High Rates Of Trauma Exposure Research Articles

Hitting the wall: The impact of barriers to care and cumulative trauma exposure on PTSD among Northern Ireland Veterans

LAY SUMMARY The Northern Ireland (NI) population has high rates of trauma exposure and posttraumatic stress disorder (PTSD) but many barriers prevent people from seeking help/care, which can worsen mental health conditions. For Veterans, these barriers can include a lack of access to or availability of services, a lack of trust in the mental health system, and stigma — negative beliefs about themselves if they were to seek help. Additionally, many UK Armed Forces veterans in Northern Ireland choose not to disclose Veteran status because of security concerns. The Armed Forces Covenant promises available, accessible, and guaranteed care to service members and Veterans, but the covenant is not in place in Northern Ireland, leaving NI Veterans in need without support and relying on charity organizations. This study explored the relationship among trauma exposure, PTSD, and barriers to care among NI Veterans. Analysis showed that an increased number of traumatic event exposures and increased barriers to care predicted a higher amount of PTSD symptoms and distress, meaning the more trauma a Veteran witnessed or experienced and the more barriers preventing them from seeking care, the worse their mental health was likely to be.

Adaptation of a trauma-informed intervention to prevent opioid use among youth in the legal system

IntroductionYouth in the legal system are at high risk for opioid and other substance use problems and exhibit high rates of trauma exposure. Trauma-focused therapeutic approaches to prevent substance use show promise, but few evidence-based interventions are designed with justice-involved youth in mind. Consequently, implementing trauma-informed, evidence-based interventions within juvenile justice systems is challenging. The current paper describes the systematic adaptation of Trust-Based Relational Intervention (TBRI) as a family-centered substance use prevention program for youth transitioning from secure residential facilities. MethodsThe study utilized the ADAPT-ITT methodological framework to adapt TBRI Caregiver Training, an evidence-based, trauma-informed intervention designed to help caregivers support children and youth with histories of trauma. Phases of adaptation included (1) Assessment, (2) Decision, (3) Prototype Development, and (4) Testing and Integration. The adaptation process explored contextual factors (e.g., systems, facilities, and staff) and the needs of the new target population (i.e., youth in the legal system and their caregivers). Adaptations were made to both content (e.g., terminology and activities) and structure (e.g., session duration and delivery setting) with input from participants from the target population, key stakeholders, and content experts. ResultsThe systematic adaptation of the intervention model resulted in a two-phase, four-component intervention package that can be implemented in juvenile justice settings as part of youth reentry services. The primary intervention, delivered while youth are in residential facilities, includes the TBRI Caregiver Curriculum, TBRI Youth & Young Adult Curriculum, and TBRI Nurture Groups. The secondary intervention, delivered after youth transition home, includes the TBRI Family Coaching Curriculum. ConclusionsUtilizing a systematic methodological framework to guide adaptation has implications for developing accessible, culturally relevant, and contextually appropriate interventions. Accounting for contextual factors and population needs can improve the fit of evidence-based interventions for youth in the legal system, facilitating uptake and ultimately improving outcomes for youth at risk for substance use problems. Trial registrationClinicalTrials.gov Identifier: NCT04678960.

Primary Care Providers' Knowledge, Perceptions, and Practice of Trauma-Informed Care in a Public Health Care Setting.

Despite serving patients with especially high rates of trauma exposure and related sequelae, many primary care providers do not receive specialized training in the provision of trauma-informed care (TIC). This study sought to document primary care providers' baseline rates of TIC training and their knowledge, perceptions, and practice of TIC at a large, urban public hospital in the Southeastern United States. Participants (n = 67; 68.7% women; 44.8% white; Mage = 36.7 years, standard deviation [SD]age = 9.8 years) completed an online self-report survey on their TIC training status, trauma-related knowledge, perceptions, and practices, as well as burnout and secondary traumatic stress. Less than half of participants (43.3%) endorsed TIC training exposure. Participants generally had adequate levels of trauma-related knowledge (76.5% of items correct) and favorable perceptions of TIC (endorsed 89.7% of TIC-supportive statements). Most participants (86.6%) endorsed recently using trauma-informed practices, but only 47.8% reported routinely screening for trauma-related disorders. Participants who reported receiving prior TIC training scored better on knowledge items and endorsed recently using more trauma-informed practices than those who did not have training exposure. TIC training status' associations with current screening practices and perceptions of TIC were trending toward significance. TIC training status was not related to burnout, and trained participants reported greater secondary traumatic stress than those without training exposure. Results point to system-wide TIC training as a well-received, translational strategy that can enhance the trauma-informed nature of primary care provision.

Suicidal thoughts and behaviors in youth seeking mental health treatment in Texas: Youth Depression and Suicide Network research registry.

Suicidality in youth is a serious public health problem. The Texas Youth Depression and Suicide Research Network (TX-YDSRN) was initiated in 2020 to create a research registry for youth with depression and/or suicidality in Texas. This report presents baseline clinical/demographic characteristics of the first 1000 participants, focusing on suicidal thoughts and behaviors. The registry includes 8-20-year-old youth receiving treatment for depression, or who screen positive for depression and/or suicidal ideation/behavior. Baseline data include diagnosis, depression/anxiety severity, suicidal ideation/behavior, trauma history, and measures of resilience. We present baseline data on the first 1000 participants. Most (79.6%) of the sample had a primary depressive disorder. The sample had moderate to severe depression (Patient Health Questionnaire for Adolescents, PHQ-A; 12.9 ± 6.4) and anxiety (Generalized Anxiety Disorder, GAD-7; 11.3 ± 5.9). Nearly half reported ≥1 lifetime suicide attempts and 90% reported lifetime or current suicidal ideation. Participants with past/current suicidality (attempts and/or ideation) had greater illness severity (depression, anxiety, and suicidal thoughts/behaviors), lower resilience, and higher rates of trauma exposure than those without suicidality. Baseline data indicate moderate levels of depression, anxiety, and suicidality and their correlates in this cohort. Future reports will determine trajectories of outcomes and predictors, moderators, and social determinants related to these outcomes.

Psychological Resilience in U.S. Military Veterans: Results from the 2019-2020 National Health and Resilience in Veterans Study.

Following exposure to traumatic life events, most individuals are psychologically resilient, and experience minimal-to-no symptoms of posttraumatic stress, major depressive, or generalized anxiety disorders. To date, however, most research has focused on factors associated with adverse post-trauma mental health outcomes rather than understanding those associated with psychological resilience. In particular, little is known about factors associated with psychological resilience in veterans, despite their high rates of trauma exposure, such as combat and military sexual trauma. To address this gap, we used a discrepancy-based psychiatric resilience (DBPR) analytic approach to operationalize psychological resilience, and to identify modifiable health and psychosocial factors associated with resilience in a nationally representative sample of U.S. veterans (N = 4,069). DBPR scores were computed by regressing a composite measure of distress (posttraumatic stress, major depressive, and generalized anxiety disorder symptoms) onto measures of adverse childhood experiences, combat exposure, military sexual trauma, and cumulative potentially traumatic events (e.g., natural disaster, life-threatening illness/injury). Psychological resilience was operationalized as lower actual, relative to predicted, composite distress scores. Results revealed that greater emotional stability (22.9% relative variance explained [RVE]) and mindfulness (13.4% RVE), lower likelihood of lifetime histories of MDD or PTSD (12.8% RVE), greater purpose in life (11.9% RVE), and lower severity of somatic symptoms (10.8% RVE) explained the majority of the variance in resilience scores (total R2 = 0.40). Taken together, results of this study illustrate the utility of a DBPR score approach to operationalizing psychological resilience to traumatic stress in U.S. veterans, and identify several modifiable health and psychosocial factors that can be targeted in prevention and treatment efforts designed to bolster resilience in this population.

Adaptation of a mindfulness-based intervention for trauma-exposed, unhoused women with substance use disorder.

Women experiencing homelessness (WEH) report exceedingly high rates of trauma exposure, posttraumatic stress disorder (PTSD), and substance use disorder (SUD). Mindfulness-based interventions including Mindfulness-based Stress Reduction (MBSR) may help lower traumatic stress-related symptoms and reduce SUD, but have been underexplored in community-based settings serving WEH with symptoms of PTSD and SUD. We used a mixed-method, community-engaged approach that implemented a Community Advisory Board and the ADAPT-ITT (assessment, decision, adaptation, production, topical experts, integration, training, testing) framework, including intervention demonstrations, to adapt and refine MBSR for WEH experiencing symptoms of PTSD/SUD. Trauma-exposed WEH (N = 28) living at a drug treatment site provided perspectives and feedback on an MBSR demonstration via quantitative questionnaires and four focus groups. Quantitative measures indicated high perceived acceptability and feasibility: Nearly all WEH reported MBSR activities (including yoga, meditation, body scans, class discussion, and home practice) would be at least "somewhat helpful"; between 71.43% to 89.29% reported each activity would be "a great deal helpful." Most reported the focus group sessions were useful for providing feedback relevant for improving program design and administration. Qualitative findings revealed four themes aligning with quantitative findings that provided useful suggestions to guide MBSR implementation with trauma-exposed WEH: (a) perception of feasibility and effectiveness of MBSR, (b) strategies for successful recruitment, (c) strategies for successful retention, and (d) characteristics of the MBSR trainer. Focus group recommendations could bolster intervention compliance, engagement, and completion for MBSR and community-based programs for WEH more generally. Results provide suggestions for implementing a trauma-sensitive approach when administering MBSR to trauma-exposed WEH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Characteristics and Correlates of Ten-Year Trajectories of Posttraumatic Stress Symptoms in Older U.S. Military Veterans

ObjectivesTo examine the nature and correlates of 10-year trajectories of posttraumatic stress disorder (PTSD) symptoms in older U.S. military Veterans. Design and SettingA nationally representative web-based survey of older U.S. Veterans who participated in the National Health and Resilience in Veterans Study over 5 waves between 2011 and 2021. ParticipantsA total of 1,843 U.S. Veterans aged 50 and older (mean age = 67). MeasurementsPTSD symptoms were assessed using the PTSD Checklist. Self-report measures at baseline assessed sociodemographic characteristics; trauma exposures; psychiatric and substance use disorders; mental, cognitive, and physical functioning; and psychosocial factors including expectations of aging. Latent growth mixture modeling identified the nature and correlates of 10-year PTSD symptom trajectories. ResultsMost of the sample had no/low PTSD symptoms (88.7%), while 6.0% had consistently subthreshold symptoms, 2.7% consistently high symptoms, and 2.6% increasing symptoms. Relative to the no/low symptom group, the subthreshold and high symptom groups reported more medical conditions and cognitive difficulties, with younger age and more lifetime traumatic events additionally linked to the high symptom trajectory. Relative to the no/low symptom group, Veterans with increasing symptoms were more likely to report functional disability and lifetime nicotine use disorder, cognitive difficulties, negative expectations regarding physical and emotional aging, and traumatic events over the study period. ConclusionsDespite high rates of trauma exposure, most older Veterans do not evidence symptomatic PTSD trajectories; however, about 11% do. Results underscore the importance of assessing PTSD symptoms in this population and considering longitudinal trajectories as well as associated risk and protective factors.

Protocol for a randomized controlled trial in Cambodian individuals with PTSD: Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (Project TITAN)

IntroductionLow- and middle-income countries shoulder a disproportionate burden of mental health disorders with limited resources to support the provision of care using culturally relevant, evidence-based interventions. This is particularly true in Cambodia where the population continues to confront traumatic consequences of the Khmer Rouge genocide that targeted educated people, including treatment providers. Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (Project TITAN) will examine proof of concept and preliminary efficacy of culturally tailored interventions for symptoms of post-traumatic stress (PTS) among Cambodian adults. MethodsA stepped care randomized controlled trial enrolling people seeking mental health treatment and priority populations with high rates of trauma exposure, including female entertainment and sex workers and sexual and gender minorities. In total, 160 participants with symptoms of PTS are randomized to Stabilization Techniques or Behavioral Activation plus Stabilization Techniques, implemented within a culturally relevant framework. Individuals who do not demonstrate a reduction in symptoms of PTS after six treatment sessions receive Eye Movement Desensitization and Reprocessing therapy. PTS, depression, anxiety, and substance use are assessed at baseline and two and four months post-randomization. Planned analysesThe percentage of individuals achieving reductions in symptoms of PTS after four months is the primary outcome. Secondary outcomes are depression, anxiety, and substance use over four months. Finally, machine learning analyses will be conducted to identify features at baseline and during treatment that predict outcomes. DiscussionFindings will guide future development and implementation of interventions to improve mental health conditions among individuals in Cambodia and other resource-limited settings.

Prevalence and risk factors of posttraumatic stress symptoms among Internally Displaced Christian couples in Erbil, Iraq.

Research about the impact of war and displacement experiences on the mental health of Internally Displaced People (IDPs) has recently grown. However, a limited number of studies focus on minorities. The objective of the present preliminary study was to estimate the prevalence of posttraumatic stress symptoms (PTSSs) among IDPs who live outside camps and belong to the Christian minority in Iraq, and to identify possible predictors. Overall, 108 internally displaced Christians (54 married couples) participated in the study. Traumatic events and PTSSs were assessed using the Harvard Trauma Questionnaire. Multivariable linear regression models were used to investigate possible predictors of PTSSs. Multivariable logistic regression models have been developed to estimate the odds of presenting PTSSs. Results demonstrated high rates of trauma exposure, with all participants having experienced at least three traumatic events. The estimated prevalence of PTSSs was 20.3%. A low economic status, the number of traumatic events, and a second experience of displacement were associated with increased PTSSs. Five traumatic events were identified as the main predictors of PTSSs. Findings from the current preliminary study indicated the impact of war-related traumatic events on IDPs' mental health and the negative effects of post-displacement experiences. These findings may have important implications for setting up psychosocial interventions, as well as for further promoting physical and mental health services among these populations.

Identifying latent profiles of emotion dysregulation in a sample of primarily Black women with trauma exposure

BackgroundEmotion dysregulation (ED) is a heterogenous, multi-dimensional transdiagnostic risk factor relevant to the development and maintenance of both internalizing and externalizing psychopathology, especially for those who have experienced trauma. The goals of the current study were to use person-centered analyses to identify distinct profiles of individuals characterized by unique patterns of ED dimensions, and to examine differences in internalizing and externalizing symptoms in a community sample. MethodsParticipants (n = 783, 97% Black, 93% women) were recruited from an urban safety net hospital with high rates of trauma exposure. Latent profile analysis was used to uncover unique patterns of ED and multinomial logistic regression to evaluate the conditional distribution of our correlates across profiles. ResultsThe best-fitting model uncovered four classes: Low ED (42%), Low Awareness/Clarity (34%), Low Impulse Control (17%), and High ED (6%). All classes differed in terms of internalizing symptoms (anxiety sensitivity, depression, PTSD), with classes characterized by higher ED reporting more severe symptoms. For externalizing symptoms (food addiction behaviors, alcohol and drug abuse, aggressive behavior), the Low ED class reported fewer symptoms than all other profiles, while Low Awareness/Clarity, Low Impulse Control, and High ED did not differ from each other. ConclusionsPatterns of emotion dysregulation ought to be assessed and considered as treatment targets for those experiencing both internalizing and externalizing psychopathology symptoms.

Anxiety, fear extinction, and threat-related amygdala reactivity in children exposed to urban trauma

Introduction Childhood trauma is strongly associated with fear-related psychopathology, like anxiety and posttraumatic stress disorder (PTSD). Atypical fear extinction and neural responses to social threat (i.e., negative emotional faces) may serve as intermediate phenotypes preceding the emergence of fear-related psychopathology during childhood and adolescence. However, few studies have examined associations among these phenotypes in trauma-exposed youth. Methods 29 9-year-old children with high rates of trauma exposure (Mdn = 4, min = 0, max= 14 total events) completed a fear-potentiated startle paradigm assessing fear conditioning and extinction and an emotional faces functional magnetic resonance imaging (fMRI) task assessing neural responses to fearful and neutral faces. Results Overall amygdala response was positively associated with anxiety (peak coordinates: x = −30, y = −6, z = −24; Z = 3.54; pFWEcorrected = 0.011; k = 24 voxels) and fear-potentiated startle during early extinction (peak coordinates x = 28, y = −6, z = −18; Z = 3.50; pFWEcorrected = 0.012; k = 19 voxels). Across the session, amygdala reactivity to fearful faces increased (F(1, 29) = 4.427, p = .044) and was positively associated with fear-potentiated startle during early extinction (r = .56, p = .002). Conclusions We found a positive association between increasing amygdala response to threatening faces and fear load, that is, heightened fear-potentiated startle during early extinction, in trauma-exposed children. These fear-based intermediate phenotypes may share underlying amygdala circuits, such that hyperactivity may represent an early marker of anxiety risk in trauma-exposed youth.

Communal mastery and associations with depressive and PTSD symptomatology among urban trauma-exposed women.

Objective: Racial and ethnic minority women from low-resource urban communities experience disproportionately high rates of trauma exposure. Higher rates of lifetime trauma exposure are strongly associated with subsequent psychological sequela, specifically depression and posttraumatic stress disorder (PTSD). Communal mastery is the ability to cope with challenges and achieve goals by being closely interconnected with friends, family, and significant others. Yet, it is unknown if communal mastery is protective specifically against PTSD and depressive symptoms. Method: Participants (N = 131) were Black and Latina women (88.5% Black, mean monthly income: < $750) recruited from an urban outpatient obstetric-gynecological clinic at an academic medical center. Participants completed an online questionnaire that assessed trauma history, PTSD and depressive symptoms, types of individualistic coping, social support, and communal mastery. Results: Hierarchical multiple regression models demonstrated that communal mastery is uniquely associated with fewer PTSD symptoms (β = -.23, p = .003). More severe trauma history, more use of passive coping skills, and poorer social support were also significantly associated with PTSD symptoms, explaining over half of the variance in PTSD symptoms. Although significantly correlated, communal mastery was not uniquely associated with fewer depressive symptoms (β = -.13, p = .201). Conclusions: These findings suggest that connectedness as assessed through communal mastery serves as an important shield against the effects of traumatic stress for Black and Latina women. Future research would benefit by exploring interventions that aim to increase communal mastery in order to help highly trauma-exposed racial and ethnic minority women in low-resource environments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Understanding the disparate PTSD prevalence for U.S. and Mexico via social comparison effect types that inform perception of trauma difficulty.

The United States (U.S.) and Mexico have vastly different lifetime prevalence of posttraumatic stress disorder (PTSD), despite similarly high rates of trauma exposure. To explain this disparate prevalence, we created the Perception of Trauma Difficulty Assessment Tool (PTDAT) to identify four social comparison effect types that inform perception of trauma difficulty (i.e., Upward Assimilation Effect, Downward Assimilation Effect, Downward Contrast Effect, Upward Contrast Effect) to determine whether there was a dominant effect type associated with respondents' perception of coping with trauma difficulty for a sample of U.S. Americans and Mexicans. We identified sociodemographic characteristics and the degree of trauma exposure that associated with PTSD, PTSD symptom severity, and functional impairment for each effect type. This was a cross-sectional study of a sample of 898 U.S. Americans and 902 Mexicans. A chi-square test determined whether there was a dominant effect type for each national group. For each effect type, multiple regression analyses identified predictors of PTSD, PTSD symptom severity, and functional impairment. For U.S. Americans, trauma exposure was a predictor for PTSD for effect type Upward Contrast Effect, when respondents contrasted from an excellent appraisal of most people by making a poor self-appraisal. For Mexicans, all effect types had predictors for PTSD, with trauma exposure being a predictor for all. These preliminary findings provide support to consider patients' social context as it informs their perception of their capacity to cope, which may maintain PTSD. Future research is needed to determine whether perceptions of trauma difficulty are stable over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Paradoxical age-related improvement in mental health in U.S. military veterans: Results from the national health and resilience in veterans study.

To determine whether a seemingly "paradoxical" trend whereby mental health improves as a function of age despite declining physical and cognitive health occurs in U.S. military veterans, who are older, and have higher rates of trauma exposure and psychiatric morbidities relative to non-veterans. Using data from a nationally representative, cross-sectional sample of 4069 U.S. veterans, polynomial regression analyses were conducted to examine changes in self-reported physical, cognitive, and mental health of veterans representing the full age spectrum. Physical health scores were consistently average and stable until around age 80 when they declined. In contrast, cognitive and mental health scores were markedly lower in young veterans and then increased linearly and positively well into late-life. While greater age is associated with relative stability and late-life decline in physical health in U.S. veterans, mental and cognitive health steadily improve until much later in life. Results may help inform age-specific prevention and treatment efforts to promote healthy aging in this population.

Preventing Suicide Among Women Veterans: Gender-Sensitive, Trauma-Informed Conceptualization.

Purpose of ReviewThere is growing concern regarding suicide among women veterans, who have experienced an increase in suicide rates that has exceeded that reported for other US adult populations. Recent research has bolstered understanding of correlates of suicide risk specific to women veterans. Yet most existing suicide prevention initiatives take a gender-neutral, rather than gender-sensitive, approach. We offer clinical considerations and suggestions for suicide prevention tailored to the needs, preferences, and experiences of women veterans. Discussion is framed around the White House strategy for preventing suicide among military service members and veterans.Recent FindingsConsidering high rates of trauma exposure among women veterans, we propose that a trauma-informed lens is essential for taking a gender-sensitive approach to suicide prevention with this population. Nonetheless, research to inform evidence-based assessment and intervention remains largely focused on veteran men or gender-neutral. Integral next steps for research are posited.SummaryExtant research provides an initial foundation for beginning to understand and address suicide among women veterans in a gender-sensitive, trauma-informed manner. Additional research that is specific to women veterans or that examines gender differences is critical to ensure women veterans receive optimal, evidence-based care to prevent suicide.

A randomized controlled trial to assess the efficacy of Parenting-STAIR in treating maternal PTSD to reduce maltreatment recidivism: protocol for the Safe Mothers, Safe Children study

BackgroundChild maltreatment recidivism substantially increases the likelihood of adverse life outcomes, but there is little evidence that family preservation services are effective at reducing recidivism. Mothers in child welfare have very high rates of trauma exposure; maternal post-traumatic stress disorder (PTSD) is an intervention target that has the potential to reduce abuse and neglect. The Safe Mothers, Safe Children (SMSC) intervention program involves the delivery of an innovative combination of interventions, including Skills Training in Affective and Interpersonal Regulation (STAIR) and Parent-Child Interaction Therapy (PCIT). The combined intervention, Parenting-STAIR (P-STAIR), targets maternal PTSD and comorbid depression symptoms to reduce the adverse effects of PTSD on parenting, improve positive parenting skills, and prevent maltreatment recidivism.MethodsThis study is a two-arm randomized controlled trial: P-STAIR (23 sessions) versus supportive counseling (23 sessions). Participants are mothers receiving child welfare family preservation services (FPS), with a child in the age range of 1–8 years old and meeting diagnostic criteria for PTSD (with/without depression). Clinical assessment occurs at pre-treatment (baseline), two in-treatment assessments (mid-assessment #1 after module 9 and mid-assessment #2 after module 15), post-treatment, and at a 6-month follow-up. Recidivism will be measured using the New York State Child Welfare Registry (NYSCWR). We will enroll a total of 220 participants over 4 years: half (N = 110) randomly assigned to the P-STAIR condition and half (N = 110) to the supportive counseling condition.DiscussionThis is the first RCT to investigate the efficacy of P-STAIR. The findings for the trial have the potential to contribute to the expansion of evidence-based practices for maternal PTSD, maltreatment, and child welfare.

Trauma involving violation of trust and mental health help seeking among homeless adults

ABSTRACT Objective Lack of trust in others is a barrier to mental health help seeking and may be a consequence of trauma exposure, which is highly prevalent among people who experience homelessness. This study examined the association between trauma involving violation of trust and mental health help seeking. Method This study was a secondary analysis of data collected for a randomised controlled trial comparing a 3-year homelessness intervention with standard service provision. The sample included trauma-exposed adults with a history of chronic homelessness in Melbourne (N = 73). Participants identified their worst lifetime trauma and indicated whether someone they knew and trusted was responsible for that event. The primary outcome was 12-month formal mental health help seeking. Results Controlling for randomisation and baseline posttraumatic stress disorder symptom severity, participants whose worst trauma involved violation of trust reported, on average, 4.34 times as many visits to an outpatient service (e.g., hospital, mental health facility, alcohol and other drug service) as those whose worst trauma did not involve a violation of trust, p = .002. Conclusions Contrary to expectation, chronically homeless adults whose worst trauma involved violation of trust sought outpatient care more than those whose worst trauma did not involve violation of trust. Mental health professionals should adopt a trauma-informed approach and be aware that trauma exposure may influence help seeking among people who experience chronic homelessness. Key Points What is already known about this topic: Chronically homeless adults have high rates of trauma exposure, trauma-related mental health disorders, and unmet mental health care needs. People experiencing homelessness face multiple barriers to accessing mental health care, and qualitative studies have found feelings of mistrust may be one such barrier. In the general population, interpersonal trauma, particularly trauma involving betrayal, is associated with reduced trust in others, including physicians and health care systems. What this topic adds: Over 12 months, greater outpatient service use was reported by chronically homeless adults whose worst trauma involved violation of trust compared to those whose worst trauma did not involve violation of trust. The violation of trust group included a higher percentage of Aboriginal persons, and a higher percentage of participants whose worst trauma occurred in childhood compared to the no violation of trust group. Mental health professionals, such as psychologists, should apply trauma-informed care principles when providing mental health care for chronically homeless adults.

A daily diary study of intrusive PTSD symptoms and suicidal ideation among transgender and gender diverse adults.

High rates of trauma exposure and related posttraumatic stress disorder symptoms (PTSS) may partly explain increased suicidal ideation (SI) in transgender and gender diverse (TGD) people. This study examined whether intrusive PTSS are proximally associated with SI among TGD people. Daily diary surveys (n = 836 surveys; 73.3% compliance rate) were collected over 30 days from a sample of 38 TGD people in the Southeastern United States (mean age: 28.63 years; 84.2% non-Hispanic White; varying gender identities). The prevalence of SI and probable diagnosis of posttraumatic stress disorder at baseline was 59.5% and 42.1%, respectively. Of those who met criteria for probable posttraumatic stress disorder (PTSD), 87.5% reported SI at baseline. Multilevel modeling revealed that only depressive symptoms were positively associated with same-day SI. A trend showed a positive association between intrusive PTSS and same-day SI. Prior-day SI and baseline depressive symptoms were the sole correlates of next-day SI. The present study does not support a proximal association between intrusive PTSS and SI beyond depressive symptoms and prior SI among TGD people. These conclusions are preliminary given the small and homogenous sample. Pending additional research, clinicians should assess suicide risk of TGD people with depressive and PTSD symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Effect of Child Gender, Parent School Involvement, and Parent Language Use on School Functioning Among Trauma-Exposed Latinx Youth

High rates of trauma exposure can impede school functioning, which is predictive of many negative long-term outcomes. This study examined school functioning in Latinx children with clinically elevated levels of posttraumatic stress symptoms. We found that child gender, parent language use, and parent school involvement were associated with school functioning in complex ways. Interactive effects revealed that the association between parent school involvement and child school functioning depended on parent language use. Greater parent school involvement was linked with better school functioning when parents spoke more English, but parent school involvement did not improve school functioning when parents spoke more Spanish, which may reflect Spanish-speaking parents’ challenges engaging with schools. These findings have important implications for improving academic outcomes for trauma-exposed Latinx youth.

Trauma-related differences in socio-emotional functioning predict housing and employment outcomes in homeless veterans

RationaleMental health and substance use disorders are strong risk factors for homelessness. Understanding the role of transdiagnostic factors could help inform efforts to reduce homelessness among veterans with a range of disorders. Homeless veterans have high rates of trauma exposure, which can result in the depletion of social and emotional resources that may contribute to housing and employment stability. In this study, we evaluated the role of problems with emotional lability and interpersonal closeness as transdiagnostic socio-emotional factors that might interfere with efforts to achieve housing and employment stability. MethodsThe sample consisted of 346 homeless veterans with co-occurring disorders that were admitted to a U.S. Department of Veterans Affairs (VA) residential treatment program between 2004 and 2009. Assessments were conducted at treatment entry (baseline) and two follow-up timepoints (6- and 12-months). Variables used in the current analyses included history of interpersonal trauma exposure, emotional lability and interpersonal closeness at baseline and 6-months, and homelessness and employment problems during follow-up. Data were analyzed using structural equation modeling and counterfactually-defined mediation effects. ResultsVeterans exposed to more trauma types experienced more baseline impairment and less improvement during treatment in emotional lability and interpersonal closeness. Problems with interpersonal closeness mediated 73% of the relationship between exposure to multiple traumas and homelessness, and 32%–61% of the relationship between trauma exposure and employment problems. Emotional lability mediated 36% of the relationship between exposure to multiple traumas and employment problems. Decomposition of indirect pathways revealed that indirect effects were primarily transmitted through changes during treatment, and not baseline levels. ConclusionFindings support a cumulative effect of trauma on persistence of socio-emotional deficits across treatment, which increased risk of homelessness and employment problems during follow-up. Greater attention and more targeted efforts should be directed at helping trauma-exposed veterans build socio-emotional resources during treatment.