Posttraumatic Research Articles

Education and socioeconomic status as predictors of refugee mental health: insights from a study of Jordan-based Syrian refugee sample.

The Syrian civil war is considered as the greatest humanitarian crisis in modern history, which has resulted in a major refugee crisis. A significant concern is the high prevalence of mental disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) among Syrian refugees. While the focus of most refugee mental health research has been pre-migration trauma, post-migration challenges and stressors, which can also be significant determinants of mental health, are often ignored. The purpose of this study was to assess mental health of Syrian refugees as compared to local Jordanians, and to examine sociodemographic factors and perceived stressors that are associated with mental distress among participants. This was a cross sectional study conducted in northern region of Jordan among Syrian refugee and Jordanian adults. We used the validated Arabic version of Afghan Symptoms Checklist (ASC) to assess mental distress among participants. A total of 929 subjects (43% Syrian refugees, 56% females) participated in this study. Disparities in education, monthly income, and health insurance were significant between Syrian refugees and Jordanians, p < 0.001. The mean score in ASC was significantly higher among Syrian refugees, particularly among refugee females (mean ASC score ± standard deviation: Syrian refugee females: 58.22 ± 1.13; Syrian refugee males: 45.31 ± 1.28; Jordanian females: 51.06 ± 0.91; Jordanian males: 46.45 ± 1.08, p = 0.002). Multivariable linear regression showed that the estimated difference in the mean of ASC score between males and females is 7.42 (p < 0.001), and the estimated mean difference between Syrian refugees and Jordanians is 2.76 (p = 0.019). Interestingly, the estimated mean of ASC scores for individuals with high education level is decreased by 4.18 as compared to individuals with lower education level (high school or less), p < 0.001. Education level was highly predictable of mental distress of Syrian refugees, particularly female refugees. Enhancing higher educational opportunities is proposed for improving socioeconomic status of refugees which might serve as a buffering strategy for mental distress among this vulnerable population.

Predictive Blood Biomarkers of Targeted Intervention for Chronic Mental Health Symptoms following Traumatic Brain Injury.

The purpose of this study was to assess the performance of predictive blood biomarkers for responsiveness to targeted treatments for chronic psychological issues years after traumatic brain injury (TBI). Targeted Evaluation Action and Monitoring of TBI was a prospective 6-month interventional trial of participants with chronic TBI sequelae (n = 95). Plasma biomarkers were analyzed pre-intervention: glial fibrillary acidic protein (GFAP), tau, hyperphosphorylated tau Thr231 (p-Tau), von Willebrand factor (vWF), brain lipid-binding protein (BLBP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), vascular endothelial growth factor-a (VEGFa), and claudin-5 (CLDN5). Clinical outcomes included the Post-Traumatic Stress Disorder (PTSD)Checklist for DSM-5 (PCL-5) and Brief Symptom Inventory-18 (BSI-18). Regression models were built for change in PCL5/BSI-18. Biomarkers and covariates were included. Two models were built to identify responders (improved beyond the minimum clinically important difference). The model to predict change in PCL5 (R2=0.64; p < 0.001) included vWF (p = 0.032), BLBP (p = 0.001), tau (p = 0.002), VEGFa (p = 0.015), female sex (p = 0.06), and military status (p = 0.014). The model to predict change in BSI-18 (R2=0.42; p = 0.003) included vWF (p = 0.042), VEGFa (p = 0.09), BLBP (p = 0.01), CLDN5 (p < 0.001), female sex (p = 0.012), and military status (p = 0.004) as predictors. The model to differentiate participants who improved for PCL5 (R2=0.68; p < 0.001; AUC = 0.93) included vWF (p = 0.02), VEGFa (p = 0.008), and BLBP (p = 0.006). The model to differentiate participants who improved for BSI-18 (R2=0.25; p = 0.04; AUC = 0.75) included UCH-L1 (p = 0.03), GFAP (p = 0.06), and vWF (p = 0.03). Combinations of pre-intervention blood biomarkers were able to differentiate responders from nonresponders in both post-traumatic stress and overall psychological health domains.

Discrimination, Traumatic Stress, and Coping Among Muslim International Students

ABSTRACT There are a significant number of Muslim international students in the United States. Little is known about these students’ experiences and mental health. This study examined the relationships among discrimination, posttraumatic stress, religious coping, and social connectedness. The sample consisted of 133 Muslim international students, with 50% reported being women and the average age being 27. The results showed that discrimination predicted post-traumatic stress symptoms above and beyond general stress, and that less social connectedness to the United States was associated with more perceived discrimination and trauma reactions. Individuals with more visible markers, like wearing a hijab, reported more experiences of discrimination, and women reported more post-traumatic stress symptoms than men. The results highlight the importance for counseling professionals to assess for trauma, discrimination, and post-traumatic stress symptoms when working with Muslim international students. Recommendations for intervention and support for these students are provided.

Beyond Depression and Anxiety in IBD: Forging a Path Towards Emotional Healing.

Inflammatory Bowel Diseases (IBD) are chronic, often debilitating diseases characterized by inflammation of the digestive tract. IBDs affect up to 1% of the world's population and tend to be diagnosed in the second and third decades of life. In addition to physical burdens, IBDs have significant psychological manifestations stemming from bidirectional inflammatory and coping pathways and thus, are best understood from a biopsychosocial perspective. Though previous IBD literature has predominantly focused on traditional psychological comorbidities, such as anxiety and depression, recent studies have uncovered adjustment disorders, post-traumatic stress, and disordered eating as prevalent manifestations of the disease. This review will summarize the rates and postulated biopsychosocial mechanisms underlying these conditions to frame how cultivating resilience can protect against IBD symptoms and help forge a path towards emotional healing. We will also provide guidance to aid clinicians in screening for these conditions and creating a trauma-informed healthcare environment.

Memory, trauma, and self: Remembering and recovering from sexual abuse in psychedelic-assisted therapy

AbstractBackground and AimsThis article examines the therapeutic potential of psilocybin in addressing Post-Traumatic Stress Disorder as the result of sexual abuse. PTSD is a prevalent form of mental distress resistant to most conventional treatment methods.MethodsThrough an in-depth analysis of the narratives of two individuals with longstanding, treatment-resistant mental health conditions, who participated in a weeklong group-based psychedelic retreat involving psilocybin, the study unveils the intricate interplay between psychedelic-assisted therapy, memory, and narrative in the healing process.ResultsThe research findings suggest that beyond the commonly acknowledged therapeutic effects of psychedelic drugs, psilocybin can facilitate the retrieval of repressed or forgotten traumatic memories, allowing for conscious awareness, recognition, and reconciliation. A noteworthy aspect of the healing progression observed is the re-narration of one's identity and biographical circumstances following the recovery of unresolved traumatic memories.ConclusionsThis study underscores the importance of memory and self-narrative in the therapeutic landscape of psychedelic-assisted therapy for trauma. The article concludes by advocating for continued exploration in future research regarding the complex dynamics of memory and self-narrative in the healing journey within psychedelic science and trauma studies.

Cortical morphological changes and associated transcriptional signatures in post-traumatic stress disorder and psychological resilience.

Individuals who have experienced severe traumatic events are estimated to have a post-traumatic stress disorder (PTSD) prevalence rate ranging from 10 to 50%, while those not affected by trauma exposure are often considered to possess psychological resilience. However, the neural mechanisms underlying the development of PTSD, especially resilience after trauma, remain unclear. This study aims to investigate changes of cortical morphometric similarity network (MSN) in PTSD and trauma-exposed healthy individuals (TEHI), as well as the associated molecular alterations in gene expression, providing potential targets for the prevention and intervention of PTSD. We recruited PTSD patients and TEHI who had experienced severe earthquakes, and healthy controls who had not experienced earthquakes. We identified alterations in the whole-brain MSN changes in PTSD and TEHI, and established associations between these changes and brain-wide gene expression patterns from the Allen Human Brain Atlas microarray dataset using partial least squares regression. At the neuroimaging level, we found not only trauma-susceptible changes in TEHI same as those in PTSD, but also unique neurobiological alterations to counteract the deleterious impact of severe trauma. We identified 1444 and 2214 genes transcriptionally related to MSN changes in PTSD and TEHI, respectively. Functional enrichment analysis of weighted gene expression for PTSD and TEHI revealed distinct enrichments in Gene Ontology biological processes and Kyoto Encyclopedia of Genes and Genomes pathways. Furthermore, gene expression profiles of astrocytes, excitatory neurons, and microglial cells are highly related to MSN abnormalities in PTSD. The formation of resilience may be by an active compensatory process of the brain. The combination of macroscopic neuroimaging changes and microscopic human brain transcriptomics could offer a more direct and in-depth understanding of the pathogenesis of PTSD and psychological resilience, shedding light on new targets for the prevention and treatment of PTSD.

Understanding nightmares after traumatic events in Detroit (UNiTED): prospective associations with interpersonal violence and posttraumatic stress disorder symptoms

ABSTRACT Background: Research suggests trauma-related nightmares (TRNs) during the acute aftermath of trauma may contribute to posttraumatic stress disorder (PTSD). However, it is unknown who is most vulnerable to TRNs, which is critical to identify at-risk patients toward whom early nightmare-focused treatments can be targeted to prevent PTSD. Objective: We tested trauma type (interpersonal violence [e.g. assault] vs non-interpersonal trauma [e.g. motor vehicle collision]) as a risk factor for TRNs in a predominantly low-income, Black, urban sample in Detroit, MI, USA. Method: We recruited patients from the intensive care unit following traumatic injury (N = 88; M age = 39.53 ± SD 14.31 years, 67.0% male, 67.0% Black, 47.7% annual income ≤ $20,000) and administered surveys at three post trauma timepoints: one week (T1), one month (T2; n = 61), and two months (T3; n = 59). Trauma type was assessed at T1 via electronic medical records. Participants reported the extent to which their dreams’ content was similar to the trauma for which they were hospitalized across T1-T3. Participants then completed the PTSD Checklist for DSM-5 at T3. Results: TRNs were more prevalent over time among patients exposed to interpersonal violence (80%) vs non-interpersonal trauma (48.7%, p = .005). Patients hospitalized for interpersonal violence faced greater odds for TRNs across timepoints relative to non-interpersonal trauma patients (Odds Ratio = 4.95, p = .021). TRNs, in turn, prospectively predicted PTSD symptoms such that TRNs at T2 presaged more severe PTSD at T3 (p = .040, η p 2 = .31), above and beyond T1 PTSD status. Conclusions: This prospective study provides first evidence that interpersonal violence exposure is a robust risk factor for TRNs, which prospectively contribute to PTSD symptom development. Early intervention on TRNs after interpersonal violence exposure may decrease PTSD risk. Future studies are encouraged to use ambulatory methods to capture nightmares sooner after they occur.

Social and Psychological Rehabilitation of Servicemen with Post-Traumatic Stress Disorder

Introduction The growing number of servicemen injured during the war in Ukraine creates a need for effective social and psychological rehabilitation and the identification of early signs of Post-Traumatic Stress Disorder (PTSD). Aims The aim of the study is to identify the need for psychological support for the rehabilitation of servicemen with PTSD. Methods The study employed the Primary Care PTSD Screen (Screen PC-PTSD), the Impact of Event Scale-Revised (IES-R), the 36-Item Short Form Health Survey (SF-36), and the Rogers-Diamond Socio-psychological Adaptation Test. The statistics were processed using descriptive statistics, analysis of variance, and regression analysis. Results This study reported that 29.65% of the servicemen showed signs of PTSD and observed symptoms of intrusion, avoidance, and hyperarousal. It was established that PTSD symptoms reduced the indicators of physical (R2=0.634, p&lt;0.001) and psychological (R2=0.607, p&lt;0.001) components of the quality of life of the servicemen, as well as socio-psychological adaptation (R2=0.576, p&lt;0.001). Conclusion Among the studied servicemen, almost 30% demonstrated signs of PTSD, emphasizing the relevance of the studied problem. The identified negative impact of PTSD on the quality of life of the servicemen proved the importance of their complex social and psychological rehabilitation, involving the use of specific means at each stage. The obtained results can be used in the development of an algorithm for providing socio-psychological assistance to servicemen with signs of PTSD.

Effect of Obstructive Sleep Disorder Treatment on Posttraumatic Stress Disorder Symptoms: A Literature Review.

To explore whether continuous positive airway pressure (CPAP) adherence among adult patients with obstructive sleep apnea (OSA) and posttraumatic stress disorder (PTSD) affects the PTSD Checklist (PCL), a validated tool that measures severity of PTSD symptoms. Studies focusing on PTSD and OSA were searched in PubMed and CINAHL databases. Inclusion and exclusion criteria were applied, decreasing the article yield to nine. All articles chosen focused on the adult population and were conducted in North America. The literature review yielded eight observational cohort studies and one descriptive study. Seven studies were conducted with Veterans and all studies used the PCL tool. Three themes were identified: (a) Trauma and OSA, (b) OSA and PTSD Symptoms, and (c) CPAP Therapy and PTSD Symptoms. An area of further study is assessing how CPAP adherence might affect improvement in PTSD symptoms and how adherence can be improved. OSA is correlated with more severe PTSD symptoms, but CPAP use is associated with improvement in PTSD symptoms. The literature reviewed found PCL scores improved up to 10 points within 3 months of CPAP use. These findings highlight the importance of collaboration between mental health and sleep medicine professionals and opportunity for further study in this area. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Assessment of the impact an educational intervention on post-traumatic stress disorder and social cognitive theory constructs in women with sexual assault experience: a study protocol for a clinical trial

BackgroundThe high psychological burden of rape, together with complications such as pregnancy and chronic conditions, is associated with an increase in mental disorders. Social cognitive theory (SCT) is an important health theory that views behavior as dynamic and influenced by environmental, behavioral and individual factors. The aim of the present research is to determine the effect of an educational intervention on post-traumatic stress disorder and social cognitive theory constructs in women who have experienced sexual assault.Methods/designThis study is randomized, double-blind clinical trial research that will be conducted on 40 women with experience of sexual. In this research, by the intervention program based on social cognitive theory include" awareness, self-efficacy, outcome expectations and environment. Written consent will be obtained from the participants to participate in the research. Participants in the intervention group will be taught about health, hygiene, psychology and stress reduction methods in group or individual sessions according to their preference in 6 sessions of 60 min each, one session per week. A post-test will be conducted for both groups.DiscussionThis study provides comprehensive data on the effect of providing an educational intervention using the social cognition Theory. Social cognitive theory focuses on how patterns of behavior are learned and how they function in interaction between the individual and the environment. It seems that the use of this theory in designing the content of educational interventions can be useful and practical.Trial registration: The trial is prospectively recorded at the IRCT registry (Trial ID: IRCT20230926059526N1. Date recorded: 18/10/2023.

Disability trajectories individuals with spinal cord injury in mainland China: do psychosocial resources and diseases factors predict trajectories?

Observational cohort study. To identify classes of disability trajectories from 1 month post-injury (acute hospital) to 6 months post-injury (individuals with SCI individuals who stay in rehabilitation setting or back in the community), and to investigate whether psychosocial resources and disease factors can predict disability trajectory. Spinal surgery in three Class III hospitals. Hospitals in China are divided into three classes (Class I, II and III). All the participants were submitted to WHO Disability Assessment Schedule (WHO-DAS 2.0) at three times; and personal data anamnesis, level of hope, level of PTSD, level of social support were recorded at first time. All the data collected by the master's students who participated in this study. Two disability trajectories were identified using the latent class growth model: the continuous high disability group (N = 196, 93.3%) and the low starting point stabilization group (N = 14, 6.7%). Complete injury(ASIA-A) with SCI and more depression in the stable condition after SCI surgery were more likely to be classified as having higher disability than those with a lower disability trajectory. Occupation, annual family income, hope, social support, and Post-traumatic Stress Disorder (PTSD) cannot predict individuals belonging to trajectory classes. These findings emphasize the importance of ASIA and depression in the early recovery stage after SCI and support the opinion that strengthening psychological nursing and rehabilitation management at an early stage after SCI will benefit individuals with a lower disability trajectory.

The Psychosocial Consequences of Sexual Violence Stigma: A Scoping Review.

Over the past decade, scholars have explored whether the stigma associated with sexual violence (SV) represents a risk factor for psychopathology and related comorbidities following SV. We conducted a scoping review to summarize and evaluate the state of this burgeoning literature. We included studies from Pubmed, APA PsychInfo, Embase, CINAHL Plus, Social Science Premium, and Web of Science that quantified stigma related to SV. Studies were screened and abstracted in accordance with the PRISMA-SCR guidelines for scoping reviews. Our final sample contained 62 studies. We address two key questions about SV stigma. First, is SV a stigmatized status? Articles (n = 14) provided evidence for SV stigma among potential stigmatizers (e.g., individuals who may perpetuate stigma) across a range of methods (e.g., vignettes) and outcomes (e.g., desire for social distance). Additional work (n = 20) corroborates perceptions of SV stigma among targets (i.e., SV survivors). Second, what are the psychosocial consequences of SV stigma? We reviewed studies (n = 28) demonstrating that SV stigma is correlated with a range of adverse psychosocial outcomes-including anxiety, depression, posttraumatic stress disorder, problematic drinking, and somatic symptoms-among individuals experiencing multiple types of SV (e.g., childhood sexual abuse and sexual assault). Thus, emerging evidence suggests that SV stigma may be a critical determinant of risk and recovery following SV exposure. However, a number of limitations were observed, including that SV stigma has not been consistently measured and that the literature has not fully incorporated stigma constructs, such as concealment and structural stigma. We offer several recommendations to advance this line of work.

NICU Music Therapy: Lessons Learned from a Randomized Trial

Abstract Mothers of infants hospitalized in the neonatal intensive care unit (NICU) are at risk for developing acute and posttraumatic stress disorder, but mothers’ positive coping may improve with progress in the infant’s well-being. There is a need to investigate complementary therapies that increase infant well-being and decrease maternal stress. A pacifier-activated lullaby (PAL) device is one evidence-based intervention to assist premature infants by playing a few bars of a lullaby after an effective suck, improving feeding behavior and shortening the length of NICU stay. The PAL may be personalized with lullabies sung and recorded by the neonate’s mother or other family. This study’s purpose was to quantify the effect of a PAL intervention on maternal stress symptoms. The experimental PAL intervention included a singing and recording session with a board-certified music therapist with NICU certification. This was a single-site randomized trial comparing the effect of maternal voice recording versus standard conditions. A total of 245 infant–mother dyads were screened; 18 mothers consented to participate and 12 were randomized to one of three conditions: mother’s recorded lullaby for PAL administration, a generic female voice used for the PAL, and no intervention. Barriers arising during the study included lengthy enrollment processes, maternal visitation patterns, and an overly ambitious study design. Despite attempts to mitigate perceived barriers, we did not achieve the enrollment necessary to perform the intended analysis. We, therefore, present lessons learned and possible solutions for future music therapy research in the interest of transparency, reducing publication bias, and replication of problematic design issues in future trials.

Life review for older adults: an integrative review.

Life review therapy is a form of psychotherapy framework which involves the guided reflection of life events throughout a patient's life journey. Patients are encouraged to actively recall and analyze important life events, both negative and positive. Through this process, patients may be able to come to terms with, or even resolve negative events such as conflicts and regrets. The aim of this study is to gain an understanding of the current knowledge of the use of life review therapy in older adults, and to identify areas for future research. A systematic literature search was conducted across CINAHL, Medline, PsycInfo, Embase and Scopus. Papers were screened and selected using predetermined inclusion and exclusion criteria using Covidence and exported into Excel. Data analysis was conducted to synthesise thematic analyses. One hundred and thirty-one articles from 1974 to 2023 were included in this study and were used to develop four themes: life satisfaction and self-esteem, depression and depressive symptoms, institutional care and cognitive decline, and post-traumatic stress disorder (PTSD) and trauma. Life review has some benefit in older adults in certain groups and situations, although the extent and duration of effectiveness of this benefit is unclear. Life review unlikely improves self-esteem. However, in the short term, life review appears to improve life satisfaction, depression or depressive symptoms, and PTSD symptoms in the elderly. Life review may be a useful therapeutic tool for older adults with cognitive decline for as long as the intervention continues. Areas for future research are explored.

Demographics, Clinical Characteristics, and Well-Being of Veterans with TBI and Dementia and Their Caregivers.

This study provides a detailed examination of older Veterans with traumatic brain injury (TBI) and dementia and their caregivers, focusing on Veterans' demographic, clinical, functional, safety risk, and behavioral characteristics and caregivers' demographic, clinical, and care-related characteristics and well-being. Veterans' caregivers (N = 110) completed a telephone-based survey. Veterans averaged eight comorbid health conditions, with over 60% having chronic pain, hypertension, post-traumatic stress disorder, or depression. Caregivers reported helping with an average of three activities of daily living, with the highest percentages of Veterans needing assistance with grooming, dressing, and bathing. Almost all Veterans needed assistance with shopping, cooking, medication management, housework, laundry, driving, and finances. Veterans averaged two safety risks, the most common being access to dangerous objects, access to a gun, and not being able to respond to emergency situations. Although Veterans averaged 14 behavioral concerns, caregivers reported that their family needs relating to TBI were generally met or partly met, and they voiced confidence in their ability to respond to behaviors and control their upsetting thoughts. Caregivers' mean burden score was severe, while mean depression and anxiety scores were mild. Caregivers reported an average of 10.5 h per day providing care and 20.1 h per day on duty. The findings demonstrate the increased presence of impairments, safety risks, and behavioral issues in Veterans with comorbid TBI and dementia, as well as increased impacts on families' burdens and care provision requirements. Clinicians should be alert for and educate TBI patients and caregivers on the warning signs of post-TBI dementia and its associated functional, behavioral, and safety risk profile, as well as challenges related to caregiver well-being. Healthcare policymakers must consider the increased caregiver demands associated with comorbid TBI and dementia, as well as the need for expanded long-term support and services.

Alliance processes in eating disorders with childhood maltreatment sequelae: Preliminary implications.

Effective eating disorder (ED) treatments are drastically needed for patients with experiences of sustained and prolonged emotional, physical and sexual childhood maltreatment (CM) that often results in post-traumatic sequelae such as severe, complex posttraumatic stress disorder (cPTSD). EDs with comorbid cPTSD (cPTSD-ED) have protracted treatment courses and poorer prognoses. To summarise the knowledge base on cPTSD-ED with specific emphasis on disturbances in self-organisation (DSO) in relation to therapeutic alliance (TA) processes. Expert opinions based on current relevant literature are critically examined. Preliminary insights on change and alliance processes suggest that neglecting to address emotional-relational processes in the conceptualisation and treatment of cPTSD-ED impedes treatment progress. We hypothesise that the DSO construct inherent in cPTSD-ED calls for a focus on TA processes in addition to traditional ED treatment elements such as nutritional rehabilitation and behaviour change, and regardless of ED treatment provided. More process research on a larger scale is urgently called for.

Age-Related Variation in Ecological Resources Among Veterans Seeking Treatment Related to Military Sexual Trauma.

Approximately 16% of Veterans experience military sexual trauma (MST), defined as sexual assault or harassment experienced during military service. Veterans across life stages may possess differing resources and face unique stressors that impact their ability to engage in mental health treatment or require additional liaison to services. The present study sought to characterize age-related differences in the socioecological contexts of Veterans seeking mental health treatment following MST in the domains of economic sufficiency, housing, spiritual coping, supportive relationships, and interpersonal violence. From 2009 to 2019, Veterans (N = 640) seeking mental health services following exposure to MST attended evaluation and treatment planning sessions at a Midwestern Veterans Health Administration posttraumatic stress disorder specialty clinic. Veterans completed semistructured interviews that included surveys and diagnostic screenings to assess psychosocial needs and resources. ANOVA and ordinal regressions were used to evaluate potential disparities in socioecological resources by age. No age-related differences in economic sufficiency and stable housing emerged, though most Veterans (57%) endorsed financial difficulties. Veterans who endorsed spiritual beliefs were significantly older than those who did not. Veterans who reported having a support system were significantly younger than Veterans who denied having a support system. Less than half (46%) of Veteran reported having peer relationships. Veterans who endorsed frequent interaction with their peers were significantly older than those who did not. Veterans who reported past-year exposure to interpersonal violence were significantly younger. Greater clarity about age-related differences in the socioecological contexts of Veterans can support clinicians in providing responsive mental health treatment and connecting Veterans to additional Veterans Health Administration resources following MST.

The dissemination and implementation of trauma-focused cognitive behavioural therapy for children and adolescents in seven European countries

BackgroundThere is broad scientific evidence for the effectiveness of individual trauma-focused evidence-based treatments (EBTs) such as “trauma-focused cognitive behavioural therapy” (TF-CBT) for children and adolescents with posttraumatic stress symptoms. However, there is a significant research-to-practice gap resulting in traumatized children in high-income countries in Europe having only very limited access to these treatments. The aim of this study was, therefore, to identify common barriers and successful dissemination and implementation (D&I) strategies of evidence-based trauma-focused treatments (in particular TF-CBT) in seven European countries.MethodsFor this study, we chose a mixed-method approach: an online survey among certified European TF-CBT trainers (N = 22) and the collection of country-based narratives from TF-CBT experts in different European countries (Finland, Germany, Italy, Netherlands, Norway, Sweden).ResultsCommon modifiable barriers to the implementation of TF-CBT were identified on different levels (e.g. government or treatment level), and successful D&I strategies were highlighted across all countries, such as translations of materials. Additionally, the experts from the country narratives put together a broad overview of TF-CBT research in Europe.ConclusionsThe results of this study revealed that especially learning collaborations and the development of joint European efforts in funding and researching D&I strategies are crucial for future implementation of trauma-focused EBTs in Europe.

Epigenetic and Genetic Profiling of Comorbidity Patterns among Substance Dependence Diagnoses.

This study investigated the genetic and epigenetic mechanisms underlying the comorbidity patterns of five substance dependence diagnoses (SDs; alcohol, AD; cannabis, CaD; cocaine, CoD; opioid, OD; tobacco, TD). A latent class analysis (LCA) was performed on 31,197 individuals (average age 42±11 years; 49% females) from six cohorts to identify comorbid DSM-IV SD patterns. In subsets of this sample, we tested SD-latent classes with respect to polygenic burden of psychiatric and behavioral traits and epigenome-wide changes in three population groups. An LCA identified four latent classes related to SD comorbidities: AD+TD, CoD+TD, AD+CoD+OD+TD (i.e., polysubstance use, PSU), and TD. In the epigenome-wide association analysis, SPATA4 cg02833127 was associated with CoD+TD, AD+TD, and PSU latent classes. AD+TD latent class was also associated with CpG sites located on ARID1B , NOTCH1 , SERTAD4, and SIN3B , while additional epigenome-wide significant associations with CoD+TD latent class were observed in ANO6 and MOV10 genes. PSU-latent class was also associated with a differentially methylated region in LDB1 . We also observed shared polygenic score (PGS) associations for PSU, AD+TD, and CoD+TD latent classes (i.e., attention-deficit hyperactivity disorder, anxiety, educational attainment, and schizophrenia PGS). In contrast, TD-latent class was exclusively associated with posttraumatic stress disorder-PGS. Other specific associations were observed for PSU-latent class (subjective wellbeing-PGS and neuroticism-PGS) and AD+TD-latent class (bipolar disorder-PGS). We identified shared and unique genetic and epigenetic mechanisms underlying SD comorbidity patterns. These findings highlight the importance of modeling the co-occurrence of SD diagnoses when investigating the molecular basis of addiction-related traits.

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.