Trauma Distress Research Articles

The intergenerational effects of trauma from terror: A real possibility.

The goals of this article are to discuss the potential risk of children whose parents were traumatized by terror, to present literature on parenting in the context of terror, and to consider factors that may mediate the transmission of trauma-effects from parents to children. Mediators considered are parents' traumatic distress, disturbed parent-child interactions, trauma-related disturbances in parents' thinking, and effects of stress on children's neural functioning. Also discussed are genetic and environmental factors that may moderate the transmission of intergenerational effects and promote children's risk and resilience. Points raised during the discussion are illustrated with segments from interviews of women who were pregnant or gave birth some time after direct exposure to a terror attack. The authors conclude that empirical studies are needed to learn more about the intergenerational transmission of trauma-effects and processes that underlie it. The authors join others in the call to improve evaluation, treatment, and support of trauma victims and their children to stymie the transmission of problems from one generation to the next.

The influence of cancer impact on patients’ preparatory grief

The aims of this study were to investigate the preparatory grief and traumatic distress in advanced cancer patients in a palliative care unit. A total of 94 advanced cancer patients completed the Preparatory Grief in Advanced Cancer Patients (PGAC) scale and the Greek version of the Impact of Events Scale- Revised (IES-R-Gr). The Eastern Cooperative Oncology Group was used to measure patients’ performance status. Statistically significant associations were found between PGAC, patients’ performance status, and all the IES-R-Gr scales (avoidance, intrusion, hyperarousal) and IES-R-Gr total score. The multiple regression analysis revealed that preparatory grief was predicted by patients’ young age, poor performance status, as well as by their high levels of intrusion and hyperarousal, in a model explaining 51.5% of the total variance. Concluding, in advanced cancer patients, preparatory grief is significantly correlated with the impact of cancer and patients’ physical condition, and seems to be influenced by components of the event impact, patients’ age, and physical performance.

Psychological risk assessment following the terrorist attacks in New York in 2001

Background: Trauma Risk Management (TRiM) is a post-traumatic psychological management model utilizing peer support/assessment, developed by the UK military. Following September 11th, 2001, the UK Foreign & Commonwealth Office (FCO) deployed TRiM personnel to New York.Aims: This report describes the use of TRiM by the FCO in New York and examines the correlation validity of the TRiM assessments.Method: Assessments were conducted among personnel shortly after the event and again after a further month. The initial and follow-up scores on the 10-item TRiM Risk Assessment Tool (RAT) and the Impact of Events Scale (IES) were compared.Results: Twenty-eight people were assessed using the RAT; 20 also completed the IES. The IES identified 19 cases at initial assessment compared to 5 using the RAT. At follow up, the IES identified 10 cases compared to two using the RAT. Initial RAT and IES scores were not correlated however the follow-up scores (Pearson's r = 0.79, p < 0.001) and the change in scores were (Pearson's r = 0.56, p = 0.02).Conclusion: Results suggest the TRiM process was well received and the RAT appears to measure a similar change in post traumatic distress as the well validated IES. Further research will determine the efficacy of this system.

Debating war-trauma and post-traumatic stress disorder (PTSD) in an interdisciplinary arena

Researchers have tried to determine and verify the effects of violent conflicts on the mental health of those affected by focusing on war trauma, posttraumatic stress disorder (PTSD), and other trauma-related disorders. This, in turn, led to the development of different kinds of theories and aid programs that aim at preventing and treating the consequences of violence and mental health. Until now, there is no agreement on the public health value of the concept of PTSD and no agreement on the appropriate type of mental-health care. Instead, psychiatrists have engaged in sometimes fierce discussions over the universality of war trauma, PTSD, and other trauma-related disorders. The two most polar positions are those who try to validate PTSD as a universal and cross-culturally valid psychopathological response to traumatic distress which may be cured or ameliorated with (Western) clinical and psychosocial therapeutic measures, and those who argue that the Western discourse on trauma only makes sense in the context of a particular cultural and moral framework and, therefore, becomes problematic in the context of other cultural and social settings. Although these positions seem mutually exclusive, their debates have led to the development of less radical approaches toward war-trauma and PTSD. The purpose of this literature review is to analyse the discourses on and debates over war-trauma and PTSD in the psychiatric literature in order to establish a better understanding for the diverse conceptualizations, interpretations and proposed healing strategies. Moreover, I discuss the cultural construction and conceptualization of war-trauma and PTSD from an anthropological perspective and show how anthropologists contribute to psychiatric debates so as to ensure more sophisticated diagnoses and healing strategies in culturally diverse contexts.

The THRIVE approach to mental wellnessThe THRIVE approach to mental wellness Marion Aslan Mike Smith , www.crazydiamond.org.uk (to order a copy of the book contact mikesvoice@aol.com or marionaslan@aol.com 123 £22.00 (discount for MHP readers who quote ref MHP 1) 9780955646102 0955646103 inc p&amp;p

Now, I am not adverse to some mental wellbeing. Sometimes I struggle a lot with voices, demons, memories and experiences such as working through ongoing ‘iatrogenic post traumatic distress’, caused by flashbacks of abusive and traumatic experiences I received at the hands of the psychiatric system because of injuries caused by my self harm, and voices which tell me I am a ‘fuck wit’. When THRIVE landed on my doorstep I wanted to find out what tips there may be to make me even more ‘well’ in my ‘being’.

Post-Traumatic Reactions in Adolescents: How Well Do the DSM-IV PTSD Criteria Fit the Real Life Experience of Trauma Exposed Youth?

This study examined the structure and symptom specific patterns of post traumatic distress in a sample of 1,581 adolescents who reported exposure to at least one traumatic event. Symptom reporting patterns are consistent with past literature in that females reported more symptoms than males and older youth reported more symptoms than did their younger peers. Young people reporting exposure to exclusively violent type traumas were also found to be more likely to endorse symptoms than peers exposed exclusively to non violent type traumas. Confirmatory factor analysis provided stronger support for a four-factor model of PTSD than either the DSM-IV model or an alternate model. Further examination of the four factor model revealed gender differences in factor loadings with small to moderate effect sizes for recurrent, distressing memories, flashbacks, restricted affect, difficulty remember details, detachment, limited future orientation, hypervigilance and startle symptoms. Differences in factor loadings with the four factor model were also noted between younger and older adolescents, with medium to large effect sizes on the arousal items. In contract, comparison of the factor loadings revealed only small differences between youth exposed exclusively to violent traumatic stressors and those exposed exclusively to non violent traumatic stressors, suggesting relative similarity between these two groups.

Childhood Adverse Events and Current Traumatic Distress

This study describes the prevalence of childhood adverse events (CAEs) among men and women prisoners and assesses the relationship of CAEs to adult symptoms of traumatic distress. Interview data for 427 men and 315 women were analyzed assessing childhood abuse and household dysfunction, drug and criminal histories, and symptoms of traumatic distress. Women offenders had much greater exposure to CAEs than did men and more often reported continued sexual abuse in adolescence and as an adult. Linear regression results showed that the impact of CAEs on traumatic distress was strong and cumulative for both men and women (greater exposure to CAEs increased the likelihood of 6 out of 7 mental health outcomes, although women had higher levels of traumatic distress overall). The findings indicate the need for early prevention and intervention as well as trauma-based treatment within the correctional setting.

Traumatic Distress and Positive Changes in Advanced Cancer Patients

This study investigated the traumatic distress and posttraumatic growth in 58 advanced cancer patients receiving palliative treatment in a Pain Relief and Palliative Care Unit. The patients completed the Greek version of the Impact of Events Scale-Revised and the Posttraumatic Growth Inventory. Statistically significant associations were found among Impact of Events Scale-Revised-Greek "Relating to Others" (r = 0.311, P = .017), "New Possibilities" ( r = 0.248, P = .050), and "Appreciation of Life" ( r = 0.419, P = .001), and the Posttraumatic Growth Inventory scores (r = 0.323, P = .013). Similarly, "Appreciation of Life" correlated significantly with "Avoidance" (r = 0.318, P = .015), "Intrusion" (r = 0.365, P = .005), and "Hyperarousal" (r = 0.398, P = .002). Statistically significant associations were also found between "Relating to Others" and "Intrusion" (r = 0.414, P = .001). The study concluded that in advanced cancer patients, the higher the impact event, the more improvement in their relationships with others, enhanced life appreciation, and more positive consequences after trauma.

Predictors of posttraumatic stress symptoms among runaway youth utilizing two service sectors

Youth who run away often experience situations that produce symptoms of traumatic distress. This exploratory study assessed predictors of trauma symptomatology among runaway youth who had been admitted to youth emergency shelter services or juvenile detention. Findings demonstrated high levels of trauma-related symptoms for both groups. Worry about family, greater runaway episodes, and living with a father who abused alcohol/drugs significantly predicted higher posttraumatic stress symptoms in detained youth, whereas only worry about family relationships predicted higher trauma symptom scores among youth in emergency shelter care. Findings suggest distressful family life may induce complex emotional responses in youth. Although services to runaway youth must continue to focus on safe, short-term residential care, trauma issues must be acknowledged.

Screening for Complicated Grief Among Project Liberty Service Recipients 18 Months After September 11, 2001

Screening for Complicated Grief Among Project Liberty Service Recipients 18 Months After September 11, 2001

Project Liberty: New York's Crisis Counseling Program Created in the Aftermath of September 11, 2001

Project Liberty: New York's Crisis Counseling Program Created in the Aftermath of September 11, 2001

Psychiatric Syndromes in Adolescents with Marijuana Abuse and Dependency in Outpatient Treatment

ABSTRACT Objective: The purpose of the current study to assist in understanding the prevalence and clinical correlates of psychiatric distress in adolescents seeking outpatient services for marijuana abuse or dependency. Methods: In a multi-site randomized clinical trial, 600 adolescents and their parents were assessed at intake using the Global Appraisals of Individual Needs. DSM-IV criteria were used to diagnose marijuana use disorders, and a symptom check list was used to measure symptoms on five syndromes: conduct disorder, ADHD, depression, anxiety, and disorders of traumatic distress. Results: Patients endorsed acute levels of conduct disorder (74%), ADHD (77%), depression (37.7%), anxiety (28.8%), and traumatic distress (13.8%), and 72% endorsed acute levels on two or more syndromes. Adolescents with a diagnosis of dependency and females evidenced the greatest severity of mental health distress, and minimal differences were found between racial groups. Patients with acute levels of both internalizing and externalizing syndromes reported problems with substance use, criminal activities, trauma experience, and family environments. Conclusion: Co-occurring psychiatric distress is the norm for adolescents seeking outpatient services for marijuana disorders. Better integration of substance use and mental health services would likely improve the quality of care for these troubled youth.

A Call for Sound Empirical Testing and Evaluation of Criteria for Complicated Grief Proposed for DSM-V

The empirical testing of diagnostic criteria for Complicated Grief (CG) by autonomous investigators is a welcome development. Cross-validation studies are essential to an impartial evaluation of diagnostic criteria for CG proposed for inclusion in the DSM-V. Nevertheless, the review of evidence to confirm or disconfirm the diagnostic validity of the proposed CG criteria requires a fair, unbiased, and relevant examination of the data. It is our view that Hogan, Worden, and Schmidt's (2003–2004) “An Empirical Study of the Complicated Grief Disorder Criteria” (see Table 1) fails to meet these standards. Hogan et al. test for the independence between: a) separation distress and traumatic distress symptoms, b) CG and depressive symptoms, c) CG symptoms and presumably “normal” symptoms of grief. Testing for the independence of these constructs is a red herring. Issues central to the validity and reliability of a CG diagnosis should focus on the ability of the symptoms to identify the small number of bereaved persons with enduring and acutely distressing grief that is associated with significant dysfunction. Despite asking the wrong questions, the basic results remain consistent with claims that we have made all along (e.g., that CG symptoms are unidimensional; that more than half the variance in CG symptoms cannot be explained by depressive symptoms; that CG symptoms distinguish themselves from normal grief symptoms with respect to their intensity and chronicity and the prediction of morbidity). There is little doubt of the need for more empirical work to evaluate the reliability, validity, sensitivity, specificity, and diagnostic efficiency of criteria proposed for CG. It is our hope that the call will be heard by investigators who will test issues relevant to the creation of a sound CG diagnosis.

Wartime faith-based reactions among traumatized Kosovar and Bosnian refugees in the United States

In William James' view, one function of prayer is a faith-based, conscious approach to a higher power when in distress. Accordingly, this study investigates the use of private prayer among Muslim war refugees from Kosovo and Bosnia (N = 138). Results show that these refugees were highly traumatized and most counted on private prayer for coping with their wartime difficulties. Four major types of prayer familiar to Americans were employed by roughly two-thirds to 86% of this sample. As expected, most types of prayer were associated with both wartime traumatic distress and greater religiousness. Also, 77% used prayer so that their enemies would “pay for what they have done.” However, this type of prayer was predicted only by higher levels of education and not by religiousness or traumatization. The need for examining the general and specific social contexts of prayer, such as war and terror, and prayer itself, perceived as a common human experience, are discussed. A structural equation model indicated that war-related trauma was associated directly only with negative religious coping but indirectly with positive coping, mediated by levels of emotional distress. Religiousness was related directly only to positive coping. These findings are discussed with respect to their theoretical and clinical implications.

Subclinical dissociation, schizotypy, and traumatic distress

The current study looked at the overlap between dissociation and schizotypy and examined two potential sources from which this overlap might originate: fantasy proneness and traumatic distress. From a sample of 191 undergraduates, those scoring in the upper and lower quartile of the Dissociative Experiences Scale (DES) were selected. Next, the scores of these groups on well-established schizotypy scales were compared to each other. The high-DES group had significantly higher schizotypy scores than the low-DES group. Although both groups also differed with regard to fantasy proneness and, to a lesser extent, traumatic distress, analyses of covariance showed that these variables could not explain group differences in schizotypy. Alternative interpretations of the dissociation–schizotypy link are discussed.

Post traumatic distress symptoms following spinal cord injury: a comparative review of European Samples

To highlight any cross-cultural differences in the prevalence of post traumatic distress (PTD), and the type of coping strategies implemented following spinal cord injury (SCI). Cross-sectional questionnaire. A spinal cord rehabilitation unit in the UK, and six Swiss and German (CH/DE) spinal injury centres. A total of 85 SCI individuals in the UK, and 71 in CH/DE were evaluated on levels of PTD using the Impact of Event Scale (IES), and depressive symptomatology using the Beck Depression Inventory or the Berne Questionnaire of Well-Being at up to 6 months postinjury. In addition, the coping strategies utilised by the two samples were assessed using the COPE measure. No significant difference between the two samples was noted with regard to levels of PTD determined by the total score on the IES, although there was a tendency for a higher rate in the UK. Approximately 20 and 10% of both samples scored above the clinical cutoff on the IES subscales of intrusion and avoidance, respectively. No significant difference was found to exist between the rate of PTD in the SCI CH/DE sample and the able-bodied sample in Switzerland. A lower prevalence of depression was noted in the CH/DE sample. The CH/DE sample scored higher on the use of positive reinterpretation and growth, suppression of competing activities, active and restraint coping, whereas the UK sample scored higher on the use of humour as a coping strategy. Overall, denial, focusing on and venting of emotions, mental disengagement and suppression of competing activities were associated with PTD. No cross-cultural differences in the level of PTD seem apparent between the UK and CH/DE populations. Future research should focus on determining what protects individuals from developing PTD following SCI.

Bereavement outcomes for parents who lose a child to cancer: are place of death and sex of parent associated with differences in psychological functioning?

Despite increasing cure rates, cancer is a leading cause of non-accidental death in childhood. Models of psychosocial care in pediatric cancer may therefore need to address bereavement planning for a 'minority group' of parents (approximately 25%) for whom cure of their child is not possible. This study addresses a gap in knowledge concerning long-term bereavement and psychological outcomes for parents, as a function of the sex of the parent and the place of the child's death: home versus hospital. Fifty Australian parents (25 father-mother dyads), whose child had died at least 1 year prior to study participation, independently completed measures of psychological functioning (depression, anxiety and stress), family functioning, and pathological grieving (separation distress, and traumatic distress). The results showed some support for a hypothesized interaction between place of death and sex of parent. Fathers reported significantly higher levels of depression, anxiety and stress when the child died in hospital rather than at home. By way of contrast, differences for mothers as function of place of death were not reflected in psychological outcomes but were more closely tied to symptoms of pathological grieving. The findings are discussed with respect to the needs for services for surviving adult family members, especially for fathers who may have an enhanced psychological vulnerability after the death of a child in hospital rather than at home.

An Empirical Study of the Proposed Complicated Grief Disorder Criteria

Diagnostic criteria for complicated grief have been proposed as a pathological disorder for inclusion into the next edition of the DSM. However, to date, little empirical testing of the criteria to support or refute the diagnostic claims has been completed. Since the original criteria were developed based on work with widows and widowers, further testing with other bereft groups is needed before advancing complicated grief to a diagnosis worthy of inclusion in diagnostic systems. The present study was undertaken to empirically test the complicated grief disorder criteria. The basic criteria of the complicated grief disorder, formerly called traumatic grief, separation distress, and traumatic distress, were not isolated as distinct constructs in confirmatory factor analyses, and conceptualization as a unitary construct did not provide an adequate fit of the model to the data. Further analyses did not support the distinctness between complicated grief and depression, or complicated grief and normal grief. Based on these findings, both further investigation into the validity of complicated grief disorder as a diagnosis and verification of the validity of the diagnostic criteria is warranted before declaring this phenomenon appropriate for inclusion in diagnostic systems.

Gender Differences in Traumatic Grief Symptom Severity after the Loss of a Spouse

Gender differences in bereavement outcome have received much attention in bereavement research in the past decades. While many studies have focused on depressive symptomatology and/or normal grief reactions, little attention has been paid to gender differences in symptoms of pathological or traumatic grief (TG). In addition, few studies have investigated gender differences beyond the acute grieving period. In the present study, cross-sectional data were used to explore gender differences in the temporal course of TG symptomatology. Data were derived from 270 spousally bereaved individuals who filled in the Inventory of Traumatic Grief on the Internet. Analyses of variance were conducted to explore differences in TG symptoms over time and between widows and widowers. No differences were found between men and women on the TG symptoms or the TG summary score, on any of the observational time points. With regard to the temporal course of TG symptomatology, indications were found that symptoms of separation distress are likely to subside over the passage of time, while symptoms of traumatic distress are unlikely to do so.

Regulation of emotion and psychological symptoms in people with spinal cord injury

This cross-sectional study examined the contribution of regulation of emotion on depression, symptoms of traumatic and general distress, perceived disability, and somatic symptoms following spinal cord injury. Depressed and non-depressed participants (N = 264, mean age = 46 years) differed in their use of adaptive and maladaptive ways of regulating emotions. In addition to somatic symptoms and symptoms of traumatic stress, maladaptive emotional regulation (avoidance and distortion of awareness) accounted for 8% of the total variance of depression. It is concluded that adaptive and maladaptive ways of regulating emotions are important factors in dealing with negative feelings. Regulation of emotion appears to influence perceived disability mainly via depression. Limitations of the study and implications for rehabilitation are discussed.