from baseline to follow-up assessments, including activation in the brainstem during early fear learning, the posterior thalamus/hippocampus during late extinction, and the occipital pole during late recall phases for contextual processing. Furthermore, activations associated with retrieving safety cues were reduced in the posterior cingulate, premotor, and calcarine cortices during the early recall phase, and activations associated with retrieving dangerous cues decreased in the occipital pole during the late recall phase. Additionally, correlations between decreased activation and elevated posttraumatic stress symptoms were observed.ConclusionThese findings suggest that activations associated with processing low arousal contextual information, safety cues, and extinguished fear cues decreased during the pandemic. These changes in brain activation may have contributed to the increase in mental health disturbances observed during this time.

Exposure to the Indian Ocean Tsunami shapes the HPA-axis resulting in HPA “burnout” 14 years later

Despite significant research on the effects of stress on the hypothalamic-pituitary-adrenal (HPA) axis, questions remain regarding long-term impacts of large-scale stressors. Leveraging data on exposure to an unanticipated major natural disaster, the 2004 Indian Ocean tsunami, we provide causal evidence of its imprint on hair cortisol levels fourteen years later. Data are drawn from the Study of the Tsunami Aftermath and Recovery, a population-representative longitudinal study of tsunami survivors who were living along the coast of Aceh, Indonesia, when the tsunami hit. Annual rounds of data, collected before, the year after and 2 y after the disaster provide detailed information about tsunami exposures and self-reported symptoms of post-traumatic stress. Hair samples collected 14 y after the tsunami from a sample of adult participants provide measures of cortisol levels, integrated over several months. Hair cortisol concentrations are substantially and significantly lower among females who were living, at the time of the tsunami, in communities directly damaged by the tsunami, in comparison with similar females living in other, nearby communities. Differences among males are small and not significant. Cortisol concentrations are lowest among those females living in damaged communities who reported elevated post-traumatic stress symptoms persistently for two years after the tsunami, indicating that the negative effects of exposure were largest for them. Low cortisol is also associated with contemporaneous reports of poor self-rated general and psychosocial health. Taken together, the evidence points to dysregulation in the HPA axis and "burnout" among these females fourteen years after exposure to the disaster.

Posttraumatic stress symptoms in adolescents and young adults with a chronic somatic disease: a mixed-methods study

BackgroundAdolescents and young adults (AYA) with a chronic somatic disease (CD) have a 3-fold higher risk of post-traumatic stress disorder (PTSD) than healthy controls. In addition, elevated post-traumatic stress symptoms (PTSS) have a negative impact on CD severity, treatment adherence, health problems and functional impairment. However, a more detailed understanding of this comorbidity is lacking.MethodsAYA with type 1 diabetes mellitus, juvenile idiopathic arthritis or cystic fibrosis (12–21 years of age) and elevated anxiety and/or depression symptoms, as well as their reference persons (≥ 18 years of age), completed online questionnaires in self- or observer report. The most stressful event related to the CD was reported descriptively. Questionnaires were used to assess PTSS, anxious and depressive symptoms, actual overall health, coping, personal growth and social support. Qualitative content analysis, linear regression models and correlations were used for mixed methods analysis.ResultsAccording to the reports of n = 235 AYA (mean age 15.61; 73% girls) and n = 70 reference persons, four categories were identified as the most stressful events due to CD: (1) psychological burden (40% of AYA / 50% of reference persons); (2) CD self-management (32% / 43%); (3) social burden (30% / 27%); and (4) physical impairment (23% / 16%). 37% of AYA reported clinically relevant PTSS due to CD. The best predictors of PTSS severity were anxious-depressive symptoms, emotional coping, personal growth and current overall health (F(4, 224) = 59.404, R² = 0.515, p < .001). Of all categories, psychological (β = 0.216, p = .002) and social burden (β = 0.143, p = .031) showed significant association with the severity of PTSS (F(4, 230) = 4.489, R² = 0.072, p = .002). The more categories the most stressful event addressed, the higher was the PTSS symptom severity (r = .168, p = .010).ConclusionsMany AYA showed clinically relevant PTSS and reported experiencing stressful events in several areas of life through their CD. The association between the stressful event categories and other variables could help identify AYA with CD who need psychological interventions the most.Trial registration: German Clinical Trials Register (DRKS): DRKS00016714, registered on 25/03/2019 and DRKS00017161, registered on 17/09/201.

0159 Sleep Disturbance, Media Consumption, and Post Traumatic Stress following Hurricane Harvey

Abstract Introduction Experiencing one-time traumatic events such as a hurricane is known to produce sleep disturbances that may contribute to the development and maintenance of PTSD symptoms (Mellman, 2019). Additionally, greater exposure to media coverage during and following such events has been shown to contribute to elevated post-traumatic stress (PTS; Shin &amp; Sommers, 2021). However, whether media consumption might moderate the relationship between sleep disturbances and PTS symptoms has not been examined. We examined these relationships in a sample of college students following Hurricane Harvey, an epic storm that hit Texas in 2017 and received non-stop media coverage for an extended period after the storm. Methods Participants were undergraduate students (N=260, M age=21.32) at the University of Houston during Hurricane Harvey. Students answered online surveys 6-8 months following the hurricane that measured sleep quality and PTS symptoms over the last month, and media use both during and immediately following the hurricane. Sleep was assessed using the Pittsburg Sleep Quality Index (PSQI) and PTS symptoms were assessed using the PTSD Checklist for DSM-5 with sleep questions removed. Results Results indicated that active media consumption post hurricane was significantly correlated with PTS symptoms (r=.21, p&amp;lt;.001). Regression analyses showed sleep quality significantly predicted PTS symptoms (R2 change=.133, p&amp;lt;.001). However, contrary to expectation, this relationship was not moderated by active media consumption after Hurricane Harvey (R2 change=.19, p=.495). Conclusion Previous research has found both sleep disturbance and greater exposure to media coverage of traumatic events are associated with greater symptoms of PTS. Although media exposure to trauma may impact sleep quality, our findings suggest these factors to exert independent effects on PTS symptoms. Better understanding of the role of media consumption in the aftermath of trauma is needed to understand these relationships. Support (if any)

Pilot randomized clinical trial of an app-based early intervention to reduce PTSD and alcohol use following sexual assault.

Sexual assault is associated with high risk for posttraumatic stress disorder (PTSD), and PTSD often co-occurs with alcohol misuse. Most sexual assault survivors do not access early preventative interventions for such conditions. App-based interventions are a promising means to extend the reach of early interventions and thereby reduce risk of chronic PTSD and alcohol misuse. This study was a pilot randomized clinical trial of an app-based early intervention with phone coaching (THRIVE) for survivors of past-10-week sexual assault (NCT#: NCT03703258). Intended active components of the THRIVE app are daily cognitive restructuring, daily activity scheduling, and as-needed relationally focused exercises, supported by coaching calls. Forty-one adult female survivors of recent sexual assault with elevated posttraumatic stress and drinking were randomized to intervention or control (symptom-monitoring app with phone coaching). Participants in both conditions were encouraged to use their respective app for 21 days and completed self-report symptom assessments at baseline, postintervention, and 3-month follow-up. At 3-month follow-up, the between-group effect size favored intervention for posttraumatic stress (d = -0.70), intoxication frequency (d = -0.62), and drinking hours per week (d = -0.39). More participants evidenced reliable change in intervention versus control for posttraumatic stress (OR = 2.67) and alcohol problems (OR = 3.05) at 3 months. The general direction of effects indicates that THRIVE, coupled with coaching, reduces risk for PTSD and alcohol outcomes beyond coached monitoring. These findings suggest that apps like THRIVE may provide an option for early intervention for sexual assault survivors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mental health during the COVID-19 pandemic in a longitudinal study of Hurricane Katrina survivors

While the COVID-19 pandemic is known to have caused widespread mental health challenges, it remains unknown how the prevalence, presentation, and predictors of mental health adversity during the pandemic compare to other mass crises. We shed light on this question using longitudinal survey data (2003–2021) from 424 low-income mothers who were affected by both the pandemic and Hurricane Katrina, which struck the U.S. Gulf Coast in 2005. The prevalence of elevated posttraumatic stress symptoms was similar 1-year into the pandemic (41.6%) as 1-year post-Katrina (41.9%), while elevated psychological distress was more prevalent 1-year into the pandemic (48.3%) than 1-year post-Katrina (37.2%). Adjusted logistic regression models showed that pandemic-related bereavement, fear or worry, lapsed medical care, and economic stressors predicted mental health adversity during the pandemic. Similar exposures were associated with mental health adversity post-Katrina. Findings underscore the continued need for pandemic-related mental health services and suggest that preventing traumatic or stressful exposures may reduce the mental health impacts of future mass crises.

Posttraumatic stress and pain-related anxiety among trauma-exposed adults with chronic pain in terms of opioid misuse and dependence

Trauma-exposure and posttraumatic stress symptoms increase risk for opioid-related problems in the context of chronic pain. Yet, there has been little exploration of moderators of the posttraumatic stress-opioid misuse association. Pain-related anxiety, defined as worry about pain and the negative consequences of pain, has shown relations to both posttraumatic stress symptoms and opioid misuse, and it may moderate the association between posttraumatic stress symptoms and opioid misuse, as well as dependence. The current study examined the moderating role of pain-related anxiety on the relationship between posttraumatic stress symptoms and opioid misuse and dependence among 292 (71.6 % female, Mage = 38.03 years, SD = 10.93) trauma exposed adults with chronic pain. Results indicated that pain-related anxiety significantly moderated the observed relations, such that compared to those with low pain-related anxiety, the relationship between posttraumatic stress symptoms and opioid misuse and dependence was stronger for those with elevated pain-related anxiety. These results highlight the importance of assessing and targeting pain-related anxiety among this trauma-exposed segment of the chronic pain population with elevated posttraumatic stress symptoms.

Reduced working memory performance in PTSD and suicide among veterans presenting for treatment

Suicide is among the leading causes of death in the United States, underscoring the continued need to understand the mechanisms underlying suicide risk. A growing body of research has examined the role of working memory deficits in suicidal thoughts and behaviors (STBs), yet little research has evaluated putative pathways via which working memory impairments may heighten suicide risk. Elevated posttraumatic stress symptoms (PTSS) represent one plausible mechanism through which poor working memory performance may increase STBs. The present study utilized data from 140 treatment-seeking veterans who presented for an intake evaluation in the PTSD Clinical Team of a large VA Medical Center. Veterans completed self-report measures, a semi-structured PTSD evaluation, and a digit span working memory test. In addition to concurrent suicidal ideation assessed during the intake, additional information regarding past suicide attempts, presence of a safety plan, documentation of past suicidal behaviors, and engagement with suicide crisis lines were collected via electronic medical records. Consistent with hypotheses, a significant indirect path emerged such that poor working memory performance predicted greater suicidal ideation, greater likelihood of a past suicide attempt, and greater latent suicide risk via increased PTSS. However, no direct effect of working memory on STBs or indirect paths of PTSS on STBs via working memory emerged. These findings suggest that the relation between working memory and STBs may be explained by PTSS severity.

The mental health impact of COVID-19-related stressors among treatment-seeking trauma-exposed veterans.

Trauma‐exposed veterans receiving mental health care may have an elevated risk of experiencing COVID‐19–related difficulties. Using data from several ongoing clinical trials (N = 458), this study examined exposure to COVID‐19–related stressors and their associations with key sociodemographic factors and mental health outcomes. The results showed that exposure to COVID‐19–related stressors was common, higher among veterans who were racial/ethnic minorities d = 0.32, and associated with elevated posttraumatic stress disorder (PTSD), r = .288, and depressive symptom severity, r = .246. Women veterans experienced more difficulty accessing social support, d = 0.31, and higher levels of COVID‐19–related distress, d = 0.31, than men. Qualitative data were consistent with survey findings and highlighted the broader societal context in veterans’ experience of COVID‐19–related distress. These findings may inform future research on the impact of the pandemic on veterans, particularly those who are women and members of minoritized racial/ethnic groups, as well as mental health treatment planning for this population.

Supporter-focused early intervention for recent sexual assault survivors: Study protocol for a pilot randomized clinical trial

IntroductionSexual assault is a common form of trauma that is associated with elevated risk for negative psychosocial outcomes. Although survivors' social relationships could serve as a major protective factor against negative outcomes, survivors' supporters often lack knowledge regarding effective responses and may inadvertently respond in ways that are detrimental to healing. Communication and Recovery Enhancement (CARE) is a 2-session early intervention for survivors of a past-10-week sexual assault and their supporters that aims to improve supporters' ability to respond effectively. ObjectiveIn this paper, we present a study protocol for a pilot randomized clinical trial of CARE (NCT05345405). The goal of this pilot trial is to understand the feasibility, acceptability, and preliminary efficacy of two versions of CARE: a version in which survivors and supporters attend sessions together (dyadic version) and a version in which supporters attend sessions alone (supporter-only version). MethodsSurvivors aged 14+ with elevated posttraumatic stress will enroll with a supporter of their choosing. Dyads will be randomized to dyadic CARE, supporter-only CARE, or waitlist control, and will complete self-report assessments at baseline, post-session-1, and follow-ups (1, 2, and 3 months post-baseline). We will use descriptive statistics, effect sizes, and exploratory statistical tests to characterize the acceptability of both CARE versions, impact on knowledge change from baseline to 1 month, impact on disclosure experiences at 1 month, and impact on functional outcomes at 3 months. DiscussionResults will be used to inform future changes to CARE and determine whether a fully-powered randomized controlled trial is warranted.

Immigration-Related Trauma Associated With Metabolic Risk and Cognition in Hispanic and Latino Immigrant Populations

Recent immigrant and undocumented Hispanic/Latino adults in the United States (U.S.) are an underserved segment of the aging population. In this cross-sectional pilot study, we examined associations between self-reported stressors metabolic syndrome, emotional reactivity, and cognitive functioning in a heterogenous sample (N=80) of Hispanic/Latino adults (43.8% Central America; 43.8% South America; 7.5% Caribbean; mean years in the U.S.=18.1, SD=12.8). Participants (Meducation=10.2 years, SD=5.34; Mage=48.6 years, SD=12.3) underwent blood draw, anthropometrics and NIH-toolbox cognitive and behavioral measures. Linear regressions indicated that, elevated glucose was inversely associated with working memory (r=-.30), whereas higher HDL and controlled glucose were associated with better episodic memory (r=.27) and executive functioning (r=.32). Results further revealed associations between immigration-related trauma and elevated posttraumatic stress symptomatology. Implications for mental health and early detection of modifiable risk factors to promote healthy aging in vulnerable Hispanic/Latino immigrant populations are discussed.

Fragmentation of the self: Characteristics of sexual assault and implications in self-drawing

The current study explored the extent to which sexually assaulted survivors' self-drawings can serve as an efficient tool to assess their mental states and psychopathology as characterized in the DAP-SPED (Naglieri et al., 1991, 1992). The sample was composed of 83 SA Israeli adult survivors. Hypothesis 1 (H1) predicted frequent distortions and omission of body parts, a disconnection between body parts, and a poor-quality line. Hypothesis 2 (H2) predicted a positive correlation between the number of indicators in the women's self-drawings and their levels of post-traumatic stress symptoms. Hypothesis 3 (H3) predicted a negative association between the number of indicators and women's levels of post-traumatic growth. Analysis of the drawings confirmed H1. The drawings lacked integration, tended to have a shadow around the body contour and/or were off-center. The figures were missing the torso, hands or feet with emphasized eyes or necks and chin. H2 and H3 were partially confirmed in that women whose drawings were characterized by omissions, cut-offs, and detached body parts scored higher on post-traumatic stress symptoms and evidenced a lower level of post-traumatic growth. Phenomenologically, the drawings were categorized into six groups (adapted, dramatic, strange, childish, unease, loneliness, and sad). Women in the dramatic drawings group had higher post-traumatic stress symptoms and post-traumatic growth. Women in the unease drawings group had the most elevated post-traumatic stress symptoms. Since SA survivors often turn to therapy without revealing the assault, draw oneself can provide the clinician with important insights into the physical and emotional aspects of the client.

Protocol for the RELATE trial: a feasibility and pilot randomised controlled trial of a low-intensity group intervention for young people in care with elevated posttraumatic stress symptoms

IntroductionYoung people in out-of-home care have often experienced trauma, such as direct maltreatment or witnessing violence. There is good evidence that rates of mental health difficulties are high in this group, including posttraumatic stress disorder (PTSD), a trauma-specific mental health outcome. There remains less evidence to guide how to effectively address elevated PTSD symptoms (PTSS) in these young people, particularly in ways that are feasible and scalable for stretched social-care and mental health services.Methods and analysisThis protocol describes a feasibility study comprising a pilot two-arm randomised controlled trial (RCT). Participants (N = 50) will be randomised to either (a) a group-based trauma-focused programme (Teaching Recovery Techniques), delivered by mental health practitioners both online and in-person, or (b) care-as-usual. Primarily, the trial aims to explore the key feasibility and protocol acceptability questions, including rates of recruitment and retention, as well as the acceptability of the intervention (particularly the online delivery format) to participants and services. In addition, outcomes including PTSS (primary clinical outcome), depression and functioning will be assessed at baseline (pre-randomisation), post-intervention and at a 3-month follow-up.Ethics and disseminationEthical approval has been received from the Health Research Authority (Wales REC1 Ref 20/WA/0100) and University, with further approval from the host trust and social care site. The results will inform the design of a definitive RCT. Dissemination will include peer-reviewed journal articles reporting the qualitative and quantitative results, as well as presentations at conferences and lay summaries.Trial registrationClinicalTrials.gov, NCT04467320. Registered on 13 July 2020.

Racial, ethnic, and neighborhood income disparities in childhood posttraumatic stress and grief: Exploring indirect effects through trauma exposure and bereavement.

Previous findings suggest that experiences with systems of oppression that disproportionately affect individuals based on race and neighborhood residency (e.g., systemic racism, neighborhood income disadvantage [NID]) can be associated with higher odds of developing psychological problems following traumatic events. Although race/ethnicity and NID residency are often associated, they are separate concepts that play unique roles in mental health outcomes among youth. Residents of Black, Latinx, and income-disadvantaged communities also have an increased risk of exposure to polyvictimization and the loss of multiple loved ones. Studies have not carefully delineated the potential relations between race/ethnicity and NID residency, polyvictimization, accumulated losses, and trauma and grief outcomes in youth. We examined mediation models to investigate whether polyvictimization, the loss of multiple loved ones, and exposure to violent death were potential mechanisms through which race/ethnicity and NID would predict trauma and grief outcomes in youth. Participants (N = 429) included Black (19.9%), Latinx (36.0%), and White (27.3%) children and adolescents who were assessed through a routine baseline assessment at a trauma and grief outpatient clinic. Black youth reported significantly elevated posttraumatic stress and maladaptive grief symptoms through higher polyvictimization and violent death exposure relative to White youth, βs = .06-.12, ps <.001. Latinx identity and NID were positively and directly associated with specific domains of maladaptive grief reactions, βs = .10-.17, ps < .001. If replicated longitudinally, these findings suggest that polyvictimization and violent death exposure may be mechanisms through which Black youth develop more severe traumatic stress and grief reactions.

Post-traumatic stress symptoms in COVID-19 survivors: a self-report and brain imaging follow-up study.

Previous coronavirus pandemics were associated elevated post-traumatic stress symptoms (PTSS), but the self-report and neurological basis of PTSS in patients who survived coronavirus disease 2019 (COVID-19) are largely unknown. We conducted a two-session study to record PTSS in the COVID-19 survivors discharged from hospitals for a short (i.e., about 3 months, Session 1) to a medium period (i.e., about 6 months, Session 2), as well as brain imaging data in Session 2. The control groups were non-COVID-19 locals. Session 1 was completed for 126 COVID-19 survivors and 126 controls. Session 2 was completed for 47 COVID-19 survivors and 43 controls. The total score of post-traumatic stress disorder (PTSD) checklist for DSM-5 (PCL-5) score was significantly higher in COVID-19 survivors compared with controls in both sessions. The PCL-5 score in COVID-19 survivors was positively correlated with the duration after discharge (r = 0.27, p = 0.003 for Session 1), and increased by 20% from Session 1 to Session 2 for the survivors who participated both sessions. The increase was positively correlated with individual’s test-retest duration (r = 0.46, p = 0.03). Brain structural volume and functional activity in bilateral hippocampus and amygdala were significantly larger in COVID-19 survivors compared with controls. However, the volumes of the left hippocampus and amygdala were negatively correlated with the PCL-5 score for the COVID-19 survivors. Our study suggests that COVID-19 survivors might face possible PTSS deteriorations, and highlights the importance of monitoring mental wellness of COVID-19 survivors.