Posttraumatic Stress Symptomatology Research Articles

Pathways towards posttraumatic stress symptomatology: A moderated mediation model including perceived stress, worry, and defense mechanisms.

The general aim of this study was to examine the psychological variables associated with post-traumatic stress disorder (PTSD) symptomatology, focusing on perceived stress, worry, as well as mature, neurotic, and immature defenses. Therefore, the differences in the study variables based on the levels of posttraumatic stress were explored, and a moderated mediation model was tested, controlling for gender and SARS-CoV-2 infection as covariates. A sample of 1,864 Italian participants completed the Impact of event scale-revised (IES-R), the 10-Item Perceived Stress Scale (PSS-10), the Penn State Worry Questionnaire (PSWQ), and the 40-Item Defense Style Questionnaire (DSQ-40). 41% (n = 764) of participants showed scores indicative of a probable presence of PTSD. They reported significantly higher levels of perceived stress, worry, neurotic and immature defenses than participants with lower PTSD symptomatology. Perceived stress was significantly associated with PTSD symptomatology, both directly and indirectly through the mediation of worry. Furthermore, neurotic and immature defenses were significant moderators in some relationships of this model. Such data can provide useful indications to elaborate tailored interventions and specific prevention activities for PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Symptoms of Post-Traumatic Stress and Mental Health in a Sample of University Students: The Mediating Role of Resilience and Psychological Well-Being.

The COVID-19 pandemic has been one of the most stressful events in recent times across the world. The long-term effect of these experiences raises several concerns, including the development of post-traumatic stress symptomatology. However, little is known about the psychological processes that mediate this association. The aim of this study was to explore the association of emotional exhaustion and anxiety in post-traumatic stress symptomatology, and the mediating role of resilience and psychological well-being in university students. A total of 526 university students of both sexes participated in this study, and they were aged between 17 and 62 years old. Symptoms of anxiety and emotional exhaustion were significantly higher in females, in contrast, males showed on average more resilience and psychological well-being. Additionally, participants with COVID-19 infection had higher levels of emotional exhaustion, anxiety, and PTSD. The results indicated that the variables were correlated with each other (p < 0.001). A conceptual model was confirmed that describes anxiety and emotional exhaustion as predictors, post-traumatic stress symptomatology as an outcome variable, and resilience and psychological well-being as mediators. Resilience and psychological well-being can be important protective factors for adaptive responses in stressful situations. The findings obtained in this study will provide a theoretical basis for designing targeted interventions to improve psychological health, whether for crisis intervention, the process of adapting to higher education, or for recovery plans from psychological trauma.

Demographic characteristics, gambling engagement, mental health, and associations with harmful gambling risk among UK Armed Forces serving personnel

IntroductionHarmful gambling negatively impacts individuals, families and communities. Growing international evidence indicates that the Armed Forces (AF) community may be at a comparatively higher risk of experiencing harm from gambling...

Perinatal posttraumatic stress disorder as a predictor of mother-child bonding quality 8 months after childbirth: a longitudinal study

BackgroundNegative childbirth experiences can be related to the onset of perinatal post-traumatic stress symptomatology (P-PTSS), which significantly impacts the mother and the infant. As a response in the face of the discomfort caused by P-PTSS, maladaptive emotion regulation strategies such as brooding can emerge, contributing to the consolidation of post-partum depressive symptoms. Ultimately, both types of symptomatology, P-PTSS and post-partum depression, can act as risk factors for developing mother-child bonding difficulties. Still, this full set of temporal paths has to date remained untested. The present longitudinal study aimed to analyze the risk factors associated with the appearance of P-PTSS after post-partum and to test a path model considering the role of P-PTSS as an indirect predictor of bonding difficulties at eight months of postpartum.MethodsAn initial sample of pregnant women in the third trimester of gestation (N = 594) participated in a longitudinal study comprising two follow-ups at two and eight months of postpartum. The mothers completed online evaluations that included socio-demographic data and measures of psychological variables. A two-step linear regression model was performed to assess the predictive role of the variables proposed as risk factors for P-PTSS, and a path model was formulated to test the pathways of influence of P-PTSS on bonding difficulties.ResultsA history of psychopathology of the mother, the presence of depression during pregnancy, the presence of medical complications in the mother, and the occurrence of traumatic birth experiences all acted as significant predictors of P-PTSS, explaining 29.5% of its variance. Furthermore, the path model tested further confirmed an indirect effect of P-PTSS, triggered by a negative childbirth experience, on subsequent bonding difficulties eight months after labor through its association with higher levels of brooding and, ultimately, postpartum depression levels. A further path showed that bonding difficulties at two months postpartum can persist at eight months postpartum due to the onset of brooding and postpartum depression symptoms.ConclusionWe identified a set of robust predictors of P-PTSS: the mother’s previous history of depression, perinatal depression during pregnancy, the presence of medical complications in the mother and the occurrence of traumatic birth experiences, which has important implications for prevention. This is particularly relevant, as P-PTSS, when triggered by a negative childbirth experience, further indirectly predicted the development of mother-child bonding difficulties through the mediation of higher use of brooding and symptoms of postpartum depression. These findings can serve as a basis for developing new longitudinal studies to further advance the understanding of perinatal mechanisms of mental health.

Associations among meaning in life, coping, and distress in trauma-exposed U.S. military veterans.

Experiencing meaning in life may be particularly relevant following traumatic experiences as individuals who report meaning post trauma report less psychological distress. Engaging in avoidant coping, however, may be a sign of underlying psychological distress in the aftermath of traumatic experiences. We sought to examine associations among meaning in life, avoidant coping, and psychological distress in a sample of trauma-exposed veterans. Secondary cross-sectional analyses were conducted on data from veterans exposed to a traumatic event(s) who experienced clinically meaningful guilt (N = 145). Questionnaires on meaning in life, avoidant coping, and psychological distress were administered, and structural equation modeling was used to test direct effects. Path analysis revealed that greater meaning was associated with lower depression, anxiety, and posttraumatic stress symptomatology, while higher avoidant coping was associated with greater depression, anxiety, posttraumatic stress, and somatization symptomatology. Participants who report more meaning in life and report lower avoidant coping post trauma may experience less psychological distress. If replicated longitudinally, results could suggest cultivating meaning in life and reducing avoidant coping may decrease psychological distress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Latent Profile Analysis of Substance Use and Post-Traumatic Stress on Substance Use Treatment Outcomes Among People Involved with the Justice System

This study used latent profile analysis to classify legally-involved persons in substance use treatment into mutually exclusive groups based on their clinical presentation of substance use and post-traumatic stress. Predictors of group membership were tested, and group classification was evaluated as a predictor of engagement in substance use treatment. There was a significant amount of variability in substance use and post-traumatic stress symptomatology at the start of treatment. Clients’ symptoms were classified into four groups: (1) high substance use, low trauma, (2) low substance use high trauma, (3) high substance use, high trauma, and (4) low substance use, low trauma. Psychological distress was the primary predictor of group classification and profile membership was differentially related to treatment engagement. Together, these results can be used to inform screening tools, assessment protocols, and adaptive treatment models to better serve people in the legal system experiencing comorbid substance use and post-traumatic stress.

Recognizing Traumatization in Children Aged 4 to 8: A Pilot Validation Study of the Odense Child Trauma Screening (OCTS) Measure in Lithuania

ABSTRACT Early identification of children at risk of posttraumatic stress symptomatology or other emotional and behavioral problems is highly needed for the prevention of long-term consequences of traumatic events and abuse. However, the assessment of the traumatization of very young children is challenging because they cannot fully verbalize their psychological experiences. The purpose of this pilot study was to test the internal consistency, interrater reliability, and validity of the Odense Child Trauma Screening (OCTS) measure, a structured play test for signs of traumatization in young children. The total sample was comprised of 26 (50%) children from the community and 26 from risk groups in Lithuania. The mean age of the participants was 6.44 (SD = 1.63; range 3–9); 62% were girls. The OCTS interviews were conducted with all children. The Child and Adolescent Trauma Screen (CATS) and the Strengths and Difficulties Questionnaire (SDQ) were used to collect data about the child from the caregivers. Caregivers of the risk sample group reported significantly more potentially traumatic events experienced by the children (M = 2.73) than in the community sample (M = 1.00). The OCTS results indicated acceptable internal consistency and good inter-rater reliability. However, only one of the four OCTS stories scores was significantly higher in the risk group. We found no sex effects on the OCTS scores. This pilot study of the psychometric properties of the OCTS supports the reliability of the OCTS and indicates that the OCTS administration and coding procedures can be consistently applied in various settings.

It’s all in the hair: Association between changes in hair cortisol concentrations in reaction to the COVID-19 pandemic and post-traumatic stress symptoms in children over time

After exposure to a stressful/traumatic event, some individuals will develop post-traumatic stress symptoms (PTSS). In adults, low cortisol levels appear to be a risk factor for the development of PTSS. Indeed, both lower pre-trauma cortisol levels and low cortisol levels in the aftermath of a traumatic event have been associated with greater PTSS. In contrast, studies conducted in children showed that elevated cortisol levels shortly after trauma exposure are associated with more severe post-traumatic stress symptomatology. The few studies that have examined how pre-trauma cortisol levels predict PTSS in children have found no effect. Given that a pandemic can induce PTSS in certain individuals, we investigated whether cortisol secretion prior to and in the early stages of the COVID-19 pandemic in Quebec (Canada) predicted PTSS in children. In June 2020, we collected a hair sample from 71 children (8–15 y/o, M = 11.65; 54.93% girls) without a history of psychopathology or exposure to previous traumatic events. Hair samples allowed us to derive cumulative measures of cortisol levels for the months prior to (from mid-December 2019 to mid-March 2020) and at the beginning of the pandemic (from mid-March 2020 to mid-June 2020). PTSS were assessed every 3 months between June 2020 (T1) and March 2021 (T4). The results showed that a greater increase in hair cortisol at the beginning of the pandemic predicted less PTSS at T1, with an increase in these symptoms over time. This study highlights the utility of using hair cortisol during future chronic stressful events to better understand its association with the evolution of distress.

Effets médiateurs de la symptomatologie de stress post-traumatique et des symptômes de dissociation somatoforme sur la relation entre l’attachement et la qualité de vie liée à la santé après un infarctus du myocarde

Myocardial infarction (MI) is a particularly frequent coronary disease: the number of new cases of MI recorded each year amounts to nearly 90,000 in France and nearly 790,000 in the United States. Over the past 15 years, the number of people who can survive this major cardiac event has substantially increased, as a result of advances in medical treatment and a reduction in delay to intervention. However, patients often report a decrease in their health-related quality of life following myocardial infarction. In other words, some patients perceive that the disease negatively affects various aspects of their daily lives, including physical functioning, emotional state, social relationships, and overall well-being. Furthermore, studies have shown that health-related quality of life is a prognostic indicator of the evolution of patients’ health status: the more health-related quality of life is reduced, the greater the risk of all-cause mortality, recurrence of cardiovascular events, and re-hospitalization for heart disease. In view of these elements, the identification of potentially modifiable factors, and in particular psychological factors, having an impact on health-related quality of life is particularly relevant. More specifically, insecure attachment, post-traumatic stress symptomatology and somatoform dissociation symptoms could have an impact on the health related-quality of life of people who have experienced a major cardiac event. ObjectivesThe objective of this study was to investigate the mediating role of posttraumatic stress symptoms and somatoform dissociative symptomatology in the relationship between insecure attachment and health related-quality of life after a myocardial infarction. Materials and methodsA total of 73 participants, having suffered a myocardial infarction and participating in a cardiovascular rehabilitation program, completed questionnaires to assess the degree of insecurity of their attachment (Experiences in Close Relationship Scale-12; ECR-12), the severity of post-traumatic stress symptoms (Post-Traumatic Stress Disorder Checklist Scale; PCL-5) and somatoform dissociation symptoms (Somatoform Dissociation Questionnaire; SDQ-20), and their health related-quality of life (MacNew Heart Disease-Health Related Quality of Life; MacNew). Mediation analyses were conducted according to the recommendations formulated by Baron and Kenny. ResultsOur results showed that only anxious attachment was positively and significantly associated with the severity of posttraumatic stress symptomatology, whereas such a link was not observed for avoidant attachment. The importance of posttraumatic symptomatology fully explained why individuals with high levels of fear of abandonment also have the poorest emotional, physical, and social quality of life after myocardial infarction. The importance of dissociative somatoform symptomatology partially explained why individuals with an insecure attachment style characterized by a high level of abandonmen were also those with the poorest health-related quality of life following myocardial infarction. ConclusionsThe results of this study tend to demonstrate the importance of taking into account the specificities of attachment, posttraumatic stress symptoms and somatoform dissociation phenomena in the context of interventions aimed at improving the health related-quality of life of people after a myocardial infarction. Insofar as secure attachment appears to be a protective factor against the risk of developing posttraumatic stress disorder, a psychotherapeutic approach aimed at promoting this form of attachment seems to be well justified. Specifically, it may be helpful to provide patients with a psychotherapeutic framework that takes into account their attachment experiences to allow them to change their beliefs about themselves and others, while helping them develop coping strategies appropriate to the stress. Psychotherapeutic interventions aimed jointly at increasing of the degree of attachment security and reducing the symptoms of posttraumatic stress and somatoform dissociation could be relevant to improve the health-related quality of life after a myocardial infarction.

The role of interoception in reducing trauma-associated distress: a feasibility study

ABSTRACT Background: Altered interoception plays an important role in chronic stress and posttraumatic stress disorder. The aim of this study was to evaluate the feasibility of a Trauma Sensitive Yoga (TSY) intervention for improving emotional distress and psychological discomfort in women living under circumstances of social and gender vulnerability. We assessed the effect of the treatment on the interoceptive mechanisms, and whether the psychological improvements were mediated by the changes in these mechanisms. Methods: The study involved a sample of 62 women who attended public community centres dedicated to supporting women victims of gender-based violence or who were socially and economically disadvantaged because of their gender. Participants underwent a six-week TSY programme. We evaluated dropout rate, adherence, and intervention satisfaction. We measured emotional distress, psychological discomfort, interoceptive mechanisms, and two nonequivalent dependent variables to enhance internal validity. We compared pre–post differences using paired samples t-test and a structural equation model (SEM) analysis was performed to compare the changes in the outcomes with the changes in the nonequivalent dependent variables. Mediation models were adjusted to evaluate the role of changes in interoception on outcome changes. Results: Fourteen (23%) women dropped out, mainly after the first intervention session. Intervention adherence (mean attendance 5.3 over 6 sessions) and acceptability were high (mean satisfaction 3.4 over 4). We observed post-intervention improvements in anxiety, depression, psychological discomfort, body responsiveness, and interoceptive awareness. The changes in the outcomes were larger than the changes in the nonequivalent dependent variables. Additionally, we found that the changes in body responsiveness partially mediated the change in anxiety and psychological discomfort but not in depression. Conclusions: TSY could be an interesting therapeutic approach for women experiencing chronic posttraumatic stress symptomatology. Our findings underscore the role of interoceptive mechanisms in traumatic stress and emphasize the importance of addressing these aspects.

The impact of perceived injustice on pain and psychological outcomes after traumatic injury: a longitudinal analysis.

Individuals' appraisals regarding the injustice of their pain or physical injury have emerged as a significant risk factor for worse physical and psychological outcomes. Injustice appraisals are defined by perceptions of external blame for pain or injury and viewing pain or injury as a source of irreparable loss. To date, research on the impact of injustice appraisal has been primarily cross sectional, and existing longitudinal studies have examined injustice appraisals at only 2 time points in the context of rehabilitation treatment. This study examined the trajectory of injustice appraisals in 171 patients admitted for traumatic injury at admission, as well as 3, 6, and 12 months after discharge and examined injustice appraisals as a potential moderator of recovery after injury. Findings can be summarized as follows: First, injustice perception was largely stable in the 12 months after hospital discharge. Second, elevated injustice perception was associated with decreased recovery in pain intensity and depressive symptomatology over the study period but did not moderate changes in pain catastrophizing or posttraumatic stress symptomatology over time. This study is the first naturalistic prospective analysis of injustice appraisal following trauma admission within the American healthcare system. Findings indicate that injustice appraisals do not naturally decrease in the aftermath of traumatic injury and may be a risk factor for poorer physical and psychological recovery. Future research should examine additional sociodemographic and psychosocial factors that may contribute to elevated injustice appraisal, as well as ways of addressing the potential deleterious impact of injustice appraisals in treatment settings.

Supplemental Material for A Weekly Diary Within-Individual Investigation of the Relationship Between Exposure to Bullying Behavior, Workplace Phobia, and Posttraumatic Stress Symptomatology

Supplemental Material for A Weekly Diary Within-Individual Investigation of the Relationship Between Exposure to Bullying Behavior, Workplace Phobia, and Posttraumatic Stress Symptomatology

A weekly diary within-individual investigation of the relationship between exposure to bullying behavior, workplace phobia, and posttraumatic stress symptomatology.

Most studies on workplace bullying have adopted a between-person approach, neglecting the potential within-individual fluctuations in the experience of bullying behaviors. However, investigating such fluctuations may prove useful for uncovering processes and mechanisms associated with bullying and its antecedents and consequences as they unfold over time. In the present study, based on recent discoveries on traumatic experiences and posttraumatic stress (PTS), we hypothesized that even short-term exposure to bullying behaviors-such as the exposure that characterizes an individual when the time window considered is a working week-may already have a substantial psychological impact at the within-individual level, as indicated by the experience of PTS symptoms. Additionally, we hypothesized that the development of workplace phobia may act as a mechanism linking the exposure to bullying behaviors during the week and the reported PTS symptomatology, and that person-level vulnerability factors to PTS (e.g., a recent trauma and female gender) accentuate the within-individual relationships. We tested the proposed hypotheses on a sample of 158 workers that were followed for 6 consecutive working weeks for a total of 860 observations. In line with other recent within-individual investigations, we found that exposure to bullying behaviors shows substantial week-level fluctuations. We also found overall support for the hypotheses, including evidence of a within-level lagged impact of bullying behaviors on workplace phobia, suggesting that even nonpersistent exposure to such behaviors is related to potentially nonignorable psychological suffering and PTS symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychological impact of the COVID-19 pandemic on Spanish healthcare workers: a systematic review of prevalence and wave-based patterns

The COVID-19 pandemic has impacted the mental health of the entire population, and especially of the healthcare, due to their close contact with the virus and the health emergency. However, the diversity of studies makes it difficult to determine the prevalence of mental health problems in Spanish healthcare workers. This study aims to examine the studies carried out during COVID-19 with the Spanish healthcare population to determine the prevalence of anxiety, depression, stress, post-traumatic stress (PTSD) and burnout symptomatology. A systematic search of the articles in the PubMed, Scopus and Web of Science databases was performed following PRISMA criteria. Pooled prevalence was obtained for all the mental health symptomatology from moderate to severe, as well as divided by wave. Our data revealed that 50.54% of healthcare workers reported stress, 41.02% burnout, 35.25% anxiety, 29.76% depression, and 25.82% PTSD symptomatology. Anxiety, depression, PTSD and burnout symptomatology diminished in the second and/or the third waves but increased in the following waves. However, stress showed the maximum prevalence during the second wave. Our study highlights a significant impact on the mental health of healthcare workers during health crises, and emphasizes the immediate need for mental health support for healthcare workers during and after pandemics. Anxiety, depression, PTSD, and burnout symptomatology exhibit a “valley” effect, initially decreasing but increasing with prolonged exposure to the COVID-19 health crisis. This underscores the necessity to implement prevention strategies to enhance stress management, emotional regulation skills, and coping abilities.

Psychological comorbidities and suicidality in sexual and gender minority foster youth

ObjectiveSexual and gender minority youth (SGMY), or those who identify as lesbian, gay, bisexual, transgender or gender diverse and questioning are suggested to be overrepresented in the U.S. foster care system. Lack of systematized data collection on youths’ sexual orientation and/or gender identity in child welfare has curtailed studies of this population. This community-based study assessed psychological and behavioral health of youth with current or past foster care involvement in an urban public child welfare system, and examined relations between types of victimization (e.g. LGBTQ-based victimization, caregiver rejection, intimate partner violence) and psychological functioning. MethodsA total of 35 (12–26 years old) participants were administered a survey assessing multiple domains of health and wellbeing between October 2018 and February 2020. Primary quantitative outcomes included depression, anxiety, post-traumatic stress symptomatology, suicide ideation, planning, and attempt, and non-suicidal self-injury. Results42.7 % of participants identified as lesbian or gay, 37.1 % as bisexual or pansexual, and 20 % identified as heterosexual. 54.3 % identified as transgender or gender diverse (TG/GD). Over 75 % (75.06 %, n = 25) of the total sample met the clinical cutoff for Total Internalizing, 64.71 % (n = 22) met the clinical cutoff for Depression, and 78.79 % (n = 26) met the clinical cutoff for Anxiety. 70 % reported suicidal ideation and 45 % past suicide attempt. Rejection experiences based on sexual orientation were associated with anxiety, depression and post-traumatic symptoms; discrimination experiences based on sexual orientation or TG/GD expression were associated with anxiety. Loneliness and everyday discrimination were associated with post-traumatic stress symptoms. IPV, everyday discrimination, rejection, discrimination, and victimization based on sexual orientation and gender identity, while not statistically significant within this sample, did emerge as factors warranting further investigation concerning suicide ideation, planning, and attempt. Conclusion75% of the SGMY in this this study met the clinical threshold for mood disorders, reinforcing the importance of integrated behavioral health support in clinical and wraparound care for SGMY in foster care, and the critical role of SGM-specific competencies for the entire care team. Teams caring for SGMY should be aware of community resources that are competent in addressing SGM-specific stressors and the impacts of multiple forms of victimization, including intimate partner violence for SGMY. Targeted efforts and to work with families are needed.

The relationship between peer bullying and PTSS in refugee schoolchildren.

This study explored the relationship between Peer bullying (PB) and Posttraumatic Stress Symptomatology (PTSS) in a sample of refugee Syrian schoolchildren in Jordanian schools. The study sample was composed of 116 Syrian refugees (female = 62, 53.4% male = 54, 46.6%) ages 9-18 years with a mean age of 14.5 years (SD 1.18) who had been in Jordan for at least 3 years and were studying in five public schools (three for females and two for males) located in Irbid and Mafraq governorates in the northern area of Jordan between the June 14, 2018 and the March 20, 2019. The results indicated that 116 children out of 180 (64.4%) suffer from high levels of PB (physical M = 1.47, verbal M = 1.41, and relational M = 1.35). The most prevailing type of bullying was the physical type, followed by the verbal and the relational types. Moreover, the three types of PB were positively and significantly correlated with PTSS (physical, r = .20, p < .05, verbal, r = .26, p < .01, relational, r = .22, p < .05), and (total PB, r = .43, p < .05). PB accounted for 14% of the variability in PTSS. Finally, the results did not indicate any significant differences in PB by gender, age, length of exposure to PB, living conditions, or disability. This study may provide a deeper understanding of the need to develop more thorough, institutionalized as well individualized, interventions to reduce PB against schoolchildren from a refugee background in schools. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cluster randomized controlled trial of Stepping Stones and Creating Futures to reduce mental health challenges among young men in informal settlements in KwaZulu-Natal Province, South Africa.

Informal settlements are high density areas in and around cities, characterized by a lack of formal planning and basic amenities, being known in South Africa for high levels of mental disorder driven by violence, and complex social and economic challenges. In particular, young men's poor mental health goes untreated, with relatively few evidenced-based interventions available in this setting. This cluster randomized controlled trial investigated the effectiveness of Stepping Stones and Creating Futures (SS/CF), a participatory gender transformative and economic empowerment intervention, on the mental health of young men living in South African informal settlement. A total of 674 young men ages 18 to 30 years were recruited in 34 clusters in Durban's urban informal settlements. Clusters were randomly allocated (1:1) to either the experimental SS/CF or control arm and participants were followed-up over 24-months. Intention-to-treat analysis based on generalized estimating equations (GEE) were fitted to quantify the impact of SS/CF on the men's anxiety and post-traumatic stress (PTS) symptomatology. At end of the 24 months follow-period, anxiety (adjusted odds ratio [aOR]: 0.62, p = .04, 95% CI [0.39, 0.99]) and PTS (aOR = 0.52, p = .03, 95% CI [0.29, 0.93]) were significantly lower for group assigned to the SS/CF compared to the control group. SS/CF, a gender transformative and livelihoods strengthening intervention designed to address poverty and other socio-economic challenges in informal settlements reduced anxiety and PTS among men with mental health challenges living in informal settlements.

A global systematic scoping review of literature on the sexual exploitation of boys

BackgroundSexual exploitation of children (SEC) is a widespread crime which impacts the child victim across developmental, health and well-being domains. As victims, boys have received much less clinical and research attention. While context-specific factors likely shape the SEC risk, under-recognized gender norms can deny boys' vulnerability. Professional failures to recognize and respond adequately to boys' sexual exploitation may prevent access to support. ObjectiveThis systematic scoping review updates and broadens a previous review of literature addressing prevalence, victim/offender/facilitator characteristics, control mechanisms, as well as the health correlates and outcomes regarding sexual exploitation of boys. This review included international peer-reviewed and gray literature from 38 countries in 14 languages. Participants and settingStudies from the years 2000 to 2022 that included samples of boys under age 18, or sex-disaggregated data for children under 18, were included. Case studies, systematic reviews, and those reporting on retrospective experiences by adults over 18 were excluded. A total of 254,744 boys were represented across 81 studies. MethodsA systematic scoping review considered qualitative and quantitative peer-reviewed publications from eight, English-language databases. English and non-English non-peer reviewed publications (‘gray literature’) was identified by both ECPAT International's global network of member organizations and citation chaining. ResultsOverall, 81 peer-reviewed (n = 51) and gray literature (n = 30) documents from 38 countries were included. In total, 254,744 youth participated in peer-reviewed studies (N = 217,726) and gray literature (N = 37,018). General prevalence of sexual exploitation of boys was reported at up to 5 %, with higher rates noted in specifically vulnerable sub-populations (e.g., 10 %, trans youth; 26 %, street-connected youth). The literature indicates that sexual exploitation of boys is reported as occurring primarily between 12 and 18 years old. Multi-level factors are linked to SEC, including individual (e.g., disability status), relationship (e.g., child maltreatment, dating violence), community (e.g., community violence), and societal domains (e.g., discriminatory beliefs). SEC victimization is linked with youth mental and physical health concerns, particularly sexual health. Post-traumatic stress symptomatology or disorder was rarely evaluated. Evidence-based treatments were not available, which may be related to a lack of gender-based theoretical models for understanding SEC specifically. ConclusionThe sexual exploitation of boys is a prevalent public health, child rights, and clinical issue. All young people experiencing sexual exploitation face sex- and gender-specific challenges, and this remains the case for boys with indications including family rejection, implicit community tolerance for abuse to service accessibility barriers. Actioning our duty to care for all children requires gender- and trauma-informed lenses. Ongoing surveillance of all forms of violence against children, with gender disaggregation, is essential for practice and policy advancement.

A prospective examination of the role of psychological (in)flexibility in posttraumatic stress: A cross-lagged panel design

Functional contextualist models of psychopathology suggest that psychological inflexibility and psychological flexibility are of central importance for understanding the development and maintenance of posttraumatic stress (PTS) symptomatology. To our knowledge, these two constructs and their domain-specific factors (e.g., cognitive fusion, experiential avoidance) have not been assessed in their entirety and examined in relation to PTS symptoms using a longitudinal study design. As such, the primary aim of the present study was to use cross-lagged panel analysis, an analytic approach that allows stronger causal inferences to be made regarding the nature of temporal relations among study variables, to determine the directional relations among PTS symptoms and psychological flexibility and inflexibility over an eight-month time period. Trauma-exposed adults (N = 810), recruited online via Amazon’s Mechanical Turk (MTurk), completed a battery of self-report measures via a secure online platform at three time points, spanning eight months. Results suggest that the relationship between psychological inflexibility and PTS symptoms is bidirectional and mutually reinforcing. In contrast, significant prospective relations were not observed between psychological flexibility and PTS symptoms. Results of a follow-up exploratory path analysis showed that cognitive fusion was the only psychological inflexibility subfactor that partially mediated the relationship between PTS symptoms from baseline to the eight-month follow-up assessment. Taken together, these results suggest that psychological inflexibility, and primarily the domain of cognitive fusion, maintains PTS symptoms following trauma exposure. As such, it may important to integrate cognitive defusion techniques into evidence-based treatments for Posttraumatic Stress Disorder (PTSD).

Supplemental Material for Pathways Towards Posttraumatic Stress Symptomatology: A Moderated Mediation Model Including Perceived Stress, Worry, and Defense Mechanisms

Supplemental Material for Pathways Towards Posttraumatic Stress Symptomatology: A Moderated Mediation Model Including Perceived Stress, Worry, and Defense Mechanisms