High Rates Of Trauma Research Articles

The Dialectical Difference: Evaluation of a Modified-Dialectical Behavior Therapy Group for Incarcerated Women in South Australia

Women in custody commonly report high rates of trauma, increased contact with mental health services, and have a significant history of mental illness. Over a 2-year period, we ran seven groups using a modified Dialectical Behavior Therapy (DBT) program at the Adelaide Women’s Prison, South Australia. Participants completed pre- and post-group measures to explore their DBT skills use, coping behaviors, and depression, anxiety and stress symptoms. We also completed post-group interviews. Quantitative and qualitative findings support the use of this modified DBT program to improve women’s coping skills, emotion regulation, mental health symptoms and self-reported behavior whilst in custody.

The Impact of Trauma-Informed Training for a Youth Residential Center on Staff Attitudes and Behavior

ABSTRACT Purpose Children with behavioral issues in residential care settings have high rates of trauma, with a range of trauma experiences such as abuse and neglect, issues with attachment, and multiple disruptions in placements. Staff in these settings should have an understanding of trauma, its impact, and how to engage in trauma-informed practice. The purpose of this study was to examine whether a trauma-informed training, developed specifically based on the identified needs of a residential group care facility, had an impact on future staff attitudes and behaviors. Materials and methods A 3-h training was delivered by the researchers. Three identical sessions were provided to all 48 staff, regardless of education and role, across a 3-day period. Prior to the training, staff were given a pretest survey measuring components of trauma-informed (TI) practice that indicated how often the staff members engaged in TI practice. Thirty days later, the same participants completed a posttest survey to gauge if the training had an impact on their subsequent attitudes and behavior. Results There were improvements in many of the trauma-informed practice areas on the posttest survey. T-test analysis revealed five trauma-informed practice areas had improvements that were statistically significant from the pretest survey. Discussion The findings present the opportunity for recommendations for trauma-informed training development and delivery, as well as providing implications for the field of social work. Conclusion This study demonstrates the feasibility of administering a trauma-informed training program and observing relatively rapid improvements in future attitudes and behavior among staff.

Trauma History Questionnaire: validation with novel samples of incarcerated women and perinatal women

ABSTRACT Trauma exposure is associated with numerous negative outcomes, many of which are amplified within at-risk populations. Two under-researched and at-risk populations, incarcerated women and perinatal women, both report high rates of trauma, psychopathology, and PTSD compared to the general population. One common measure of trauma exposure in various populations, including incarcerated women and perinatal women, is the Trauma History Questionnaire (THQ). However, no known studies have validated the THQ within these two unique, understudied populations. Using data from two studies of incarcerated women and one study of perinatal women, researchers explored indices of THQ construct, predictive, and convergent validity. The study also included between-sample comparisons, highlighting differences in trauma incidence between the included samples. Analyses supported statistically significant relations between THQ scores and Severity of Violence Against Women Scale (SVAWS), depressive symptoms, PTSD, and psychological distress. Prenatal women’s THQ scores were also predictive of later postpartum depressive symptoms. Significantly higher THQ scores were found within the incarcerated samples compared to the perinatal sample. The study results provide further information about trauma within incarcerated and perinatal populations, as well as increase understanding of the utility of trauma assessments within these vulnerable groups.

Transdiagnostic Mood, Anxiety, and Trauma Symptom Factors in Alcohol Use Disorder: Neural Correlates Across 3 Brain Networks

BackgroundAlcohol use disorder (AUD) is associated with high rates of trauma, mood, and anxiety disorders. Across these diagnoses, individual symptoms substantially overlap, highlighting the need for a transdiagnostic approach. Furthermore, there is limited research on how transdiagnostic psychopathology impacts the neural correlates of AUD. Thus, we aimed to identify symptom factors spanning diagnoses and examine how they relate to the neurocircuitry of addiction. MethodsEighty-six veterans with AUD completed self-report measures and reward, incentive salience, and cognitive control functional magnetic resonance imaging tasks. Factor analysis was performed on self-reported trauma, depression, anxiety, and stress symptoms to obtain transdiagnostic symptom compositions. Neural correlates of a priori–defined regions of interest in the 3 networks were assessed. Independent sample t tests were used to compare the same nodes by DSM-5 diagnosis. ResultsFour symptom factors were identified: Trauma distress, Negative affect, Hyperarousal, and Somatic anxiety. Trauma distress score was associated with increased cognitive control activity during response inhibition (dorsal anterior cingulate cortex). Negative affect was related to lower activation in reward regions (right caudate) but higher activation in cognitive control regions during response inhibition (left dorsolateral prefrontal cortex). Hyperarousal was related to lower reward activity during monetary reward anticipation (left caudate, right caudate). Somatic anxiety was not significantly associated with brain activation. No difference in neural activity was found by posttraumatic stress disorder, major depressive disorder, or generalized anxiety disorder diagnosis. ConclusionsThese hypothesis-generating findings offer transdiagnostic symptom factors that are differentially associated with neural function and could guide us toward a brain-based classification of psychiatric dysfunction in AUD. Results warrant further investigation of transdiagnostic approaches in addiction.

Trauma and the perinatal period: A review of the theory and practice of trauma-sensitive interactions for nurses and midwives.

With high rates of trauma in the population, known links between trauma and perinatal distress, and the intimate and close nature of the nursing and midwifery roles, ensuring awareness and understandings of trauma is crucial for guiding practice. This paper aims to explore the relationship of trauma to the perinatal period, based on theory and practice, to consider on how nurses and midwives can deliver trauma-sensitive interactions. This discursive discussion draws on relevant research from the fields of trauma therapy, attachment theory and nursing and midwifery practice to consider elements of trauma-sensitive practice in the perinatal period. Nurses and midwives can foster safety for people who have experienced trauma through noticing and responding to triggers, supporting awareness of attachment and its relationships to trauma, undertaking psychosocial screening with care, supporting linearity and cohesion in narratives and developing collaborative care plans that maximise safety and agency. For nurses and midwives, understandings of the relationship between trauma, pregnancy, birth, early parenting and distress is crucial for effective care delivery. Delivering perinatal nursing or midwifery care of any kind, without universal trauma precautions risks reinforcing, misinterpreting or re-enacting dynamics of trauma. To be trauma-sensitive in this period requires nurses and midwives to have awareness of the dynamics of trauma in relation to pregnancy, birth and attachment. This paper fills a gap in the translation of theory to practice for trauma-sensitive care in the perinatal period, with a focus on the therapeutic relationship formed by nurses and midwives. The findings highlight that nurses and midwives can foster safety for people who have experienced trauma within their practice, when they hold a robust understanding of the relationship between trauma, pregnancy, birth, early parenting and distress. No patient or public contribution.

Barriers to Assessing and Treating Trauma in Primary Care and Opportunities for Improvement: Perspectives from Prescribers of Medications for Opioid Use Disorder

Background: Medication for Opioid Use Disorder (MOUD) is a best practice for treating individuals with opioid use disorder (OUD), and primary care-based MOUD management can reduce treatment barriers among OUD patients. Individuals with OUD experience disproportionately high rates of trauma and violence, highlighting the importance of addressing trauma, mental health, and substance use concurrently. However, clear guidelines for trauma-informed treatment in a primary care setting remain poorly established. Methods: A qualitative approach was engaged to explore primary care providers’ perceptions of barriers and facilitators to assessing and treating trauma among MOUD patients. Twenty in-depth interviews were conducted in 2021 with Baltimore-based MOUD prescribers, including primary care physicians and nurse practitioners. Interview questions assessed experiences with identifying and treating trauma among MOUD patients, including challenges and opportunities. Results: Providers reported extensive histories of trauma experienced by MOUD patients. Barriers to addressing trauma include a lack of standardized protocols/procedures for identifying trauma, insufficient training/time to assess and treat trauma, and the limited availability of external mental health providers and specialty services. Opportunities included building strong, mutually respectful patient-provider relationships, providing individualized, person-centered care, and establishing connections to coordinated multidisciplinary treatment networks. Conclusions: MOUD treatment within primary care is an important way to increase OUD treatment access, but clearer standards are needed for the treatment of trauma within this patient population. These findings demonstrate opportunities to improve standards and systems such that primary care providers are better equipped to assess and treat the complex histories of trauma experienced by individuals with OUD.

Unmet needs in street homeless people: a commentary on multiple interconnected needs in a vulnerable group

Street homeless people face stigmas in addition multiple unmet needs, which may include physical, psychological, mental health and social needs to name a few. Their life expectancy is shorter than that of the general population. Mental health problems are common but street homeless people face considerable barriers accessing support. Institutional approaches from the health system re-traumatise street homeless people seeking care and cause moral injury and burn-out in staff. Given high rates of trauma in street homeless people, trauma-informed care approaches should be used. Professionals should make every contact count, using it as an opportunity to build trust with honesty and consistency and find out what matters to the person, as well as taking practical steps such as ensuring a means of contact. Engaging with the person's wider support system, such as support workers from homeless organisations, is key as they may have a good understanding how the mental health affects the person.

Childhood trauma is prevalent and associated with co-occurring depression, anxiety, mania and psychosis in young people attending Australian youth mental health services.

Childhood trauma is common and associated with mental ill health. While high rates of trauma are observed across individual disorders, there is evidence that trauma is associated with an admixture of affective, anxiety and psychotic symptoms in adults. Given that early onset of mental disorder and trauma exposure herald poor outcomes, it is important to examine trauma prevalence rates in youth mental health services and to determine whether this trauma-related clustering is present in help-seeking young people. We used data from the Transitions Study, a longitudinal investigation of young people attending headspace youth mental health services in Australia between January 2011 and August 2012. Participants were 775 young people aged 12-25. Childhood trauma was assessed using the Childhood Trauma Questionnaire. Multinomial regression was used to assess whether reported childhood trauma was more strongly associated with the co-occurrence of depression, anxiety, mania and psychosis symptoms than with any one in isolation. Approximately 84% of participants reported some form of abuse (emotional: 68%; physical: 32%; sexual: 22%) or neglect (emotional: 65%; physical: 46%). Exposure to multiple trauma types was common. Childhood trauma was significantly associated with each symptom domain. More severe childhood trauma was more strongly associated with the co-occurrence of symptoms than with any one symptom domain in isolation, such that more severely trauma-exposed young people were more likely to experience increased symptom clustering. Childhood trauma is pervasive in youth mental health services and associated with a symptom profile that cuts across traditional diagnostic boundaries.

Application of the ecobiodevelopmental model for research among youth experiencing homelessness.

Youth experiencing homelessness (YEH) often face increased levels of adversity and higher rates of trauma, suicide, and mortality compared to their housed peers. A multi-level life course lens is proposed by applying the ecobiodevelopmental model to examine social support mechanisms as a buffer to psychopathologies following adversity within YEH. Further discussion contributes to the theoretical basis for future public health research and intervention work addressing youth homelessness and related adversities.

The impact of trauma and daily hardships on the mental health of unaccompanied refugee minors detained in Libya.

The high trauma load and prevalence of mental distress in unaccompanied refugee minors (URMs) who resettle in Western (European) countries is well documented. However, the lack of studies investigating the potentially most vulnerable population, URMs who are currently on the move in transit countries such as Libya, is alarming. To document the mental health of URMs detained in Libya and the possible associations with trauma, flight and daily hardships. In total n = 99 (94.9% male; n = 93) URMs participated in this cross-sectional study conducted in four detention centres near the Libyan capital Tripoli. Data were collected via standardised questionnaires in an interview format and analysed using structured equation modelling. Participants reported high rates of trauma, especially within Libya itself. Reports of daily hardships in detention ranged between 40 and 95% for basic needs and between 27 and 80% for social needs. Higher social needs were associated with increased anxiety symptoms (β = 0.59; P = 0.028) and increased pre-migration (β = 0.10; P = 0.061) and peri-migration trauma (β = 0.16; P = 0.017) with symptoms of depression. Similarly, higher levels of pre-migration trauma were associated with higher post-traumatic stress disorder levels (β = 0.17; P = 0.010). The rates of daily hardships and traumatic events are higher compared with those recorded for URMs living in asylum centres in Europe. The emotional, social and cognitive development of detained URMs is severely threatened in both the short and long term. This paper outlines some of the most detrimental effects of migration policies on URMs transiting through Libya.

Socioemotional health, trauma exposure, and internalizing symptoms in students attending an alternative high school.

Students attending alternative schools often present with internalizing symptoms, likely related to high rates of trauma. Little is known about factors that buffer the relationship between trauma exposure and internalizing symptoms in this population. The present study examined the role of internal (i.e., self-efficacy, self-awareness, persistence) and external resources (i.e., peer support, family coherence, school support) as buffers in the association between trauma exposure and symptoms of depression and anxiety in 113 students (55% female, 91% Black, 8% Hispanic or Latinx, Mage = 18.0, SD = 1.5) attending an alternative school in a large, southeastern city. Results showed that trauma exposure was positively associated with depression and anxiety symptoms, while self-awareness and family coherence were negatively associated with depression and anxiety symptoms. Additionally, significant interactions revealed that trauma exposure was associated with depression symptoms at low but not high levels of self-awareness, and at low but not high levels of family coherence. Understanding strengths to support alternative high school students exposed to trauma is a valuable component of mental health intervention. Future research should investigate ways to cultivate self-awareness and enhance family coherence to address the complex needs of alternative school students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

O20Trauma responsive abortion care (on trac study): The abortion experiences of patients with a history of trauma

<h3>Objectives</h3> Due to intersectional structural inequities, individuals seeking abortion have experienced disproportionately high rates of trauma. We sought to elicit patient perspectives on how prior trauma(s) influenced their abortion experiences. <h3>Methods</h3> We recruited individuals from Chicago-area abortion clinics to participate in semi-structured interviews exploring how prior trauma(s) influenced their abortion experience and how interactions with providers/staff ameliorate or worsen the impact of past trauma(s). Participants were aged 18 or older, had experienced an abortion and self-identified a history of trauma (sexual assault, domestic violence, or adverse childhood experience). We used modified grounded theory to identify salient themes. <h3>Results</h3> We conducted 30 interviews, identifying trauma-activating factors and trauma-responsive strategies before, during, and after obtaining the abortion. Participants reported that, pre-abortion, restricted access and a lack of procedure options activated trauma-related feelings of autonomy loss and that they desired unbiased information, particularly from peers. Participants described how physical pain/discomfort and provider/staff use of inappropriate language during procedures worsened their experience; while use of neutral language, warnings prior to touch, proper draping, and constant checking-in and offering options helped mitigate effects of prior trauma(s). Post-procedurally, participants desired mental health support specifically addressing stigma, though this resource was rarely available. <h3>Conclusions</h3> Applying key tenets of trauma-responsive care to all patients seeking abortion mitigates impacts of prior traumas on the abortion experience. Providers can resist re-traumatization on a clinical level via the use of language, bi-directional communication, and by offering options, including pain management and behavioral support. On a systemic level, providers can advocate for increased abortion access and address stigma.

Socioeconomic status is associated with mechanism and intent of injury in patients presenting to a UK Major Trauma Centre

BackgroundLower socioeconomic status (SES) is linked to poorer health, health outcomes and higher rates of trauma. The aim of this study was to investigate the impact SES had on the mechanism and intent of trauma in patients presenting to a UK regional Major Trauma Centre (MTC). Materials and MethodsTrauma data from a UK MTC over a five-year period was obtained from the Trauma Audit and Research Network. Deprivation data was obtained from English Indices of Multiple Deprivation 2019 data and the study population classified into quintiles. Odds ratios were calculated, comparing mechanism and intent of trauma with each SES quintile with the least deprived quintile as the baseline for comparison. ResultsLower SES was associated with an increased odds ratio of undifferentiated trauma (OR 1.32, P<0.001). Falls from less than 2m constitute most trauma presentations and were not associated with SES (OR 1.09, P=0.114, 58.3% of trauma). The greater odds ratios for trauma in the socially deprived was accounted for by an increase in high-energy mechanisms and injury intents that include falls more than 2m (OR 1.75), stabbing (OR 5.18), blow injury (OR 2.75), high-risk behaviour (OR 4.61), assault (OR 6.63) and self-harm (OR 2.94) (P-values <0.001). ConclusionIn this large, retrospective analysis of a UK MTC, we have shown that the increased risk of trauma seen with lower SES is not uniform across all mechanisms or intents and is mediated by high-energy and violent mechanisms. Targeted public health education and intervention within these demographics, appropriate to mechanisms observed as over-represented, may prove beneficial in the primary prevention of trauma, and help to guide local health service planning.

Ecological Constraints on Violence Avoidance Tactics in the Prehispanic Central Andes

ABSTRACT Prehispanic agricultural populations in the central Andes exhibit some of the highest rates of lethal and sublethal trauma ever recorded. Explanations for high rates of violence focus on what factors drove proactive conflict. While it is true that incentives for proactive violence must exist for high rates of trauma to ensue, it is far less recognized how ecological conditions may promote economic activities that constrain violence avoidance tactics and thus influence rates of violence. Here, we draw on models from behavioral ecology to generate predictions about how violence co-varies with environmental gradients, related subsistence strategies, and attendant defensive tactics. We hypothesize that rates of violence will be highest in marginal and variable environments where high-mobility subsistence strategies serve to reduce subsistence risk while increasing the costs of violence avoidance. Our results show that high elevation locations with variable topography where high mobility subsistence strategies are common exhibit the highest rates of generalized interpersonal violence. These results suggest that as ecological conditions become marginal and variable, risk-reducing subsistence strategies are emphasized, which result in increased exposure to violence. This study shows that environmental influences on the efficacy of violence avoidance tactics are important for explaining variability in rates of violence.

Incorporating a trauma-informed perspective in HIV-related research with transgender and gender diverse individuals.

Incorporating a trauma-informed perspective in HIV-related research with transgender and gender diverse individuals.

Psychedelic Therapies at the Crossroads of Trauma and Substance Use: Historical Perspectives and Future Directions, Taking a Lead From New Mexico.

Post-traumatic stress disorder (PTSD), a common condition with potentially devastating individual, family, and societal consequences, is highly associated with substance use disorders (SUDs). The association between PTSD and SUD is complex and may involve adverse childhood experiences (ACEs), historical and multi-generational traumas, and social determinants of health as well as cultural and spiritual contexts. Current psychosocial and pharmacological treatments for PTSD are only modestly effective, and there is a need for more research on therapeutic interventions for co-occurring PTSD and SUD, including whether to provide integrated or sequential treatments. There is a current resurgence of interest in psychedelics as potential treatment augmentation for PTSD and SUDs with an appreciation of the risks in this target population. This paper reviews the historical perspective of psychedelic research and practices, as well as the intersection of historical trauma, ACEs, PTSD, and SUDs through the lens of New Mexico. New Mexico is a state with high populations of Indigenous and Hispanic peoples as well as high rates of trauma, PTSD, and SUDs. Researchers in New Mexico have been leaders in psychedelic research. Future directions for psychedelic researchers to consider are discussed, including the importance of community-based participatory approaches that are more inclusive and respectful of Indigenous and other minority communities.

Research With Women Who Use Drugs: Applying a Trauma-informed Framework.

Women who use drugs (WWUD) experience high rates of trauma. The complex impacts of trauma can act as a barrier to accessing substance use and harm reduction services, and to participation and representation within substance use research. Trauma-informed practice is an evidence-based approach for improved clinical care among WWUD, the principles of which can be applied to substance use research. Many researchers are integrating trauma-informed approaches across research settings, yet these principles are often not referenced specifically within publications, and there is a lack of comprehensive guidance regarding integration of trauma-informed methods across different research designs and methodologies. This commentary describes and discusses the merits of applying the 4 principles of trauma-informed practice - trauma awareness, safety and trustworthiness, choice collaboration and connection, and strengths-based and skills building - to promote safety and inclusion of WWUD in substance use research.

COVID-19 News and Its Association With the Mental Health of Sexual and Gender Minority Adults: Cross-sectional Study.

BackgroundSexual and gender minority (SGM; people whose sexual orientation is not heterosexual or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and substantial disparities in anxiety and posttraumatic stress disorder (PTSD). Exposure to traumatic stressors such as news related to COVID-19 may be associated with symptoms of anxiety and PTSD.ObjectiveThis study aims to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States.MethodsData were collected between March 23 and August 2, 2020, from The PRIDE Study, a national longitudinal cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and symptoms of anxiety using the Generalized Anxiety Disorder-7 and symptoms of COVID-19–related PTSD using the Impact of Events Scale-Revised.ResultsOur sample included a total of 3079 SGM participants. Each unit increase in COVID-19–related news exposure was associated with greater anxiety symptoms (odds ratio 1.77, 95% CI 1.63-1.93; P<.001) and 1.93 greater odds of PTSD (95% CI 1.74-2.14; P<.001).ConclusionsOur study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities.

Multisite randomised controlled trial of trauma-focused cognitive behaviour therapy for psychosis to reduce post-traumatic stress symptoms in people with co-morbid post-traumatic stress disorder and psychosis, compared to treatment as usual: study protocol for the STAR (Study of Trauma And Recovery) trial

BackgroundPeople with psychosis have high rates of trauma, with a post-traumatic stress disorder (PTSD) prevalence rate of approximately 15%, which exacerbates psychotic symptoms such as delusions and hallucinations. Pilot studies have shown that trauma-focused (TF) psychological therapies can be safe and effective in such individuals. This trial, the largest to date, will evaluate the clinical effectiveness of a TF therapy integrated with cognitive behaviour therapy for psychosis (TF-CBTp) on post-traumatic stress symptoms in people with psychosis. The secondary aims are to compare groups on cost-effectiveness; ascertain whether TF-CBTp impacts on a range of other meaningful outcomes; determine whether therapy effects endure; and determine acceptability of the therapy in participants and therapists.MethodsRater-blind, parallel arm, pragmatic randomised controlled trial comparing TF-CBTp + treatment as usual (TAU) to TAU only. Adults (N = 300) with distressing post-traumatic stress and psychosis symptoms from five mental health Trusts (60 per site) will be randomised to the two groups. Therapy will be manualised, lasting 9 months (m) with trained therapists. We will assess PTSD symptom severity (primary outcome); percentage who show loss of PTSD diagnosis and clinically significant change; psychosis symptoms; emotional well-being; substance use; suicidal ideation; psychological recovery; social functioning; health-related quality of life; service use, a total of four times: before randomisation; 4 m (mid-therapy); 9 m (end of therapy; primary end point); 24 m (15 m after end of therapy) post-randomisation. Four 3-monthly phone calls will be made between 9 m and 24 m assessment points, to collect service use over the previous 3 months. Therapy acceptability will be assessed through qualitative interviews with participants (N = 35) and therapists (N = 5–10). An internal pilot will ensure integrity of trial recruitment and outcome data, as well as therapy protocol safety and adherence. Data will be analysed following intention-to-treat principles using generalised linear mixed models and reported according to Consolidated Standards of Reporting Trials-Social and Psychological Interventions Statement.DiscussionThe proposed intervention has the potential to provide significant patient benefit in terms of reductions in distressing symptoms of post-traumatic stress, psychosis, and emotional problems; enable clinicians to implement trauma-focused therapy confidently in this population; and be cost-effective compared to TAU through reduced service use.Trial registrationISRCTN93382525 (03/08/20)

\u201cMost of the cases are very similar.\u201d: Documenting and corroborating conflict-related sexual violence affecting Rohingya refugees

BackgroundIn August 2017, a large population of Rohingya from northern Rakhine state in Myanmar fled to Bangladesh due to “clearance operations” by the Myanmar security forces characterized by widespread and systematic violence, including extensive conflict-related sexual violence (CRSV). This study sought to document the patterns of injuries and conditions experienced by the Rohingya, with a specific focus on sexual violence.MethodsQualitative interviews were conducted with 26 health care professionals who cared for Rohingya refugees after their arrival in Bangladesh between November 2019 and August 2020.ResultsHealth care workers universally reported hearing accounts and seeing evidence of sexual and gender-based violence committed against Rohingya people of all genders by the Myanmar military and security forces. They observed physical and psychological consequences of such acts against the Rohingya while patients were seeking care. Health care workers shared that patients faced pressure not to disclose their experiences of CRSV, likely resulted in an underreporting of the prevalence of sexual violence. Forced witnessing of sexual violence and observed increases in pregnancy and birth rates as a result of rape are two less-reported issues that emerged from these data.ConclusionsHealthcare workers corroborated previous reports that the Rohingya experienced CRSV at the hands of the Myanmar military and security forces. Survivors often revealed their experiences of sexual violence while seeking care for a variety of physical and psychological conditions. Stigma, cultural pressure, and trauma created barriers to disclosing experiences of sexual violence and likely resulted in an underreporting of the prevalence of sexual violence. The findings of this research emphasize the importance of offering universal and comprehensive trauma-informed services to all refugees with the presumption of high rates of trauma in this population and many survivors who may never identify themselves as such.