Trauma Exposure Research Articles

Primary Cutaneous Cryptococcus Following Traumatic Exposure: A Case Report and Retrospective Analysis

Primary cutaneous cryptococcus (PCC) is a form of Cryptococcal neoformans infection characterized by localized cutaneous colonization and proliferation. In this case study, we present PCC occurring following a previous trauma in a 77-year-old male with a history of renal organ transplant maintained by immunosuppressive therapy. Colonies of C. neoformans were successfully identified during a secondary workup after the patient had been misdiagnosed. Despite the delay in treatment, complete remission was achieved through aggressive antifungal therapy. Our case highlights common clinical pitfalls that contribute to the prolonged diagnosis of PCC. Our findings and retrospective analysis underscore commonalities in disease presentation, such as high-risk patient populations, transmission routes, and associated symptoms. Integrating these insights into clinical practice may heighten provider suspicion and enhance patient outcomes.

Examining posttraumatic cognitions as a pathway linking trauma exposure and eating disorder symptoms in veteran men and women: A replication and extension study

ABSTRACT Trauma is a risk factor for eating disorders (EDs). Enhanced understanding of the pathways from trauma to EDs could identify important treatment targets. Guided by theory, the present study sought to replicate previous findings identifying posttraumatic stress disorder (PTSD) symptoms and shape/weight overvaluation as important pathways between trauma and ED symptoms and extend this work by investigating the role of posttraumatic cognitions in these associations. The sample included 825 female and 565 male post-9/11 veterans who completed cross-sectional survey measures of trauma, posttraumatic cognitions, PTSD symptoms, shape/weight overvaluation, and ED symptoms. Gender-stratified structural equation models were used to examine direct and indirect pathways from trauma exposure to EDs via PTSD symptoms and shape/weight overvaluation (replication) and posttraumatic cognitions (extension). Results suggested that trauma exposure was indirectly associated with ED symptoms via shape/weight overvaluation and posttraumatic cognitions. There was no indirect association between trauma exposure and ED symptoms via PTSD symptoms. Overall, findings from this study highlight the potential role of posttraumatic cognitions in understanding the association between trauma and ED symptoms. However, future longitudinal research is needed to verify the directionality of these associations and investigate cognitions as a potentially targetable risk mechanism in co-occurring trauma and EDs.

Further evidence that peritraumatic 17β-estradiol levels influence chronic posttraumatic pain outcomes in women, data from both humans and animals.

Chronic posttraumatic pain (CPTP) is common after traumatic stress exposure (TSE) and disproportionately burdens women. We previously showed across 3 independent longitudinal cohort studies that, in women, increased peritraumatic 17β-estradiol (E2) levels were associated with substantially lower CPTP over 1 year. Here, we assessed this relationship in a fourth longitudinal cohort and also assessed the relationship between E2 and CPTP at additional time points post-TSE. Furthermore, we used a well-validated animal model of TSE to determine whether exogenous E2 administration protects against mechanical hypersensitivity. Using nested samples and data from the Advancing Understanding of RecOvery afteR traumA study (n = 543 samples, 389 participants), an emergency department-based prospective study of TSE survivors, we assessed the relationship between circulating E2 levels and CPTP in women and men using multivariate repeated-measures mixed modeling. Male and ovariectomized female Sprague Dawley rats were exposed to TSE and administered E2 either immediately after or 3 days post-TSE. Consistent with previous results, we observed an inverse relationship between peritraumatic E2 and longitudinal CPTP in women only (β = -0.137, P = 0.033). In animals, E2 protected against mechanical hypersensitivity in female ovariectomized rats only if administered immediately post-TSE. In conclusion, peritraumatic E2 levels, but not those at post-TSE time points, predict CPTP in women TSE survivors. Administration of E2 immediately post TSE protects against mechanical hypersensitivity in female rats. Together with previous findings, these data indicate that increased peritraumatic E2 levels in women have protective effects against CPTP development and suggest that immediate post-TSE E2 administration in women could be a promising therapeutic strategy for reducing risk of CPTP.

Associations between avoidant/restrictive food intake disorder profiles and trauma exposure in veteran men and women.

Trauma exposure, particularly interpersonal trauma, is prevalent among individuals with eating disorders (EDs), and trauma exposure and the subsequent development of posttraumatic stress disorder have been associated with poorer outcomes for ED treatment. To our knowledge, there are no published investigations of trauma exposure among individuals with avoidant/restrictive food intake disorder (ARFID), a new diagnosis introduced by the Diagnostic and Statistical Manual of Mental Disorders-5. We investigated associations between trauma exposure and ARFID profiles in a sample of U.S. military veteran men and women. Participants in this cross-sectional study included 1494 veterans randomly selected from the population of post-9/11 veterans who had separated from military service within the previous 18 months. They completed a survey assessing EDs, including the Nine Item ARFID Screen and trauma exposure. Results revealed that 9.8% of the sample exceeded cutoffs for any ARFID profile, with the picky eating profile being the most common. Trauma exposure was prevalent among participants who exceeded cutoffs for ARFID, particularly the picky eating profile. Findings highlight the importance of addressing EDs, including ARFID, in veterans. It will be important to examine the extent to which trauma and trauma-related disorders impact treatment outcomes for individuals with ARFID.

A - 35 Effects of Childhood Trauma Exposure on Psychological Symptom Endorsement among Adult ADHD Referrals

Abstract Objective Adults with attention-deficit/hyperactivity disorder (ADHD) are more likely to have childhood trauma exposure. Trauma exposure evaluations are not always standard practice for adult ADHD evaluations, but personality inventories like the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) are more commonly used to differentiate neurodevelopmental symptoms from psychiatric disorders. This study assessed the impact of childhood trauma exposure on MMPI-2-RF profiles among adults referred for ADHD evaluation. Method Cross-sectional data from 222 patients referred for neuropsychological evaluation for attention concerns and administered the Adverse Childhood Experiences (ACE) Checklist and MMPI-2RF were examined. Patients were racially diverse with a Mage 29.15 (SD = 7.63) and Meducation 16.15 years (SD = 2.13). Patients were divided into low (0–3 ACEs) and high (>3 ACEs) ACE groups. ACEs groups’ MMPI-2RF Restructured Clinical (RC) scale scores were compared via multivariate analyses of variance (MANOVAs) for the overall sample and subsample of those who ultimately received an ADHD diagnosis. Results The sample had 52% low ACEs/48% high ACEs, and 65% ADHD diagnosis/35% non-ADHD diagnosis. Overall, there was a significant multivariate effect (Wilks Λ =0.812; F(9,212) = 5.45, p < 0.001; np2 = 0.188); those with high ACE scores had significantly higher RC1, RC4, RC6, RC7, and RC8 scores. Significant MANOVA effects remained when the sample with subdivided. Across ADHD and non-ADHD subgroups, significantly higher RC4 and RC6 scores were consistent. Conclusions Exposure to childhood trauma had a significant impact on the MMPI-2-RF profile of adults being evaluated for ADHD. Screening for trauma exposure should be incorporated into standard neuropsychological batteries to inform the interpretation of personality inventories used to differentiate psychopathology.

If the Body Keeps the Score, What Happens When You Bring the Body to Work? Exploring the Health Effects of Trauma on Human Capital

Data reveal that the physical effects of trauma exposure increasingly surface in business, social, and other settings. Exposure to trauma at any point in life can cause employee health concerns, yet many firms do not acknowledge or address this. Herein, we combine trauma theory with human capital theory to explain how manifestations of trauma exposure— hyperarousal, intrusion, and constriction—impact employee health and performance. This article outlines how each manifestation affects human capital deployment, and thus employee performance. It further demonstrates how these human capital deployment issues have individual- and unit-level performance implications. This article offers a theory linking health effects of trauma to performance outcomes at work. It suggests how managerial awareness of trauma manifestations is a necessary step toward workplaces becoming supportive or healing. Our model offers new explanations related to why some individuals behave as they do at work and connects trauma to employee behavior and value creation.

Protective Factors as Mediators Between Trauma and Internalizing Difficulties Among Male and Female Young Adults

The goal of this study was to examine the indirect effect of protective factors (i.e., resilience, coping, and self-esteem) on the association between exposure to traumatic events in childhood and internalizing difficulties for men and women. We surveyed 583 young adults aged 18 to 25 years about past exposure to traumatic events and current internalizing difficulties. The results suggest that there is a significant indirect effect of protective factors on the association between lifetime traumatic event exposure and internalizing distress. Furthermore, there was a gender difference between groups for the indirect effect of protective factors; protective factors had a mediating effect for women but not for men. This study highlights the importance of protective factors in understanding why some individuals experience internalizing difficulties after exposure to traumatic events. When working with victims of traumatic events, it is essential to consider their sex and the presence of protective factors such as coping, resilience, and self-esteem.

The role of maternal postmigration living difficulties in intergenerational trauma transmission among asylum-seeker mother-child dyads: Exploring complex posttraumatic stress disorder as a mechanism.

Among forcibly displaced people, maternal trauma and stress have been implicated in poor child socioemotional outcomes via intergenerational trauma transmission. This study explored the role of maternal postmigration living difficulties (PMLD) in the pathway linking maternal trauma, trauma-related psychopathology, and child socioemotional outcomes among mother-child dyads seeking asylum in a high-risk urban setting. Participants were East African (Eritrean) mothers (N = 127) of preschool-aged children seeking asylum in Israel. Using moderated mediation analysis, we tested whether and how PMLD may moderate the mediating role of current maternal International Classification of Diseases, 11th revision (ICD-11) posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder disturbances in self-organization (DSO) symptoms between past maternal trauma exposure and current postdisplacement child internalizing and externalizing difficulties. Children's direct exposure to adverse life experiences was controlled for. Maternal PTSD symptoms mediated the association between past maternal trauma exposure and child internalizing difficulties, but not externalizing difficulties, across all levels of current maternal PMLD. However, maternal DSO symptoms mediated internalizing and externalizing child outcomes, but only among mothers reporting high levels of current PMLD. This study provides novel evidence that PMLD may amplify the toxicity of past maternal trauma exposure for poor child socioemotional outcomes via ICD-11 DSO symptoms. The intergenerational transmission pathway via the narrower fear-based ICD-11 PTSD, however, is independent of the degree of maternal PMLD. Findings suggest that policies designed to buffer intergenerational trauma transmission among forcibly displaced people may need to consider the toxicity of PMLD as well as enable mothers to heal from PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trauma-Informed Development and Education: Turning the TIDE on Transition to Practice.

Transition to practice (TTP), the first year of a nurse's career postlicensure, is widely recognized as a stressful time. Previous trauma exposure and additional workplace trauma exacerbate the stress of this transitional period. Trauma-informed environments are associated with clinician wellness and engagement. Because workforce training for leaders is a necessary precursor to developing supportive environments, we studied changes in trauma knowledge, awareness, and attitudes among TTP leaders. Our mixed methods study included administering the Attitudes Related to Trauma-Informed Care Scale (ARTIC) pre- and post-training, with additional open-ended questions about the impact of training. Paired data from participants showed overall mean improvement that was statistically significant, with a large effect size. Statistically significant knowledge gains related to trauma recognition and safety, how to respond to trauma, and how to promote healthy behaviors. Our study underscores the importance of trauma education, which not only increased awareness but also prompted nurse leaders to reflect on enhanced support for early nursing professionals. [J Contin Educ Nurs. 2024;55(10):501-508.].

Mitigating the impact of secondary traumatic stress and compassion fatigue among forensic interviewing professionals: utilization of the four quadrants of self-preservation to promote post-traumatic growth

Forensic interviewing professionals, who regularly engage with children and youth reporting traumatic experiences, are particularly susceptible to secondary traumatic stress (STS) and compassion fatigue (CF). This conceptual article delves into the occupational hazards associated with forensic interviewing, emphasizing the inevitability of STS and CF due to frequent exposure to harrowing accounts of abuse. The article underscores the importance of recognizing these phenomena and differentiating them from burnout—a critical distinction that guides appropriate interventions. Utilizing the "Four Quadrants of Self-Preservation," a trauma- informed framework, the article offers practical strategies for forensic interviewers to mitigate the impacts of STS and CF. This approach promotes resilience through intentional self-care practices across four stages of secondary trauma exposure: before, during, immediately after, and ongoing post-exposure to traumatic material. The article advocates for organizational support in implementing these strategies, emphasizing the ethical imperative to safeguard the well-being of forensic interviewers. The findings suggest that addressing STS and CF not only enhances the personal resilience of professionals but also improves client outcomes, by reducing the likelihood of turnover and professional errors. This article contributes to the growing body of literature calling for trauma-informed practices in forensic settings, highlighting the need for continued research and organizational commitment to support these professionals.

Mental health and trauma exposure in the humanitarian sector: A case of humanitarian logisticians.

Mental health and trauma exposure in the humanitarian sector: A case of humanitarian logisticians.

Clinical correlates of irritability, anger, hostility, and aggression in posttraumatic stress disorder.

Although irritability, anger, and aggression are diagnostic symptoms of posttraumatic stress disorder (PTSD), their clinical significance and associations with psychopathology remain unclear. In a sample of community adults with probable PTSD (n = 151), we measured irritability, physical aggression, verbal aggression, anger, and hostility with the Brief Irritability Test and the Brief Aggression Questionnaire. Participants' psychopathology, including depression, attention deficit and hyperactivity disorder (ADHD), psychotic-like experiences, insomnia, as well as suicidal behaviors were also assessed. Correlation analysis showed that irritability and anger were modestly related to all PTSD dimensions; physical aggression was related to avoidance, negative alterations in cognitions and mood (NACM), and hyperarousal; hostility was related to reexperiencing, NACM, and hyperarousal; while verbal aggression was not significantly related to any PTSD dimensions. After adjustment for trauma exposure and PTSD symptoms, irritability was associated with almost all psychopathology and suicidal behaviors, however, anger, hostility, and aggression were sparsely related to some psychopathology or suicidal behaviors. Particularly, anger was only related to ADHD and insomnia. Latent profile analysis based on PTSD, irritability, anger, hostility, and aggression indicated two discrete subgroups: the high severity group (33.8%) and the low severity group (66.2%), with high severity group reporting higher rates of comorbidity and suicidal behaviors. The findings support irritability, aggression, anger, and hostility as separate constructs; moreover, irritability, anger, and aggression should be independently measured in PTSD. Our findings also suggest the significance of irritability as a separate hallmark of PTSD and the need to incorporate PTSD dimensions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical Education: Addressing Prior Trauma and Its Impacts in Medical Settings.

Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma's effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes.

Trauma exposure proximity associated with eating disorder diagnosis in women with food insecurity

Trauma exposure is a risk factor for both food insecurity (FI) and increased eating disorder (ED) pathology. The purpose of this study was to explore the relation between trauma and ED diagnosis in a sample of women experiencing FI. A cross-sectional analysis of surveys from 99 women with self-reported FI (54% White; mean [SD] age = 40.26 [14.33] years) in the United States was employed. Participants completed online surveys including the Life Events Checklist (LEC) questionnaire, General Anxiety Disorder-7, Patient Health Questionnaire-9, and an interview comprised of the Household Food Security Survey Module (HFSSM) and Eating Disorder Diagnostic Interview (EDDI). LEC traumatic events were weighted by proximity: events experienced directly were weighted by a factor of 3, witnessed by 2, learned about by 1, and summed to a total weighted score. ED diagnosis in the past 12 months was assessed via the EDDI using DSM-5 diagnostic criteria. A binary logistic regression model tested associations between weighted trauma score, FI, and ED diagnosis. Weighted trauma score significantly predicted any ED diagnosis (OR = 1.039, p = .016), but FI severity did not (OR = .746, p = .101). These results suggest trauma proximity predicts ED diagnosis beyond that of FI severity and may be an important component of the association between FI and ED pathology. Future work may consider evaluating longitudinal symptoms of trauma and trauma severity in relation to FI.

Clinical implications of head trauma in frontotemporal dementia and primary progressive aphasia

BackgroundTraumatic brain injury (TBI) and repetitive head impacts (RHI) have been linked to increased risk for multiple types of neurodegenerative disease, higher dementia risk, and earlier age of dementia symptom onset, suggesting transdiagnostic implications for later-life brain health. Frontotemporal dementia (FTD) and primary progressive aphasia (PPA) represent a spectrum of clinical phenotypes that are neuropathologically diverse. FTD/PPA diagnoses bring unique challenges due to complex cognitive and behavioral symptoms that disproportionately present as an early-onset dementia (before age 65). We performed a detailed characterization of lifetime head trauma exposure in individuals with FTD and PPA compared to healthy controls to examine frequency of lifetime TBI and RHI and associated clinical implications.MethodsWe studied 132 FTD/PPA (age 68.9 ± 8.1, 65% male) and 132 sex-matched healthy controls (HC; age 73.4 ± 7.6). We compared rates of prior TBI and RHI (contact/collision sports) between FTD/PPA and HC (chi-square, logistic regression, analysis of variance). Within FTD/PPA, we evaluated associations with age of symptom onset (analysis of variance). Within behavioral variant FTD, we evaluated associations with cognitive function and neuropsychiatric symptoms (linear regression controlling for age, sex, and years of education).ResultsYears of participation were greater in FTD/PPA than HC for any contact/collision sport (8.5 ± 6.7yrs vs. 5.3 ± 4.5yrs, p = .008) and for American football (6.2yrs ± 4.3yrs vs. 3.1 ± 2.4yrs; p = .003). Within FTD/PPA, there were dose-dependent associations with earlier age of symptom onset for TBI (0 TBI: 62.1 ± 8.1, 1 TBI: 59.9 ± 6.9, 2 + TBI: 57.3 ± 8.4; p = .03) and years of American football (0yrs: 62.2 ± 8.7, 1-4yrs: 59.7 ± 7.0, 5 + yrs: 55.9 ± 6.3; p = .009). Within bvFTD, those who played American football had worse memory (z-score: -2.4 ± 1.2 vs. -1.4 ± 1.6, p = .02, d = 1.1).ConclusionsLifetime head trauma may represent a preventable environmental risk factor for FTD/PPA. Dose-dependent exposure to TBI or RHI influences FTD/PPA symptom onset and memory function in bvFTD. Clinico-pathological studies are needed to better understand the neuropathological correlates linking RHI or TBI to FTD/PPA onset and symptoms.

Interpersonal trauma Dissociates borderline from other personality disorders in social orienting

Patients with Borderline Personality Disorder (BPD), particularly with comorbid trauma-disorders, show an attentional bias towards angry facial expressions. This is often interpreted to reflect increased anxiety and sensitivity to social threats. Given BPDs severe problems in reacting to and interpreting social communication, we investigated whether this threat bias extends to social orienting. Using a gaze-cueing task, we assessed whether centrally presented dynamic fearful and happy gaze stimuli promote the detection of peripherally presented targets. Groups with BPD (N = 50) and other personality disorders (OPD, N = 51) were compared to healthy controls (HC, N = 46), and evaluated on the independent influence of traumatic experience, trait anxiety and trait anger. Across groups we find reliable gaze-cueing. In line with earlier evidence, trait anxiety predicts faster detection of targets signaled by a fearful gaze in HCs. This threat bias is however not present in BPDs and OPDs, thus the threat bias in BPD does not extend to social orienting. Instead, self-experienced trauma predicts amplified gaze-cueing in BPDs, but reduced gaze-cueing in OPDs. This not only emphasizes the importance of evaluating trauma exposure in personality disorders, but also suggests that the childhood adversity typically associated with the development of BPD promotes increased social orienting.

RTMS mechanisms for posttraumatic stress disorder treatment in a mouse model

BackgroundPosttraumatic stress disorder (PTSD) is a psychiatric disease that may follow traumatic exposure. Current treatments fail in about 30% of patients. Although repeated transcranial magnetic stimulation (rTMS) applied to the prefrontal cortex has been shown to be effective in the treatment of PTSD, the mechanisms need further investigation. ObjectiveUsing a PTSD animal model, we verify the beneficial effect of rTMS, and explore the changes it induces on two putative PTSD mechanisms, GABA/glutamate neurotransmission and neuroinflammation. MethodsPTSD-like symptoms were elicited in twenty-six mice using a foot-shock conditioning procedure. Fourteen of the 26 were then treated using rTMS (12 were untreated). In the control group (n = 30), 18 were treated with rTMS and 12 were untreated. Animals were sacrificed after re-exposure. The infralimbic (IL) cortex, basolateral amygdala (BLA) and ventral CA1 (vCA1) were isolated using laser microdissection. mRNA was then investigated using PCR array analysis targeting GABA/glutamate and inflammatory pathways. ResultsThe rTMS treatment significantly decreased the contextual fear memory phenotype. These changes were associated with reduced mRNA expression related to inflammation in the IL cortex and the vCA1, and lowered mRNA-related glutamate neurotransmission and increased GABA neurotransmission in the BLA. ConclusionOur results suggest that our rTMS treatment was associated with local anti-inflammatory effects and limbic effects, which seemed to counteract PTSD effects. Several of these changes (both stress- and rTMS-induced) have implications for the drug sensitivity of limbic brain areas, and may help in the design of future therapeutic protocols.

Refining the scope of genetic influences on alcohol misuse through environmental stratification and gene-environment interaction.

Gene-environment interaction (G × E) is likely an important influence shaping individual differences in alcohol misuse (AM), yet it has not been extensively studied in molecular genetic research. In this study, we use a series of genome-wide gene-environment interaction (GWEIS) and in silico annotation methods with the aim of improving gene identification and biological understanding of AM. We carried out GWEIS for four AM phenotypes in the large UK Biobank sample (N = 360,314), with trauma exposure and socioeconomic status (SES) as moderators of the genetic effects. Exploratory analyses compared stratified genome-wide association (GWAS) and GWEIS modeling approaches. We applied functional annotation, gene- and gene-set enrichment, and polygenic score analyses to interpret the GWEIS results. GWEIS models showed few genetic variants with significant interaction effects across gene-environment pairs. Enrichment analyses identified moderation by SES of the genes NOXA1, DLGAP1, and UBE2L3 on drinking quantity and the gene IFIT1B on drinking frequency. Except for DLGAP1, these genes have not previously been linked to AM. The most robust results (GWEIS interaction p = 4.59e-09) were seen for SES moderating the effects of variants linked to immune-related genes on a pattern of drinking with versus without meals. Our results highlight several genes and a potential mechanism of immune system functioning behind the moderating effect of SES on the genetic influences on AM. Although GWEIS seems to be a preferred approach over stratified GWAS, modeling G × E effects at the molecular level remains a challenge even in large samples. Understanding these effects will require substantial effort and more in-depth phenotypic measurement.

Co-occurring experiences of traumatic events and substance use among young people

ObjectiveHarmful substance use among young people is concerningly prevalent. Substance use disorder (SUD) and post-traumatic stress disorder (PTSD) frequently co-occur in treatment settings and are well researched among adults but lacking among young community cohorts. The aim of this study was to explore the prevalence and relationship between substance use, SUD, trauma, and PTSD among a community sample of young people in Australia. MethodA cross-sectional examination of data collected from participants (n = 1007, 48.9 % male) aged 18–22 years (M = 20 years, SD = 0.44), who took part in the 7-year follow-up of a cluster RCT of school-based substance use prevention interventions: The Climate and Preventure (CAP) study. A series of regressions were conducted to examine the relationship between trauma-related variables and substance use outcomes. Results48.3 % experienced a traumatic event (median = 2, range = 1–11) and of those 10.9 % met a probable PTSD diagnosis. Median age of first trauma exposure was 14 years (range = 0–21). 89.9 % used substances; 73.1 % reported binge drinking, and 35.6 % met a probable diagnosis of SUD (alcohol/cannabis). Those who experienced any traumatic event had almost 1.5 times greater odds of binge drinking. Cannabis use was significantly associated with most trauma-related variables. Sexual trauma exposure was the only trauma type significantly associated with all substance use variables. ConclusionsThis study demonstrated that substance use/SUD and experiences of trauma/PTSD are prevalent among a community sample of young people. Importantly, substance use among young people is associated with experiencing a traumatic event, particularly sexual and physical types of traumatic events, and developing PTSD.

An optimal trauma-informed pathway for PTSD, complex PTSD and other mental health and psychosocial impacts of trauma in prisons: an expert consensus statement

ABSTRACT People in prisons have high levels of trauma exposure throughout their lives. Presentations are often complex, with a high prevalence of PTSD and CPTSD and other mental health comorbidities. Prisons themselves can be stressful and traumatising environments. There are challenges in the delivery of effective treatments for PTSD and CPTSD. There is a need for the development of effective clinical pathways for these conditions that are embedded within trauma-informed organisational approaches. Responding to this need, this report is the result of a multidisciplinary expert consensus meeting and review of the research literature on PTSD, CPTSD, associated comorbidities and optimal approaches to trauma-informed practice. The group consisted of 24 expert representatives from psychology, psychiatry, healthcare, academia, social care and Welsh Government. The meeting commenced with presentations on various aspects of the clinical pathway for PTSD and complex PTSD in prisons, and of applications of trauma-informed practice within prisons. Small sub-groups then provided practical recommendations and solutions relevant to their assigned topic. Findings were presented to all meeting attendees for another round of discussion and debate, until consensus was reached. The resulting recommendations provide guidance to improve identification, treatment and support for people living in prison who have experienced trauma.