Negative Acts in the Courtroom: Characteristics, Distribution, and Frequency among a National Cohort of Danish Prosecutors.

Danish prosecutors report exposure to negative acts from professional counterparts in courtrooms, which is associated with an increased risk of burnout. However, knowledge of the characteristics of these acts is limited. Based on existing theoretical frameworks, this study aims to characterize these negative acts. A nation-wide survey of Danish prosecutors (response rate: 81%) yielded 687 descriptions of experiences with negative acts from professional counterparts from a career perspective. These were analyzed using theory-directed content analysis based on the Stress-as-Offense-to-Self (SOS) theory by Semmer and colleagues and Cortina and colleagues' characterization of incivility in American courtrooms. We identified a total of 15 types of behavior within the three main themes: illegitimate tasks (n = 22), illegitimate stressors (n = 68), and illegitimate behavior (n = 612). Tentative differences in the distribution of experienced negative acts from a career perspective were found for gender and seniority. Women reported negative acts more frequently than men, and assistant prosecutors reported verbal abuse more frequently than senior prosecutors, who, conversely, more often reported a perceived lack of court management. More prospective research is needed on negative acts experienced by prosecutors to assess the scope of these in Danish courtrooms and how they impact the risk of burnout.

When multidisciplinary clinical practice and research meet: Quality development in the Danish Children Centers.

BACKGROUND: Collaboration between clinical practice and research is often warranted. Extended periods of collaboration integrating research and practice is however rare. This article is about a series of joint research projects through the course of 8 years involving the Danish Center of Psychotraumatology and five regional centres dedicated to combating the sequelae of child abuse across Denmark. METHOD: We describe the development of a standardized assessment battery and how this work evolves, analyses of administrative data, what happens after the assessment, the impact of working with child abuse on employees, profiles of abuse that vary by gender, national conferences and training programs, and international collaboration. RESULT: The collaboration between research and practice against child abuse has been seminal and is still ongoing. We have learnt about new problem areas and have produced information that can be used to serve children, employees, and civil society in better ways. DISCUSSION: This work is inspired by and aligns with initiatives abroad pertaining the construction of Children Centers, of assessments tools and child abuse trauma research. CONCLUSION: Mutual respect, dedication, and patient persistence pave the way for significant results in a committed relationship.

This article describes and reflect upon a year-long collaboration between a multidisciplinary clinical organization, the Danish Children Centers, and a research centre, the Danish Center of Psychotraumatology who have joined forces to provide the best help for children exposed to physical, sexual, or psychological abuse. The article describes the collaboration on developing a trauma-focused, developmentally sensitive psychological assessment battery for children of all ages. The article thereafter describes and reflects upon other projects of the collaboration that benefit both research and practice, including the establishment of data base for studying the psychological state of children exposed to abuse and related studies on child abuse; evaluations of the Children Centers practices; examinations of care and treatment for abused and traumatized children, training of staff and other interested parties; and examination and prevention of secondary traumatization among the Children Centers staff. With mutual respect for all professions, dedication, and patient persistence a professional collaboration can evolve.

Attachment Anxiety and Dissociation Mediate Associations Between Polytrauma and Somatization in Kenyan Adolescents.

The experience of several potentially traumatic events (PTE) is a risk factor for higher somatization symptoms severity among adolescents. Attachment orientations and dissociation may influence the link between exposure to PTE and somatization symptoms severity. We analyzed the associations between direct exposure to PTE and somatization symptoms in Kenyan adolescents and explored the mediating role of attachment orientations and dissociation symptoms in the associations between direct exposure to PTE with somatization symptoms severity. A sample of 475 Kenyan adolescents completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modeling employing Preacher and Hayes' procedures (2008). Attachment anxiety and dissociation symptoms mediate the association between direct exposure to traumatic events and somatization symptoms. Higher exposure to traumatic events was significantly associated with higher attachment anxiety levels, which was associated with higher levels of dissociation symptoms, which was then associated with higher somatization symptoms severity. High levels of attachment anxiety and dissociation might aggravate somatization symptoms differently according to sex, which might be seen as a psychological distress mechanism subsequent to exposure to multiple PTE in African adolescents.

Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis.

Background: Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking.Objectives: This systematic review and meta-analysis aimed to evaluate associations between exposure to ACEs and chronic pain and pain-related disability in adults.Methods: We searched 10 electronic databases from inception to February 2023. We included observational studies assessing associations between direct ACEs (childhood sexual, physical, emotional abuse, or neglect) alone or in combination with indirect ACEs (witnessing domestic violence, household mental illness), and adult chronic pain (≥3 months duration) and pain-related disability (daily activities limited by chronic pain). Pairs of reviewers independently extracted data and assessed study risks of bias. Random-effect models were used to calculate pooled adjusted odds ratios [aOR]. Tau square [T2], 95% prediction intervals [95%PI] and I2 expressed the amount of heterogeneity, and meta-regressions and subgroup meta-analyses investigated sources of heterogeneity (PROSPERO: CRD42020150230).Results: We identified 85 studies including 826,452 adults of which 57 studies were included in meta-analyses. Study quality was generally good or fair (n = 70). The odds of reporting chronic pain in adulthood were significantly higher among individuals exposed to a direct ACE (aOR, 1.45, 95%CI, 1.38-1.53). Individuals reporting childhood physical abuse were significantly more likely to report both chronic pain (aOR, 1.50, 95CI, 1.39-1.64) and pain-related disability (1.46, 95CI, 1.03-2.08) during adulthood. Exposure to any ACEs alone or combined with indirect ACEs significantly increase the odds of adult chronic painful conditions (aOR, 1.53, 95%CI, 1.42-1.65) and pain-related disability (aOR, 1.29; 95%CI, 1.01-1.66). The risk of chronic pain in adulthood significantly increased from one ACE (aOR, 1.29, 95%CI, 1.22-1.37) to four or more ACEs (1.95, 95%CI, 1.73-2.19).Conclusions: Single and cumulative ACEs are significantly associated with reporting of chronic pain and pain-related disability as an adult.

Previous meta-analyses highlighted the negative impact of adverse childhood experiences on physical, psychological, and behavioural health across the lifespan.We found exposure to any direct adverse childhood experience, i.e. childhood sexual, physical, emotional abuse, or neglect alone or combined, increased the risk of reporting chronic pain and pain-related disability in adulthood.The risk of reporting chronic painful disorders increased with increasing numbers of adverse childhood experiences.

Sexual Violence against Children with Disabilities: A Danish National Birth Cohort Prospective Study.

Background: Children with disabilities are at heightened risk of sexual violence compared to non-disabled peers. Objective: We aimed to examine the associations between ten childhood disabilities and sexual victimization. Methods: Data were drawn from the Danish Psychiatric Case Register, the Criminal Register, and other population-based registers. Children born between 1994 and 2001 (n=570,351) were followed until 18 years of age. Using logistic regression, the association between the disabilities and risk of sexual victimisation was estimated. Results: We identified 8,860 cases of sexual victimization towards children and adolescents. In the fully adjusted models, children with a diagnosis of ADHD, speech disability and intellectual disability were at highest risk of sexual victimization. Children with comorbid disabilities were particularly vulnerable to sexual victimization. Conclusions: We found that children with certain types of disability have a higher risk of sexual victimization. Our findings indicate that educational institutions and health care professionals should be aware of and have specialized training in, recognizing and assessing sexual victimization among children with disabilities.

Greenlandic norms for the parent-report and self-report versions of the Strengths and Difficulties Questionnaire (SDQ).

The Strengths and Difficulties Questionnaire (SDQ) is a brief screening questionnaire of child behaviour, used to evaluate mental health. It is applicable for children 2-17 years, available to both parents and professionals, and exists in a self-report version available from the age of 11 years. This paper aims to generate Greenlandic norms on the self-report and parent-report versions of the SDQ. In 2023, the self-report version was translated, and a representative sample of children and adolescents completed the SDQ (N = 641). In 2008, the parent-report version was translated into Greenlandic and used in a study of children's well-being (N = 939). Data from both samples were analysed, generating normative scores. Results show significant differences between genders (effect sizes of .006-.145), and discrepancies between parent and self-report. Parents report higher total problems for boys, while self-reporting indicate higher total problems for girls. Cut-off values are higher for self-report norms than parent-report norms. Mean scores on the SDQ total score and subscales differ across age, area of living, caregiver constellation and caregiver's educational level (effect sizes of .011-.064). With the availability of Greenlandic norms, we anticipate further use of the SDQ in clinical practice and research settings, strengthening screening and assessment of children and adolescents.

The psychological consequences of stalking: cross-sectional findings in a sample of Danish help-seeking stalking victims.

Background: The experience of stalking presents a threat to the mental and physical health and wellbeing of victims. Although some studies have explored the impact of stalking on victims, few have gone into detail about specific mental health outcomes and their association with various types of stalking behaviour.Objective: To investigate the psychological consequences among Danish help-seeking victims of stalking who have contacted and received help through the Danish Stalking Center (DSC).Methods: We used survey-data from stalking victims who sought and received help from the DSC during 2015-2020 (N = 591). Descriptive statistics, correlation analysis, T-tests, and hierarchical logistic regression analysis were used to examine psychological distress symptoms and the relationship between psychopathological symptoms and stalking behaviour characteristics.Results: Victims reported considerable levels of stalking and psychological distress. Almost 80% of victims reported symptom levels indicative of a diagnosable disorder of PTSD, depression, or anxiety. T-test shoved that following behaviour had the greatest effect size for PTSD-symptoms (t(575) = -5.81, p < .01, d = -.58), anxiety (t(576) = -4.21, p < .01, d = -.42), and somatization (t(572) = -4.29, p < .01, d = -.43). Hierarchical logistic regression analysis showed that stalking victims who experienced following had significantly higher odds of experiencing symptoms of PTSD (OR 2.869; 95% CI, [1.641-5.016]) and anxiety (OR 2.274; 95% CI [1.265; 4.090]).Conclusion: Being stalked is associated with substantial PTSD-, affective and trauma-related symptoms and psychological distress in general. Together with the strikingly high levels of psychopathology and the particularly grave effects of being followed, it is indicated that stalking is a special type of trauma with many negative and harmful effects. Hence, further research into how to properly help stalking victims through preventive interventions and treatment is needed.

Stalking is a special type of trauma with many negative and harmful effects.Being stalked is associated with substantial PTSD-, affective symptoms, functional impairment, general psychological distress, and strikingly high levels of psychopathology.Especially following behaviour has grave effects on victims' mental health.

Polytraumatization, defense mechanisms, PTSD and complex PTSD in Indian adolescents: a mediation model.

BACKGROUND: Adolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms. METHODS: We analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes' procedures (2008). RESULTS: Immature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters. CONCLUSIONS: Maladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.

Trauma exposure and diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) posttraumatic stress disorder among Danish adults: Implications of narrow and broad operationalizations of criterion A.

OBJECTIVE: Posttraumatic stress disorder (PTSD) has long been recognized as a debilitating psychiatric disorder. The definition of Criterion A has been a topic of controversy, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases, 11th version have opted for a narrow and a broad approach to the gatekeeper criterion, respectively. The aim of this study was to test the implications of a narrow (DSM-5) versus broad (including psychologically threatening events) Criterion A for endorsement of a probable PTSD diagnosis and symptom severity. METHOD: The study was based on a cross-sectional survey conducted in March 2021 among the general population of adult Danish residents in Denmark, ranging in age between 18 and 79 years (n = 1,033). RESULTS: Psychologically threatening events did not lead to a statistically significant increase in probable PTSD diagnoses, but psychologically threatening events were independently related to probable PTSD risk and severity. Controlling for other potentially traumatizing events and demographic factors, psychologically threatening events were the strongest risk factor for higher symptom severity. We found probable PTSD rates higher but comparable to other Scandinavian countries such as Norway and Sweden. CONCLUSION: Exposure to psychologically threatening events is an important factor in explaining probable PTSD risk and severity although not independently leading to a significant increase in probable PTSD rates. Probable rates of DSM-5 PTSD are higher than Danish official estimates in a random sample of the Danish adult population (6.8%-6.9% compared to 1%). The generalizability of study findings is limited by nonrepresentativity, the use of self-report measures, and assessment during the COVID-19 lockdown. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Do early symptoms of prolonged grief disorder lead to symptoms of posttraumatic stress disorder and depression? A longitudinal register-based study of the two first years of bereavement.

INTRODUCTION: Symptoms of prolonged grief disorder (PGD), depression, and posttraumatic stress disorder (PTSD) often emerge concurrently in bereavement. The understanding of temporal relationships between these syndromes in a general bereaved population is limited. This study aims to investigate temporal relationships between these syndromes from 2 months postloss throughout the two first years of bereavement. METHOD: Data were derived from a registry-based cohort study with 1,224 adult participants, who lost a spouse or parent. Participants completed self-report measures of PGD, depression, and PTSD at 2, 6, 11, 18, and 26 months postloss. Random intercept cross-lagged panel analyses examined the temporal relationships between PGD, PTSD, and depression. RESULTS: In spousal and parental bereavement, high levels of grief symptoms at 2 months postloss predicted subsequent high symptoms of PTSD and depression at 6 months postloss, not vice versa. PGD, PTSD, and depression showed strong intertwined relationships over the two first years of bereavement. Between-person differences explained an increasingly large amount of variance in symptoms of PGD, PTSD, and depression over time. Losing a spouse and younger age was associated with higher symptoms of PGD, PTSD, and depression compared to losing a parent and older age. CONCLUSION: In the early years of bereavement, large differences exist between bereaved individuals in general levels of PGD, PTSD, and depression. Within bereaved individuals, the temporal relationships between these syndromes become increasingly complex and intertwined over time. Findings should be interpreted with respect to the nonclinical sample and self-report data used. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychological distress 35 years after the Chornobyl accident in the Lithuanian clean-up workers.

The adverse effects on the health of the Chornobyl nuclear power plant accident clean-up workers have been reported previously. However, there is a lack of studies on the mental health of Chornobyl clean-up workers. The current study explored psychological distress in a sample of Lithuanian clean-up workers 35 years after the accident. In total, 107 Lithuanian Chornobyl clean-up workers (Mage = 62.5) and 107 controls were included in the study. The Hospital Anxiety and Depression Scale (HAD) was used for the assessment of anxiety and depression. The depression symptoms were significantly higher in the clean-up workers compared to the control group. The prevalence of severe depression symptoms was 23.4% and 4.7% in the Chornobyl clean-up workers and control groups, respectively. The risk for severe depression was associated with Chornobyl clean-up work (adjusted OR = 5.9). No differences in the anxiety symptoms were found between clean-up workers and controls. The study revealed the deteriorated mental health of the Lithuanian Chornobyl clean-up workers 35 years after the disaster - in particular, high levels of depression. Psychosocial support programmes for clean-up workers should be provided to mitigate the adverse effects of the disaster.

Examination of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire - Child and Adolescent version (ITQ-CA) in a sample of Danish children and adolescents exposed to abuse.

Background: International research has established that children and adolescents are at risk for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined by the WHO ICD-11. There is a need for a Danish language version of the International Trauma Questionnaire - Child and Adolescent (ITQ-CA) to assess symptoms of PTSD and CPTSD.Objective: To test the ICD-11 formulations of PTSD and DSO (Disturbances of Self-Organization) using the ITQ-CA version in a sample of children exposed to abuse. Additionally, to study the distribution of symptoms and probable prevalence of ICD-11 PTSD and CPTSD among the population of children exposed to violence or sexual abuse.Method: Confirmatory factor analysis of competing models of the dimensionality of the ITQ-CA was tested among a sample of 119 children and adolescents that were referred to the Danish Children Centres on suspicion of physical or sexual abuse or both. Latent class analysis (LCA) was used to study the distribution of symptoms and consequences of different operationalisations of functional impairment were explored.Results: Findings supported a two-factor second-order model corresponding to the operationalisation of CPTSD in ICD-11 as the best representation of the data. Findings from the LCA suggested that symptoms were distributed in a pattern consistent with the ICD-11 proposal for CPTSD. CPTSD was more prevalent than PTSD regardless of the operationalisation of functional impairment.Conclusion: ITQ-CA is a valid tool for identifying symptoms of ICD-11 PTSD and CPTSD among Danish children exposed to physical or sexual abuse. Further research is needed to study the relationship between ICD-11 C/PTSD symptomatology and anxiety and depression in this population.

The International Trauma Questionnaire ­ Child and Adolescent version (ITQ-CA) is a valid measure of symptoms of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD among Danish children exposed to physical or sexual violence.The structure of the ITQ-CA in the Danish sample reflects the ICD-11 diagnostic algorithm.CPTSD is a more prevalent disorder among children recently exposed to violence than PTSD.

Physical violence against children with disabilities: A Danish national birth cohort prospective study.

Background: Children with disabilities are at heightened risk of violence compared to their non-disabled peers. However, extant research suffers from several limitations, focusing on child abuse and one or few types of disability, ignoring conventional violent crimes.Objective: The aim was to assess 10 disabilities and to examine whether different disabilities vary in their risk of criminal victimization.Method: Using the Danish Psychiatric Case Register, the Criminal Register, and other population-based registers, we included nine birth cohorts (n = 570,351) and followed them until 18 years of age. We compared children exposed to violence with non-exposed children. We estimated odds ratios (ORs) for the disabilities and adjusted the ORs for several risk factors.Results: We identified 12,830 cases of reported violence (2.25% of the population) towards children and adolescents. Children with disabilities were overrepresented, as were boys and ethnic minorities. After controlling for risk factors, four disabilities had heightened risk for criminal violence: attention-deficit hyperactivity disorder (ADHD), brain injury, speech, and physical disabilities. When we compared risk factors controlling for the various disabilities, parental history of violence, family break-up, out-of-home placement, and parental unemployment contributed especially to the violence, while parental alcohol/drug abuse was no longer a predictor. Having several disabilities increased the risk of violence.Conclusions: Criminal victimization of children and adolescents with specific disabilities was common. However, compared to the previous decade, a considerable reduction of one-third has taken place. Four risk factors contributed particularly to the risk of violence; therefore, precautions should be taken to further reduce the violence.

Based on data from nine full birth cohorts, followed for 18 years, the study concludes that disabled children are considerably more exposed to police-reported physical violence than non-disabled children.Four disabilities were especially exposed to physical violence when we controlled for risk factors.Four risk factors contributed particularly to physical violence when we controlled for diagnoses.

Cross-cultural validity and psychometric properties of the International Trauma Questionnaire in a clinical refugee sample.

Background: The ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD diagnoses have been examined in several studies using the International Trauma Questionnaire (ITQ). The cross-cultural validity of the ITQ has not previously been studied using item responses theory methods focused on the issue of equal item functioning and thus comparability of scores across language groups.Objective: To investigate the cross-cultural validity of the ITQ scales considering specifically local independence of items and differential item functioning (DIF) in a cross-cultural sample of refugees.Method: Data from 490 treatment-seeking refugees were included, covering Danish, Arabic, and Bosnian languages and different levels of interpreter-assisted administration. Rasch and graphical log-linear Rasch models were used.Results: There was strong local dependence among items from the same symptom clusters in the PTSD and disorders in self-organization (DSO) scales, except between affective dysregulation items. Weak local dependence was discovered between an item from the affective dysregulation cluster and an item from the disturbed relationship cluster. There was no evidence of DIF related to language or interpreter assistance. There was evidence of DIF for two PTSD items relative to gender and time since the traumatic event. The targeting of the scales to the study population was not optimal. Reliability varied from 0.55 to 0.78 for subgroups.Conclusions: The PTSD and the DSO scales have stable psychometric properties across the Danish, Arabic, and Bosnian language versions and different levels of assisted administration. Scores are comparable across these groups. However, DIF relative to gender and time since trauma introduces considerable measurement bias. DIF-adjusted summed scale scores or estimated person parameters should be used to avoid measurement bias. Future research should investigate whether scales including more and/or alternative items that require higher levels of PTSD and DSO to be endorsed will improve targeting and measurement precision for refugee populations.

A first cross-cultural validity study of the ITQ using IRT.PTSD and DSO subscales functioned invariantly across Danish, Arabic, and Bosnian, and also across degrees of interpreter assistance. Two PTSD items did not function invariantly across gender and time since trauma.The Danish, Arabic, and Bosnian ITQ can be used for screening treatment-seeking refugees, taking into account the item bias in the PTSD subscale, and suboptimal targeting and reliability, which require extensions or modification of items.

Validation of the "Darryl" PTSD Cartoon Test with Abused Children.

Background: There is a lack of reliable and valid PTSD tests for young children that cannot read or are weak readers. The semi-projective cartoon test, "Darryl", which is read aloud, is a measure that appeals to this age group. The test has been applied in both clinical and epidemiological studies. Objective: to validate a cartoon test, "Darryl", for children aged 6 or older in a population of children suspectedly sexually and/or physically abused. Methods: In the Danish Child Centres, 327 children were screened with Darryl as part of an assessment for further intervention. The Bech Youth Inventory was filled out by 113 children, and 63 caregivers filled out the Strengths & Difficulties Questionnaire. Correlations were used to study the convergent validity between the scales and subscales and effect sizes were estimated. Reliability of the scales was investigated using Cronbach's alpha. Results: Following the DSM-IV, 55.7% of the children (n = 182) had a possible PTSD diagnosis. More girls (n = 110, 62.9 %) than boys (n = 72, 47.4%) had PTSD. A total of 21.7 % (n = 71) had subclinical PTSD, lacking only one symptom of the full diagnosis. There was no significant difference in PTSD regarding physical or sexual abuse. Clinical significance: The test allows clinicians in the pediatric field to screen for possible PTSD in a population where systematic self-report data have paramount importance. Conclusions: Darryl appears to be a valid and reliable test for screening young children who have been physically or sexually abused. The test is helpful for clinician working with young children to identify those have developed trauma symptoms to secure them early treatment.

The co-occurrence of potentially traumatic events (PTEs) and their associations with posttraumatic stress disorder (PTSD) in Indian and Malaysian adolescents.

BACKGROUND: Although it is well-established that people can experience multiple traumatic events, there are few studies examining the co-occurrence of such experiences in non-Western nations. The current study sought to examine the occurrence of multiple potentially traumatic experiences (PTEs) and their associations with posttraumatic stress disorder (PTSD) among adolescents from two Asian nations. METHODS: Latent class analysis (LCA) was employed to model the co-occurrence of PTEs in two school samples of adolescents from India (n = 411) and Malaysia (n = 469). Demographic correlates (i.e., sex, age, household composition, parent education) of the latent classes and the association between latent class membership and probable diagnosis of posttraumatic stress disorder (PTSD) were examined. RESULTS: The LCA identified three latent classes for the Indian sample: 'Low Risk - moderate sexual trauma', 'Moderate Risk', and 'High Risk'. Similarly, three classes were also identified for the Malaysian sample: 'Low Risk', 'Moderate Risk', and 'High Risk'. Membership of 'Moderate Risk' was associated with male sex in both samples, and with older age and lower levels of parental education attainment in the Malaysian sample. No correlates of 'High Risk' class were identified in either sample. Membership of the 'High Risk' class was significantly associated with probable PTSD diagnosis in both samples, while membership of the 'Moderate Risk' class was associated with probable PTSD diagnosis in the Malaysian sample. CONCLUSION: Findings from this study correspond with Western studies indicating co-occurrence of PTEs to be common and to represent a salient risk factor for the development of PTSD.

Improvements in Compassion and Fears of Compassion throughout the COVID-19 Pandemic: A Multinational Study.

During large-scale disasters, social support, caring behaviours, and compassion are shown to protect against poor mental health outcomes. This multi-national study aimed to assess the fluctuations in compassion over time during the COVID-19 pandemic. Respondents (Time 1 n = 4156, Time 2 n = 980, Time 3 n = 825) from 23 countries completed online self-report questionnaires measuring the flows of compassion (i.e., Compassionate Engagement and Action Scales) and fears of compassion toward self and others and from others (i.e., Fears of Compassion Scales) and mental health at three time-points during a 10-month period. The results for the flows of compassion showed that self-compassion increased at Time 3. Compassion for others increased at Time 2 and 3 for the general population, but in contrast, it decreased in health professionals, possibly linked to burnout. Compassion from others did not change in Time 2, but it did increase significantly in Time 3. For fears of compassion, fears of self-compassion reduced over time, fears of compassion for others showed more variation, reducing for the general public but increasing for health professionals, whilst fears of compassion from others did not change over time. Health professionals, those with compassion training, older adults, and women showed greater flows of compassion and lower fears of compassion compared with the general population, those without compassion training, younger adults, and men. These findings highlight that, in a period of shared suffering, people from multiple countries and nationalities show a cumulative improvement in compassion and reduction in fears of compassion, suggesting that, when there is intense suffering, people become more compassionate to self and others and less afraid of, and resistant to, compassion.

Crisis social support after work-related violence and threats and risk for depressive symptoms: a 3-months follow-up study.

INTRODUCTION: Employees working at psychiatric wards are at risk for work-related threats and violence that may impact their physical and mental health. Studies have found that crisis social support may mitigate these adverse health effects. PURPOSE: To examine the effects crisis social support on depressive symptoms 3 months after a violent or threating work incident and furthermore, to examine the effect of variations in prolonged social support on depressive symptoms during 3 months after a violent or threating incident. METHODOLOGY: After exposure to work-related violence and threats at work, the employees received a questionnaire within the first month and after 3 months. Right after the incident, 374 employees answered both the depression and crisis support items and were included in the analyses. 3 months later 276 employees answered both the depression and social support items. Prospective associations between crisis social support and depression were calculated using stepwise regressions and linear mixed models. RESULTS: Crisis social support at T1 was significantly and inversely associated with a lower level of depressive symptoms at T2, Std. Beta = - 012, t (3) = - 2.1, p = .040. Employees experiencing either a stable or increasing level of support from T1 to T2 had significantly lower levels of depressive symptoms compared to employees who experienced a decrease in support in the same period, mean differenceStable-Decreasing = 4.0 t (190) = 5.2, p = 0.006 and mean differenceIncreasing-Decreasing = 7.6, t (189) = 5.3, p < .001. CONCLUSION: The study results indicate that depressive symptoms following work-related violence or threats can be mitigated by prolonged social support. We recommend that organizations continue to offer crisis social support in the subsequent months, and not just immediately after a violent or threating incident.