Trauma-related Distress Research Articles

Emotional regulation as a mediating variable between risk of psychosis and common mental health problems in adolescents

BackgroundThe main clinical high-risk of psychosis (CHRp) approaches are focused on core features of schizophrenia that might surface in the prodromal phases, mainly psychotic-like experiences (PLEs) (e.g., prodromal or schizotypal symptoms) or associated phenomena like basic symptoms or anomalous experiences of the self. Given that PLEs vary depending on distress levels, related common mental health problems, emotional regulation (ER) strategies and eventual clinical outcomes, exploring the heterogeneous nature of these PLEs and their psychological correlates could aid in distinguishing between subclinical and clinical psychotic experiences. The present study aims firstly to generate new evidence on the understanding of clinical relevance of PLEs and associated phenomena in a non-clinical representative sample of 1824 Spanish adolescents, according to their CHRp level (high/moderate/low). Secondly, we analyzed the possible mediating effect of three different emotional regulation strategies ((experiential avoidance (EA), cognitive reappraisal (CR) and emotional suppression (ES)) between PLEs and non-specific symptoms of depression, anxiety, stress, trauma related distress and substance use. Results showed that a more frequent use of EA and ES resulted in a higher CHRp, with no differences in the use of CR. In addition, EA emerged as a significant mediating factor between CHRp and the development of emotional symptoms and substance use. Emotion regulation strategy may account for heterogeneity in PLE outcomes. The use of EA as a coping strategy for their PLEs in adolescents with CHRp may facilitate the development of common mental health problems such as anxiety, depression or cannabis use pathologies. Helping adolescents at CHRp to use non-avoidant coping strategies may be indicated if their preventive effects are demonstrated.

From sleep to sip? Examining a daily model of sleep and trauma-related drinking among sexual violence survivors.

Alcohol misuse is common among women who have experienced sexual violence and is often attributed to the self-medication model of alcohol use to alleviate posttraumatic stress disorder (PTSD) symptoms. Despite the proximal theorized role of PTSD symptoms, less attention has been given to daily associations between PTSD symptoms, trauma-related drinking to cope (TRD) motives, and ensuing alcohol use by survivors. Moreover, despite indications that poor sleep impacts affective functioning and may exacerbate daily PTSD symptoms, the role of sleep duration and quality in drinking to cope with PTSD symptoms is not well understood. This study examined an integrated model testing whether shorter sleep duration and poorer sleep quality predict greater daily PTSD symptoms and, in turn, greater alcohol use later that day through TRD motives. Participants were 82 cisgender women (Mage = 22.8, 73.2% White, 13.4% Hispanic/Latina, 56.1% heterosexual, 30.5% bisexual) who had experienced sexual violence. Participants completed ecological momentary assessment measures and wore actigraphs for 3 weeks. Contrary to hypotheses, shorter-than-usual sleep duration did not predict greater alcohol use quantity via daily PTSD symptoms and TRD motives. However, poorer-than-usual sleep quality predicted greater PTSD symptoms that day, which in turn predicted greater same-day TRD motives. Findings underscore the importance of sleep quality in heightened PTSD symptoms but suggest survivors did not drink more to alleviate trauma-related distress. Future research should examine other drinking motives among survivors to inform proximal interventions to prevent alcohol misuse. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social support and (complex) posttraumatic stress symptom severity: does gender matter?

ABSTRACT Background: Perceived social support is an established predictor of post-traumatic stress disorder (PTSD) after exposure to a traumatic event. Gender is an important factor that could differentiate responses to social support, yet this has been little explored. Symptoms of complex PTSD are also common following trauma but have been under-researched in this context. Large scale studies with culturally diverse samples are particularly lacking. Objectives: In a multi-country sample, we examined: (a) gender differences in perceived social support and both posttraumatic stress symptom severity (PTSS) and complex posttraumatic stress symptom severity (CPTSS); (b) associations between social support and PTSS/CPTSS; and (c) the potential moderating role of gender in the relationship between perceived social support and trauma-related distress. Method: A total of 2483 adults (Mage = 30yrs, 69.9% females) from 39 countries, who had been exposed to mixed trauma types, completed the Multidimensional Scale of Perceived Social Support and the International Trauma Questionnaire (which captures PTSS/CPTSS). Regression analyses examined associations between gender, perceived social support, and PTSS/CPTSS; and tested for gender by social support interactions in predicting PTSS/CPTSS scores. Models were adjusted for age and socioeconomic status. Results: In our cross-country sample, females had greater PTSS/CPTSS than males (B = .23 [95% CI 0.16, 0.30], p < .001; B = .20 [0.12, 0.27], p < .001; respectively), but there was no evidence of gender differences in perceived social support (B = .05 [−0.05, 0.16], p = .33). For both genders, low perceived social support was associated with higher PTSS/CPTSS (females: B = −.16 [−0.20, −0.12], p < .001; B = −.27 [−0.30, −0.24], p < .001; respectively; males: B = −.22 [−0.29, −0.15], p < .001; B = −.31 [−0.36, −0.26], p < .001; respectively), and for PTSS only we found weak evidence that this association was stronger for males vs. females (B = .07 [0.04, 0.14, p = .04). Conclusion: Individuals who feel more socially supported have lower trauma-related distress, and this association is similar in males and females. PTSD/CPTSD interventions may benefit from augmenting perceived social support, regardless of gender.

Effects of acceptance and commitment therapy on trauma-related symptoms: A systematic review and meta-analysis.

Acceptance and commitment therapy (ACT) is a third-wave cognitive behavioral therapy that has shown promise as an effective treatment for reducing trauma-related symptoms. Although there have been systematic reviews on the clinical effectiveness of ACT for posttraumatic stress disorder, there are no known meta-analyses published on the impact of ACT in adult populations with trauma-related symptoms. Hence, the purpose of this meta-analysis and systematic review was to update the literature and assess the effectiveness of ACT interventions for decreasing trauma-related distress in adults who have developed trauma symptoms following exposure to one or more traumatic events. A systematic review of the literature was completed, and between-groups random effects meta-analysis was conducted assessing trauma symptom reduction at the initial posttest. Subgroup analyses were also performed to assess differences between groups based on research design, type of trauma, and comparator group. A meta-analysis of 11 studies revealed a moderate and statistically significant overall effect of ACT on symptom reduction at immediate posttest (Hedges' g = -.423, 95% CI [-.605, -.240]; I² = 25.75%), indicating that on average, those who received ACT interventions reported fewer trauma symptoms postintervention than those in various comparison groups. Ultimately, this research provides additional evidence supporting the effectiveness of ACT interventions for clients reporting trauma-related concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Does the link between posttraumatic cognitions and eating pathology depend on trauma type? The role of sexual violence.

Exposure to potentially traumatic events is well-known to disrupt cognitions about the self. Among trauma-exposed college students, negative cognitions about the self can include low self-worth and heightened perception of behavioral control over outcomes (i.e., self-controllability), including overevaluation of self-control over weight, shape, and eating behaviors. Thus, posttraumatic cognitions may increase risk for eating pathology. These associations may be particularly heightened among those whose trauma was of a sexual nature, given the stigma and inaccurate rape myths that often place the blame on sexual violence survivors rather than perpetrators. Consistent with these possibilities, the present study tested whether sexual violence history moderated expected associations between lower self-worth and greater eating pathology and between greater self-controllability and eating pathology. Participants were 1,303 trauma-exposed college students (71.6% cisgender women) who completed self-report measures. Two linear regression models were examined, controlling for gender identity and posttraumatic stress symptom severity. As expected, more negative views toward the self were associated with greater eating pathology, and this association was stronger among college students who had experienced sexual violence compared with those who only experienced other trauma types. In contrast, beliefs about behavioral control over outcomes were unrelated to eating pathology regardless of trauma type. Findings point to low self-worth as a cognitive target for future research and clinical efforts aimed at addressing trauma-related distress and eating pathology concurrently, especially among individuals with a history of sexual violence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring Subjective Experiences of Eye Movement Desensitization Reprocessing (EMDR) for Psychosis - a Power Threat Meaning Framework (PTMF) Informed Narrative Inquiry

An extensive body of evidence supports the association between life adversity and experiences such as hearing voices and holding beliefs that others may find unusual. Emerging evidence suggests Eye Movement Desensitization Reprocessing (EMDR) may be an effective intervention for reducing the emotional impact of trauma memories in the context of psychosis and, as a result, may lessen the impact of unusual experiences. Despite this, there has been limited research into clients’ subjective experiences of EMDR for psychosis with existing research predominantly focused on its ability to resolve what are viewed as ‘comorbid symptoms’ of Post-Traumatic Stress Disorder (PTSD). The theoretical assumptions of the Power Threat Meaning Framework (PTMF) suggest that unusual experiences can be understood as trauma related distress. In line with this perspective, the aims of the current study were to explore what focusing therapeutically on traumatic experiences in the context of psychosis might reveal about the link between adversity and psychosis and, furthermore, to explore what clients’ depict as important when engaging with EMDR for psychosis. Participants recruited from specialist psychosis community mental health services were interviewed and a qualitative narrative analysis methodology employed. Within the narratives, trauma-derived personal meanings were common and could be linked to the content of unusual experiences. Participants consistently positioned themselves as advocates of EMDR for psychosis, citing improved relationships and feeling calmer amongst positive changes. In reflecting on their experiences of EMDR, participants more commonly cited the importance of a trusting therapeutic relationship than specific EMDR techniques. A number of clinical implications are raised, including recommendations for care resourcing and planning.

Assessing transgenerational trauma transmission: development and psychometric properties of the Historical Intergenerational Trauma Transmission Questionnaire (HITT-Q)

ABSTRACT Objective/Background: Despite increasing attention on transgenerational trauma, currently no comprehensive model and measure exists to be applied on various populations. This study represents the first step in the validation of such a model and a related scale. The Historical Intergenerational Trauma Questionnaire (HITT-Q) assesses family and offspring self-reported vulnerability and resilience, as well as offspring historical moral injury and current levels of insidious trauma. Method: We developed the HITT-Q based on the cross-population model (HITT model; [Starrs, C. & Békés, V. (2024). Historical and transgenerational trauma: A conceptual framework. Traumatology. In Press]) which incorporates key findings in existing population specific studies. For initial validation of the model and its measurement, Holocaust survivors’ offspring (N = 1104) completed the HITT-Q, measures of current mental health symptoms (PTSD, C-PTSD, anxiety, and depression), and a resilience scale. Results: In line with the HITT model, confirmatory factor analyses supported a 12-factor solution with the following factors under theorized dimensions: I. Family Vulnerability: (1) Dysregulated and Trauma-related Communication; (2)Trauma-influenced Parenting, (3) Fear; (4) Distress; II. (5) Family Resilience, III. Offspring Vulnerability: (6) Escape; (7) Heightened Responsibility; (8) Trauma-related distress; IV. Offspring Resilience: (9) Coping; (10) Belonging; (11) Values; V. (12) Historical Moral injury. The 12-factor model showed acceptable to good internal validity, and comparison with an existing measure of transgenerational Holocaust trauma indicated good concurrent validity. Finally, the HITT-Q demonstrated predictive validity for mental health symptoms and current resilience. Conclusions: The current study represents the first step in validating the HITT-Q as a comprehensive measure of historical intergenerational vulnerability and resilience. Our findings provide strong support for the underlying model, and suggest that the HITT-Q represents a valuable scale for both research and historical trauma-informed care.

Item-wise validity study of the Impact of Event Scale - Revised (IES-R): self-reported reactions of hospital personnel exposed to a stressful workplace.

Recent studies have revealed a heterogeneous prevalence and presentation of PTSD across countries. It is crucial to assess the methodological and item-level measurement factors that contribute to variations in mental disorder rates across cultures. This study aimed to investigate the traumatic experiences of hospital workers by employing item analysis of the Impact of Event Scale-Revised (IES-R). Data were collected from 1,000 employees of a large hospital during the COVID-19 pandemic and were further subjected to item response theory (IRT) analysis with respect to the discrimination (a) and difficulty (b) parameters of the item pool. Our results demonstrated that the IES-R items had a good discriminative ability (a) and covered a range of distress severity (b) associated with traumatic experiences. The IES-R was found to be a reliable and informative instrument for assessing individuals with moderate to severe trauma-related distress across the spectrum of traumatic symptoms. In particular, items #10 ("jumpy or easily startled") and #6 (" thought about it when didn't mean to"), reflecting the PTSD domains of hyperarousal and intrusion, excelled in discriminating between different levels of traumatic distress. Conversely, items related to avoidance and sleep disturbance showed diminished discriminative ability. The item analysis of the IES-R may be used to assess trauma symptoms in the context of a traumatic exposure, thereby identifying the most discriminative and informative items of the PTSD measure in our context. Our findings may refine the IES-R and facilitate the development of a more effective scale with optimized item parameters.

Effect of daily stressors and collective efficacy on post-traumatic stress symptoms among internally displaced persons in post-war northern Sri Lanka.

Daily stressors have been shown to mediate the relationship of war trauma and trauma-related distress among refugees and internally displaced persons exposed to war and conflict. To examine the extent to which the relationship between war-related trauma and mental distress was mediated by daily stressors and collective efficacy among internally displaced communities a decade after exposure to war. In a cross-sectional study, we recruited a random sample of residents in villages severely affected by conflict in five districts in the Northern Province of Sri Lanka. Measures of war trauma, daily stressors, collective efficacy and post-traumatic stress symptoms (PTSS) were examined. Statistical analyses of the mediating and moderating effects of daily stressors were conducted using regression based methods. Daily stressors mediated the association of war trauma and PTSS, as both paths of the indirect effect, war trauma to daily stressors and daily stressors to PTSS, were significant. The predictive effect of war trauma on PTSS was positive and significant at moderate and high levels of daily stressors but not at low levels. Higher levels of neighbourhood informal social control, a component of collective efficacy, function as a protective factor to reduce effects of war trauma and daily stressors on mental distress in this population. Daily stressors are an important mediator in the well-established relationship between war exposure and traumatic stress among internally displaced persons, even a decade after the conflict. Mental health and psychosocial support programmes that aim to address mental distress among war-affected communities could reduce daily stressors and enhance collective efficacy in this context.

A longitudinal mediational investigation of risk pathways among cannabis use, interpersonal trauma exposure, and trauma-related distress.

College students are at high risk for cannabis use, interpersonal trauma (IPT) exposure, and trauma-related distress (TRD). Two phenotypic etiologic models posited to explain associations between cannabis use and trauma-related phenotypes are the self-medication (trauma/TRD → cannabis use) and high-risk (cannabis use → trauma/TRD) hypotheses. The primary objective of the present study was to investigate direct and indirect associations among cannabis use, IPT exposure, and TRD above and beyond established covariates. The current study used data from the first assessment (i.e., baseline survey at Year 1 Fall) and two follow-up assessments (i.e., Year 1 Spring and Year 2 Spring) from an ongoing longitudinal study on college behavioral health. Participants were 4 cohorts of college students (n = 9,889) who completed measures of demographics, substance use, IPT, and TRD. Indirect effects of IPT on cannabis through TRD (i.e., self-medication) and cannabis on TRD through IPT (i.e., high-risk), including tests of covariate effects (e.g., gender, age, race, cohort, alcohol, nicotine), were simultaneously estimated using a longitudinal mediation modeling framework. Results suggest that more IPT exposure increases risk for TRD and subsequent nonexperimental (use 6+ times) cannabis use, and that experimental (use 1-5 times) and nonexperimental cannabis use increases risk for IPT exposure and subsequent TRD. Both the self-medication and high-risk hypotheses were supported. Findings support a bidirectional causal relationship between cannabis use and trauma-related phenotypes. Additionally, results highlight areas for colleges to intervene among students to help reduce cannabis use and create a safer environment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Parental Preconception Posttraumatic Stress Symptoms and Maternal Prenatal Inflammation Prospectively Predict Shorter Telomere Length in Children.

Parental trauma exposure and trauma-related distress can increase the risk of adverse health outcomes in offspring, but the pathways implicated in intergenerational transmission are not fully explicated. Accelerated biological aging may be one mechanism underlying less favorable health in trauma-exposed individuals and their offspring. This study examines the associations of preconception maternal and paternal posttraumatic stress disorder (PTSD) symptoms with child telomere length, and maternal prenatal C-reactive protein (CRP) as a biological mechanism. Mothers ( n = 127) and a subset of the fathers ( n = 84) reported on PTSD symptoms before conception. Mothers provided blood spots in the second and third trimesters that were assayed for CRP. At age 4 years, children provided buccal cells for measurement of telomere length. Models adjusted for parental age, socioeconomic status, maternal prepregnancy body mass index, child biological sex, and child age. Mothers' PTSD symptoms were significantly associated with shorter child telomere length ( β = -0.22, SE = 0.10, p = .023). Fathers' PTSD symptoms were also inversely associated with child telomere length ( β = -0.21, SE = 0.11), although nonsignificant ( p = .065). There was no significant indirect effect of mothers' PTSD symptoms on child telomere length through CRP in pregnancy, but higher second-trimester CRP was significantly associated with shorter child telomere length ( β = -0.35, SE = 0.18, p = .048). Maternal symptoms of PTSD before conception and second-trimester inflammation were associated with shorter telomere length in offspring in early childhood, independent of covariates. Findings indicate that intergenerational transmission of parental trauma may occur in part through accelerated biological aging processes and provide further evidence that prenatal proinflammatory processes program child telomere length.Open Science Framework Preregistration:https://osf.io/7c2d5/?view_only=cd0fb81f48db4b8f9c59fc8bb7b0ef97 .

The psychosocial experience of traumatic birth in couples: an interpretative phenomenological study

ABSTRACT Background One-third of women report a psychologically traumatic event during birth; limited research exists on how couples experience and process self-reported traumatic birth. Aims and objectives This study aimed to examine the lived experience and psychosocial impact of traumatic birth in couples. Methods Interpretative Phenomenological Analysis was used to explore in-depth participants’ lived experience during and after traumatic childbirth. Four couples were recruited, from women experiencing vaginal deliveries in the public hospital system in Australia during the past 5 years. Women and men were interviewed individually. Results Three superordinate themes were identified: ‘Compassionless care’ (experiences of being dismissed, devalued and degraded by care providers), ‘Violation and subjugation’ (women’s bodies and birthing experiences being violated) and ‘Parenting after birth trauma’ (challenges in caring for a newborn following trauma and recovery from trauma). Discussion Couples described care providers’ actions as a major contributing factor to trauma experiences. Couples contextualised care in terms of under-resourced wards and perceived women were treated as a means to an end. Women and men both described feeling fearful, distressed and devalued. Following birth trauma, individual cognitive factors, such as negative self-evaluations and avoidance of the trauma memory interacted with family system to shape trauma-related distress. Conclusions Future research would benefit from highlighting the systemic context in which compassionless care occurs, and the family system in which trauma is experienced and processed. Findings reinforce that psychosocial safety must be considered in addition to physical safety for both women and men in maternity care practices.

Barriers to young people seeking help for trauma: A qualitative analysis of Internet forums.

Exposure to trauma is common in childhood and adolescence and is associated with significant psychopathology. Despite being amenable to treatment, many young people suffering trauma-related distress do not disclose or seek help. Multiple barriers to young people help seeking for mental health concerns have been identified, but very little research has focused on help seeking after trauma exposure. We undertook a qualitative analysis of Internet forums in which young people discuss trauma, aiming to understand the barriers preventing them from disclosing and seeking help offline. Posts about trauma written in 2016 from five Internet forums targeting young people were analyzed by thematic analysis. Barriers to offline help-seeking for trauma aligned with five key themes: questioning the validity of the trauma response; negative emotions and beliefs about the self; fear of a negative response; difficulties trusting others; and not thinking or talking about the trauma. Young people conceptualized many barriers as consequences of the trauma, such as avoidance of the trauma memory, and difficulties trusting others, indicating there are trauma-specific barriers to help-seeking. Understanding of, and attempts to minimize, these barriers may facilitate provision of services to vulnerable young people. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Forced social isolation and lockdown during the COVID-19 pandemic: depression, anxiety, trauma-distress and coping mechanisms of a Greek sample.

The COVID-19 outbreak escalated into a global pandemic, pushing many governments around the world to impose measures affecting all aspects of life. Similar to other countries, Greece adopted social restriction, lockdowns, and quarantines to reduce transmission from person-to-person. This cross-sectional study investigated the association between social restriction measures, an mental health and coping strategies employed by a Greek adult sample. An online questionnaire was used to collect data during the second national lockdown (February to May 2021). A total of 650 participants (M age 33.13, 71.5% female) comprised the final sample. The results show 21.3% of respondents reported moderate-to-extremely severe anxiety, 33% moderate-to-extremely severe depression, 31.8% moderate-to-severe stress, and 38% clinically significant trauma-related distress. Hierarchical linear regression analyses revealed that the strongest contributors to adverse mental health outcomes were being female, ofyounger age, experiencing increases in verbal arguments at home, being separated from family and close friends, and being unable to afford enough or healthy food. Lastly, participantsreported moving away from social support and into more individual strength and resilience-based coping strategies to cope with challenges. These findings suggest that in addition to the detrimental effects on physical health, social restriction measures related to COVID-19 also imposed a heavy psychological burden on the population via forced social isolation, which, by design, increased not only physical distancing but also psychological distancing between people. The online version contains supplementary material available at 10.1007/s10389-023-01907-3.

Longitudinal follow-up of the randomized controlled trial of access to the trauma-focused self-management app PTSD Coach

Apps that target posttraumatic stress are rarely evaluated and long-term examination of symptom change is rare. In a waitlist-controlled randomized controlled trial, we found that the Swedish version of the self-management app PTSD Coach confers benefits on posttraumatic stress and depressive symptoms after three months use. Here, we aimed to evaluate between-group effects on functional disability as well as within-group changes on mental health, somatic illness and functional disability after access to the Swedish PTSD Coach app during 9 months. In addition, we described negative effects, helpfulness and satisfaction with the app. Among the 179 trauma-exposed adults (92 % women) randomized to instant access or delayed access to PTSD Coach, symptoms of posttraumatic stress, depression, somatic illness and functional disability decreased and were maintained within 3 to 9 months of app access. Posttraumatic stress continued to improve during follow-up. PTSD Coach was considered slightly to moderately helpful and satisfactory and 43 % reported any negative effect related to using the app. PTSD Coach is an effective self-management intervention for trauma-related distress. Future research should investigate mechanisms of change, as well as individual characteristics that predict symptom reduction after access to PTSD Coach in order to inform clinical practice.

Evidence of a traumatic stress dimension of psychopathology among at-risk children living in Denmark

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative model of psychopathology. HiTOP proposes that trauma-related distress is a facet of Internalizing psychopathology, but recent evidence with young people suggests that it may reflect a unique dimension of psychopathology. This study assessed the latent structure of child and adolescent psychopathology to determine whether there is evidence of a unique ‘Traumatic Stress’ dimension, and how dimensions of psychopathology are associated with specific types of childhood adversity and trauma, and suicidal ideation and self-injurious behavior. Participants were children and adolescents aged 1–17 years (N = 1,800) who were in contact with the Danish child protection system due to suspected child abuse. Confirmatory factor analysis was used to determine the optimal latent structure of psychopathology, and structural equation modelling was used to determine how the dimensions of psychopathology were associated with different forms of trauma and adversity and suicidality/self-harm. The best fitting model included three factors of Internalizing, Externalizing, and Traumatic Stress. The Traumatic Stress dimensions was associated with older age, living outside of the family home, parental mental illness, higher levels of parental conflict, and the presence of domestic violence in the child’s home. The Traumatic Stress dimension was not associated with suicidality/self-harm. This study provides additional evidence of a distinct dimension of Traumatic Stress among young people. Further studies are needed to determine if these findings are replicable, particularly in older participants.

The Impact of Event Scale-Revised: Examining Its Cutoff Scores among Arab Psychiatric Patients and Healthy Adults within the Context of COVID-19 as a Collective Traumatic Event.

The Impact of Event Scale-Revised (IES-R) is the most popular measure of post-traumatic stress disorder (PTSD). It has been recently validated in Arabic. This instrumental study aimed to determine optimal cutoff scores of the IES-R and its determined six subscales in Arab samples of psychiatric patients (N = 168, 70.8% females) and healthy adults (N = 992, 62.7% females) from Saudi Arabia during the COVID-19 pandemic as a probable ongoing collective traumatic event. Based on a cutoff score of 14 of the Depression Anxiety Stress Scale 8-items (DASS-8), receiver operator curve (ROC) analysis revealed two optimal points of 39.5 and 30.5 for the IES-R in the samples (area under the curve (AUC) = 0.86 & 0.91, p values = 0.001, 95% CI: 0.80-0.92 & 0.87-0.94, sensitivity = 0.85 & 0.87, specificity = 0.73 & 0.83, Youden index = 0.58 & 0.70, respectively). Different cutoffs were detected for the six subscales of the IES-R, with numbing and avoidance expressing the lowest predictivity for distress. Meanwhile, hyperarousal followed by pandemic-related irritability expressed a stronger predictive capacity for distress than all subscales in both samples. In path analysis, pandemic-related irritability/dysphoric mood evolved as a direct and indirect effect of key PTSD symptoms (intrusion, hyperarousal, and numbing). The irritability dimension of the IES-R directly predicted the traumatic symptoms of sleep disturbance in both samples while sleep disturbance did not predict irritability. The findings suggest the usefulness of the IES-R at a score of 30.5 for detecting adults prone to trauma related distress, with higher scores needed for screening in psychiatric patients. Various PTSD symptoms may induce dysphoric mood, which represents a considerable burden that may induce circadian misalignment and more noxious psychiatric problems/co-morbidities (e.g., sleep disturbance) in both healthy and diseased groups.

"I Know Myself Again, Which Makes Me Motivated for Life": Feasibility and Acceptability of Using Experience Sampling Methods With Trauma-Exposed Sexual Minority Women.

Intensive longitudinal designs (e.g., experience sampling methods [ESMs]) hold promise for examining the dynamic interplay between daily adversity, coping strategies, and behavioral and mental health issues among marginalized populations. However, few studies have used intensive longitudinal designs with sexual minority women (SMW), an understudied and at-risk population. We assessed feasibility and acceptability of using once-daily, interval-contingent ESM with 161 trauma-exposed SMW (Mage = 29.1, SD = 7.57); 20.5% nonbinary; 32.3% queer; 52.2% people of color; 14.3% with annual incomes ≤$9,999; and 30.4% in Southern United States (U.S.). SMW completed one comprehensive online baseline assessment and once-daily brief online assessments for 14 days. Daily surveys assessed past-24-hour stressors, stress responses, and behavioral and mental health symptoms. At the end of the 14-day ESM period, SMW answered three open-ended questions about participating in this study and about research with SMW. Regarding feasibility, 151 participants (94.0%) initiated the post-baseline ESM study portion and 72 (45.0%) completed all 14 daily surveys. An average of 11.70 (median = 13, SD = 3.31) daily surveys (83.5%) were completed by those who initiated the ESM. ESM completion level varied by race/ethnicity and U.S. region. Qualitative acceptability data revealed several themes, namely that SMW (1) enjoyed participating and felt positively about the ESM experience, (2) felt supported to reflect on impacts of early and ongoing stressors, (3) appreciated the chance to self-reflect and challenge existing thought patterns and coping behaviors, (4) recognized their capacity to tolerate trauma-related distress, (5) recommended that researchers focus on SMW's diverse stressors and daily experiences, (6) wanted a rationale for providing sensitive information and more space to narrate their experiences, and (7) recognized the need for affirmative treatment and policies. Findings could inform modifications to ESM protocols to improve their feasibility and acceptability among trauma-exposed SMW and promote ongoing utility of this valuable method.

Risk for trauma-related distress following difficult childbirth: Trajectories of traumatic intrusions across 2 years postpartum.

There is heightened risk for maternal posttraumatic stress disorder (PTSD) during the perinatal period. However, it is unclear whether pregnancy and childbirth uniquely contribute to PTSD symptoms above and beyond elevations in negative affectivity that commonly occur among postpartum women (e.g., irritability, fatigue, depressed mood) and past trauma exposure. The present study explored the associations between childbirth stressors and trauma-related distress (TRD; intrusion and avoidance symptoms) across the 2years following childbirth in a community sample of women (n = 159). Maternal TRD was assessed at pregnancy and four additional timepoints across 2years postpartum. At pregnancy, mothers completed surveys measuring exposure to trauma and pregnancy-related anxiety. They also reported on pregnancy and childbirth complications across the first 6months postpartum. Consistent with predictions, labor/delivery complications uniquely predicted increased maternal intrusions during the first 6months postpartum above and beyond past trauma exposure. Furthermore, growth mixture models identified a subset of women with intrusion symptoms that persisted up to 2years postpartum and, on average, exceeded the screening threshold for PTSD. Women who experienced greater labor complications were more likely to exhibit this clinical profile relative to low, stable symptoms. Findings highlight the importance of ongoing screening for TRD across the first 2years postpartum, particularly among women who experience greater labor/delivery complications.

The impact of family income and parental factors on children's resilience and mental well-being.

Although there is robust evidence on the intergenerational transmission of trauma-related distress, much less is known about the relation of family income and parental resilience on the resilience and mental well-being of traumatized children. We aimed to determine the association between parental resilience and perceived financial stability, and the resilience and depression of their children among Syrian refugees in Jordan.We carried out a survey of 363 parent-child dyads from a refugee clinic in Northern Jordan. Measures of resilience, trauma, symptoms of mental illnesses, and demographics were reported by the mother and child. We evaluated the associations between parental resilience and their children's mental health.Resilience was highest among parents who reported that their income met their financial needs, (65.77 [standard deviation (SD) 15.96]), and lower for those who reported less income or who stated that their income met their needs only fairly well (62.77 [SD 17.56]). Resilience was lowest for those who reported that that income met their needs poorly (48.02 [SD 23.24]). Parent resilience was positively correlated with child resilience (β = 0.076 [95% confidence interval 0.035-0.12], p < 0.001). Depression and resilience of parents were most closely correlated with the depression and resilience scores of their children, among parents who reported the highest financial stability.Income plays a modifying role in the parent-child resilience and depression associations, with this association being least pronounced within those families who were financially less secure. These findings can help develop interventions to target parental transgenerational impacts according to income status.