Posttraumatic Stress Symptoms Research Articles

Initial Witnessing on Future Witnessing: A Mediation Analysis of Chronic Community Violence, Post-Traumatic Stress, and Delinquency in Urban, African American Youth.

Witnessing community violence can predict negative mental health outcomes for youth such as post-traumatic stress symptoms and delinquent behavior. Such outcomes differ by gender. Variables that predict witnessing community violence in youth are less understood. This study aims to explore potential pathways between initial witnessing and continued witnessing for early adolescents. The relationship between witnessing as a predictor and witnessing as an outcome is hypothesized to be mediated by both post-traumatic stress and delinquency and moderated by gender. A sample of 153 African American, sixth-grade students (M= 11.65, 59% female) in high crime, high poverty areas completed self-report surveys at baseline, 12 and 24 months. Moderated serial mediation was used to assess longitudinal associations. For the full model, delinquency at Time 3 was associated with a positive change in witnessing at Time 3. Gender moderated several paths. For girls, witnessing at Time 1 was predictive of high post-traumatic stress (aggregate) at Time 2 and high delinquency at Time 3. For girls, witnessing at Time 1 also was predictive of higher hyperarousal and higher intrusion subscale symptoms than other symptoms at Time 2. Analyses also indicated that hyperarousal at Time 2 significantly predicted witnessing at Time 3 for girls only. Lastly, delinquency at Time 3 was associated with a positive change in witnessing at Time 3. For boys, no analyses indicated witnessing at Time 1 as a significant predictor. Results contribute to our understanding of the trajectory of witnessing community violence and the roles both post-traumatic stress subscales and delinquency play in that trajectory, especially among girls.

Brief Peer-Supported Web-Based Skills Training in Affective and Interpersonal Regulation (BPS webSTAIR) for Trauma-Exposed Veterans in the Community: Randomized Controlled Trial.

Peer-supported mobile health (mHealth) programs hold the promise of providing a low-burden approach to increasing access to care and improving mental health. While peer support has been shown to improve engagement in care, there is limited investigation into the impact of peers on symptom outcomes. Trauma-exposed populations frequently endure co-occurring posttraumatic stress and depressive symptoms as well as difficulties in day-to-day functioning. This study evaluated the potential benefits of a peer-supported, transdiagnostic mHealth program on symptom outcomes and functioning. This randomized controlled trial tested the effectiveness of Brief Peer-Supported (BPS) web-based Skills Training in Affective and Interpersonal Regulation (webSTAIR), a 6-module transdiagnostic digital program derived from Skills Training in Affective and Interpersonal Regulation and compared to waitlist control in a community sample of veterans who screened positive for either posttraumatic stress disorder (PTSD) or depression. A total of 178 veterans were enrolled in this study using a 2:1 randomization scheme with 117 assigned to BPS webSTAIR and 61 assigned to waitlist control. PTSD and depressive symptoms as well as emotion regulation and psychosocial functioning were assessed at pretreatment, posttreatment, and 8-week follow-up time points. Mixed-effects models were used to assess change in outcome measures across time points. Exploratory analyses were conducted to determine whether the type and number of peer interactions influenced outcomes. Significant interaction effects were observed for all outcomes such that participants randomized to BPS webSTAIR reported significantly greater improvement at the posttreatment time point compared to waitlist control with moderate effect sizes for PTSD (d=0.48), depression (d=0.64), emotion regulation (d=0.61), and functional impairment (d=0.61); gains were maintained at 8-week follow-up. An initial cohort of participants who were required to engage with a peer coach to progress through the modules interacted more frequently with peers but completed fewer modules compared to a later cohort for whom peer engagement was optional. Overall, those who completed more modules reported greater improvement in all outcomes. BPS webSTAIR was effective in improving PTSD and depression symptoms, emotion regulation, and psychosocial functioning in community veterans. Peer-supported, transdiagnostic mHealth programs may be a particularly efficient, effective, and low-burden approach to improving mental health among trauma-exposed populations. Investigation of peer-supported programs among other populations is necessary to evaluate the generalizability of the findings. Analyses comparing peer support that was required versus optional indicated that some veterans may not need or want peer support. Future research should evaluate how best to deliver peer support and for whom it is most beneficial. If successful, peer-supported tech programs may increase the Veteran Affairs workforce as well as improve veteran mental health services and outcomes. ClinicalTrials.gov NCT04286165; https://clinicaltrials.gov/study/NCT04286165.

High rates of probable PTSD among Ukrainian war refugees: the role of intolerance of uncertainty, loss of control and subsequent discrimination

ABSTRACT Background: Intolerance of uncertainty is a well-known predictor of post-traumatic stress symptoms following a traumatic event. At the same time, it is relatively unknown whether intolerance of uncertainty amplifies the effects of other adverse life events on PTSD symptoms among traumatized individuals. Objective: This article addresses this problem in a study of Ukrainian war refugees’ experiences with post-migration discrimination and powerlessness (loss of control). Method: 4972 forced immigrants from Ukraine took part in the study (90.2% women, Mage = 40.4, SD = 12.5) completing the PTSD-8 scale, measures of post-migration discrimination and loss of control experiences, and intolerance of uncertainty. Results: Almost half of respondents (47.5%) have probable PTSD. Regression analysis confirmed that war-related experiences, as well as intolerance of uncertainty, post-migration loss of control and experiences of discrimination were significant predictors of self-reported PTSD symptoms. Also, intolerance of uncertainty weakly moderated the effects of experienced discrimination and control deprivation on self-reported PTSD symptoms, so that the effects of adverse post-migration experiences were more pronounced among individuals high in intolerance of uncertainty. Conclusions: Understanding the effect of post-migration experiences on war refugees’ mental health is crucial for developing improved acculturation policies and fostering a supportive environment for forced migrants.

Longitudinal relationship between posttraumatic cognitions and internalising symptoms in children and adolescents

ABSTRACT Background: Little is known about the naturalistic course of posttraumatic cognitions (PTCs) after exposure to a potentially traumatic event (PTE) in children and adolescents. Moreover, previous studies on the longitudinal associations of PTCs with internalising symptoms yielded mixed results. Objective: To explore the naturalistic courses and longitudinal associations of dysfunctional PTCs and functional PTCs with posttraumatic stress symptoms (PTSS), depression, and anxiety. Method: A total of 115 children and adolescents, aged 7–15 years, were assessed within 1 month, 3 months, and 6 months after exposure to an acute accidental PTE. Repeated measures analyses of variance were conducted to capture the naturalistic courses of PTCs and internalising symptoms. Cross-lagged panel analyses were applied to explore the longitudinal relationship between dysfunctional and functional PTCs, along with their longitudinal associations with PTSS, depression, and anxiety. Results: Dysfunctional PTCs and internalising symptoms decreased, whereas functional PTCs increased over time. Dysfunctional and functional PTCs were moderately inversely related, but no significant cross-lagged paths emerged among them. Dysfunctional PTCs were moderately to strongly associated with internalising symptoms, while functional PTCs were weakly to moderately inversely associated with internalising symptoms. Initial PTSS predicted later dysfunctional PTCs (β = .31, p < .05), but not vice versa. Conclusions: Dysfunctional PTCs, functional PTCs, and internalising symptoms were entangled over time. Our findings support the cognitive scar model with initial PTSS predicting later dysfunctional PTCs. Future research complementing between-subject with within-subject analyses could offer additional insights into the longitudinal relationship between dysfunctional PTCs, functional PTCs, and psychological symptoms.

Effects of skin-to-skin contact on mental health outcomes in the parents of full-term newborns: A systematic review and meta-analysis of randomized clinical trials

BackgroundThe postpartum period can be emotionally challenging for parents, with documented levels of anxiety, stress, and depression. While the benefits of skin-to-skin contact (SSC) are well-known, its impact on the mental health of parents of full-term newborns has been less studied. Objective: We aimed to assess the effects of SSC in mental health outcomes in the parents of full-term newborns. MethodsIn this systematic review, a comprehensive search was conducted to identify randomized clinical trials (RCTs) comparing SSC versus no SSC and assessing mental health outcomes. Meta-analyses were performed whenever possible, and the GRADE approach was used to rate the certainty of evidence. ResultsWe included 9 RCTs with 1201 participants. Regarding the risk of bias, the most affected domains were selective reporting, blinding, and allocation concealment. Regarding parental anxiety, SSC may reduce it at short-term, while it is unsure its effect at mid-term and it may not have any effect at long-term. Regarding Psychological stress, SSC may not have an impact at mid- and long-term. Regarding delivery-related post-traumatic stress symptoms, SSC may not have an impact at short-, mid-, and long-term. Regarding depressive symptoms, the evidence is uncertain at short- and mid-term. LimitationsFor the assessed outcomes, certainty of the evidence was low or very low. ConclusionSSC may reduce parental anxiety at short-term, while it may not have an impact in psychological stress and delivery-related post-traumatic stress symptoms. Moreover, the evidence is uncertain regarding its effect in long-term anxiety and depressive symptoms.

Autistic children and their parents in the context of war: Preliminary findings.

While existing literature on the intersection of trauma and autism is limited, emerging evidence suggests heightened vulnerability of autistic children to the psychological consequences of traumatic events, including an elevated risk of developing posttraumatic stress disorder (PTSD). Additionally, parents of autistic children often experience elevated levels of negative emotional states, compared to parents of typically developing children. This study investigates the impact of terrorism and war on autistic and non-autistic children and their parents, presenting preliminary results from the initial data collection phase of a year-long longitudinal investigation of the experience of autistic children and their parents following Hamas' 7 October 2023 attack on Israel. Data gathered within 30days of the initial attack reveal that both autistic and non-autistic children exhibited clinically significant post-traumatic stress symptoms, with autistic children demonstrating a more pronounced manifestation. Moreover, parents of autistic children reported significantly higher levels of depression, anxiety, and stress in the aftermath of the events, compared to an independent cohort of parents of autistic children assessed prior to the crisis. These results underscore the heightened susceptibility of autistic children to post-traumatic stress and the unique challenges confronted by their parents during times of conflict. The study highlights the imperative for tailored support services for autistic children and their families amidst traumatic incidents and stresses the need for further research in comparable contexts globally.

Stress responses of infants and mothers to a still-face paradigm after traumatic childbirth

IntroductionOne-third of women experience childbirth as traumatic and some develop symptoms of childbirth-related posttraumatic stress symptoms (CB-PTSS). Whether CB-PTSS negatively impact on physiological and psychological stress responses in mothers and their offspring and whether they are associated with mother-infant synchrony is not clear. This study aimed to investigate stress responses of (1) mothers with CB-PTSS, (2) of their infant, and (3) the physiological mother-child-synchrony at six months postpartum. MethodPsychophysiological (cortisol and vagal tone) and psychological stress responses of mothers and infant’s (n=31 dyads) from the Swiss TrAumatic biRth Trial (NCT03576586) were assessed during a face-to-face still-face paradigm (FFSF-R). ResultsThere was a significant time effect in maternal stress responses for salivary cortisol, vagal tone, and for maternal subjective stress. As expected, mothers’ subjective stress increased during the stress task and mothers vagal tone changed during the first stressful period but not during the second, whereas cortisol unexpectedly decreased over the FFSF-R. Infant negative mood increased over the experiment, but there were no physiological changes. However, a significant interaction effect for mother-infant synchrony during the second reunion period of the FFSF-R was found. ConclusionAlthough mothers and their infants were subjectively stressed, they showed only limited physiological stress responses.

Between mourning and hope: A mixed-methods study of ambiguous loss and posttraumatic stress symptoms among partners of Israel defence force veterans.

Spouses of military combatants often experience adverse outcomes, including posttraumatic stress symptoms (PTSS) in the event of ambiguous loss (AL). AL refers to an uncertain situation regarding a person's status as alive or as cognitively present. The former ambiguity is categorized by the term physical AL (PAL), which refers to the continued psychological presence of a person, despite their physical absence. The latter ambiguity, categorized by the term psychological AL or ambiguous presence, refers to when a person is emotionally absent, despite their physical presence. Though AL has been widely researched, there are still gaps around the AL-posttraumatic stress disorder (PTSD) relationship, especially regarding dyadic variables that can moderate this relationship. Also, most of the AL military-related studies are qualitative, with only a few that combine qualitative and quantitative research methods. We address these gaps in an innovative mixed-methods study examining the emotional experience of Israeli veterans' spouses with a focus on the relationship between AL, PTSS, and dyadic adjustment (DA). The study included 63 participants, all spouses of Israeli veterans. We used self-report questionnaires (AL, Dyadic Adjustment Scale, and PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition) and a semistructured narrative interview. Our results revealed positive correlations between AL-PTSS and PAL-PTSS. Also, an interaction effect was found in which the lower the DA level, the stronger the PAL-PTSS correlation. Conversely, the higher the DA level, the stronger the ambiguous presence-PTSS correlation. Qualitative findings identified themes in the experience of these situations, including uncertainty and ambivalence. Our qualitative and quantitative results combined suggest that the way military couples deal with AL may be an important emotional experience requiring specific attention from mental health professionals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Posttraumatic Stress Disorder in Children: A Narrative Review

Method: This narrative review summarizes research from the years 2019-2024 on posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in children. Results: This research suggests that prevalence rates have been highly variable as a function of the stress experienced, for example, post-surgery (15%), following exposure to war (28%) and following head injury (34%). The negative effects have included cognitive dysfunction, aggression and other behavioral difficulties and the comorbidities include sleep disorders, somatic symptoms and depression. Predictors/risk factors have been the primary focus in this literature and have included parent risk factors including exposure to intimate partner violence, sexual and emotional abuse. Sensory modulation and cognitive processes have been implicated as, for example, negative attention bias and subjective threat. Injuries and hospitalizations have been predictors as has been exposure to explosions and earthquakes. The most frequently studied intervention has been cognitive behavioral therapy which has consistently reduced the symptoms of PTSD. Potential underlying biological mechanisms have included parent PTSD, pregnancy inflammation, and autonomic dysregulation including low cortisol and heartrate, although reduced cortical thickness (volume) in several areas of the brain has been the most frequently studied potential mechanism. Discussion: The studies in this review highlight the prevalence and severity of posttraumatic stress disorder in children. However, they have been primarily based on mixed-age child and adolescent samples and the results have varied by the type of stress experienced and the severity of the stress.

Predicting Parental Post-Traumatic Stress Symptoms Following their Child's Stay in a Pediatric Intensive Care Unit, Prior to Discharge.

Objective: Develop an inpatient predictive model of parental post-traumatic stress (PTS) following their child's care in the Pediatric Intensive Care Unit (PICU). Design: Prospective observational cohort. Setting: Two tertiary care children's hospitals with mixed medical/surgical/cardiac PICUs. Subjects: Parents of patients admitted to the PICU. Interventions: None. Measurements and Main Results: Preadmission and admission data from 169 parents of 129 children who completed follow up screening for parental post-traumatic stress symptoms at 3-9 months post PICU discharge were utilized to develop a predictive model estimating the risk of parental PTS 3-9 months after hospital discharge. The parent cohort was predominantly female (63%), partnered (75%), and working (70%). Child median age was 3 years (IQR 0.36-9.04), and more than half had chronic illnesses (56%) or previous ICU admissions (64%). Thirty-five percent (60/169) of parents met criteria for PTS (>9 on the Post-traumatic Stress Disorder Symptom Scale-Interview). The machine learning model (XGBoost) predicted subjects with parental PTS with 76.7% accuracy, had a sensitivity of 0.83 (95% CI 0.586, 0.964), a specificity of 0.72 (95% CI 0.506, 0.879), a precision of 0.682 (95% CI 0.451, 0.861) and number needed to evaluate of 1.47 (95% CI 1.16, 1.98). The area under the receiver operating curve was 0.78 (95% CI 0.64, 0.92). The most important predictive pre-admission and admission variables were determined using the Local Interpretable Model-Agnostic Explanation, which identified seven variables used 100% of the time. Composite variables of parental history of mental illness and traumatic experiences were most important. Conclusion: A machine learning model using parent risk factors predicted subsequent PTS at 3-9 months following their child's PICU discharge with an accuracy of 76.7% and number needed to evaluate of 1.47. This performance is sufficient to identify parents who are at risk during hospitalization, making inpatient and acute post admission mitigation initiatives possible.

Childhood Maltreatment Associated with Anxiety and Depression and Complex PTSD Symptoms.

Childhood maltreatment has great impact on physical and mental health. This study was designed to investigate the relationship between childhood maltreatment experience, social support, Anxiety and Depression, and traumatic stress symptoms in adults. There were 113 subjects aged 20-35 recruited. They filled out self-reported questionnaires, including the Childhood Trauma Questionnaire Short Form (CTQ-SF), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), International Trauma Questionnaire (ITQ), Chinese version of the PTSD Checklist for DSM-5 (PCL-5), and Multidimensional Scale of Perceived Social Support (MSPSS), to measure symptom severity regarding childhood maltreatment, Anxiety and Depression, post-traumatic stress/complex post-traumatic stress symptoms (PTSD/CPTSD), and social support. The symptom severity was compared between maltreatment and non-maltreatment groups. Regression and mediator analyzes were done to investigate the relationship between maltreatment experience, mental impact severity, and the role of social support. There were 74.3% of participants who had been maltreated as children. Those who experienced maltreatment had more PTSD/CPTSD symptom severity than those who did not. Family support, but not friend support, mediated the relationship between maltreatment and PTSD/CPTSD symptom severity. Childhood maltreatment was associated with Anxiety and Depression and CPTSD symptom severity in young adults. Future prospective studies are warranted to investigate the role of family support in preventing consequences after maltreatment.

Posttraumatic growth trajectories and the psychopathological response to Covid-19: A longitudinal study of former prisoners of war and combat veterans

BackgroundPosttraumatic Growth (PTG) is the subjective experience of positive psychological change following exposure to trauma. Yet, researchers have discussed whether PTG is a positive outcome or a self-deceptive coping mechanism. The present study investigates PTG-trajectories and their ability to predict psychopathology in response to the Covid-19 pandemic in a longitudinal study of former prisoners of war (ex-POWs) and combat veterans from the 1973 Yom Kippur War in Israel. MethodsData was collected in five waves from 1991 to 2020 (NT5 = 256). To identify latent profiles of change in PTG over time, Group-Based Trajectory Modeling was applied. Logistic regression examined whether study group and PTSD-clusters predict latent trajectories of change. Boostrap MANOVA was applied to examine if the latent trajectories predict veterans’ psychopathological response to Covid-19. ResultsA 2-class solution was the best representation of the data. Being ex-POW significantly predicted the likelihood of developing high PTG over time. The High PTG group had significantly higher Acute Stress Disorder, Posttraumatic Stress Symptoms, and general psychopathology in response to Covid-19. ConclusionIn conclusion, PTG is associated with greater vulnerability for psychopathology in response to later adversities. Hence, the subjective experience of positive change does not appear to signify higher resilience in trauma victims.

Suicidal Ideation, Clinical Worsening and Outcomes among Child Participants in Trauma-Focused Treatment.

Research on clinical trajectories of children with suicidal ideation (SI) and clinical worsening (CW) during cognitive behavioral therapy (CBT) for childhood trauma is limited. The current study utilized secondary data from a randomized clinical trial comparing Trauma-Focused CBT versus Stepped care CBT to examine (1) clinical profile and outcomes of children with SI, recurrent thoughts of death/dying, and past attempts; and (2) clinical worsening during treatment and difference in outcomes. Children (ages 4-12) and their parents (N = 183) participated and 132 completed treatment. Interviews assessing SI, thoughts of death/dying, past attempts, and number/type of trauma were conducted with children (ages 7-12) and parents. Outcome measures (baseline and post-treatment) completed by parents included child posttraumatic stress symptoms, impairment, and internalizing and externalizing problems and an independent evaluator rated overall severity. Children (ages 7-12), parents and therapists completed ratings during treatment that indicated CW. Results did not differ by treatment group; thus, the pooled sample was used. Children with SI at baseline had higher severity than children without. For completers, no children (n = 14) with SI at baseline had SI at post-treatment. Child (n = 3) and therapist (n = 5) ratings of CW were low. Eighteen children (13.64%) were rated as CW by parents. Most ratings occurred at the beginning of treatment. Children with therapist ratings of CW had higher internalizing problems. Findings suggest that children with SI and CW can improve from trauma-focused CBT. More research is needed on the clinical trajectory of children with SI and trauma, and on clinical tools to monitor CW. Clinical trial registration information: https://clinicaltrials.gov : NCT02537678.

Investigating the Prevalence of Post-traumatic Stress Disorder in Patients Who Have Recovered From COVID-19

Background: The purpose of this study is to investigate the prevalence of post-traumatic stress disorder (PTSD) in patients who have recovered from COVID-19. Methods: In this descriptive cross-sectional study, 97 individuals who had recovered from COVID-19 and had a history of hospitalization were selected using a cluster sampling method. Data was collected through demographic questionnaires created by the researcher. The studied variables were first analyzed using descriptive statistical methods, followed by appropriate statistical tests to examine the relationships between variables. A significance level of less than 0.05 was considered for all tests. Data analysis was conducted using SPSS 21 statistical software. Results: The average PTSD score was severe in 48% of the recovered patients. Regression results indicated that variables such as age, education, marital status, occupation, and illness positively affected the development of PTSD. The relationship between PTSD and age was direct, with men having higher average PTSD scores than women. Additionally, individuals with lower levels of education were more likely to exhibit PTSD. Married individuals showed higher rates of PTSD than others. Retired individuals had higher PTSD scores compared to those in other occupations. However, no statistically significant relationship was found between PTSD and physical or mental illness (P &gt; 0.05). Conclusions: Based on the results, at least half of the individuals who faced COVID-19 are at risk of psychological effects and post-traumatic stress symptoms. Timely counseling and treatment services may prevent potential long-term consequences.

Occurrence of potentially traumatic events, type, and severity in undergraduate students

ABSTRACT Background Trauma exposure can have significant mental health impacts on students that impair academic performance and engagement. It is therefore important to describe the occurrence of trauma experiences and associated symptoms among undergraduate students. Objective This study aimed to 1) assess the rates of potentially traumatic experiences, 2) examine the frequency of different trauma experience types, and 3) compare post-traumatic stress (PTS) symptom severity across experience subtypes in a large sample of undergraduate students. Methods Participants were 806 undergraduate students from three Australian universities who completed online self-report measures of trauma exposure, psychological distress, and PTS symptoms. Results Approximately two-thirds of students (64%) reported having experienced at least one potentially traumatic event. The most common experience types were the unexpected death of a loved one and accidents. Students reporting exposure to potential trauma had significantly higher general distress than non-exposed students. Events involving interpersonal violence were associated with greater PTS symptom severity. Conclusions This study provides evidence that the occurrence of potentially traumatic events is high among university students and may carry negative effects for mental health and functioning. Results highlight the need for trauma-informed educational approaches and robust counselling services to support students managing trauma histories.

Cognitive flexibility and emotion regulation in eating disorder patients with comorbid generalized anxiety and posttraumatic stress symptoms

ABSTRACT Research has found that difficulties in emotion regulation negatively impact mental health, whereas cognitive flexibility may promote stress resilience and positive mental health. Little is known about cognitive flexibility and emotion regulation in people with comorbid eating disorder (ED) and anxiety and stress disorders. A transdiagnostic ED population (N = 227) at an outpatient ED treatment facility completed several self-report instruments that measured cognitive flexibility, emotion regulation difficulties, posttraumatic stress disorder (PTSD) symptoms, and generalized anxiety disorder (GAD) symptoms upon admission. We investigated cognitive flexibility and emotion regulation differences for those with an ED without comorbidity and those with various combinations of comorbidity. In a one-way between-groups ANOVA, we investigated differences in cognitive flexibility for those with GAD, PTSD, neither, and both comorbidities. We found a statistically significant difference between these groups, with mean cognitive flexibility inventory scores being the lowest in the group with both comorbidities. However, when controlling for emotion regulation, a one-way between-groups ANCOVA indicated no significant differences in cognitive flexibility between comorbidity groups F(3, 222) = 1.20, p = .31 Partial η 2 = .02. Though self-reported cognitive flexibility levels differ among ED patients with and without comorbidities, it appears that these differences are better explained by emotion regulation. Therefore, addressing emotion regulation early in treatment for all individuals with EDs, regardless of comorbidity, is recommended as a future research focus to enhance treatment outcomes. Further research is needed to understand the impact of treating emotion regulation on ED treatment engagement, dropout, and effectiveness.

The contribution of exposure to potentially morally injurious events to trajectories of posttraumatic stress symptoms among discharged veterans – a five-year study

The contribution of exposure to potentially morally injurious events to trajectories of posttraumatic stress symptoms among discharged veterans – a five-year study

Posttraumatic growth among Israeli female combat veterans: The mediating roles of posttraumatic stress symptoms and self-efficacy.

Posttraumatic growth (PTG) is a possible common reaction to exposure to potentially traumatic events (PTEs) during military service. However, knowledge about correlates of PTG among female combat veterans is sparse. This study examines associations between combat exposure, posttraumatic stress symptoms (PTSS), general self-efficacy (GSE), and PTG among Israeli female veterans. This is a cross-sectional studyA volunteer sample of female Israeli combat veterans (n=616) and non-combat veterans (n=484) responded to self-report questionnaires. Combat veterans reported higher levels of combat exposure, PTSS, GSE, and PTG, as compared to non-combat veterans. Among combat veterans, combat exposure and GSE were associated with greater PTG. Importantly, PTSS and GSE mediated the link between combat exposure and PTG. The study's findings are among the first to report about possible psychological growth outcomes among Israeli combat veterans. Clinicians treating female veterans coping with combat trauma should be aware of the heterogeneity of reactions to military service challenges and the importance of enhancing veterans' GSE to facilitate PTG.

Links between ethnic discrimination, mental health, protective factors, and hair cortisol concentrations in asylum seekers living in Germany

ABSTRACT Objective: Asylum seekers often experience ethnic discrimination on the flight or in the host country, which may be associated with chronic stress and impaired mental health. Dysregulation of the hypothalamic–pituitary–adrenal axis, a known physiological correlate of chronic stress, can be assessed using hair cortisol concentrations (HCC). The present study aimed to investigate how different forms of perceived ethnic discrimination are associated with mental health outcomes, HCC, and protective factors in asylum seekers living in Germany. Methods: Somatic symptoms (PHQ-15), symptoms of posttraumatic stress (PDS), depressive symptoms (PHQ-9), different forms of ethnic discrimination (active harm, passive harm, institutional discrimination), and protective factors (in-group identification, social support) were assessed cross-sectionally in 144 asylum seekers (average age 32 years, average duration of stay in Germany nine months; 67% men). HCC were obtained from 68 participants. Multiple regression analyses were conducted and social support and in-group identification were tested as potential moderators. Results: Active ethnic discrimination was positively associated with all assessed mental health outcomes, and all forms of ethnic discrimination positively correlated with depressive symptoms. Ethnic discrimination was not associated with HCC. When controlling for other possible influences (e.g. age, gender, traumatic events), passive harm was negatively associated with depressive symptoms (β = −0.17, p = .033) and active harm was positively associated (β = 0.28, p = .022) with somatic symptoms. After the inclusion of the protective factors, the associations were no longer significant. Lower social support was associated with higher depressive symptoms (β = −0.35, p < .001), posttraumatic stress (β = −0.77, p < .001), and somatic symptoms (β = −0.32, p < .001), but did not moderate the associations between ethnic discrimination and the mental health outcomes. Conclusions: Perceived ethnic discrimination may negatively influence asylum seekers’ mental health but does not seem to be associated with HCC. Social support was associated with psychological symptom severity, but did not buffer the effects of ethnic discrimination on mental health.

Development and validation of the Transgender Adolescent Stress Survey-Dysphoria.

Transgender and nonbinary adolescents (TNBA) may experience gender dysphoria arising from incongruities between their body and their gender. Prior dysphoria measures have largely focused on clinical diagnosis with little regard to comparability of forms for people assigned male or female at birth, overall psychometric performance, or applicability to nonbinary populations. This study develops and validates the Transgender Adolescent Stress Survey-Dysphoria (TASS-D), intended to address these gaps. The current study recruited a U.S. national sample of TNBA (N = 444, aged 12-17; 65.5% White, 9.5% Black, 9.5% Latine, 15.5% other ethnicity; 34.7% transmasculine, 17.3% transfeminine, 38.3% nonbinary, 9.5% agender). The item pool was developed from life history calendars, a modified Delphi process, and cognitive interviews with TNBA. Scale development included factor analysis, item response theory modeling, measurement invariance testing, and reliability analyses. Associations were examined between the TASS-D and existing measures of gender dysphoria (convergent validity), gender minority stress (divergent validity), and behavioral health outcomes (criterion validity). TASS-D and its subscales (body distress and gender expression burden) were significantly and strongly associated with gender dysphoria; significantly but weakly associated with gender minority stress; and significantly associated with most indicators of psychological distress including depressive, anxiety, and posttraumatic stress symptoms, suicidal behaviors and nonsuicidal self-injury. The TASS-D is a reliable and valid measure of gender dysphoria for TNBA, offering notable benefits over existing measures: It is psychometrically sound, inclusive of all gender identities, and does not assume that respondents identify binarily or desire medical transition as a terminal goal.