Evaluating narrative exposure therapy for post-traumatic stress disorder and depression symptoms: A meta-analysis of the evidence base.

Narrative exposure therapy (NET) is an intervention for trauma spectrum disorders. Originally developed to treat refugee populations, NET has since been tested for efficacy across different settings. In this review, the NET evidence base is examined through a retrieval, synthesis and appraisal of randomized controlled trials (RCTs) published since 2002. Two independent reviewers (S. R. and N. S.) searched online databases including EMBASE, PsycINFO and PubMed. Twenty-four RCTs were selected for a meta-analysis of three outcomes: post-traumatic stress disorder (PTSD) diagnosis and PTSD and depression symptoms. All outcomes were analysed at short-term (3-4 months), midterm (6-7 months) and long-term (≥12 months) data points. A random-effects model was applied to yield standardized mean differences (SMDs) and odds ratios (ORs) as indicators of NET treatment effect. Subgroup analyses for type of trauma and type of control groups were conducted to examine potential heterogeneity. For the NET group, moderate effect sizes for PTSD symptom severity were observed at midterm and long term and at midterm for depression symptom severity. The number of PTSD diagnoses decreased significantly in the short term for the NET condition, but this was not sustained at the long term. Caution must be exercised when interpreting these results due to high heterogeneity estimates and low quality of evidence across trials. Potential small-study effects further complicate the interpretation of the findings. Recommendations are made for augmenting statistical significance research with qualitative analyses of NET efficacy to better inform clinical practice.

Psychological support for orthognathic patients: Who is doing what?

OBJECTIVE: To investigate: (1) orthodontists' training experience in the psychological assessment of orthognathic patients and their wish for training/further training; (2) the availability of psychological support, referral patterns and outcomes after referral; (3) and adverse incidents prompting orthodontists to refer patients for psychological assessment. DESIGN: Prospective cross-sectional study. METHODS: A 25-item questionnaire was designed to investigate the above mentioned aims. After a pilot study, the questionnaire was distributed to all members of the Consultant Orthodontist Group, British Orthodontic Society. RESULTS: Based on a 29.1% response rate (n = 102), 76.5% of respondents had undertaken training in identifying orthognathic patients who may benefit from psychological assessment. However, 90.2% favoured further training. All respondents believed that some orthognathic patients would benefit from referral; however, 31.3% of units referred no patients at all, mostly due to limited/no access (66.7%). Most referrals (68.9%) were to psychiatrists/psychologists with dentofacial deformity expertise, with 28.9% of units having such services onsite (14 different units). Psychological referrals had potentially useful outcomes, with 36.4% of respondents sometimes changing treatment plans following referral. Clinical incidents were experienced by 35.1% of respondents, prompting referral of patients for psychological assessment; such incidents included patient suicides (n = 4). CONCLUSION: Most respondents had trained in psychological assessment of orthognathic patients; however there was a large demand for further training. Clinicians value the psychological services available; however, limited availability may affect referrals for some respondents. Adverse incidents are of real concern and highlight the need to ensure that training and resources are provided to support orthognathic patients and teams.

Is visual imagery ability higher for orthodontic students than those in other disciplines? A cross-sectional questionnaire-based study.

OBJECTIVE: To investigate the effect visual imagery may have on career choice among current university students across a range of subjects and disciplines. SETTING: University College London (UCL), UK. DESIGN: Cross-sectional questionnaire-based study. PARTICIPANTS: The study compared four main groups of UCL students: current students at the Slade School of Fine Art; UCL Eastman Dental Institute; UCL Bartlett School of Architecture; and the Faculty of Laws. METHOD: A questionnaire based on the Vividness of Visual Imagery Questionnaire (VVIQ) was distributed along with questions regarding demographic information. RESULTS: There were no significant differences between the VVIQ scores across the four included Schools/Faculty: The Slade School of Fine Art; UCL Bartlett School of Architecture; Faculty of Laws; and UCL Eastman Dental Institute, F(3,219) = 2.160, P = 0.094. There were also no significant differences in the scores for the Eastman (M = 60.21, SD = 13.58) and the three other Schools/Faculty (M = 62.87, SD = 10.96); t(-1.317) = 221, P = 0.189, and no significant difference in the scores for the Orthodontic students (M = 60.80, SD = 13.39) and the remaining other included students (M = 61.44, SD = 9.68); t(-0.232) = 221, P = 0.817. Aphantasia was uncommon in this sample, with a prevalence of 0.9%. A positive correlation was found between age group and total VVIQ score, with older participants scoring higher on the VVIQ. Women were significantly more likely to say that their ability to visualise had affected their career choice than male respondents. CONCLUSIONS: There were no significant differences between the VVIQ scores across the four included Schools/Faculty. Visual imagery ability did not differ in dental or orthodontic students in comparison to other student groups. Further work is needed to replicate these findings in more diverse samples.

National British Orthodontic Society (BOS) Orthognathic Audit 2017-2018.

OBJECTIVE: To carry out a UK national clinical audit of orthognathic acceptance criteria and information provided to orthognathic patients before treatment. DESIGN: National clinical audit. SETTING: Data collected using Bristol Online Surveys. PARTICIPANTS: Sixty-nine UK hospital orthodontic departments submitted data. METHODS: Data were collected at two time points using Bristol Online Surveys over a period of 12 months. These were before treatment at the first multidisciplinary clinic (MDT) and immediately after surgery. The data collected included: Index of Orthognathic Functional Treatment Need (IOFTN); Index of Orthodontic Treatment Need (IOTN); age; previous orthodontic treatment; attendance at an MDT; treatment times; and information provision. RESULTS: Eighty-five units agreed to take part in the audit with 69 submitting data, giving a response rate of 81%. The data from 3404 patients were uploaded, 2263 before treatment and 1141 immediately after surgery. Of patients, 91.07% had an IOFTN score of 4 or 5 and 88.73% had an IOTN score of 4 or 5. The mean age at the first MDT was 22 years in the first cohort and 21 years and 4 months in the second immediate post-surgery cohort. Of patients, 37.93% had undergone some form of previous orthodontic treatment, but only 0.28% had undergone previous orthognathic treatment; 96.93% had an MDT confirm that orthodontic treatment by itself was insufficient to adequately correct their functional symptoms. The average treatment time from bond up to surgery was 2 years and 6 months. With respect to information provision, patients received information from a number of sources, principally the British Orthodontic Society (BOS) patient information leaflets and the BOS website Your Jaw Surgery. CONCLUSIONS: In the UK, the majority of orthognathic cases fulfil the criteria for acceptance for NHS-funded orthognathic treatment, as outlined by the Chief Dental Officer's interim guidance on orthognathic treatment. This suggests any prior approval process would not be a good use of NHS resources in the commissioning of orthognathic treatment.

Occlusal outcomes in combined orthodontic and orthognathic treatment.

OBJECTIVE: To investigate the treatment outcome in terms of the malocclusion features and the changes in the occlusion of patients undergoing orthodontic/orthognathic treatment using the Peer Assessment Rating (PAR) and the Index of Complexity, Outcome and Need (ICON) and to test the application of the Index of Orthognathic Functional Treatment Need (IOFTN) on this sample as a measure of orthognathic pre-treatment need. DESIGN: Retrospective longitudinal cohort study. SETTING: The orthodontic department at the Eastman Dental Hospital. MATERIAL AND METHODS: The study models of a sample of 100 orthodontic/orthognathic patients who were treated at the Eastman Dental Hospital were measured using the PAR index and ICON at three stages: pre-treatment, pre-surgery and at debond. Treatment need was assessed by measuring IOTN and IOFTN using start study models. RESULTS: 99% of the sample showed an improvement in PAR score, with 82% of the sample being greatly improved. ICON showed that 95% of the sample had an improvement of different degrees with 5% being not improved or worse. The IOFTN qualified 97% of the patients for orthognathic treatment when used retrospectively on the sample while the DHC of IOTN qualified the whole sample for orthodontic treatment. CONCLUSIONS: Orthodontic/orthognathic treatment showed improved and acceptable overall results. The PAR index and ICON were valid measures to investigate the outcome of orthognathic treatment. IOFTN proved to be a useful tool in determining and prioritizing orthognathic treatment based purely on functional need.

Towards motion insensitive EEG-fMRI: Correcting motion-induced voltages and gradient artefact instability in EEG using an fMRI prospective motion correction (PMC) system.

The simultaneous acquisition of electroencephalography and functional magnetic resonance imaging (EEG-fMRI) is a multimodal technique extensively applied for mapping the human brain. However, the quality of EEG data obtained within the MRI environment is strongly affected by subject motion due to the induction of voltages in addition to artefacts caused by the scanning gradients and the heartbeat. This has limited its application in populations such as paediatric patients or to study epileptic seizure onset. Recent work has used a Moiré-phase grating and a MR-compatible camera to prospectively update image acquisition and improve fMRI quality (prospective motion correction: PMC). In this study, we use this technology to retrospectively reduce the spurious voltages induced by motion in the EEG data acquired inside the MRI scanner, with and without fMRI acquisitions. This was achieved by modelling induced voltages from the tracking system motion parameters; position and angles, their first derivative (velocities) and the velocity squared. This model was used to remove the voltages related to the detected motion via a linear regression. Since EEG quality during fMRI relies on a temporally stable gradient artefact (GA) template (calculated from averaging EEG epochs matched to scan volume or slice acquisition), this was evaluated in sessions both with and without motion contamination, and with and without PMC. We demonstrate that our approach is capable of significantly reducing motion-related artefact with a magnitude of up to 10mm of translation, 6° of rotation and velocities of 50mm/s, while preserving physiological information. We also demonstrate that the EEG-GA variance is not increased by the gradient direction changes associated with PMC. Provided a scan slice-based GA template is used (rather than a scan volume GA template) we demonstrate that EEG variance during motion can be supressed towards levels found when subjects are still. In summary, we show that PMC can be used to dramatically improve EEG quality during large amplitude movements, while benefiting from previously reported improvements in fMRI quality, and does not affect EEG data quality in the absence of large amplitude movements.

Cross-Cultural Validation and Psychometric Properties of the Arabic Brief Religious Coping Scale (A-BRCS).

The aim of this study was to translate and validate the psychometric properties of an Arabic Brief Religious Coping Scale. A descriptive correlational design was used to conduct the study among participants of 403 Iraqi secondary school students. The A-BRCS and both the subscales, positive and negative, had Cronbach's alphas of .70, .86 and .82, respectively. All inter-item and item-to-total correlations for each subscale were above the recommended criteria of .30. Factor loadings of the positive subscale using oblique (oblimin) and orthogonal (varimax) rotations ranged from .72 to .86 and from .71 to .86, respectively. Factor loadings of the negative subscale using oblimin and varimax rotations ranged from .64 to .83 and from .63 to .83, respectively. The A-BRCS was found to be a valid and reliable instrument to measure religious coping among Iraqi secondary school students.

The influences of nursing transformational leadership style on the quality of nurses' working lives in Taiwan: a cross-sectional quantitative study.

BACKGROUND: Taiwan's NHI system is one of the most successful health care models for countries around the globe. However, little research has demonstrated the mental health issues associated with nursing transformational leadership style under the NHI system, especially in the quality of nurses' working lives in Taiwan. It is important to know the relationship between transformational leadership style and the mental health of nurses, organisational commitment and job satisfaction. The research aimed to understand the influences of nursing transformational leadership style on the quality of nurses' working lives in Taiwan. The research hypothesis was that transformational leadership styles would have positive influence on the quality of nurses' working lives. METHODS: This was a cross-sectional quantitative study. Nurses from each type of hospital ownership (private, public and religious) were recruited. Participation was voluntary and signed informed consent was obtained. The inclusion criteria were nurses with at least one year's work experience in the hospitals. Self-administrated questionnaires were used. A total of 807 participants were contacted and 651 questionnaires were fully completed (response rate 80.7 %). A theory driven model was used to test the research hypotheses using structural equation modelling performed with AMOS 16.0. RESULTS: Transformational leadership contributes significantly to supervisor support. Workplace support, particularly from the supervisor, is an important mediator variable that explains the relationship between transformational leadership and job satisfaction. Organisational commitment was the strongest factor relevant to the general health well-being in Taiwanese nurses than job satisfaction. The hypothesized positive relationships between transformational leadership and all variables were supported by the data. CONCLUSIONS: Our findings have important consequences for organisational health. Our model demonstrates a complete picture of the work relationships on the quality of nurses' working lives. The results provided information about the subordinates' perceptions of transformational nursing leadership styles and mental health outcomes in different hospital settings, as well as identified organisational factors that could improve the quality of nurses' working lives.

Development of the scale of perceived social support in HIV (PSS-HIV).

Social support (SS) plays a key role for HIV/AIDS prevention and disease management. Numerous general and disease-specific SS instruments have been developed and perception of support has been increasingly considered, though no scales have been specifically developed to measure perceived social support (PSS) in HIV/AIDS. To help fill this gap a 12-item scale was developed. The study comprised 406 (HIV(+) and HIV(-)) participants from Chile and the UK. A principal component factor analysis yielded three factors explaining 77.0 % of the total variance: Belonging, Esteem and Self-development with Cronbach α of 0.759, 0.882 and 0.927 respectively and 0.893 on the full scale. The PSS-HIV is brief, easy-to-apply, available in English and Spanish and evaluates the perception of supportive social interactions. Further research is needed to corroborate its capacity to detect psycho-socio-immune interactions, its connection with Maslow's hierarchy of need theory and to evaluate its properties for different health states.

Adapting narrative exposure therapy for Chinese earthquake survivors: a pilot randomised controlled feasibility study.

BACKGROUND: Narrative exposure therapy (NET) is a brief, manualised treatment for Posttraumatic Stress Disorder (PTSD). It has been shown to have therapeutic benefits for a wide range of individuals and settings. This study, following our previous work applying the original NET in earthquake survivors, aimed to revise NET to be adaptable for treating PTSD after a natural disaster. METHODS: A randomised waiting-list controlled study was conducted with 30 adult participants with PTSD who were randomly allocated to NET (n = 10), revised NET (NET-R; n = 10) or a waiting list condition (WL; n = 10). Participants in NET and NET-R received treatment immediately; those in the WL condition received NET-R treatment after a waiting period. All groups were assessed on PTSD, general distress, anxiety, depression, social support, coping and posttraumatic change before and after treatment and three-month follow-up. RESULTS: Compared with WL, both NET and NET-R groups showed significant reductions in PTSD and related symptoms. Significant increases were found in posttraumatic growth, active coping and perceived social support. The WL group showed similar improvements after treatment. Further reductions on PTSD symptoms were found at three months, showing that NET-R is as effective as the original NET in treating post-earthquake traumatic symptoms in adult Chinese earthquake survivors. CONCLUSIONS: NET-R is a feasible and cost-effective intervention for Chinese earthquake survivors. Further studies are needed to replicate these findings in other survivor populations, and with larger samples and over longer periods. This study highlighted the value of oral narrative approach, which is well-accepted and useful in the context of single natural disaster and lower- income area. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-TRC-12002931.

An exploration of workplace social capital as an antecedent of occupational safety and health climate and outcomes in the Chinese education sector.

PURPOSE: It is widely acknowledged that teachers are at greater risk of work-related health problems. At the same time, employee perceptions of different dimensions of organizational climate can influence their attitudes, performance, and well-being at work. This study applied and extended a safety climate model in the context of the education sector in Hong Kong. Apart from safety considerations alone, the study included occupational health considerations and social capital and tested their relationships with occupational safety and health (OSH) outcomes. METHODS: Seven hundred and four Hong Kong teachers completed a range of questionnaires exploring social capital, OSH climate, OSH knowledge, OSH performance (compliance and participation), general health, and self-rated health complaints and injuries. Structural equation modeling (SEM) was used to analyze the relationships between predictive and outcome variables. RESULTS: SEM analysis revealed a high level of goodness of fit, and the hypothesized model including social capital yielded a better fit than the original model. Social capital, OSH climate, and OSH performance were determinants of both positive and negative outcome variables. In addition, social capital not only significantly predicted general health directly, but also had a predictive effect on the OSH climate-behavior-outcome relationship. CONCLUSIONS: This study makes a contribution to the workplace social capital and OSH climate literature by empirically assessing their relationship in the Chinese education sector.

An index of orthognathic functional treatment need (IOFTN).

OBJECTIVE: To design a new index categorizing the functional need for orthognathic treatment. DESIGN: Laboratory-based study. SETTING: Records were obtained from two UK hospital-based orthodontic departments. PARTICIPANTS: A panel of four consultant orthodontists, experienced in providing orthognathic care, devised a new index of Orthognathic Functional Treatment Need (IOFTN) with the aid of the membership of the British Orthodontic Society Consultant Orthodontists Group (COG). Twenty-three consultants and post-CCST level specialists took part in the study as raters to test the validity and reliability of the new index. METHODS: A total of 163 start study models of patients who had previously undergone orthognathic treatment were assessed by the panel of four consultant orthodontists using the new index (IOFTN) and the agreed category was set as the 'gold standard'. Twenty-one consultants and post-CCST level specialists then scored the models on one occasion and two scored 50 sets of models twice to determine the test-re-test reliability. RESULTS: Kappa scores for inter-rater agreement with the expert panel for the major categories (1-5) demonstrated good to very good agreement (kappa: 0·64-0·89) for all raters. The percentage agreement ranged from 68·1 to 92% in all cases. Intra-rater agreement for the major categories was moderate to good (kappa: 0·53-0·80). CONCLUSIONS: A new index, the IOFTN, has been developed to help in the prioritization of severe malocclusions not amenable to orthodontic treatment alone. It demonstrates good content validity and good inter-rater and moderate to good intra-rater reliability. As a result of being an evolution of the IOTN, the familiar format should make it easy to determine functional treatment need within daily orthognathic practice.

A randomised controlled pilot study: the effectiveness of narrative exposure therapy with adult survivors of the Sichuan earthquake.

BACKGROUND: Post-Traumatic Stress Disorder (PTSD) is a common psychological reaction after large-scale natural disasters. Given the number of people involved and shortage of resources in any major disaster, brief, pragmatic and easily trainable interventions are needed. The aim of this study is to evaluate the efficacy of Narrative Exposure Therapy (NET) as a short-term treatment for PTSD using Chinese earthquake survivors. METHODS: A randomized waiting-list control pilot study was conducted between December 2009 and March 2010, at the site of the Sichuan earthquake in Beichuan County, China. Adult participants with newly diagnosed Post Traumatic Stress Disorder (PTSD) were randomly allocated to Narrative Exposure Therapy (NET) or a Waiting-List (WL) condition. The latter received NET treatment after a two-week waiting period. To compare the effectiveness of NET in traumatised earthquake survivors, both groups were assessed on PTSD symptoms, general mental health, anxiety and depression, social support, coping style and posttraumatic change before and after treatment and two months post treatment. RESULTS: Adult participants (n=22) were randomly allocated to receive NET (n=11) or WL (n=11). Twenty two participants (11 in NET group, 11 in WL) were included in the analysis of primary outcomes. Compared with WL, NET showed significant reductions in PTSD symptoms, anxiety and depression, general mental stress and increased posttraumatic growth. The WL group later showed similar improvements after treatment. These changes remained stable for a two-month follow-up. Measures of social support and coping showed no stable effects. CONCLUSIONS: NET is effective in treating post-earthquake traumatic symptoms in adult Chinese earthquake survivors. The findings help advance current knowledge in the management of PTSD after natural disasters and inform future research. Larger sample sizes are needed to extend the present findings. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-TRC-12002473.

Molecular changes in detrained & retrained adult jaw muscle.

A hypofunctional masticatory system was developed in 21-day-old male rats by feeding them a soft diet for 27 weeks. Retraining of a parallel group for 6 weeks was achieved by switching back to a hard diet after 21 weeks. A control group was fed a hard diet for 27 weeks. At the end of the experimental period, the expression levels of the myosin heavy chain isoform genes MYH 1 and 2 (fast), 3 (embryonic) and 7 (slow) in the deep masseter were compared using qRT-PCR analysis. The gene expressions of MYH 3 and MYH 7 were significantly higher in the rehabilitation group compared with the normal and hypofunctional group, but no significant differences were found in regards to the gene expression of MYH 1 and 2. Retraining made it possible for the slow (MYH 7) isoform levels to adapt to the increased mechanical load. The increased level of embryonic (MYH 3) isoform could be due to the need of creation of new MYH isoforms.

Short form of the Changes in Outlook Questionnaire: translation and validation of the Chinese version.

BACKGROUND: The Changes in Outlook Questionnaire (CiOQ) is a self-report instrument designed to measure both positive and negative changes following the experience of severely stressful events. Previous research has focused on the Western context. The aim of this study is to translate the short form of the measure (CiOQ-S) into simplified Chinese and examine its validity and reliability in a sample of Chinese earthquake survivors. METHOD: The English language version of the 10-item CiOQ was translated into simplified Chinese and completed along with other measures in a sample of earthquake survivors (n = 120). Statistical analyses were performed to explore the structure of the simplified Chinese version of CiOQ-S (CiOQ-SCS), its reliability and validity. RESULTS: Principal components analysis (PCA) was conducted to test the structure of the CiOQ-SCS. The reliability and convergent validity were also assessed. The CiOQ-SCS demonstrated a similar factor structure to the English version, high internal consistency and convergent validity with measures of posttraumatic stress symptoms, anxiety and depression, coping and social support. CONCLUSION: The data are comparable to those reported for the original version of the instrument indicating that the CiOQ-SCS is a reliable and valid measure assessing positive and negative changes in the aftermath of adversity. However, the sampling method cannot permit us to know how representative our samples were of the earthquake survivor population.

Accuracy of positioning three types of self-ligating brackets compared with a conventionally ligating bracket.

OBJECTIVES: The aim of this study was to determine whether the morphology of three different self-ligating brackets affects the accuracy of their positioning when compared with a conventionally ligating bracket. DESIGN: An ex vivo prospective comparison of the accuracy of positioning self-ligating brackets with conventionally ligating brackets. SETTING: Orthodontic Department, Eastman Dental Institute, London, UK. SUBJECTS AND METHODS: Twenty-five clinicians with 2 or more years experience of bracket placement bonded four identical typodont malocclusions with Damon MX(TM), In-Ovation System R(TM) and SmartClip(TM) self-ligating brackets and also Victory Series(TM) conventionally ligating brackets. Four hundred brackets of each type were positioned. Vertical, horizontal and angular bracket position errors were assessed by reference to the FA point and FACC respectively, using digital images and image analysis software. RESULTS: Method error analysis showed no evidence of bias and minimal random error. The Victory Series brackets were the most accurately positioned. Although the amount of positioning error for all the self-ligating brackets was small, a greater number were positioned outside vertical and horizontal tolerance limits compared to the conventionally ligated brackets (P<0·001). The Damon MX bracket type was nearly 10 times more likely to be inaccurately placed relative to the FA point compared with the Victory Series bracket. The differences relating to angular positioning error were not statistically significant (P>0·05). CONCLUSION: The findings indicate that the positioning of three types of self-ligating brackets was less accurate than the conventional pre-adjusted edgewise bracket, when using a direct bonding technique. This may have implications for their clinical application.

Extreme sport as an intervention for physically injured military veterans: the example of competitive motorsport.

PURPOSE: Physically or psychologically injured military veterans are motivated and benefited by physical activity or sport that may involve high levels of achievement. The aim of this study was to provide an in-depth insight into the impact of Competitive Motorsport (CM) on physically injured/disabled veterans' subjective well-being and in turn determine if it improves the quality of their lives. METHODS: This is a qualitative study. Two sets of semi-structured interviews were conducted with 14 male British military veterans including a 6-month follow-up. All participants were subjected to a permanent, moderate or severe, physical injury/disability. Data were analysed in accordance with the principles of Thematic Analysis. RESULTS/CONCLUSIONS: Five key elements (familiar environment, team spirit, adrenaline rush, competition and equality) made CM a unique experience for physically injured/disabled veterans. Various psychological and physical benefits were found, including an increased sense of accomplishment, opportunity to socialise in a non-clinical environment, embracement of body image and adoption of a healthier lifestyle. Since physical activity and sport are among growing research on alternative interventions for military veterans, they deserve serious consideration as part of the treatment regimens and rehabilitation programmes to improve physically inured/disabled veterans' physical and mental health.Implications for RehabilitationCompetitive Motorsport is an effective means of improving physical health and subjective well-being of physically injured/disabled military veterans.Multiple perceived psychological and physical benefits were identified over time, including motivation for living, embracement of body image and adoption of a healthier lifestyle.Competitive Motorsport deserves consideration as part of the treatment regimens and rehabilitation programmes to improve physically injured/disabled veterans' physical and mental health while facilitating transition to civilian life.

The Prevalence of Adverse Childhood Experiences Among Children and Adolescents Who Display Harmful Sexual Behaviour: A Review of the Existing Research.

There is no systematic review focusing on the prevalence of adverse childhood experiences (ACEs) among children and adolescents who display harmful sexual behaviour (HSB). This study addresses this gap to further our understanding of the aetiology of HSB among children and adolescents. The full text of 87 articles was retrieved and assessed for eligibility, following which 10 articles were deemed relevant for inclusion in the review. These 10 studies were then subjected to quality assessment, data extraction and synthesis. The present review included only studies that used data pertaining to both males and females, and some studies provided a comparison between males and females. There were higher rates of sexual victimisation among females who display HSB. Additionally, child sexual abuse perpetrated by female caregivers is likely to be higher than most of the existing body of research suggests. The findings of the present review corroborate many of the hypotheses discussed in the introduction, emphasising that children and adolescents who display HSB are more likely to have come from backgrounds of trauma, signaling the importance of multi-agency responses, early intervention and the importance of protective factors.

Cognitive processing, rumination, and posttraumatic growth.

Intrusive thoughts about traumatic events are an important factor in determining the development of posttraumatic growth, although research has focused on the frequency rather than the type of intrusions. Based on cognitive processing models of posttraumatic growth, the authors present two cross-sectional studies exploring different types of intrusive ruminations about trauma and their associations with posttraumatic growth. Study 1 examines brooding and reflection; Study 2 uses measures of both deliberate and intrusive rumination regarding a past trauma. The results indicate that intrusive reexperiencing and ruminative brooding are not significantly associated with posttraumatic growth, whereas deliberate rumination is significantly positively associated with posttraumatic growth (ß = .44, p < .001) and reflection (partial r = .20, p = .003) is positively associated with posttraumatic growth in the context of low brooding.