Ongoing Adversity Research Articles

Prevalence and correlates of explosive anger among pregnant and post-partum women in post-conflict Timor-Leste.

BackgroundLittle is known about explosive anger as a response pattern among pregnant and post-partum women in conflict-affected societies.AimsTo investigate the prevalence and correlates of explosive anger among this population in Timor-Leste.MethodWe assessed traumatic events, intimate partner violence, an index of adversity, explosive anger, psychological distress and post-traumatic stress disorder among 427 women (257 in the second trimester of pregnancy, 170 who were 3–6 months post-partum) residing in two districts of Timor-Leste (response >99%).ResultsTwo-fifths (43.6%) had explosive anger. Levels of functional impairment were related to frequency of explosive anger episodes. Explosive anger was associated with age (>35 years), being married, low levels of education, being employed, traumatic event count, ongoing adversity and intimate partner violence.ConclusionsA combination of social programmes and novel psychological therapies may assist in reducing severe anger among pregnant and post-partum women in conflict-affected countries such as Timor-Leste.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Negative Trauma Appraisals and PTSD Symptoms in Sri Lankan Adolescents.

The cognitive model posits that negative appraisals play an important role in posttraumatic stress disorder, in children as well as in adults. This study examined correlates of negative appraisals in relation to trauma exposure and their relationship to posttraumatic stress symptoms (PTSS) in 414 Sri Lankan adolescents, aged 12 to 16, living in areas impacted in varying degrees by the 2004 tsunami. In 2008, participants completed measures of negative appraisals, lifetime traumatic events, posttraumatic stress symptoms, internalizing symptoms, ongoing adversity, and social support. The majority (70 %) of the participants reported multiple traumatic events; 25 % met DSM-IV criteria for full or partial PTSD. Adolescents who had experienced more severe events, abusive events, greater cumulative trauma, or greater current adversity reported more negative appraisals. In regression analyses controlling for known risk factors such as female gender, cumulative trauma, ongoing adversity, and low social support, negative appraisals were the best predictor of PTSS, explaining 22 % of the variance. This relationship appeared specific to PTSS, as negative appraisals did not predict internalizing symptoms. Findings confirm the link between negative cognitions concerning traumatic events and persistent PTSS in adolescents, but longitudinal studies are needed to determine whether appraisals contribute to symptom maintenance over time.

The coherence and correlates of intermittent explosive disorder amongst West Papuan refugees displaced to Papua New Guinea

Questions remain about the nosological status of intermittent explosive disorder (IED) as a universal diagnosis. Cross-cultural studies are needed to establish whether IED symptoms form a coherent pattern and are distinguishable from other related symptom constellations. A study amongst a refugee population also allows further inquiry of the relationship between exposure to potentially traumatic events (PTEs) and other adversities with the IED constellation. In the present study amongst West Papuan refugees residing in Port Moresby, Papua New Guinea, we apply culturally adapted interview modules to assess symptoms of IED, post-traumatic stress disorder (PTSD), and depression, as well as the potentially traumatic events (PTEs) of conflict and ongoing adversity in the post-migration environment. Latent class analysis yielded a PTSD class (23%), a posttraumatic depressive class (14%), an IED class (12%), and a low/no symptom class (49%). Compared to the low/no-symptom class, the PTSD class had high levels of exposure to all PTE domains including childhood-related adversities, witnessing murder, human rights trauma, and traumatic losses, as well as ongoing adversity relating to displacement and separation from families, safety concerns, and lack of access to basic needs and health care. The posttraumatic depression class had greater exposure to traumatic losses and childhood-related adversities, higher levels of stress relating to material loss and deprivation, as well as to displacement and separation from families. In contrast, the IED class was distinguished only by the ongoing stress of displacement and separation from families in the homeland. Our findings provide support for the phenomenological distinctiveness of IED symptoms in this transcultural setting. Although not exclusive to IED, conditions of long-term displacement and separation appear to be a source of ongoing anger and explosive aggression amongst this population.

Development and Piloting the MMMM Ecological Interactive Open Systems Model: A Prospective One-Year Treatment Outcome of Children of Tortured Refugees

Children of refugee torture survivors present a compelling case of cumulative and continuous chronic past and current traumas and complex post-cumulative trauma symptoms. Traditional models of interventions with victims of single past traumas may not be effective with such victims. The goal is to develop and initially test a new open multi-systemic, multi-component and multi-modal intervention model (MMMM) as applied in the context of Summer Day Treatment and After School (SDTAS) program, and to determine its potential effectiveness as well as the feasibility of a larger study with more rigorous experimental design. A total of 27 secondary torture survivor Iraqi refugee children (13 males and 14 females, age between 11-16), living in the US, who suffered from serious symptoms and were non-responsive to treatment as usual for at least the previous six months, completed the planned interventions and three times follow-up assessments of five domains: PTSD, complex PTSD, anxiety, depression, and global level of functioning (GAF). Repeated measure analysis of variance was used to analyze changes over the three time points. Results indicated significant decrease in symptoms, and increased GAF with high effect sized (Partial Eta Squared ranged between 0.85 - 0.93). The amount of change displayed by the treated individuals was large enough to be clinically meaningful. Current study provides evidence of potential effectiveness of this novel intervention and of the feasibility of more rigorous and larger future controlled clinical trials to help develop evidence-based treatments for the multiply traumatized children who suffer past and present ongoing adversities. We suggest that the model is cost effective, and can be conducted with children of torture survivors and refugees in different settings world-wide by professionals or by trained supervised para-professionals.

Trauma, Adversity, and Parent–Child Relationships Among Young Children Experiencing Homelessness

This study examined experiences of adversity and potentially traumatic life events among 138 young children (56% female) residing with their families in emergency housing. Experiences of these children were examined from a developmental perspective, testing the impact of cumulative adversity on trauma symptoms, other emotional/behavior problems, and executive functioning in relation to the quality of observed parent-child interactions. Cumulative adversity was related to children’s trauma symptoms and total problem scores. Quality of observed parentchild interactions related to fewer child symptoms, congruent with a promotive role. Quality of parent-child interactions also moderated the associations between adversity and both specific trauma symptoms and broad emotional/behavior problems, consistent with an expected protective effect. Parenting quality was generally associated with better child executive functioning, consistent with a promotive rather than a protective effect among homeless children. Findings are discussed in the context of family homelessness, including chronic poverty and acute or ongoing adversity.

Responsibilised Resilience? Reworking Neoliberal Social Policy Texts

Responsibilised Resilience? Reworking Neoliberal Social Policy Texts

Factors affecting the psychological functioning of Australian adults with chronic pain

The role of resilience, for adults facing ongoing adversity in the form of chronic medical conditions, has received little attention in the past. This research investigated the impact of resilience and coping strategies on the psychological functioning of 87 Australian adults with chronic pain, using a self-report questionnaire. It included the McGill Pain Questionnaire, the Connor-Davidson Resilience Scale, the Coping Strategies Questionnaire, the 36-item Short Form Health Survey, and the Depression, Anxiety and Stress Scale. Using hierarchical regression, after the effects of pain severity, catastrophizing, and ignoring the pain were controlled for, resilience was significantly associated with mental health-related quality of life (β = 0.18, P < 0.05), depression (β = -0.31, P < 0.01), and anxiety (β = -0.20, P < 0.05). In the final model for depression, resilience had a stronger association than pain severity. Resilience did not, however, influence individual's perceptions of their physical health-related quality of life. The link between resilience and mental health-related quality of life outcomes provides initial evidence for the potential application of resilience related interventions to pain management programs.

Longitudinal Determinants of Posttraumatic Stress in a Population-Based Cohort Study

Posttraumatic stress disorder is a prevalent and disabling psychologic pathology. Longitudinal research on the predictors of posttraumatic stress symptomatology is limited. We recruited 2752 participants to a prospective, population-based cohort study by conducting a telephone survey of adult residents of the New York City metropolitan area in 2002; participants completed 3 follow-up interviews over a 30-month period. Censoring weights were estimated to account for potential bias. We used generalized estimating equation logistic regression models with bootstrapped confidence intervals to assess the predictors of posttraumatic stress over time in multivariable models. Predictors of posttraumatic stress over time included ongoing stressors (odds ratio [OR] = 1.91 per 1 unit increase in number of stressors, [95% confidence interval = 1.55-2.36]) and traumatic events (OR = 1.92 per 1 unit increase in number of traumatic events [CI = 1.71-2.22]), social support (compared with high levels, OR = 1.71 for medium [1.09-2.52]; OR = 1.57 for low [1.08-2.35]), low income (OR = 0.87 per $10,000 increase [0.81-0.92]), female sex (1.60 [1.11-2.23]), and Latino ethnicity (compared with white, OR = 1.74 [1.05-2.97]). These findings suggest that ongoing stressors play a central role in explaining the trajectory of posttraumatic stress over time, and that factors beyond the experience of stressors and traumas may account for sex and ethnic differences in posttraumatic stress risk. Interventions that focus on reducing ongoing adversity may help mitigate the consequences of traumatic events.

Treating Survivors of Terrorism While Adversity Continues

The current situation in Israel of continuous terrorist attacks poses unique challenges to the treatment of Posttraumatic Stress Disorder (PTSD). This article addresses issues that arise when treating survivors of ongoing terrorism. These include: (a) Is PTSD treatable during ongoing adversity? (b) When should treatment be offered? (c) Is avoidance maladaptive or adaptive? (d) How does one deal with re-exposure? (e) How to define the end of treatment? and (f) What are the effects on the therapist when conducting treatment during ongoing adversity? Case studies are provided to illustrate these issues when treating clients with PTSD during ongoing terror.

Prophecies of childhood: how children's social environments and biological propensities affect the health of populations.

During the past decade, important steps have been taken globally to improve the status of children. Concurrently, significant advances have been made toward understanding how child development is shaped by transactions between biological and environmental influences. Despite such advances, ongoing adversities in the lives of children worldwide undermine the development of individuals and thus the health of nations. The primary tenets of this paper are that: children continue to suffer a disproportionate share of the world's adversities; exposure to early adversities is not only associated with increased morbidity during childhood, but also across the lifespan; and recent advances in understanding the operation and ontogeny of stress-response systems can help explain how adversity is translated into lifelong effects on health. Acknowledging the long-lasting sequelae of childhood adversity has important implications for public health and society.

The Corticotropin-Releasing Hormone Challenge in Depressed Abused, Depressed Nonabused, and Normal Control Children

Hypothalamic–pituitary–adrenal (HPA) axis disturbances in depressed children with a history of abuse were examined. Thirteen depressed abused, 13 depressed nonabused, and 13 normal control children were given 1.0 μg/kg of human corticotropin-releasing hormone (CRH) intravenously. Blood samples for corticotropin (ACTH) and cortisol were obtained at nine intervals. When compared to depressed nonabused and normal control children, depressed abused children had significantly greater peak, total, and net ACTH secretion post-CRH. Increased ACTH secretion was only observed in depressed abused children experiencing ongoing chronic adversity (marital violence, emotional abuse, poverty, lack of supports). The pattern of findings of the depressed abused children experiencing ongoing adversity parallels the pattern of HPA axis dysregulation reported in animal studies of chronic stress. They add to a growing body of literature suggesting measures of past trauma and current adversity are important sources of variability in psychobiological correlates of major depression.