Trauma Response Research Articles

A Call for Mental Health Treatment in Incarcerated Settings with Transgender Individuals

The U.S. correctional system has become the epicenter for public health and mental health crisis. This article discusses literature documenting incarcerated transgender individuals’ mental health treatment. The severity of mental illness treatment issues within the system amongst transgender and other LGBTQ + individuals, clearly displays the need for interventions tailored to this population. Recommended interventions are centered around post traumatic response and cater to those who exist in marginalized populations with consideration given to the significance of family strain and support. Overall, there is a need for a shift in mindset and available services to treat incarcerated transgender individuals.

Historical Trauma, Race-based Trauma and Resilience of Indigenous Peoples: A Literature Review

This literature review examines the various responses to trauma suffered by Indigenous peoples as a result of governmental policies geared towards assimilation. Both traumatic and resilient responses are demonstrated at the individual, family and community levels. Much of the research that has been done in the United States to develop theories around historical trauma and race-based traumatic stress may also be applied to Canada’s First Nations due to similar histories of oppression and colonization. Overall, the research finds that self government and a connection to culture and spirituality result in better outcomes for Indigenous peoples.

Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals.

Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.

Trauma‐Informed Interventions in Parent–Child Contact Cases

Parent–child contact problems may arise in the context of high conflict separation/divorce dynamics between parents. In cases where there are parent–child contact problems and children resist or refuse contact with one of their parents, there may also be incidents of child maltreatment, intimate partner violence, or compromised parenting that can be experienced by a parent or child as traumatic. The circumstances around separation and/or post‐divorce often result in intense stress for families. In this paper we distinguish between the stressful circumstances that may arise as a result of high interparental conflict and pulls for alignment from a parent, and the real or perceived trauma as a factor which contributes to resistance or refusal of a child to have contact with a parent. Interventions to address both trauma responses and the resist‐refuse dynamics are differentiated and discussed. After screening and assessment, the intent is to treat trauma responses with short‐term, evidence‐based therapy, either before or concurrent with co‐parent and family intervention.

Experimental study on the relationship between traumatic stress and tumor growth, proliferation, and metastasis*

Abstract Objective This study aimed to investigate the relationship between traumatic stress and tumor growth, proliferation, and metastasis. Methods A scalding method was used as an injurious factor to induce traumatic stress in Wistar rats. The rats were randomly divided into three groups—the control group, mild-scald group, and severe-scald group, with 14 rats in each group. Wistar rats were used to subculture the Walker-256 cell line for the generation of tumor ascites. Tumor cells from the ascites were cultured and used to establish a rat subcutaneous xenograft model. After 7 days, the mild-burn group and the severe-burn group were subjected burns to 10% and 15% of their backs, respectively. Blood was taken from the tail vein of rats at different times to detect changes in blood cortisol, IL-1β, and TNF-α levels. Pathological specimens were collected 14 days later, and immunohistochemistry was performed to examine vascular endothelial growth factor (VEGF), proliferating cell nuclear antigen (PCNA), E-cadherin, and vimentin. Results Cortisol, IL-1β and TNF-α levels were significantly higher in the scalding groups than in the control group. Tumor examination was performed after 14 days. The changes in tumor size showed that the tumor volume in the control group (0.593 ± 0.195 cm3) and the mild-scald group (0.782 ± 0.344 cm3) were not significantly different. However, the tumor volume was significantly larger in the severe-burn group (1.806 ± 0.838 cm3) than in the control and the mild-burn groups(P < 0.05). Tumor tissue immunohistochemistry showed that the percentage of cells expressing PCNA in the control group, mild-scald group, and severe-scald group was 57.1%, 71.4% and 85.7%, respectively, and the differences among the groups were statistically significant. The number of VEGF-positive cells in the mild- and severe-scald groups was significantly higher than those of the control group (P < 0.05). The number of E-cadherin-positive cells in the tumor tissues was significantly lower in the severe-scald group than that in the control and mild-scald groups. Vimentin showed the opposite trend in the tumor tissue, and the differences were statistically significant (P < 0.05). Conclusion Different degrees of a traumatic response in tissues caused by scalding can cause a corresponding stress response in the body. The release of inflammatory mediators; increase in VEGF, PCNA and vimentin in the tumor tissue; and decrease in E-cadherin lead to a change in tumor tissue growth and metastasis. Traumatic stress is associated with tumor growth, proliferation, and metastasis.

Before, during and after: Trauma-informed care in burns settings.

Trauma-informed care (TIC) is a model for the relationship of care between service users and service providers that recognises the importance of trauma, past and present, on that person's experiences, vulnerabilities and recovery. Burn injuries are a complex area of healthcare where trauma and the mental health disorders associated with trauma can both precede and proceed a burns injury with complications for recovery. Incorporating a model of TIC in the assessment and treatment of burns patients will proactively work to mitigate and arrest trauma responses, mental disorders and their sequelae in this population. With reference to the existing TIC knowledge base, we propose development of a model for the TIC of burns patients divided into three stages; before, during and after initial engagement with the patient. In the before stage, TIC will require clinical-level change, organisational integration, training and time. In the during stage, five elements are identified; creating safety, screening, collaborative inclusion of the patient in the intervention and recovery planning process, psychoeducation of the patient and supporters, and the use of peer-led services. In the after stage, patients need to be proactively supported through outreach and follow-up. Implementation of a trauma-informed model of care for burns injury patients provides significant opportunities to burns services and benefits towards their patients' recovery.

Public School Preparedness for School Shootings: A Phenomenological Overview of School Staff Perspectives

Public school trauma responses to school shootings in the USA would benefit from a greater focus on trauma intervention in the aftermath of a shooting. The current research explored school staff attitudes toward public school trauma response after school shootings. This phenomenological study was conducted with 12 public school staff members with school shooting experience through convenience sampling. Data were collected through semi-structured interviews with questions about public school responses to trauma following a school shooting. Findings indicated school staff concerns related to public school trauma response to school shootings were categorized by four major themes: trauma intervention, perception of support, unintended negative consequences, and barriers to trauma intervention. Reflections of school staff offer insight into where the public schools can begin to more adequately address the needs of students and faculty members who have also survived school shootings.

Development of an international data repository and research resource: the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive

ABSTRACT Background: Studies that identify children after acute trauma and prospectively track risk/protective factors and trauma responses over time are resource-intensive; small sample sizes often limit power and generalizability. The Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive was created to facilitate more robust integrative cross-study data analyses. Objectives: To (a) describe creation of this research resource, including harmonization of key variables; (b) describe key study- and participant-level variables; and (c) examine retention to follow-up across studies. Methods: For the first 30 studies in the Archive, we described study-level (design factors, retention rates) and participant-level (demographic, event, traumatic stress) variables. We used Chi square or ANOVA to examine study- and participant-level variables potentially associated with retention. Results: These 30 prospective studies (N per study = 50 to 568; overall N = 5499) conducted by 15 research teams in 5 countries enrolled children exposed to injury (46%), disaster (24%), violence (13%), traffic accidents (10%), or other acute events. Participants were school-age or adolescent (97%), 60% were male, and approximately half were of minority ethnicity. Using harmonized data from 22 measures, 24% reported significant traumatic stress ≥1 month post-event. Other commonly assessed outcomes included depression (19 studies), internalizing/externalizing symptoms (19), and parent mental health (19). Studies involved 2 to 5 research assessments; 80% of participants were retained for ≥2 assessments. At the study level, greater retention was associated with more planned assessments. At the participant level, adolescents, minority youth, and those of lower socioeconomic status had lower retention rates. Conclusion: This project demonstrates the feasibility and value of bringing together traumatic stress research data and making it available for re-use. As an ongoing research resource, the Archive can promote ‘FAIR’ data practices and facilitate integrated analyses to advance understanding of child traumatic stress.

There's Nothing Broken. You've Had a Whiplash, That's It: A Qualitative Study of Comorbid Posttraumatic Stress Disorder and Whiplash Associated Disorders.

Posttraumatic stress disorder (PTSD) symptoms are common in chronic Whiplash associated disorders (WAD) and have been found to be associated with higher levels of pain and disability. Theoretical frameworks have suggested that PTSD and pain not only coexist, but also mutually maintain one another. Although the comorbidity has been subject to increasing quantitative research, patients' experiences of the comorbidity and symptom interaction remain largely uninvestigated using qualitative methods. The present study set out to explore the potential relationship of PTSD and pain in people with WAD and properly assessed PTSD after motor vehicle accidents. A qualitative explorative study of eight individual face-to-face semistructured interviews were conducted. Interviews were recorded and transcribed verbatim and analyzed using framework analysis. Through the analysis, we developed three overarching themes. The first theme illustrated the complex and burdensome comorbidity with overlapping and transdiagnostic symptoms, whereas the second theme highlighted how several circumstances, some related to the health care system, could extend and amplify the traumatic response. The final theme illustrated symptom associations and interactions, particularly between pain and PTSD, both supporting and rejecting parts of the mutual maintenance framework. These findings underlined the great complexity and variability of the comorbidity and the traumatic event, but also emphasized how experiences of psyche and soma seem closely connected in these patients. The results provide support for the importance of thorough assessment by multidisciplinary teams, minimizing distress post-injury, and a critical approach to the idea of mutual maintenance between pain and PTSD.

How to Stop the Bleed: First Care Provider Model for Developing Public Trauma Response Beyond Basic Hemorrhage Control.

IntroductionSince 2013, the First Care Provider (FCP) model has successfully educated the non-medical population on how to recognize life-threatening injuries and perform interventions recommended by the Committee for Tactical Emergency Casualty Care (C-TECC) and the Hartford Consensus in the disaster setting. Recent programs, such as the federal “Stop The Bleed” campaign, have placed the emphasis of public training on hemorrhage control. However, recent attacks demonstrate that access to wounded, recognition of injury, and rapid evacuation are equally as important as hemorrhage control in minimizing mortality. To date, no training programs have produced a validated study with regard to training a community population in these necessary principles of disaster response.MethodsIn our study, we created a reproducible community training model for implementation into prehospital systems. Two matched demographic groups were chosen and divided into “trained” and “untrained” groups. The trained group was taught the FCP curriculum, which the Department of Homeland Security recognizes as a Stop the Bleed program, while the untrained group received no instruction. Both groups then participated in a simulated mass casualty event, which required evaluation of multiple victims with varying degree of injury, particularly a patient with an arterial bleed and a patient with an airway obstruction.ResultsThe objective measures in comparing the two groups were the time elapse until their first action was taken (T1A) and time to their solution of the simulation (TtS). We compared their times using one-sided t-test to demonstrate their responses were not due to chance alone. At the arterial bleed simulation, the T1A for the trained and untrained groups, respectively, were 34.75 seconds and 111 seconds (p-value = .1064), while the TtS were 3 minutes and 33 seconds in the trained group and eight minutes in the untrained groups (physiologic cutoff) (p-value = .0014). At the airway obstruction simulation, the T1A for the trained and untrained groups, respectively, were 20.5 seconds and 43 seconds (p-value = .1064), while the TtS were 32.6 seconds in the trained group and 7 minutes and 3 seconds in the untrained group (p-value = .0087). Simulation values for recently graduated nursing students and a local fire department engine company (emergency medical services [EMS]) were also given for reference. The trained group’s results mirrored times of EMS.ConclusionThis study demonstrates an effective training model to civilian trauma response, while adhering to established recommendations. We offer our model as a potential solution for accomplishing the Stop The Bleed mission while advancing the potential of public disaster response.

Dewey’s Theory of Experience, Traumatic Memory, and Music Education

Trauma’s ubiquity in society leads to an acknowledgement that damaging experiences likely affect more students than they leave untouched. Dewey acknowledged the importance of the past throughout his theorizing of experience and simultaneously recognized that students need to draw upon past experiences in new learning encounters. In this paper, we argue that Dewey may have opened the door to account for the possibility of traumatic experience affecting learning. We acknowledge the potential of music to prompt a trauma response and seek to explore ways that music education may also provide a mechanism for working through difficult and traumatic pasts.

Fibrinolysis and the Immune Response in Trauma.

It has long been known that the fibrinolytic system becomes activated following trauma. At first glance, this is not at all surprising and would appear to be in response to coagulation and the apparent need to remove blood clots and restore blood flow. However, in a bleeding patient, the opposite is what is actually needed. Therefore, one may ask why the fibrinolytic system gets activated in the first place or is there another purpose? Or is it that the waxing and waning of hemostasis in such severely injured patients creates a "moving target" such that the fibrinolytic system itself is constantly responding to changing circumstances? Depending on the injury modalities and the time point post injury, the fibrinolytic system could be either turned on or off. Various theories now abound that offer new insights into the turmoil and paradoxes associated with the fibrinolytic system in this unique setting and the use of antifibrinolytic agents. While this presents one conundrum, there is also another dimension to add to this discussion that has nothing to do with hemostasis per se but rather with the modulation of other critical processes that are also essential for optimal recovery following severe injury. Indeed, overwhelming data are now supporting an important role of the fibrinolytic system in the removal of necrotic tissue (mortolysis) and as a modulator of the innate immune response. Therefore, what is really going on when the fibrinolytic system decides to go into overdrive and generate plasmin, albeit even briefly after a traumatic event? Moreover, what other consequence may occur when antifibrinolytic agents are administered? This review will address this developing story and will outline a hypothesis that places the fibrinolytic system as a gateway to a myriad of processes that are not only linked to fibrin removal but are also broader players in the modulation of innate immunity.

Applying trauma systems concepts to humanitarian battlefield care: a qualitative analysis of the Mosul trauma pathway

BackgroundTrauma systems have been shown to save lives in military and civilian settings, but their use by humanitarians in conflict settings has been more limited. During the Battle of Mosul (October 2016–July 2017), trauma care for injured civilians was provided through a novel approach in which humanitarian actors were organized into a trauma pathway involving echelons of care, a key component of military trauma systems. A better understanding of this approach may help inform trauma care delivery in future humanitarian responses in conflicts.MethodologyA qualitative study design was used to examine the Mosul civilian trauma response. From August–December 2017, in-depth semi-structured interviews were conducted with stakeholders (n = 54) representing nearly two dozen organizations that directly participated in or had first-hand knowledge of the response. Source document reviews were also conducted. Responses were analyzed in accordance with a published framework on civilian battlefield trauma systems, focusing on whether the response functioned as an integrated trauma system. Opportunities for improvement were identified.ResultsThe Mosul civilian trauma pathway was implemented as a chain of care for civilian casualties with three successive echelons (trauma stabilization points, field hospitals, and referral hospitals). Coordinated by the World Health Organization, it comprised a variety of actors, including non-governmental organizations, civilian institutions, and at least one private medical company. Stakeholders generally felt that this approach improved access to trauma care for civilians injured near the frontlines compared to what would have been available. Several trauma systems elements such as transportation, data collection, field coordination, and post-operative rehabilitative care might have been further developed to support a more integrated system.ConclusionsThe Mosul trauma pathway evolved to address critical gaps in trauma care during the Battle of Mosul. It adapted the concept of echelons of care from western military practice to push humanitarian actors closer to the frontlines and improve access to care for injured civilians. Although efforts were made to incorporate some of the integrative components (e.g. evidence-based pre-hospital care, transportation, and data collection) that have enabled recent achievements by military trauma systems, many of these proved difficult to implement in the Mosul context. Further discussion and research are needed to determine how trauma systems insights can be adapted in future humanitarian responses given resource, logistical, and security constraints, as well as to clarify the responsibilities of various actors.

Outcomes of Participation in a Service Dog Training Program for Veterans with PTSD

Abstract Canine-assisted interventions have emerged as an increasingly popular means to engage and assist veterans coping with military-associated trauma responses. The present study evaluates the use of a 14-week service dog training program for these trauma-impacted veterans. The service dog program guides veterans in small group cohorts on how to train their own dog to be their personal service animal. All 71 veterans participating in this investigation had been diagnosed with PTSD. Fifty-five veterans (77%) finished the entire 14-week program and took all pretests and posttests. Compared to pretest scores, participants reported significant decreases in self-disturbance, posttraumatic stress, externalization, and somatization after completing the program. Participants experienced significant reductions in a broad scope of psychological impacts associated with their PTSD including interpersonal difficulties and suicidality. Findings provide evidence that service dog training programs may be an effective therapeutic alternative to traditional approaches that PTSD-impacted veterans are willing to utilize.

Wer schreibt Geschichte? Ein kulturelles Trauma und seine Träger im Jeremiabuch

Abstract In a chorus of voices, the book of Jeremiah commemorates Jerusalem’s destruction by the Babylonians as an event that generated traumatic responses. Jer 40-44 narrates the story of the Judean survivors who flee to Egypt after the murder of the Babylonian governor Gedaliah. This article uses the theory of “cultural trauma”, defined by an international group of sociologists around Jeffrey C. Alexander, as a heuristic tool for analyzing Jer 40-44, especially the description of perpetrators and victims, and the conflicting interpretations of history. It aims at demonstrating why and in what way the perspective of the Babylonian golah prevails in the book of Jeremiah, which as a whole presents a master narrative about Judah’s cultural trauma.

Reconceptualizing the U.S. Military’s Transition Assistance Program: The Success in Transition Model

This article describes and proposes the Success in Transition Model as a guiding framework for a reconceptualized Transition Assistance Program (TAP) to support U.S. military members as they leave the service. Key groups of veterans have ongoing difficulties adjusting to civilian settings after their time in the service. Even with recent changes, the current TAP has a narrow focus of primarily aiding members to prepare for finding post-military employment, education, and benefits. Little attention is given to other key areas of their functioning such as adjusting to their new work/educational/cultural settings, meeting family transition needs, financial management issues, procuring housing, dealing with trauma responses, or assuring that veterans truly obtain the benefits and support they need. This new model addresses key flaws with the current TAP and is grounded in human and military transition theories and research into optimal ways to foster improved outcomes for transitioning military members.

Cultural Appropriation and Substance Use Disorder: A Case Report

A 16 year old Caucasian male presented for initial mental health visit at an outpatient community psychiatry clinic. Two years prior, he found his father dead after overdosing on heroin. Since this time, he has been involved in numerous altercations with peers. He began using high doses of alprazolam daily after his father’s death. He adopted an urban culture and changed his body language, style of clothing and vernacular. His behavioral changes and substance use after his father’s death is due to psychological, sociological and biological factors, which are explored in this case report. Psychosocial factors include peer and parental mimicry along with attachment styles and biological causes include epigenetics relationship to post traumatic stress disorder responses.

Breaking the Cycle of Trauma – Koori Parenting, What Works for Us

Objective:To develop an understanding of parenting strategies used by Aboriginal Australian parents impacted by colonisation and other forms of adversity to break cycles of trauma within families.Design:“Yarning circles” involving qualitative interviews with six Aboriginal parents were conducted. Parents who identified as having experienced childhood histories of trauma and historical loss were asked about parenting strategies that helped them to break cycles of intergenerational trauma. Interviews were transcribed and independently coded by Aboriginal and non-Aboriginal psychologists who worked for an Aboriginal Community Controlled Health Organisation.Results:Parents identified over 100 strategies associated with parenting and breaking cycles of trauma. Some strategies aligned well with research on the protective effects of safe, stable, nurturing relationships. Other strategies focused upon domains of culture, community, and history, and addressed issues such as family violence, colonisation, and the intergenerational links between trauma and parenting. The strategies were collated into a community resource that could be used by other Aboriginal parents.Conclusion:Parental histories of colonisation and interpersonal and intergenerational trauma can have a significant impact on kinship networks and community environments that Aboriginal parenting practices are embedded within. Parents who identified with having managed to break cycles of trauma reported using a wide range of successful parenting strategies. These strategies serve a diversity of functions, such as parenting approaches that aim to directly influence children’s behaviour and foster wellbeing, manage family and community conflict, and manage parental histories of trauma and trauma responses in ways that mitigate the impact on their children.

Sources of functioning, symptoms of trauma, and psychological distress: A cross-sectional study with Palestinian health workers operating in West Bank and Gaza strip.

Health-care workers operating in conflict zones are at severe risk of psychological consequences, given their extended exposure to traumatic events under conditions of stress and violence. This quantitative, cross-sectional study was designed to explore the relationships between personal resources (sources of functioning)-operationalized as sense of coherence, posttraumatic growth, and perceived well-being-psychological distress, and trauma symptoms in a specific population of health workers exposed to war and violence. Palestinian health professionals (N = 181) completed quantitative measures of well-being, posttraumatic growth, sense of coherence, psychological distress, and traumatic response. The data were analyzed using structural equation modeling (SEM). The outcomes suggest that sources of psychological functioning consistently play a role in the mental health of different types of health professionals. Health-care workers in an environment characterized by instability and ongoing risk need to protect their own mental health by mobilizing sources of resistance and resilience, such as a sense of coherence, subjective well-being, and growth. We discuss the clinical implications of these findings and offer recommendations for training and supervision. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Influence of lithium chloride on the apoptosis of endotheliocytes in systemic inflammatory response syndrome in patients with severe multiple injury. A retrospective study

Objectives. The goal is to study the effect of lithium chloride on the intensity of endotheliocytes apoptosis in a monolayer in vitro under the action of blood serum of patients with the syndrome of systemic inflammatory response in severe multiple trauma. Materials and methods. We used toxic blood serum of 5 patients with severe multiple trauma. As controls we used blood serum of 5 healthy donors. In different series of the experiment EA.hy926 endothelial cells were incubated with blood serum of a healthy person (control), with blood serum of patients with systemic inflammatory response syndrome in severe multiple trauma. Lithium chloride was added to the cell samples at final concentrations of 0.01, 0.1, 1, 10 mmol/L. After incubation the cells were removed with trypsin-versen solution fixed with 70 % ethanol and stained with propidium iodide. Cells containing fragmented genomic DNA were analyzed by flow cytometry. Results. It was revealed that toxic serum suppressed GSK-3β phosphorylation in endotheliocytes and also caused the splitting of VE-cadherin, a decrease in the amount of claudine and actin, initiating the destruction of intercellular contacts of the endothelial monolayer and apoptosis of endotheliocytes. Incubation of a monolayer of endotheliocytes with lithium chloride at a concentration of 1.0 mmol/l and higher almost completely prevented the dismantling of claudine, actin and VE-cadherin, and also reduced the intensity of apoptosis of endotheliocytes by more than 2 times. It was found that preincubation with lithium chloride at a concentration of 1 mmol/L not only prevented the inactivation of GSK-3β, but even stimulated its phosphorylation. Conclusion. Lithium chloride prevents the dismantling of claudine and VE-cadherin in the intercellular contacts, reduces the number of apoptotic cells in the monolayer of the endothelial cells of the EA.hy926 line under the action of the blood serum of patients with a systemic inflammatory response syndrome in severe multiple trauma, which may indicate a protective effect of the drug on endothelial barrier. The results of this investigation suggest that the protective effect of lithium chloride on endothelium is realized via GSK-3β phosphorylation.