Posttraumatic Reactions Research Articles

Schönberg, Trauma, and the Unrepresentable

This examination raises the possibility, that the completion of Schönberg's opera Moses und Aron became impossible in light of antisemitism and the Holocaust, Schönberg’s personal memory of the family’s precipitous flight from Nazi Germany just as Act II was completed, and the murders of those relatives left behind. Did Schönberg suffer from a resulting form of writer’s block, in whicha hopeful conclusion to Act III of the opera could no longer be envisioned? Extant text sketches for Act III suggest a grim post-traumatic reaction, and preoccupation with a militant version of Zionism. To understand these factors, we must first examine the vicissitudes of Schönberg’s cultural and political identifications over many years.

Emotional Dysregulation and Worry as Mediators between Stressful Life Events and Posttraumatic Stress Symptoms in Adult Mexican Women: A Cross-Sectional Study

Introduction. Women experience numerous episodes of adverse events, often linked to violence, which create emotional difficulties that contribute to the development of post-traumatic stress disorder. However, more research is required to understand the nature of post-traumatic reactions and the underlying psycho-emotional processes. Objective. To determine whether emotional dysregulation and worry mediate the relationship between the experience of stressful events and post-traumatic stress symptoms in a sample of adult Mexican women seeking online psychological treatment. Method. A cross-sectional study was conducted with a non-probabilistic sample of 687 women ages 18 to 76. Results. The data show that emotional dysregulation mediated the relationship between the type of trauma and post-traumatic stress symptoms for illness- and death-related events, but not for other types of stressors, whereas worry mediated the association between sexual and physical assault and post-traumatic stress symptoms. Discussion and conclusion. This study contributes to current psychopathology models focused on the transdiagnostic perspective. The findings may guide interventions targeting emotion regulation and worry as modifiable risk factors for the development of post-traumatic stress.

Post-traumatic reactions and quality of life after pelvic exenteration for gynecologic cancer: a retrospective cohort study.

We examined post-traumatic reactions and quality of life in women with recurrent gynecologic cancer who underwent a pelvic exenteration (PE), a potentially life-saving radical surgery associated with life-altering sequelae. Twenty-one women who had completed PE at least 6months prior completed the Impact of Event Scale-Revised, a measure of post-traumatic stress, the Post-Traumatic Growth Inventory, a measure of post-traumatic growth, the Center for Epidemiologic Studies-Depression Scale, and the European Organization for Research and Treatment of Cancer 30-item core Quality of Life Questionnaire. We examined the associations between these outcome variables, and quality of life scores were compared to normative values for the general and gynecologic cancer populations. Thirty percent of women reported clinically significant post-traumatic stress symptoms and 71% endorsed clinically significant depressive symptoms. More post-traumatic stress was associated with less post-traumatic growth, more depressive symptoms, and worse quality of life. In general, women's quality of life was worse than the general population but comparable to women with stage III-IV ovarian cancer and women with cervical cancer. Social functioning was markedly lower in our sample and women reported more pain, diarrhea, and financial difficulties post-PE compared to published norms for the general population and women with ovarian or cervical cancer. There were no differences in quality of life based on age, type of PE, type of urinary diversion, or cancer type. Findings support long-term continued symptom management and the ongoing rehabilitation of patients to optimize physical, psychological, and social well-being in PE survivorship.

'I can feel sad about it and I can worry, but inside I know everything happens for a reason': personal experiences in the aftermath of the March 15 Christchurch mosque attacks.

On 15 March 2019, a white supremacist gunman sequentially attacked two mosques in Christchurch, New Zealand, killing 51 people aged from 3 to 77 years and bullet-injuring 40 more. Approximately 250 people survived the atrocity, and many more family and community members have been directly or indirectly affected. To develop an understanding of the personal experiences of some of those affected, including effects on daily life and well-being, in the 18-30 months following the attacks. Qualitative thematic analysis of semi-structured interviews with 21 men and women from September 2020 to August 2021 was performed. Participants were drawn from a larger quantitative study and included injured, bereaved, witnesses, family members and those from the wider Muslim community in Christchurch. Four superordinate themes were identified: being overwhelmed in the midst of chaos; experiencing silent and enduring impact; living similarly, but differently; and gaining meaning and growth. These themes captured ongoing distress inclusive of physical symptoms, family and community relationship dynamics and connectedness, secondary stressors, and diversity in coping and growth. For most, the centrality of Islam as a faith tradition was woven throughout. Consistent with previous literature, post-trauma reactions were pervasive and varied. This appeared to be compounded by secondary stressors in this cohort, such as sociopolitical circumstances, demographic diversity, the COVID-19 pandemic and justice processes. Findings also revealed a strong spiritual thread in the experiences of this minority faith community, shedding light on a complex interaction between recovery and post-traumatic growth.

Post-traumatic Reactions and Social–Emotional Competence Among Chinese High School Students Experiencing COVID-19 Lockdown: A Network Analysis

Post-traumatic Reactions and Social–Emotional Competence Among Chinese High School Students Experiencing COVID-19 Lockdown: A Network Analysis

A three-phase process model of posttraumatic stress disorder and growth: Understanding the mechanisms underlying posttraumatic reactions.

This theoretical review proposes a three-phase process model of posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). By combining trauma-related theories, emotional regulation theories, social support theories, and empirical study findings to elucidate the mechanisms underlying PTSD and PTG, we then propose our model. The proposed model highlights the dynamic characteristics of the PTSD and PTG developmental processes as well as their coexistence and places equal emphasis on the roles of cognitive and emotional activities and social support in three distinct dynamic phases of PTSD and PTG. It emphasizes that PTSD and PTG share similar prerequisites but that these two outcomes later diverge and ultimately manifest via three distinct phases. The specific roles of cognitive regulation, emotional regulation, and social support, and the potential theoretical and practical implications of this model, are discussed. This integrative and dynamic process model has the potential to advance scientific understanding of the mechanisms underlying PTSD and PTG. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Enhancing recovery in post-earthquake adolescents: examining the impact of a psychoeducational intervention on traumatic stress symptoms and coping strategies

Adolescents exposed to natural disasters are among the most vulnerable groups to the devastating effects of these events, including experiencing mental health issues such as Post-Traumatic Stress Disorder (PTSD), depression, and anxiety disorders. The study aims to evaluate the impact of an early-term psychoeducational intervention (2 months after the disaster) on adolescents who were exposed to the February 6th earthquakes in Turkey regarding symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, and coping styles. The study employed AB experimental design with a single-group, pre-test, post-test, and follow-up test evaluation. The sample consisted of 8 individuals aged between 12 and 18, relocated to another city (Istanbul) with their families to a container camp after exposure to the earthquake. Participants underwent an 8-session (one session per week) psychoeducational program developed by researchers composed of psychologists 2 months after the earthquake. To assess the effectiveness of the psychoeducational intervention, the Child and Adolescent Post-Traumatic Stress Disorder Reaction Index, Brief Symptom Inventory, and Coping Styles Scale-Brief Form was employed at three different time points (pre-intervention, post-intervention, and 4-month follow-up). Percentage distribution and the Friedman Test for comparisons were done for the data to be analyzed. Following the psychoeducational intervention, a statistically non-significant decrease in depression symptoms was observed, but the effect of the intervention was maintained over the 4-month follow-up period. While no change in anxiety symptoms was noted after the intervention, a significant decrease was observed in the follow-up. However, no improvement was observed in PTSD symptoms. Participants showed a statistically significant increase in religious coping, whereas a non-significant increase in planning, using emotional social support, and positive reinterpretation coping styles were observed. After large-scale disasters affecting numerous individuals, early psychological interventions should be planned and tailored for specific groups and specific needs instead of including every member of the group would be more time and cost-efficient.

PTSD symptoms and subjective traumatic outlook in the Israel-Hamas war: Capturing a broader picture of posttraumatic reactions

This study examined the unique associations of both probable posttraumatic stress disorder (PTSD) and subjective traumatic outlook (STO) with psychiatric and psychological concomitants among Israelis during the Israel-Hamas War. While PTSD reflects phenomenological psychiatric reactions to traumatic events, STO reflects subjective evaluations that one is traumatized. A convenience sample of 375 Israelis aged 20–87 from around Israel completed an online survey in the first two months of the war. A series of univariate logistic and linear regressions showed that while both probable PTSD and STO were associated with significant depression and anxiety symptoms, STO showed unique associations with hope and revenge, psychological variables that may be more sensitive following exposure to human-made and war trauma. Theoretical and practical considerations regarding these results suggest that a broader picture of post-trauma reactions can be captured by accounting for both the observed symptoms (PTSD) and one's introspective perception of being traumatized (STO).

Mindful Non-Judging and Posttraumatic Reactions in Police Academy Cadets: A Path Analysis

ObjectivesDispositional mindfulness has been associated with lower posttraumatic stress disorder (PTSD) and other negative health symptoms in the police population. Of the various mindfulness facets (i.e., non-judging, observing, describing, acting with awareness), non-judging has been demonstrated to be the strongest predictor of lower PTSD symptoms in police academy cadets. The mechanisms by which non-judging may lead to enhanced health outcomes in police officers are poorly understood and require further investigation.MethodThe purpose of the current study was to test a model involving a pathway from pre-trauma mindful non-judging to PTSD symptoms and ultimately posttraumatic growth (PTG) that is mediated by worldviews in a sample of police academy cadets (n = 379). Data were collected via a survey packet distributed at a police academy located in a Southern state of the United States. We examined the relationships among demographic factors, adverse child events, negative life events, mindful non-judgment, world assumptions, PTSD, and PTG using path analysis.ResultsThe results indicated that positive worldviews served as a mediator between dispositional mindful non-judging and lower PTSD symptoms, which ultimately led to lower PTG.ConclusionsThese findings have important implications for the selection and training of police academy cadets with the goal of increasing resilience to occupational trauma exposure. Additionally, these results have clinical implications regarding the treatment of officers experiencing symptoms of PTSD.PreregistrationThis study is not preregistered.

COVID-19 Posttraumatic Effects on Perinatal Psychological Distress: A Cross-Sectional Study at the End of the Pandemic Health Emergency.

Psychological distress in pregnant and postpartum women increased during the COVID-19 pandemic. However, the impact of the pandemic in perinatal women at the end of the health emergency has been rarely studied. This study is aimed at investigating the psychological health of pregnant and postpartum women at the end of the COVID-19 public health emergency, hypothesizing that the COVID-19-related fears influence perinatal psychological distress via the mediation of the COVID-19-related posttraumatic impact and loneliness. A total of 200 women in the perinatal period, of which 125 were pregnant and 75 were postpartum, participated in an online survey at the end of the COVID-19 public health emergency in Italy. Depression, anxiety, stress, loneliness, posttraumatic impact of COVID-19 pandemic and COVID-19-related fears were assessed. To test the hypotheses, robust serial mediation analyses were performed. Increased levels of COVID-19-related fears were associated with an increase in perinatal depression, anxiety and stress indirectly through the serial mediation of COVID-19 posttraumatic impact and loneliness. Loneliness played a stronger role in mediating the relationship between COVID-19-related fears and depression than anxiety and stress outcomes. This study should be considered exploratory for its methodological characteristics and nonreplicability of the pandemic condition. However, this study suggests the importance of assessing posttraumatic reactions to 'collective' crises in pregnant and postpartum women for research and clinical practice. In addition, it sustains the role of loneliness as a transversal construct that should be greatly considered in targeting psychological interventions for women in the perinatal period.

Early predictors of prolonged grief among bereaved trauma survivors 8.5 years after a terrorist attack.

A better understanding of the development of prolonged grief disorder can help professionals identify bereaved in need of intervention efforts and improve the efficiency of services. We aimed to examine the prevalence of and risk factors for prolonged grief disorder in a sample of young, bereaved terrorist attack survivors almost a decade postloss. In total, 165 bereaved survivors (Mage = 27.75, SD = 4.27; 45.5% females) of the 2011 terror attack on Utøya island, Norway, participated in face-to-face, semistructured interviews. At 4-5 months after the attack, early posttraumatic reactions were measured using the Brief Grief Questionnaire, University of California at Los Angeles PTSD Reaction Index, the Hopkins Symptom Checklist-8, and the eight-item Children's Somatic Symptoms Inventory. At 8.5 years postloss, the Traumatic Grief Inventory-Self Report Plus was used to assess prolonged grief disorder. To explore the association between participants' sociodemographic characteristics, early postloss clinical characteristics, and later prolonged grief reactions, we used multiple linear regression analyses. We found that 4.8% of the participants fulfilled the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision diagnostic criteria for prolonged grief disorder 8.5 years after their traumatic loss. Lower age and high levels of early somatic complaints predicted higher prolonged grief reactions almost a decade postloss. Young, bereaved survivors may be at particularly high risk of experiencing persistent grief reactions following the traumatic loss of a peer. Pending replication of our findings, professionals should focus on identifying bereaved who experience intense somatic symptoms early after a traumatic loss. Targeting these symptoms may alleviate the exacerbation of persistent grief reactions several years after a traumatic loss. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The use of biofeedback training in complex therapy of neurotic disorders and correction of negative psychological consequences of combat stress in combatants

The parameters and effectiveness of biofeedback training in the complex treatment of neurotic disorders at the hospital stage and psychological correction at the sanatorium stages of rehabilitation of military personnel were assessed. We examined 40 mentally healthy military personnel who participated in combat operations and 36 military personnel who participated in combat operations and suffered from stress-associated neurotic disorders and who were undergoing inpatient treatment in the S.M. Kirov Military Medical Academy clinics. In identifying possible negative psychological consequences of combat stress in a group of mentally healthy military personnel, a medical and psychological examination was performed using the military version of the Mississippi scale for assessing post-traumatic reactions, Neurotic Disorders-Symptomatic Questionnaire, and Quality of Life Questionnaire-12. The military personnel underwent stress testing according to a specially developed scenario using a biofeedback hardware software complex to assess individual changes in physiological parameters in response to emotionally significant stimuli. In the military personnel who participated in combat operations and suffered from neurotic disorders, a medical and psychological examination was performed using the Neurotic Disorders-Symptomatic Questionnaire and Quality of Life Questionnaire-12 upon admission to the hospital and on the eve of discharge, and stress testing was conducted upon admission to the hospital. The therapeutic effectiveness of biofeedback training in the treatment of neurotic disorders was evaluated by comparing the results of treatment between two groups of 18 individuals each. One group received only drug therapy, whereas the other group, in addition to drug therapy, underwent biofeedback training on the amplitude of the systolic wave. The level of stress-associated psychogenic damage was found to be correlated with the amplitude of the systolic wave according to the digital photoplethysmogram. Moreover, the physiological indicators of the circulatory and respiratory systems, used in foreign studies for psychophysiological training in the treatment of post-stress disorders, were not associated with the level of psychogenic damage, indicating their lack of involvement in pathogenesis and the ineffectiveness of their use. The addition of biofeedback training on the amplitude of the systolic wave to the complex therapy of neurotic disorders leveled astheno-neurotic symptoms and improved quality of life. Therefore, when treating astheno-neurotic disorders in military personnel participating in combat operations, it is critical to include biofeedback training on the amplitude of the systolic wave; this reduces severity of neurotic symptoms, improves quality of life, and forms preventive skill of conscious control of excessive physiological reactions of combat stress. Furthermore, the correlation between the magnitude of the decrease in the amplitude of the systolic wave and level of mental damage in combatants, revealed during stress testing, indicates the importance of biofeedback training on the amplitude of the systolic wave in sanatorium-resort organizations and military clinical hospitals of the Russian Ministry of Defense for the medical and psychological rehabilitation of military personnel exhibiting negative symptoms and those suffering from psychological consequences of combat stress.

Phenomenology of Somatization in Immigrants: An Idealtypical Approach

Introduction: Somatization in immigrants is frequent but standard studies do not differentiate between various forms of somatization. In this qualitative study, we used an idealtypical approach with the aim of phenomenologically differentiating between different forms of somatization in immigrants. Methods: The clinical description of the ideal types was based on seven levels: medical examination; description of somatization symptoms; the patients’ own interpretation of their somatic experience; concomitant psychopathological phenomena; genetic understanding; clinician’s interpretation; and course and treatment. Results: Five different ideal typologies of patients emerged: anxious hypochondriasis, somatization with cultural features playing a pathogenetic role, culturally shaped somatization (through pathoplastic effects), somatization as part of adjustment reactions due to migratory living difficulties, and somatization as post-traumatic reaction. Conclusion: These differences are useful to highlight the complex interrelationship between socioeconomic, migratory, cultural, and value factors in the construction of somatization among immigrants. Implications for research methodology, nosology, clinical management, and organization of medical facilities are also discussed.

Less-lethal weapons: ocular trauma in Chile as psychosocial trauma. Challenges from a human rights and comprehensive perspective.

In October 2019 in Chile, massive protests broke out in the so-called social uprising. The repressive response of the armed forces and Carabineros (Police) resulted in serious and mas-sive violations of human rights, with between 400 and 500 victims of ocular trauma caused mainly by shots from anti-riot shotguns, constituting the largest number of cases in the world linked to a single event. It is proposed to evaluate the different dimensions of the impact of ocular trauma due to state violence, using the concept of psychosocial trauma and a support model that integrates the medical-psychological and social dimensions. Human rights violations of the period are described, focusing on cases of ocular trauma, and state and civil society responses. The requests of a survivors' organisations regarding truth, justice and reparation is presented. A clinical case of ocular trauma treated in our centre is analyzed. Survivors of ocular trauma manifest post-traumatic reactions regardless of the severity of their ocular injuries. The impact on the mental health of survi-vors of ocular trauma due to state violence is a phenomenon where the psychic and psychosocial im-pact of trauma due to socio-political violence intersects with the short- and long-term mental health effects. The impact of sociopolitical trauma must be understood considering both the in-dividual and social subject, considering their cultural, socioeconomic and political reality. Recovery from traumatic psychological injury must be addressed in its medical, sensory rehabilitation, psycho-logical and psychosocial dimensions, including processes of social recognition, search for justice and comprehensive reparation of damage. In contexts of impunity, a model is proposed that integrates rehabilitation with psycho-legal support, promotion of agency and organisation, within the frame-work of commitment to the movement and principles of human rights.

Posttraumatic stress disorder symptoms and posttraumatic growth among college students with a history of childhood maltreatment in China: A latent profile analysis.

Childhood maltreatment is prevalent in China, and research indicates that trauma-exposed individuals may exhibit concurrent negative and positive posttraumatic psychological responses. To examine the co-occurring patterns of posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) among college students in China having a history of childhood maltreatment. Participants (N = 2,968) were college students from China who had experienced childhood maltreatment and had completed the PTSD Checklist, a PTG inventory, and a childhood maltreatment questionnaire. The results revealed four heterogeneous profiles characterized by low symptoms (n = 666, 22.4%), growth (n = 960, 32.3%), struggle (n = 1,285, 43.3%), and distress (n = 57, 1.9%). The three-step approach revealed emotional abuse and sexual abuse as crucial risk factors for the distress profile. In addition, age, sex, parental education, and forms of childhood maltreatment play distinctive roles in the four profiles of posttraumatic reactions. Posttraumatic reactions exhibit heterogeneous characteristics among Chinese college students exposed to childhood maltreatment, and professionals provide the service targeting their needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A unique combination of horror and longing: Traumatic grief in post-October 7, 2023, Israel.

On October 7, 2023 (10/7), Hamas militants brutally attacked Israeli towns and villages surrounding the Gaza Strip, resulting in the killing of more than 1100 people, most of whom were civilians slaughtered in their own homes. The killings occurred under highly traumatic circumstances, including shooting, the burning of homes, hunting down people who attempted to escape, and severe sexual assault. Thus, many Israelis today experience a unique mix of both posttraumatic and severe grief reactions. Traumatic grief (TG) is often defined as a condition that results from the death of a significant other and includes symptoms similar to posttraumatic stress disorder (PTSD) that are specifically related to the deceased, such as intrusive thoughts and memories about the deceased and hypervigilance expressed by constantly looking for them or cues associated with them. However, whereas definitions, phenomenological descriptions, and clinical illustrations of PTSD are abundant and widely validated, TG has yet to receive formal diagnostic status. In this paper, we aim to reexamine TG in the context of post-10/7 Israel. We argue that TG is a critical concept for clinicians working in Israel and other conflict-exposed areas of the world today, as it accurately captures the painful mix of grief- and trauma-related symptoms. We also suggest potential explanations for the lack of acknowledgment of TG as a formal diagnosis and discuss the possible role of historical events in the formation of new, relevant psychiatric diagnoses.

Predictors of early adulthood insomnia following exposure to a single mass violence attack during adolescence: 7–13 year follow-up from the Utøya and HUNT studies

ABSTRACT Background: The long-term impact of mass violence attacks is practically unknown, especially in children and adolescents. In a previous study, we found that 8.5 years after a terror attack targeting mainly adolescents, nearly half of the survivors met diagnostic criteria for insomnia. Objectives: The aims of this study were to investigate: (1) whether exposure to a single mass violence event during adolescence increases the risk of insomnia almost a decade later above that expected for a non-exposed population; and (2) whether prior interpersonal violence exposure and early post-traumatic reactions predict later insomnia. Method: Participants were survivors of the 2011 Utøya Island terrorist attack (n = 279) and controls from the HUNT Norwegian general population study (n = 35,664). Early adulthood insomnia was assessed using four items from the Karolinska Sleep Questionnaire 8.5 years after the attack. Participants who had also completed earlier data collection waves for both studies (n = 116 and 2382, respectively) were included in logistic regression models testing the associations between predictors during adolescence and later insomnia. Results: Nearly a decade after the Utøya attack, 38.4% (n = 56) of the survivors reported symptoms of insomnia indicative of probable insomnia compared to 20.5% (n = 5771) of controls. Terror exposure during adolescence was a significant predictor of later insomnia [odds ratio (OR) = 3.18, 95% confidence interval (CI) = 2.05–4.87, p < .001]. Early post-trauma symptoms of anxiety and depression (OR = 1.34, 95% CI = 1.02–1.76, p = .033) and weekly headaches (OR = 1.64, 95% CI = 1.08–2.47, p = .018) were also significant predictors while controlling for background factors and other predictors. Conclusion: Long-term assessment and treatment are needed for survivors of mass violence to improve resilience and recovery.

The association between looming cognitive style and posttraumatic stress symptoms: The case of older Holocaust survivors

The looming cognitive style (LCS) refers to a tendency to produce mental illustrations and images of adverse events and potentially threatening situations with perceived accumulating threat and danger. LCS is a well-known cognitive vulnerability for anxiety, nevertheless few studies examined the relationship between LCS and posttraumatic reactions. Among the existing studies, a higher LCS was reported in Holocaust survivors relative to matched comparisons, and directly associated with posttraumatic stress symptoms (PTSS) in older Holocaust survivors. The current study aimed to expand the understanding of the relationship between LCS with PTSS in general, and among older Holocaust survivors in particular. Moreover, whether the number of Holocaust experiences encountered by Holocaust survivors moderated this relationship. The sample consisted of 153 older Holocaust survivors (Mage = 82.42, SD = 5.75). Participants were interviewed regarding their background characteristics, PTSS, LCS, and number of Holocaust experiences. Participants reporting higher LCS showed higher PTSS. There was an interaction between LCS and number of Holocaust experiences for predicting PTSS, suggesting that LCS was associated with higher PTSS to a stronger degree among Holocaust survivors who experienced a smaller number of Holocaust experiences. The findings indicate that Holocaust trauma may have influenced the LCS of Holocaust survivors throughout their lives and into old age. The results provide insight for mental health practitioners treating older Holocaust survivors in focusing on reducing schematic processing biases for threat information and anxiety to enhance better mental health for those suffering from posttraumatic stress symptoms.

What will others think of me? The longitudinal association between trauma-related shame and guilt and psychopathology after a terror attack.

Trauma-related shame and guilt have been identified as important factors for mental health following interpersonal trauma. For survivors of terror and disasters, however, the role of shame and guilt remains largely unknown. To explore the long-term occurrence of trauma-related shame and guilt among survivors of a terror attack, and the potential importance of these emotions for mental health. A total of 347 survivors (48.7% female, mean age at the time of the attack: 19.25 years, s.d. = 4.40) of the 2011 massacre on Utøya island, Norway, participated in face-to-face, semi-structured interviews. Trauma-related shame and guilt were measured with items from the Shame and Guilt After Trauma Scale at 2.5 and 8.5 years post-terror attack. Post-traumatic reactions and anxiety/depression at 8.5 years post-terror attack were measured with the University of California at Los Angeles PTSD Reaction Index and the Hopkins Symptom Checklist-25, respectively. Associations between trauma-related shame/guilt and post-trauma psychopathology were analysed by multiple linear regressions. Trauma-related shame and guilt were prevalent among survivors at both 2.5 and 8.5 years post-terror attack. In unadjusted analyses, shame and guilt, at both time points, were significantly associated with post-traumatic stress reactions and anxiety/depression. Shame remained significantly associated with mental health when adjusted for guilt. Both earlier and current shame were uniquely related to mental health. Trauma-related shame and guilt may be prevalent in survivors of mass trauma several years after the event. Shame, in particular, may play an important role for long-term mental health. Clinicians may find it helpful to explicitly address shame in treatment of mass trauma survivors.

Using Military Screening Questions to Anonymously Recruit Post-9/11 Era Service Members andVeterans Using Online Survey Methods.

The ability to collect data on posttraumatic reactions following military sexual trauma is impacted by data collection methods, such that under-reporting can occur when data are believed to be identifiable. This may be especially true for topics that are sensitive, including sexual trauma. Ensuring participation from service members using non-identifiable methods is challenging when service history cannot be confirmed. The COVID-19 pandemic complicated data collection due to contact and social distancing requirements and limitations. To attempt to overcome these challenges, this study utilized an anonymous survey delivered by Qualtrics, Inc. with military validation checks that served as a screening mechanism. The purpose of the current report is to describe the development and use of military validation questions to recruit a sample of military sexual assault survivors using an anonymous survey. Qualtrics, Inc., a data collection software company, was contracted to collect data on military service members and veterans who reported military sexual assault. We developed and piloted four validation checks regarding military knowledge, which had to be answered correctly before participants could engage in the survey. This information was common to those who have served but uncommon to civilians, ensuring, to the best of our ability, that those responding were or had been service members. An incorrect response to any of the validation checks resulted in termination from the study. The probability of guessing correctly all four items was 0.16%. The current study collected data on 200 women and 200 men, all of whom reported military sexual assault. Data collection took approximately 6 weeks to complete. The validation checks resulted in screening out 1,450 potential participants who provided fraudulent responses. The average cost per participant, which included recruitment costs and participant payment, was $20. Given the histories of military sexual assault, the cohort reported high rates of probable positive screens for posttraumatic stress disorder (PTSD), suicide risk, and moderately severe depression, as well as other interpersonal challenges that are typically reported by those exposed to sexual assault, suggesting our validation checks were effective in recruiting the desired sample. Though not an original goal of our recruitment efforts, 9.75% (n = 39) of our sample identified as a sexual orientation other than heterosexual, including gay, bisexual, questioning, or "other." Use of Qualtrics, Inc. to incorporate validation checks helped us to be more reasonably confident that we were collecting data from military service members who reported military sexual assault. While the probability of a person without current or past military service passing the validation checks was low, it was not impossible. An unanticipated benefit of this platform was the short duration of time it took to complete data collection; the sample was collected within about 6 weeks. This platform may be a good option for investigators who cannot collect face-to-face data.