Posttraumatic Research Articles

The Kya’s PTSD and Defense Mechanism as Represented in Delia Owens’ Where The Crawdads Sing

This descriptive qualitative study aims to identify the types of causes of post-traumatic stress disorder and to reveal how the defense mechanism experienced by Kya as the main character of the novel Where the Crawdads Sing. Sigmund Freud's psychological theory of defence mechanism is applied in this study. The data of this research are narratives, paragraphs, and dialogues of Delia Owen’s Where the Crawdads Sing that indicate the causes of post-traumatic stress disorder and the defense mechanisms used by Kya. The findings showed that Kya experienced post-traumatic stress disorder due to causes such as domestic violence, abandonment, bullying, isolation, rape, and murder. In addition, the defense mechanisms used by Kya in overcoming the causes of post-traumatic stress disorder and survival are employing denial to deal with the truth of the traumatic event she went through; sublimation to redirect her negative energy or focus on more productive and beneficial activities; and projection to project her own emotions onto other people, perceiving her own motivations or feelings in their actions. These defense mechanisms help Kya to adjust to difficult situations and find ways to survive due to the trauma she experienced.

Feasibility of Schema Therapy for Recurrent Depression in a Disaster Relief Worker with Prior Post-Traumatic Stress Disorder Treatment Using Prolonged Exposure Therapy

This report presents the follow-up treatment course of a previously published case that demonstrated the effectiveness of prolonged exposure (PE) therapy for a disaster relief worker. The patient, a municipal employee in Fukushima Prefecture, developed post-traumatic stress disorder (PTSD) and mood disorders after the 2011 Great East Japan Earthquake and subsequent disasters. This follow-up focuses on the period from 2021 to early 2024, during which the patient experienced symptom recurrence after his father’s death. This event revealed psychological patterns similar to his disaster-related responses. Schema therapy was introduced to address over-adaptive work behaviors and vulnerabilities in relationships, identified as relapse risk factors. Combined with antidepressants, schema therapy achieved sustained improvement. This longitudinal perspective demonstrates schema therapy’s effectiveness in addressing underlying vulnerabilities when symptoms re-emerge after trauma-focused treatment. The findings underscore how initial trauma responses may interact with subsequent life events and suggest schema therapy’s potential as a secondary intervention for disaster relief workers facing complex challenges.

Symptom structure of complex posttraumatic stress disorder among de facto unattended children in China: A network analysis

BackgroundsComplex posttraumatic stress disorder (CPTSD) is closely related to childhood trauma, yet there is a dearth of studies that have explored the symptoms of CPTSD among children in adversity. ObjectiveThe current study aimed to explore the structure of the CPTSD network and to identify central symptoms in a sample of de facto unattended children in China. MethodsIn total, 244 children and adolescents were included in the analysis, ranging from 9 to 16 years old (11.72 ± 1.64), with 45.49 % girls and 53.67 % boys. The International Trauma Questionnaire (ITQ) was used to assess CPTSD symptoms. We used a regularized partial correlation network to identify which symptoms had a high level of strength centrality or bridge centrality, and a Bayesian network to identify the upstream symptoms. ResultsThe results showed that avoidance and emotional numbing had the highest level of strength centrality. Exaggerated startle response and emotional numbing had the highest level of bridge centrality. Last, re-experiencing was identified as upstream in the Bayesian network. Developmental differences are observed in CPTSD symptom centrality compared to adult populations. ConclusionsThese findings offer insight into key symptoms of CPTSD in vulnerable children and adolescents. We revealed that children and adolescents in adversity who exhibit avoidance, emotional numbing, and re-experiencing should be given more attention.

Lived experiences of mothers: A longitudinal study of impacts and adjustment following adolescent psychiatric hospitalization for suicide attempts or other reasons.

Parents play crucial roles in monitoring and supporting youth who have been hospitalized after suicide attempts, but their adjustment in the period following hospitalization has been understudied. This study assessed the adjustment and impacts on mothers during the year following hospitalization. Participants included 135 mothers of suicidal adolescents and 117 mothers of adolescents hospitalized for other reasons. The Structured Clinical Interview for DSM (SCID) and the Child and Adolescent Impact Assessment were used to assess psychiatric diagnoses of Major Depressive Disorder [MDD], Generalized Anxiety Disorder [GAD], and Post-Traumatic Stress Disorder [PTSD], and impacts on caregivers at one, three, six, and 12 months after hospitalization. Higher rates of MDD, GAD, and PTSD, and greater impacts were evidenced closer in time to the hospitalization. There were few overall differences between mothers of youth with and without suicidal behavior. However, family history of suicidal behavior was related to higher rates of MDD and PTSD, and greater severity of youth suicidal thoughts and behavior over the follow-up was related to greater impact upon mothers of suicidal youth. This study highlights the mental health struggles of mothers of suicidal and other hospitalized youth and underscores the importance of support for caregivers.

Mediators of change in a condensed online exposure-based intervention provided soon after trauma: insights from a randomised controlled trial

ABSTRACT Background: The active mechanisms of change are unclear in early-provided exposure-based interventions for psychological trauma. This study aimed to address this gap by analysing weekly data from a randomised trial involving a 3-week therapist-guided online intervention based on prolonged exposure compared to a waiting-list control group. Method: The objective was to investigate whether changes in each of the four subscales of the Posttraumatic Stress Disorder Checklist, fifth version (PCL-5; i.e. intrusions, avoidance behaviours, negative alternations in cognitions and hyperarousal) during the three-week intervention period mediated subsequent improvements in other post-traumatic stress symptoms at the controlled 1-month follow-up. We included baseline levels of both the mediator and the outcome as well as changes in the outcome from baseline to week 3 as covariates in a mediation model. Results: The results showed that reductions in avoidance during the intervention period mediated reduced symptom levels of intrusions, negative alternations in cognitions, and hyperarousal at week 7 (z-scores of indirect effect estimates = −0.12 to −0.07). No other PCL-5 subscales were found to be mediators of change. Conclusions: The results from this study highlight the importance of addressing avoidance behaviours in online exposure-based interventions provided in the early aftermath of trauma. Sensitivity analysis showed that the mediation effects were sensitive to assumptions related to mediator-outcome confounders, which could be considered a study limitation. Trial registration: ClinicalTrials.gov identifier: NCT03850639.

Interplay of serum BDNF levels and childhood adversity in predicting earlier-onset post-traumatic stress disorder: A two-year longitudinal study

This longitudinal study explored the intricate relationships between serum Brain-Derived Neurotrophic Factor (sBDNF) levels, exposure to childhood adversities, and the subsequent development of Post-Traumatic Stress Disorder (PTSD), distinguishing between earlier- and delayed-onset forms over a two-year follow-up period in individuals sustaining physical injuries. We recruited patients presenting with moderate to severe physical injuries at a trauma center, conducting baseline assessments of sBDNF levels and childhood adversities through the Adverse Childhood Experiences (ACE) questionnaire. Additionally, detailed socio-demographic and clinical data were compiled. The Clinician-Administered PTSD Scale for DSM-5 was employed to diagnose PTSD at 3, 6, 12, and 24 months post-injury. Binary and multinomial logistic regression analyses were applied to elucidate the interactions between sBDNF levels, childhood adversities, and PTSD onset patterns. Among 895 participants, PTSD was diagnosed in 107 individuals (11.9 %), with 76 (8.4 %) exhibiting symptoms indicative of earlier-onset PTSD and 31 (3.5 %) demonstrating delayed-onset PTSD. Significantly, lower sBDNF levels were associated with a higher risk of earlier-onset PTSD specifically in the context of childhood adversities. This association was not observed in individuals without childhood adversities or in those with delayed-onset PTSD. The findings suggest a complex and critical interplay between neurobiological factors, specifically sBDNF levels, and early life adversities in influencing the timing of PTSD onset, potentially deepening the understanding of PTSD etiology.

Greek anaesthesiologists' post-traumatic stress syndrome in the post COVID-19 era: An observational, multicenter, cross-sectional study from COVID-19 referral, university/tertiary hospitals.

Anaesthesiologists actively involved with COVID-19 are at increased risk for post-traumatic stress syndrome (PTSS). We assessed the PTSD and possible determinants of anaesthesiologists in COVID-19 referral hospitals in the post-COVID-19 era with the validated PTSD Checklist for DSM-5 (PCL-5) and the Eysenck Personality Questionnaire (EPQ). A multicenter cross-sectional survey was conducted among anaesthesiologists working in the 7 COVID-19 referral university/tertiary hospitals during November 2022 (post-COVID-19 era) in Greece. PCL-5 is a 20-item, 5-point Likert scale self-report measure, scored in two different ways to ensure a provisional diagnosis of PTSS. Eysenck Personality Questionnaire (EPQ) explores 3 main dimensions of personality, whereas the Lie (L) scale serves as a measure of "dishonesty". Multivariate logistic regression analysis was performed to identify predicting factors of PTSS using the stepwise forward method. One hundred doctors (response rate 85%) from 7 hospitals (72% females, median age 46 [33-51.5] years) participated. The overall Cronbach's alpha for PCL-5 was 0.946. According to each scoring, 18% and 23% of responders were diagnosed with PTSS, respectively, while 7% were classified as suffering from probable PTSD. Interestingly, children (OR=0.17, p=0.048) and the satisfaction with job position (OR=0.211, p=0.024) exhibited a protective effect against PTSS. On the other hand, family obligations were identified as an aggravating factor (OR=4.274, p=0.026). Concerning personality traits, only neuroticism was identified as a statistically significant independent factor predicting PTSS (OR=1.524, p=0.001). Finally, job ranking was also a statistically significant independent factor predicting PTSS, with a 3 times risk augmentation for each level in the job hierarchy (from Residents towards Academics) (OR=3.034, p=0.022). In the post-COVID-19 era, up to 23% of Greek anaesthesiologists working in referral hospitals suffered from PTSS. Children and job satisfaction exhibited a protective role in contrast to higher ranks of the job hierarchy.

Evaluating the Impact of a Peer Support Program on Participants' Well-Being: Finding Belongingness Through the Women Veterans Network.

Loss of belongingness may be particularly pronounced for women veterans, representing a threat to long-term well-being. Improvements in social support through engagement in a structured peer support program may mitigate the negative effects of loss of belongingness on well-being. We assessed the impact of participation in a peer-led, structured, social support group-based network on outcomes related to well-being [i.e., belongingness, social support, quality of life, posttraumatic stress disorder (PTSD), depression]. Subgroup analyses examined relative impact among those who completed the intervention and those reporting clinical levels of PTSD and depression symptoms. We analyzed survey data consisting of reliable and valid measures collected at baseline, postgroup and 3-month follow-up among 393 participants in the Woven Veterans Network's (WoVeN) group program. We observed improvements in posttraumatic stress disorder (PTSD) symptoms over time. We observed additional benefits among those who received an adequate dose of the intervention (significant improvements on PTSD, belongingness) and those with clinical levels of mental health symptoms (significant improvements on PTSD, depression, belongingness, quality of life). Impacts on social support may have been masked due to ceiling effects given wide dispersion baseline social support in this sample. This social support network had particularly profound impacts on well-being for those veterans who suffered from conditions for which isolation and loneliness are particularly salient.

New Insights into Contradictory Changes in Brain-Derived Neurotrophic Factor (BDNF) in Rodent Models of Posttraumatic Stress Disorder (PTSD).

Post-traumatic stress disorder (PTSD) is a neuropsychiatric disorder that may develop after experiencing traumatic events. Preclinical studies use various methods to induce PTSD-like models such as fear-conditioning, single-prolonged stress (SPS), restraint stress, and social defeat. Brain-derived neurotrophic factor (BDNF) is a crucial neurotrophin in mood regulation. Evidence shows BDNF changes in different neuropsychiatric disorders particularly PTSD. This review examined BDNF alterations in preclinical rodent models of PTSD where we demonstrated a wide range of paradoxical changes in BDNF. We found that the fear-conditioning model produced the most inconsistent alterations in BDNF, and suggest that conclusions drawn from these changes be approached with caution. We suggest that BDNF maladaptive changes in social defeat and restraint stress models may be related to the duration of stress, while the SPS model appears to have more consistent results. Ultimately, we propose that evaluating BDNF alterations in the process of treating PTSD symptoms may not be a reliable factor.

The influence of trauma history on opiate use disorder in an urban treatment facility in Pennsylvania

BackgroundOpioid use disorder is one of the most severe forms of substance use disorder and is associated with high morbidity and mortality. Opiate overdose deaths in the US are increasing every year, claiming over 100,000 lives in 2022. Psychological trauma exposure and post-traumatic stress disorder are major health problems in the United States and may contribute to the development of an opiate use disorder. The purpose of this study was to examine the association of psychological trauma exposure and post-traumatic stress disorder with opiate use disorder. MethodsThis study used a retrospective design with a convenience sample size of n = 150 participants diagnosed with opiate use disorder or substance use disorder from a drug treatment center in urban Pennsylvania. Retrospective data was collected on demographic characteristics, trauma exposures, diagnoses of post-traumatic stress disorder, opiate use disorder, and substance use disorder. Demographic data was gathered using a demographic survey, psychological trauma exposure was documented using the self-reported Life Events Checklist, and a diagnosis of post-traumatic stress disorder, opiate use disorder, and substance use disorder was confirmed as documented in the medical record by mental health providers. ResultsPersons with psychological trauma exposure >5 are more likely to develop opiate use disorder, Chi-Square (χ2 = 5.17, df = 1, p = 0.023). ConclusionOur study showed that psychological trauma exposure may lead to opiate use disorder, emphasizing the importance of identification of psychological trauma exposure and post-traumatic stress disorder diagnosis as part of trauma-informed strategies during the treatment of persons with opiate use disorder to help prevent disability and death.

Using Compressed Virtual Reality Exposure Therapy for an Adult Critical Illness Survivor: A Case Report.

Nearly one-quarter of adult critical illness survivors develop posttraumatic stress disorder symptoms triggered by sensory stimuli after intensive care unit discharge. Intensive care unit delirium is a risk factor for posttraumatic stress disorder. Compressed virtual reality exposure therapy (C-VRET) incorporates sensory stimuli to reduce posttraumatic stress disorder symptoms through habituation. A critical illness survivor developed intensive care unit delirium and enrolled in a C-VRET trial to treat posttraumatic stress disorder. She reported self-isolation because of infection fears and posttraumatic stress disorder symptoms triggered by medical commercials and lawn equipment sounds. She repetitively checked her heart rate at night for fear of missing illness signs and waking up intubated. The participant completed therapy. Screening tests were administered before, 2 weeks after, and 3 months after therapy to measure posttraumatic stress disorder symptoms (Clinician-Administered PTSD Scale for DSM-5; range, 0-60), depression (Center for Epidemiologic Studies Depression Scale; range, 0-60), physical activity (International Physical Activity Questionnaire), and resiliency (Connor-Davidson Resilience Scale; range, 0-100). The participant's posttraumatic stress disorder symptom scores declined from 36 to 11 to 5; depression scores declined from 19 to 5 to 1; physical activity scores increased from 499 to 2013 to 4599; and resiliency scores increased from 70 to 76 to 83. This report highlights the severity of posttraumatic stress disorder symptoms in critical illness survivors and the importance of strategies to limit delirium and posttraumatic stress disorder. Compressed virtual reality exposure therapy may reduce posttraumatic stress disorder symptoms in critical illness survivors.

Investigation of psychopathology in patients with chronic idiopathic urticaria

Aims: Aim of this study is, to establish the frequency of axis I and axis II comorbidity and post-traumatic stress disorder (PTSD) and coping ability of patients who admitted to allergy policlinics of Dermatology and Respiratory Diseases departments and who were diagnosed as chronic idiopathic urticaria. Methods: Study population divided into three groups consisted of fifty patients each, chronic urticaria, contact dermatitis and control groups, respectively. All patients underwent SCID-I (Structured Clinical Interview for DSM-IV Axis-I Disorders) and SCID-II (Structured Clinical Interview for DSM-III-R Personamy Disorders) for determining axis I and axis II diagnosis and trauma evaluation form for traumatic life events. Patients who showed high scores in this test also underwent SCID-I PTSD module. Coping scale (COPE) was applied in order to evaluate patients’ coping ability for problems which he encounters. Results: In our study, when axis I diagnosis were compared; major depression (%48) and anxiety disorder (%48) were significantly more frequent in chronic idiopathic urticaria group than other two groups. When it came to comparison of axis II diagnosis, avoidant personal disorder (%20) and dependent personality disorder (%16) were significantly more frequent in chronic idiopathic urticaria group than other two groups. Urticaria group also showed significantly higher frequency for PTSD (%42) than other two groups. Patients with chronic idiopathic urticaria used religious (%64), denial (%26), substance abuse (%40), adoption (%40), emotional social support (%32) and abstaining (%26) maladaptive coping methods which were incoherent, significantly more than other two groups. Conclusion: Probability of mental disorders is high among patients with chronic idiopathic urticaria. It is important to consider existence of PTSD and coping methods for life events. Studies enrolling larger patient groups are needed for detailed investigation of cause-and-effect relationship.

Veterans' Experiences of and Preferences for Patient-Centered, Measurement-Based PTSD Care.

Up to 50% of veterans drop out of trauma-focused evidence-based psychotherapies (TF-EBP) without completing treatment or recovering; evidence suggests this is in part because their posttraumatic stress disorder (PTSD) care is insufficiently patient-centered. There is also evidence that measurement-based care (MBC) for mental health should be personalized to the patient, yet this is not common practice in VA PTSD care. To explore veterans' experiences and preferences for aligning measurement-based PTSD care with their own treatment goals. Qualitative interviews were conducted with veterans (n=15) with PTSD who had received at least 2 sessions of a TF-EBP. Survey on the administration of outcomes questionnaires and demographics and an interview about their most recent TF-EBP episode. Half of veterans had symptom-focused goals and half did not; all had at least one treatment goal that was not symptom-focused. They typically met their goals about functioning and coping skills but not their symptom reduction goals. We found veterans overall were receptive to MBC but preferred patient-reported outcomes measures about functioning, wellbeing, coping skills, and understanding their trauma more than the commonly used PTSD symptom scale (the PCL-5). Many veterans in this sample disliked the PCL-5 because it reinforced their maladaptive cognitions. Such veterans might be more receptive to MBC if offered patient-report outcomes measures that better align with their functional and wellbeing goals. For many goal/outcome areas, psychometrically sound measures exist and require better implementation in PTSD care. For some areas, scale development is needed.

Symptoms of PTSD and depression in newly diagnosed people with multiple sclerosis during the outbreak Oct.7th war on Gaza: A case-control study from Jordan

The present study examined the severity and the correlates of post-traumatic stress disorder (PTSD) and depression symptoms severity in newly diagnosed people with multiple sclerosis (PwMS) compared to healthy people during the outbreak of the Oct.7th war on Gaza.This is a cross-sectional case-control study recruiting 63 PwMS and 79 controls. The severity of PTSD and depression were measured using validated scales.There was no significant (p>0.05) difference in PTSD and depression scores between the PwMS and the controls. In addition, PwMS who experienced one or more relapses since diagnosis were at a significantly higher risk (B=9.29, t=2.06, p=0.04) for severe PTSD and severe depressive (OR=5.50, 95% CI=1.32–22.92, p=0.01).The study of the mental health of PwMS during times of crisis is emerging in developing countries, future larger-scale and follow-up studies are yet required.

Novel Pharmacologic and Other Somatic Treatment Approaches for Posttraumatic Stress Disorder in Adults: State of the Evidence.

Posttraumatic stress disorder (PTSD) is a highly prevalent psychiatric disorder that can become chronic and debilitating when left untreated. The most commonly recommended first-line treatments for PTSD among adults are individual trauma-focused psychotherapies. Other evidence-based treatments include specific antidepressant medications and non-trauma-focused psychotherapies. Despite the effectiveness of these available treatments, many patients' symptoms do not remit. This has led to the search for novel treatments for PTSD. In this review, the authors critically evaluate the data supporting several emerging pharmacological and other somatic interventions in the categories of medication-assisted psychotherapy, novel medication monotherapy strategies, and neuromodulation, selected because of the salience of their mechanisms of action to the pathophysiology of PTSD (e.g., MDMA-assisted psychotherapy, ketamine, cannabidiol, transcranial magnetic stimulation). The authors also evaluate the evidence for treatments that are the focus of increasing scientific or public interest (i.e., hyperbaric oxygen therapy, stellate ganglion block, neurofeedback). To date, the evidence supporting most novel pharmacological and somatic treatments for PTSD is preliminary and highly variable; however, the data for several specific treatments, such as transcranial magnetic stimulation, are encouraging.

Bereaved family quality of life varies with comorbid psychological distress and ICU-care quality.

Health-related quality of life (HRQOL) is highly endorsed, but HRQOL studies scarcely investigate the following: ICU family members; modifiable end-of-life (EOL) ICU-care factors; conjoint associations with prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression; and long-term bereavement outcomes. Exploratorily investigate associations of PGD-PTSD-depressive-symptom states (resilient, subthreshold-depression dominant, PGD dominant, and PGD-PTSD-depression comorbid) and quality of EOL ICU care with families' HRQOL 6-24 months post loss. This cohort study examined symptoms of PGD (11 items of the PG-13), PTSD (Impact of Event Scale-Revised), and depression (Hospital Anxiety and Depression Scale), and HRQOL (Medical Outcomes Study 36-Item Short-Form Health Survey) among 303 ICU family members. Quality of EOL ICU care was measured by objective process-based care-quality indicators abstracted from medical records and classified by subjective family-assessed quality of patient dying and death (QODD). Associations were simultaneously examined by multivariate hierarchical linear modeling with resilient state and high QODD class as reference. Physical and mental HRQOL were worse in the three more distressed symptom states, especially mental HRQOL which showed an incremental dose-response effect: subthreshold depression-dominant (β [95% CI]=-2.419 [-3.374, -1.464]), PGD-dominant (-8.366 [-10.116, -6.616]), and PGD-PTSD-depression comorbid (-14.736 [-17.772, -11.700]) states. Mental HRQOL was significantly worse in the three poorer QODD classes: moderate (-1.085 [-2.138, -0.032]), poor to uncertain (-4.362 [-5.616, -3.108]), and worst (-3.239 [-4.433, -2.045]). HRQOL was not associated with objective care-quality indicators. Bereaved family members' HRQOL was significantly associated with PGD-PTSD-depressive-symptom states and QODD classes-both modifiable through high-quality EOL ICU care.

Eating- and Weight-Related Disorders in the Armed Forces

Background/Objectives: Like in the general population, the prevalences of eating- and weight-related health issues in the armed forces are increasing. Relevant medical conditions include the eating disorders (EDs) anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder (ARFID), as well as body dysmorphic disorder, muscle dysmorphia, and the relative energy deficiency in sport (RED-S) syndrome. Methods: We performed a narrative literature review on eating- and weight-related disorders in the armed forces. Results: Entry standards might exclude people with obesity, with EDs, or at high risk for EDs from entering the armed forces for military reasons and to protect the individual’s health. Relevant potential risk factors of eating- and weight-related disorders in the military are the emphasis on appearance and fitness in the military, high levels of stress, military sexual trauma, post-traumatic stress disorder, deployment, relocation, long commutes, consumption of ultra-processed foods and beverages, limitations on food selection and physical exercise, and intensive combat training and field exercises. Eating- and weight-related disorders negatively impact professional military appearance and lead to problems with cardiorespiratory and neuromuscular fitness; daytime sleepiness; and a higher risk of musculoskeletal injuries, and other physical and mental health problems. Current and potential future therapeutic options include occupational health measures, psychosocial therapies, neuromodulation, and drug treatments. Conclusions: Even though randomized controlled trials (RCTs) have been performed to test treatments for obesity in the armed forces, RCTs for the treatment of EDs, body dysmorphic disorder, muscle dysmorphia, and RED-S syndrome are lacking in the military context.

Pathways to Homelessness: Childhood Maltreatment and Psychiatric Symptoms Increase Risk of Homelessness.

Homelessness is a serious and increasing public health concern. Childhood maltreatment and psychiatric problems have been associated with homelessness as risk factors; however, reliance on cross-sectional studies introduces ambiguity into interpreting previous findings. This study seeks to understand whether psychiatric symptoms in part explain the relationship between childhood maltreatment and homelessness. The authors used data from a prospective cohort design study in which individuals with documented histories of childhood maltreatment (ages 0-11 years) and a demographically matched group of children without those histories (N=1,196) were followed up into middle adulthood and interviewed. Psychiatric symptoms (anxiety, depression, post-traumatic stress disorder [PTSD], antisocial personality disorder [ASPD], and alcohol and drug use) were assessed at mean age 29. Homelessness was assessed at mean ages 29, 39, 41, and 47 years. Structural equation modeling was used to test mediation. Twice as many individuals with histories of childhood maltreatment reported ever being homeless (25.6% vs. 12.3%, AOR=2.54, 95% CI= 1.86-3.50) and past year homelessness (5.5% vs. 2.5%, AOR=2.09, 95% CI=1.31-3.43) at age 29, compared to controls. Controlling for past homelessness, psychiatric symptoms predicted future homelessness at mean ages 41 and 47. Three significant paths from childhood maltreatment to future homelessness were identified through depression, PTSD, and ASPD. This longitudinal study with documented cases of childhood maltreatment found that psychiatric symptoms earlier in life predict homelessness. Depression, PTSD, and ASPD represent pathways through which childhood maltreatment increases homelessness risk and warrant greater attention.

Key Components of Trauma-Informed Yoga Nidra.

Trauma exposure is universal to the human condition, with many affected individuals experiencing either posttraumatic stress disorder (PTSD) or subthreshold manifestations. Both scenarios can become functionally debilitating and collectively lay a heavy burden on individuals and society. Yoga nidra is one adjunctive treatment of growing interest, holding potential for its ability to alleviate symptoms of trauma, including hypervigilance, sleep disturbances, and disembodiment. However, yoga nidra practices can have re-traumatizing side-effects if not delivered conscientiously. For instance, adverse reactions such as overwhelming flashbacks, emotional distress, and extended dissociation have been reported as a result of yoga nidra practice. To prevent harm and maximize yoga nidra's therapeutic potential, 10 key components of trauma-informed yoga nidra practice are presented: (1) safe(r) and comfortable environment; (2) personal autonomy, healthy boundaries, and consent; (3) skillful mindful awareness; (4) appropriate length and preparation; (5) adequate settling and externalization; (6) sleep permission; (7) self-chosen intention; (8) flexible rotation of consciousness and breath awareness; (9) embodied pairs of opposites; and (10) conscientious visualizations. These measures protect those living with trauma and have extended benefits for nonclinical populations as well. That said, some of these components may be adapted based on context, especially in settings where direct feedback is readily available and can be prioritized. Ultimately, thoughtful decisions must be made with the intention of optimizing the safety of and benefit to the practitioners under the facilitator's care.

Design and methodology of a randomized clinical trial of quetiapine to reduce central nervous system polypharmacy in veterans with postconcussive syndrome symptoms

Lack of evidence to guide medication treatments for mild traumatic brain injury (mTBI) in veterans too often results in polypharmacy practices attempting to provide symptomatic relief from multiple postconcussive syndrome symptoms. Therefore, the field needs to find an effective medication that reduces the burden of postconcussive symptoms without complicating the treatment burden of veterans. This clinical trial seeks to determine whether switching veterans to quetiapine monotherapy (intervention) is superior to continuing to receive treatment as usual (TAU, control) polypharmacy for veterans with symptoms of postconcussive syndrome and posttraumatic stress disorder who are receiving rehabilitation treatment for mTBI. This study will test the conceptual mediation model hypothesis that quetiapine monotherapy may enhance recovery from mTBI by (1) increasing engagement in rehabilitation services, and/or (2) reducing the adverse effects of TAU polypharmacy. This study will enroll 146 patients from two Veterans Administration Medical Centers into a 12- week phase III, randomized, pragmatic clinical trial comparing outcomes from treatment with quetiapine monotherapy and TAU. Quetiapine will be cross tapered up to a maximum dose of 200 mg (as tolerated) as other medications are discontinued. The primary outcome measures are postconcussive syndrome symptoms (Neurobehavioral Symptom Inventory), functional disability (World Health Organization Disability Assessment), and quality of life (World Health Organization Quality of Life Assessment). Overall, this study aims to determine whether quetiapine monotherapy is superior to TAU polypharmacy and improves the quality of life for veterans with comorbid postconcussive syndrome and posttraumatic stress disorder symptoms who are receiving rehabilitation treatment for mTBI.