Trauma-related Mental Health Problems Research Articles

Trauma therapies for psychosis: A state-of-the-art review.

Traumatic events, particularly childhood interpersonal victimisation, have been found to play a causal role in the occurrence of psychosis and shape the phenomenology of psychotic experiences. Higher rates of post-traumatic stress disorder (PTSD) and other trauma-related mental health problems are also found in people with psychosis diagnoses compared to the general population. It is, therefore, imperative that therapists are willing and able to address trauma and its consequences when supporting recovery from distressing psychosis. This paper will support this need by providing a state-of-the-art overview of the safety, acceptability and effects of trauma therapies for psychosis. We will first introduce how seminal cognitive-behavioural models of psychosis shed light on the mechanisms by which trauma may give rise to psychotic experiences, including a putative role for trauma-related emotions, beliefs and episodic memories. The initial application of prolonged exposure and eye movement and desensitation and reprocessing therapy (EMDR) for treating PTSD in psychosis will be described, followed by consideration of integrative approaches. These integrative approaches aim to address the impact of trauma on both post-traumatic stress symptoms and trauma-related psychosis. Integrative approaches include EMDR for psychosis (EMDRp) and trauma-focused Cognitive-Behavioural Therapy for psychosis (tf-CBTp). Finally, emerging dialogic approaches for targeting trauma-related voice-hearing will be considered, demonstrating the potential value of adopting co-produced (Talking with Voices) and digitally augmented (AVATAR) therapies. We will conclude by reflecting on current issues in the area, and implications for research and clinical practice.

A balancing act: how interpreters affect the therapeutic alliance in psychotherapy with trauma-affected refugees-a qualitative study with therapists.

The therapeutic alliance (TA) has the highest predictive value concerning the success of psychotherapy. The presented study aimed to explore how the presence of an interpreter affects the TA when working with trauma-affected refugees. Semi-structured interviews were conducted with seven psychologists working in an outpatient clinic specialized in mental health care for migrant and refugee patients with trauma-related mental health problems in Denmark. Interviews were transcribed verbatim and analyzed using a structuring content analysis approach. TA has been described as a dynamic therapist-interpreter-patient alliance triangle consisting of three distinct but highly intertwined and mutually influential dyadic alliances. Specific factors affecting the quality of the TA were identified, e.g., interpreter being emotionally attuned yet not overly involved; interpreter being barely visible yet present as a human being. Characteristics of trauma-affected refugee patients affecting the TA formation were also identified, e.g., a high level of personal distrust, different understandings of mental disorders and psychotherapy, stigmatization, perceptions of authorities. The presence of interpreters was perceived ambivalently and the formation of a good TA seems to be a balancing act. Based on the findings, recommendations for forming and maintaining a good TA in interpreter-mediated psychotherapy are provided.

Unaccompanied foreign minors and mental health: Implementation and evaluation of the RHS-15 screening procedure for unaccompanied foreign minors

Background and objectiveThe recent notable increase in refugees' flows, with refugee children and adolescents relocating worldwide, posed severe challenges to the different national healthcare systems. Social groups such as refugees fleeing from their countries because of persecution, wars and violence are considered at high risk of developing mental health-related problems. Despite international and national policies legally regulating the reception process and protecting health-related rights, including the mental well-being of refugee migrants, there is a theoretical and applied need for evidence-based instruments and procedures to support mental health within this population. Recent evidence refers to the Refugee Health Screener-15 (RHS-15) as a reliable and valid instrument for the early detection of trauma-related mental health problems. In this scenario, this study aimed to test the RHS screening process within a multidisciplinary first intervention reception context for unaccompanied refugee minors. DesignThe RHS-15 was administered with the support of cultural-linguistic mediators to 81 unaccompanied minor residents in a first intervention facility in Milan, Italy. This study aimed to assess psychometric characteristics, such as reliability, sensitivity and specificity feasibility and its implementation within a first intervention reception process. ResultsThe analysis resulted in the validation of the RHS in its 13-item format. The results highlighted and confirmed an efficient delivery, excellent reliability and a positive predictive and convergent validity of the 13-item version. Further analysis showed an excellent ability to avoid false negatives, although there was a clear tendency to identify false positives. ConclusionsThe early identification of vulnerabilities among refugee minors is recommended to promote their long-term overall well-being. Integrating the screening results with additional observational elements and more specific diagnostic tools is recommended to gain a comprehensive perspective of the minors’ well-being.

The effect of an integrated care intervention of multidisciplinary mental health treatment and employment services for trauma-affected refugees: study protocol for a randomised controlled trial

BackgroundThe complexity of past trauma and ongoing post-migration stressors challenges the existing mental health treatment for trauma-affected refugees. Therefore, interventions are needed to accommodate these complex challenges in mental health treatment. This study examines the effect of an add-on integrated care intervention compared to treatment as usual (TAU) for trauma-affected refugees in a randomised controlled trial (RCT).MethodsThe study is carried out at a Danish outpatient clinic and will include 197 treatment-seeking refugees with post-traumatic stress disorder (PTSD) who are unemployed and affiliated with municipal employment services. Mental health TAU comprises 10 sessions with a medical doctor (pharmacological treatment and psychoeducation) and 16–20 sessions with a psychologist (manual-based cognitive behavioural therapy) for a period of 8 to 12 months. The add-on intervention strengthens coordination between mental health treatment and employment interventions with three cross-sectoral collaborative meetings during the mental health treatment. The integrated care intervention draws attention to the bidirectional impact of mental health problems and post-migration stressors and focuses on cross-sectoral shared plans. The primary outcome is functioning, measured by WHODAS 2.0, the interviewer-administered 12-item version, with secondary outcomes measuring quality of life, mental health symptoms, and post-migration stressors.DiscussionThe RCT is novel in intervention design for trauma-affected refugees and will bring forward new perspectives and knowledge of integrated care interventions for trauma-affected refugees. The integrated care intervention is expected to reduce post-migration stressors that negatively affect the treatment of trauma-related mental health problems, thereby improving preconditions for enhanced treatment outcomes. The intervention builds on existing practices in the Danish healthcare and employment sectors, which ensures high scalability and sustainability for future practices.Trial registrationClinicalTrials.gov Identifier: NCT04244864, registered 28 January 2020. Protocol version: 17 September 2022, version 2.

Trauma bij ASS: valkuilen in diagnostiek en behandeling

Individuals with ASD have an elevated risk of exposure to potentially traumatic events. This does not only pertain to events meeting the DSM-5 PTSD A criterion for trauma such as assault and abuse but also to seemingly less shocking adverse events such as bullying. In clinical practice, PTSD and other trauma and stressor-related patterns of complaints often remain undetected and therefore untreated. A limiting factor is that it is not common use to systematically investigate a patient’s trauma history routinely. Further, trauma-related complaints show a lot of overlap with other disorders, in particular anxiety and mood disorders, as well as overlap with characteristics of ASD. In addition, until now validated assessment tools for trauma in individuals with ASD are missing. Finally, the application of standard trauma treatment protocols is often hindered by ASD-related problems. Research into the applicability and effectiveness of trauma treatment for ASD is still in its infancy. In this paper, research findings and clinical experiences regarding assessment and treatment of trauma in individuals with ASD are shared to contribute to the prevention of long-term serious trauma-related mental health problems and to underpin the need for further research on this topic.

Moral injury: the effect on mental health and implications for treatment

Moral injury is understood to be the strong cognitive and emotional response that can occur following events that violate a person's moral or ethical code.1Litz BT Stein N Delaney E et al.Moral injury and moral repair in war veterans: a preliminary model and intervention strategy.Clin Psychol Rev. 2009; 29: 695-706Crossref PubMed Scopus (818) Google Scholar Potentially morally injurious events include a person's own or other people's acts of omission or commission, or betrayal by a trusted person in a high-stakes situation. For example, health-care staff working during the COVID-19 pandemic might experience moral injury because they perceive that they received inadequate protective equipment, or when their workload is such that they deliver care of a standard that falls well below what they would usually consider to be good enough. Unlike post-traumatic stress disorder, which can occur following threat-based trauma, potentially morally injurious events do not necessarily involve a threat to life. Rather, morally injurious events threaten one's deeply held beliefs and trust. Moral injury is not considered a mental illness. However, an individual's experiences of potentially morally injurious events can cause profound feelings of shame and guilt, and alterations in cognitions and beliefs (eg, “I am a failure”, “colleagues don't care about me”), as well as maladaptive coping responses (eg, substance misuse, social withdrawal, or self-destructive acts). It is these challenged beliefs and altered appraisals that are thought to lead to the development of mental health problems, with a 2018 meta-analysis finding that exposure to potentially morally injurious events was significantly associated with post-traumatic stress disorder, depression, and suicidality.2Williamson V Stevelink SAM Greenberg N Occupational moral injury and mental health: systematic review and meta-analysis.Br J Psychiatry. 2018; 212: 339-346Crossref PubMed Scopus (92) Google Scholar Although exposure to potentially morally injurious events, and the moral injuries that followed, were initially examined in military personnel in combat settings,1Litz BT Stein N Delaney E et al.Moral injury and moral repair in war veterans: a preliminary model and intervention strategy.Clin Psychol Rev. 2009; 29: 695-706Crossref PubMed Scopus (818) Google Scholar moral injury is not limited by occupation. Studies increasingly show many professionals are exposed to potentially morally injurious events and the risk of moral injury, including journalists, police, and veterinarians, as well as military personnel.2Williamson V Stevelink SAM Greenberg N Occupational moral injury and mental health: systematic review and meta-analysis.Br J Psychiatry. 2018; 212: 339-346Crossref PubMed Scopus (92) Google Scholar In the context of the COVID-19 pandemic, moral injury has been found to be one of the greatest challenges reported by UK National Health Service frontline health-care staff and is significantly associated with post-traumatic stress disorder and depression.3Greenberg N Tracy D What healthcare leaders need to do to protect the psychological well-being of frontline staff in the COVID-19 pandemic.BMJ Leader. 2020; 4: 101-102Crossref Scopus (19) Google Scholar, 4Lamb D Gnanapragasam S Greenberg N et al.The psychosocial impact of the COVID-19 pandemic on 4,378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic.medRxiv. 2021; (published online Jan 22.) (preprint).https://doi.org/10.1101/2021.01.21.20240887Google Scholar Moral injury was also reported to be a key cause of distress for journalists during their coverage of the 2015 migrant crisis.5Feinstein A Pavisian B Storm H Journalists covering the refugee and migration crisis are affected by moral injury not PTSD.JRSM Open. 2018; 9: 1-7Crossref Google Scholar Nonetheless, moral injury remains a difficult concept to measure objectively because existing tools often have methodological problems or are not validated for use in non-military populations. Beyond the reported associations between potentially morally injurious events and mental health outcomes, studies have begun to examine what moral injury can mean for the person affected and how this type of experience can affect their daily functioning. Studies, largely from the USA, highlight how people with moral injury can undergo an existential crisis as a result of their experience.6Ames D Erickson Z Nagy A et al.Moral injury, religiosity, and suicide risk in U.S. veterans and active duty military with PTSD symptoms.Mil Med. 2019; 184: 271Crossref PubMed Scopus (18) Google Scholar Other studies show how moral injury can adversely affect the person's familial and occupational functioning, with many affected individuals reporting familial breakdown and unemployment due to their distress related to potentially morally injurious events and maladaptive coping responses.7Williamson V Murphy D Stevelink SAM Allen S Jones E Greenberg N The impact of trauma exposure and moral injury on UK military veterans: a qualitative study.Eur J Psychotraumatol. 2020; 111704554Crossref PubMed Scopus (12) Google Scholar Taken together, the international literature indicates that moral injury might be an important public health concern. Yet, no validated treatment for moral injury currently exists. Treating patients whose mental health problems are caused by moral injuries can be challenging for clinicians. Firstly, exposure-based approaches could be unhelpful or even harmful in cases of moral injury if inadequate attention is paid to emotional processing of feelings of shame and guilt. Secondly, many commonly used evidence-based treatments for trauma-related mental health problems (eg, trauma-focused cognitive behavioural therapy) often involve cognitive restructuring of a patient's erroneous, pathological, or distorted appraisals and their replacement with new and more adaptive appraisals of the self or the event. Such methods might not be effective or appropriate when treating patients whose shame and guilt arise from commission of transgressive acts of perpetration, rather than from erroneous appraisals.8Steinmetz S Gray M Treatment for distress associated with accurate appraisals of self-blame for moral transgressions.Curr Psychiatry Rev. 2015; 11: 207-219Crossref Scopus (10) Google Scholar For example, with a prison officer who seriously injured a detainee with undue force, it might be futile at best, or increase the likelihood of future perpetration at worst, for a clinician to challenge their accurate appraisals of wrongdoing. Approaches that focus on self-forgiveness, acceptance, self-compassion, and (if possible) making amends, might hold more promise. In cases in which the effects of moral injury extend beyond psychological to spiritual harms, spiritual care providers could have a role alongside mental health clinicians.9Carey LB Hodgson TJ Chaplaincy, spiritual care and moral injury: considerations regarding screening and treatment.Front Psychiatry. 2018; 9: 619Crossref PubMed Scopus (28) Google Scholar It is essential that clinicians who assess people exposed to potentially morally injurious events ask about moral injuries sensitively because otherwise patients might avoid talking about their experience or their altered beliefs for which they fear others might judge them.7Williamson V Murphy D Stevelink SAM Allen S Jones E Greenberg N The impact of trauma exposure and moral injury on UK military veterans: a qualitative study.Eur J Psychotraumatol. 2020; 111704554Crossref PubMed Scopus (12) Google Scholar In this regard, there is promising emerging evidence for some treatment approaches, such as adaptive disclosure and acceptance and commitment therapy, but these treatments have mainly been trialled in morally injured US military veterans.8Steinmetz S Gray M Treatment for distress associated with accurate appraisals of self-blame for moral transgressions.Curr Psychiatry Rev. 2015; 11: 207-219Crossref Scopus (10) Google Scholar As moral injury becomes increasingly recognised in other spheres, more evidence is needed to understand the extent of the problem across populations exposed to potentially morally injurious events and whether such treatment approaches are appropriate and effective for civilian, non-US populations. More consistent reporting of adverse events, treatment dropout, and long-term remission rates is needed for clinicians to be able to offer such treatments to patients with confidence. VW, DM, and NG had financial support from a Forces in Mind Trust grant ( FiMT17/0920E ) for the submitted work. NG was funded by the National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, a partnership between Public Health England, King's College London, and the University of East Anglia. The views expressed are those of the authors and not necessarily those of the NIHR, Public Health England, or the Department of Health and Social Care. The funders did not have a role in the drafting of the manuscript or the decision to submit for publication. The other authors declare no competing interests.

The social legacies of conflict: The mediating role of mental health with regard to the association between war exposure and social capital of Burundian refugees.

Objective: There is an often-hypothesized link between war exposure and social capital. Empirical studies testing this linkage, however, show mixed results. One potential influential factor that might explain these mixed results is impaired mental health, which includes a number of symptoms and behaviors that are associated with impaired social interactions. Method: To examine the influence of mental health on the relationship between war exposure and social capital, we used a mediation framework. Data were collected from 460 Burundian refugees in three Tanzania refugee camps. Result: Our results showed an overall positive effect of war exposure on social capital. In addition, war exposure may increase mental health problems (posttraumatic stress symptoms and general psychological distress), which in turn was related to a decline in social capital. Conclusions: Policymakers and scholars examining the consequences of war and armed conflict should consider not only the direct effects of war exposure but also the indirect effect of mental health impairments. Treating trauma-related mental health problems may not only improve individual well-being but may also improve social capital, influencing the livelihoods of entire communities affected by armed conflict.

A randomized controlled dismantling study of Visual Schema Displacement Therapy (VSDT) vs an abbreviated EMDR protocol vs a non-active control condition in individuals with disturbing memories

ABSTRACT Background: Visual Schema Displacement Therapy (VSDT) is a novel therapy for the treatment of fears and trauma-related mental health problems including PTSD. VSDT proved to be effective in reducing emotionality of aversive memories in healthy individuals in two previous randomized controlled trials and outperformed both a non-active control condition (CC) and an abbreviated version of EMDR therapy, a well-established first-line treatment for posttraumatic stress disorder. Objectives: In an effort to enhance the understanding concerning the efficacy of VSDT, and to determine its active components, a dismantling study was conducted in individuals with disturbing memories in which the effects of VSDT were tested against EMDR therapy, a non-active CC and three different VSDT-protocols, each excluding or altering a hypothesized active component. Method: Participants (N = 144) were asked to recall an emotional aversive event and were randomly assigned to one of these six interventions, each lasting 8 minutes. Emotional disturbance and vividness of participants’ memories were rated before and after the intervention and at one and four-week follow-up. Results: Replicatory Bayesian analyses supported hypotheses in which VSDT was superior to the CC and the EMDR condition in reducing emotionality, both directly after the intervention and at one week follow-up. However, at four-week follow-up, VSDT proved equal to EMDR while both treatments were superior to the CC. Concerning vividness the data also showed support for hypotheses predicting VSDT being equal to EMDR and both being superior to the CC in vividness reduction. Further analyses specifying differences between the abbreviated VSDT protocols detected no differences between these conditions. Conclusion: It remains unclear how VSDT yields its positive effects. Because VSDT appears to be unique and effective in decreasing emotionality of aversive memories, replication of the results in clinical samples is needed.

A qualitative assessment of psycho-educational videos for frontline COVID-19 healthcare workers in Mexico

Introduction. Frontline COVID-19 healthcare workers (FLHCWs) are at a high-risk of suffering occupational stress- and trauma-related mental health problems, including burnout and compassion fatigue (B&CF). Given the time limitations (due to their heavy workloads) and need to minimize face-to-face interventions (in order to avoid contagions), psychological interventions for FHCWs should be as brief and remote as possible. Objective. To evaluate the usability and clarity of evidence-based psycho-educational videos to prevent B&CF, to deal with uncooperative, hostile, and anxious patients and relatives, and to use personal protective equipment (PPE), from the perspective of Mexican FLHCWs. Method. Based on a convenience sampling by intensity approach, videos were distributed requesting feedback based on specific questions through WhatsApp to FLHCWs. Field notes were used to triangulate the information. Results. Content analysis of feedback from a final sample of 24 participants ‒75% women, 42 ± 8.4 years old‒ yielded three general thematic categories and seven subthemes: 1. content evaluation, which included three subthemes: utility, pertinence, and practicality; 2. dissemination and other needs, with two subcategories: willingness to share and receive more videos (other needs); and 3. format aspects, also comprising two subthemes: attractiveness and duration. All participants found the videos content very beneficial, relevant, and applicable to the workplace and even in their everyday personal and family life, and were willing to share them and to receive more videos on other issues, including strategies to manage problems related to isolation. Discussion and conclusion. Escalation of this remote preventive intervention to other COVID-19 centers and future similar epidemics is recommended.

Predictors of substance use in a clinical sample of youth seeking treatment for Trauma-related mental health problems

Child maltreatment and traumatic events are well established risk factors for adolescent substance use problems, but little is known about the unique contributions of etiological factors on trauma-exposed youths’ pre-treatment substance use in clinical settings. This study examined associations between substance use and risk and protective factors measured across multiple ecological levels among a unique sample of youth seeking treatment for trauma-related mental health problems in child advocacy centers. Participants were adolescents (N = 135; 85% female; 60% white, 31% black) aged 13–17 years (M = 15.4) with ≥ 1 experience of child maltreatment or other interpersonal violence, current substance use, and ≥5 PTSD symptoms. Youth and caregivers completed validated questionnaires and clinical interviews at a pre-treatment assessment in a randomized controlled trial of a treatment for co-occurring traumatic stress and substance use. Negative binomial regression models identified different patterns of risk and protective factors for alcohol and cannabis. Clinical implications of these results are discussed, including the potential targets for integrated psychotherapies that address co-occurring substance use and traumatic stress in youth.

To Increase Mental Health Literacy and Human Rights Among New-Coming, Low-Educated Mothers With Experience of War: A Culturally, Tailor-Made Group Health Promotion Intervention With Participatory Methodology Addressing Indirectly the Children.

Due to the increasing numbers of newcomers with impacts of war, civil war and persecution, at high risk of trauma-related mental health problems, there is a need for increase the poor mental health literacy (MHL) and human rights among the new-comers, especially low-educated mothers with children. This article aimed to present a case study report of several years’ experience of tailor-made group health promotion intervention. It describes as an example, a project during autumn 2018 in five municipalities of Sweden and in collaboration between academia, primary care, social welfare, police, and an NGO. Fifty-one women, Arabic- or Somalian speaking, with 1–7 children, mean age 40 years, low-educated and in average four years’ of living in Sweden participated. Under supervision, a local female member of the NGO coordinated the group meetings in Swedish with up to ten participants and the moderators were representatives of healthcare, social services and police/lawyer, with an interpreter present. Each intervention focused on human rights, health including mental health, psychosocial and parenting support, by using a 5-week group intervention a 2 h/week, totally 10 h excluding pre- and post-evaluation, and one language per intervention. Each meeting included 1-h lecture and after a short break with refreshments, the participants asked questions to the respective moderator. It was a mixed method but emphasis on qualitative design and participatory methodology with co-creation and evaluation of the intervention. The results showed that this tailor-made group intervention gave the participants empowerment and a sense of coherence, MHL and tools to deal with stress/anxiety, based on their needs that were mapped before in a pilot study during Spring 2018, indirectly addressing their children. However, they did not primarily talk about mental illness experience. It is vital that these interventions toward the target group with limited exposure to Western concepts (e.g., illness, anxiety, and trauma), may bridge the gap between Western and traditional cultural understanding of pre- and postmigration stress. In conclusion, MHL may be a function of both the cultural origin of the target group’s background and their resettlement in a Western reception country. Implications are discussed.

Gender differences in response to war-related trauma and posttraumatic stress disorder \u2013 a study among the Congolese refugees in Uganda

BackgroundThe wars in the Democratic Republic of Congo have left indelible marks on the mental health and functioning of the Congolese civilians that sought refuge in Uganda. Even though it is clear that civilians who are exposed to potentially traumatizing events in war and conflict areas develop trauma-related mental health problems, scholarly information on gender differences on exposure to different war-related traumatic events, their conditional risks to developing PTSD and whether the cumulative exposure to traumatic events affects men and women differently is still scanty.MethodsIn total, 325 (n = 143 males, n = 182 females) Congolese refugees who lived in Nakivale, a refugee settlement in the Southwestern part of Uganda were interviewed within a year after their arrival. Assessment included exposure to war-related traumatic events, and DSM-IV PTSD symptom severity.ResultsOur main findings were that refugees were highly exposed to war-related traumatic events with experiencing dangerous flight as the most common event for both men (97%) and women (97%). The overall high prevalence of PTSD differed among women (94%) and men (84%). The highest conditional prevalence of PTSD in women was associated with experiencing rape. The dose-response effect differed significantly between men and women with women showing higher PTSD symptom severity when experiencing low and moderate levels of potentially traumatizing event types.ConclusionIn conflict areas, civilians are highly exposed to different types of war-related traumatic events that expose them to high levels of PTSD symptoms, particularly women. Interventions focused at reducing mental health problems resulting from war should take the context of gender into consideration.

Mentalno zdravlje izbeglica, tražilaca azila i migranta - izazovi i primeri dobre prakse

In the past few years the number of refugees, migrants and asylum seekers worldwide has increased dramatically. Serbia, as a mainly transit country currently hosts over 6,000 new asylum-seekers and refugees, over 26.200 refugees and 198.500 internally displaced persons from the ex-Yugoslavia region, and 1.950 persons at risk of statelessness. Migrants are often under acute and chronic stress. Many of them were traumatized in their homelands and during their journey , due to persecution, violence, and human right violations, and they are confronted with ongoing stressors in the exile countries. Extensive research has shown increased rates and substantial variability in the prevalence of short-term and long-term mental health problems among refugees, asylum seekers and migrants. The most prevalent psychiatric disorders are depression, anxiety, prolonged grief, somatoform disorders, psychosis, substance use disorders, and disorders specifically related to stress, particularly posttraumatic stress disorder. It's urgent to offer a systemic and sustainable solutions for mental health protection, in order to reduce trauma related mental health problems and prevent long-term consequences. Multisectoral, evidence-based and multidisciplinary approach is recognized as crucial in identifying needs of these populations and enabling proper protection of their mental health and psychosocial wellbeing.

Community Case Study on Trauma-Specific Treatment and Counseling for Refugee Women Exposed to Intimate Partner Violence.

Women experiencing intimate partner violence (IPV) are at high risk to suffer from severe mental health consequences, such as posttraumatic stress disorder (PTSD) and depression. Refugee women being exposed to IPV in the country of arrival are an especially vulnerable and understudied group and post migration persistent IPV should not be underestimated. Hence, research on special requirements regarding the treatment of these women is needed. We describe two individual cases from our work with refugee women suffering from PTSD symptoms who experienced IPV representing our trauma-specific therapeutic approach targeting this population. By analyzing their personal and medical history as well as their interactions with several institutions of the public sector and counseling centers, we illustrate the possibilities and limitations when helping our clients dealing with trauma-related mental health problems following the experience of IPV. Furthermore, we formulate general recommendations for providing adequate therapeutic frameworks concerning special requirements for the work with refugee women.

Prevalence and co-existence of morbidity of posttraumatic stress and functional impairment among Burundian refugee children and their parents

ABSTRACT Background: Although the family constitutes the prime source of risk and resilience for the well-being of children growing up in adverse conditions, the mental health of children living in refugee camps has rarely been investigated in conjunction with their parents’ mental health. Objectives: To examine the prevalence of posttraumatic stress disorder (PTSD) and other mental health problems among Burundian refugee children and their parents living in Tanzanian refugee camps and to identify patterns of comorbidity among children and their parents based on PTSD symptom levels and functional impairment. Methods: We recruited a representative sample of 230 children aged 7–15 years and both of their parents (n = 690) and conducted separate structured clinical interviews. Latent Class Analysis was applied to identify patterns of comorbidity. Results: Children and parents were exposed to multiple traumatic event types. In total, 5.7% of children fulfilled DSM-5 criteria for PTSD in the past month and 10.9% reported enhanced levels of other mental health problems. 42.6% indicated clinically significant functional impairment due to PTSD symptoms. PTSD prevalence was higher among mothers (32.6%) and fathers (29.1%). Latent Class Analysis (LCA) revealed a familial accumulation of PTSD symptoms as children with high symptom levels and impairment were likely to live in families with two traumatized parents. Conclusions: Although the number of children who need support for trauma-related mental health problems was relatively low, taking into account parental trauma could aid to identify at-risk children with elevated PTSD symptom levels and impairment even in the face of existing barriers to mental health care access for children in refugee camp settings (e.g. lack of targeted services, prioritization of managing daily stressors).

Trauma- and Stressor-Related History and Symptoms Predict Distress Experienced during a Brief Mindfulness Meditation Sitting: Moving toward Trauma-Informed Care in Mindfulness-Based Therapy

The present study evaluated focused attention, affective response, and other subjective experiences during a mindfulness meditation exercise, relative to participant exposure to lifetime trauma, life stress experienced in the past year, and trauma-related symptoms experienced over the past month. Participants were recruited from a university introductory psychology course (n = 151). Meditation Breath Attention Scores (MBAS) were used to assess focused attention during a brief mindfulness meditation, and self-report questionnaires assessing subjective responses to the meditation were administered afterward. All participants completed self-report questionnaires assessing trauma exposure, life stress, and trauma-related symptoms prior to the meditation. Participant history of stressful and traumatic life events and trauma- and stressor-related symptoms that were assessed prior to the meditation were found to be predictive of distress experienced during the meditation. We conclude that mindfulness meditation-based therapy for persons with trauma-related mental health problems should be trauma-informed. Limitations of the study and future research directions are discussed.

The relationship between adolescent refugees’ attachment patterns and their experiences of trauma

ABSTRACTNearly half of all young refugees experience trauma-related mental health problems. However, protective factors, such as attachment style, may mitigate the impact of traumatic events. This study explores the relationship between adolescent refugees’ traumatic experiences and their Adult Attachment Inventory classifications. Attachment and trauma data were gathered from 37 refugee youths resettled in the United States. Results suggest refugees who are securely attached may have greater resilience in the face of traumatic events than refugees with insecure or disorganized attachment styles. Future research should further explore links between adolescent refugee attachment and resiliency in the face of traumatic experiences.

Innovations in digital interventions for psychological trauma: harnessing advances in cognitive science.

A range of digital psychological interventions have demonstrated a positive impact on trauma-related problems in controlled trials, but there is room for further improvements in their form, reach and impact. Most to date have been adaptions of established face-to-face treatments. In this paper, we highlight a complementary emerging route to their development, which draws on advances in cognitive science theory and research and applies them to clinical contexts. Three examples are given regarding laboratory research with potential applications to digital interventions for trauma-related mental health problems: a digital game to reduce intrusive memories of trauma, novel cognitive techniques for worry, and digitally supported mental imagery to enhance motivation for functional behavior change. Much of this research is still at an early stage, meriting a balance of optimism and caution. However, even if only a few digital applications of cognitive science constitute substantial improvements to complement current treatments, their potential for large-scale use at low unit cost may provide significant benefits across populations.

Recent approaches to provision of mental healthcare in refugee populations.

The present review provides an overview of key issues and concepts on the provision of mental healthcare to refugees with mental health conditions. Several barriers to mental healthcare for refugees have been described, and principles for good mental care in this group have been framed. Evidence for specific interventions for refugees is available for trauma-related mental health problems. The best evidence is available for psychosocial interventions for the treatment of posttraumatic stress disorder. The worldwide increase in the number of refugees and the substantial burden of psychological distress and mental health problems associated with this condition has led to an increased research and policy interest for optimizing the provision of effective mental healthcare. To date, with the exception of trauma-related conditions, there is almost no evidence on the efficacy of psychosocial interventions for anxiety and depressive conditions, and there is no information on how mental healthcare should be embedded into existing health and social care services. Existing research and implementation activities will hopefully contribute to better characterize the effective components and elements of mental healthcare programmes for refugees.

Trauma-related mental health problems and effectiveness of a stress management group in national humanitarian workers in the Central African Republic

The aim of this study is to assess the levels of anxiety, depression and post-traumatic stress disorder (PTSD) in national aid workers in Central African Republic as well as to evaluate the effectiveness of a stress management group in reducing those symptoms. Twenty-seven stress management groups were evaluated in two international non-governmental organisations in which 197 national humanitarian aid workers took part. There was a significant decrease in the intensity of every psychopathological variable tested despite a decrease in the sample between the pre- and post-tests. At post-test, 8.1, 5.1 and 11.1% of the participants had scores indicating anxiety, depression and PTSD compared to 25, 18.9 and 26% at pre-test. The group intervention has demonstrated to be a realistic, effective and cost-effective way to respond to mental health problems in national aid workers living in a context of ongoing violence and where access to specialised services is extremely limited. Key implications for practice Documenting the mental health of national humanitarian staff working in unsecure environment in Central African Republic A one session stress management group protocol can reduce the levels of anxiety, depression and PTSD in this population and hence demonstrating that it is feasible and cost-effective for organizations to honour their duty of care towards national humanitarian workers Further research is needed to confirm these preliminary results, especially in other cultural and humanitarian contexts.