[,,It overtook my body and soul": The experience of individuals receiving health-promoting service, of psychological trauma and health-related problems].

INTRODUCTION: Accumulating evidence shows that those having experienced psychological trauma have increased risk of complex health problems. In primary health care health-promoting services are offered to individuals with complex health problems, based on an individualized approach. Trauma focused approach in healthcare help individuals increase quality of life after psychological trauma. Trauma focused services are important to help improve quality of life after psychological trauma. To examine the experience of psychological trauma and health-related problems in individuals receiving health-promoting services. METHOD: Qualitative research based on the Vancouver School of phenomenology. Participants were ten, five male and five female, selected through health-promoting services. Two interviews were taken with each participant. The ACE questionnaire was used, as a screening tool for childhood psychological trauma, combined with interview-frame with open questions. RESULTS: The results were divided into six main themes: Experience of trauma; Repeated trauma; Childhood neglect; Health-related problems in child- and adulthood; Psychiatric problems in child- and adulthood; Processing and trauma-focused approach. Participants had experienced conciderable trauma as well as complex health problems in child- and adulthood. CONCLUSIONS: It is of importance that healthcare professionals pay attention to psychological traumas in relation to complex health problems to provide support for recovery. Primary health care is the first place of contact within the health care system and therefore it is important that patients' experience of trauma is taken into account. It is key to identify the signs of lifetime trauma in relation to health problems and focus the care according to the individual needs of the patient.

[An evaluation of a Hungarian questionnaire to assess childhood adversities: A pilot study].

BACKGROUND: Detection of childhood traumas is important both in clinical practice and in research. There is a pressing need for methods that are relatively simple but comprehensive, non-intrusive, and possess adequate psyc - ho metric properties. In this study we translated one of the most widely used and well-studied measure of childhood abuse and neglect and explored the psychometrical properties of this questionnaire. METHODS: The study was based on data from a clinical (N=171) and a normative (N=358) sample. In total 529 adults participated in the testing process. Beside the trauma questionnaire Parental Bonding Inventory, Impact of Events Scale and Dissociative Experiences Scale were administered. RESULTS: We examined the internal consistency of the translated trauma questionnaire. The Cronbach's a coefficients for the five subscales ranged from 0,639 to 0,934. Participants in the clinical sample reached higher scores on all trauma subscales except sexual abuse, than normative adults [PA: t (398)=-2,771; p=0,006; PN: t (398)=-5,990; p=0,000; EA: t (398)=-3,679; p=0,000; EN: t (398)=-4,759; p=0,000; total score: t (398)=-4,669; p=0,000]. Correlations among the trauma questionnaire total score and the scales of Parental Bonding Inventory indicating some medium effects (with maternal care: r=-0,661; p=0,000; with paternal care: r=-0,483; p=0,000). CONCLUSION: Our preliminary findings suggest that this trauma questionnaire is practical and facilitates the systema - tic evaluation of adverse early life events and maximizes the possibility of detecting childhood abuse and neglect.

Identifying diseases that cause psychological trauma and social avoidance by GCN-Xgboost.

BACKGROUND: With the rapid development of medical treatment, many patients not only consider the survival time, but also care about the quality of life. Changes in physical, psychological and social functions after and during treatment have caused a lot of troubles to patients and their families. Based on the bio-psycho-social medical model theory, mental health plays an important role in treatment. Therefore, it is necessary for medical staff to know the diseases which have high potential to cause psychological trauma and social avoidance (PTSA). RESULTS: Firstly, we obtained diseases which can cause PTSA from literatures. Then, we calculated the similarities of related-diseases to build a disease network. The similarities between diseases were based on their known related genes. Then, we obtained these diseases-related proteins from UniProt. These proteins were extracted as the features of diseases. Therefore, in the disease network, each node denotes a disease and contains the information of its related proteins, and the edges of the network are the similarities of diseases. Then, graph convolutional network (GCN) was used to encode the disease network. In this way, each disease's own feature and its relationship with other diseases were extracted. Finally, Xgboost was used to identify PTSA diseases. CONCLUSION: We developed a novel method 'GCN-Xgboost' and compared it with some traditional methods. Using leave-one-out cross-validation, the AUC and AUPR were higher than some existing methods. In addition, case studies have been done to verify our results. We also discussed the trajectory of social avoidance and distress during acute survival of breast cancer patients.

Neuropsychological Impact of Trauma-Related Mental Illnesses: A Systematic Review of Clinically Meaningful Results.

A trauma history is present in approximately 90% of adults in the United States. Comparatively, lifetime post-traumatic stress disorder (PTSD) prevalence is only 8.3% (Kilpatrick et al. Journal of Traumatic Stress, 26, 537-547, 2013). A neuropsychological understanding of trauma is essential to effective trauma-informed assessments and treatments. Prior reviews have focused on PTSD, specific neuropsychological domains, and statistically rather than clinically significant results. The current systematic review investigated standardized test performance across neuropsychological domains in participants with trauma histories and any psychiatric diagnosis. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From 2350 records, the search returned 21 eligible studies: 8 for combat trauma, 2 for childhood trauma, 2 for intimate partner violence and sexual assault, 2 for accidental trauma, 1 for refugee trauma, and 6 for unspecified trauma. Mean neuropsychological scores ranged from low to high average, with one mean verbal memory score in the borderline range. These findings diverge from reports of between-group differences or experimental task performance, which suggest greater levels of static cognitive impairment. Current results are limited by lack of distinction between trauma types in the literature, a dearth of cognitive domains examined, wide use of self-report trauma measures, and publication and outcome reporting biases. Clinical implications for assessment and rehabilitation are discussed in relation to clinical significance, state versus trait based changes, intra-individual variability, changes from pre- to post-trauma, and within-group variability in resilience. Future directions are recommended in consideration of cultural factors, prospective and follow-up designs, and psychiatric diagnosis.

Incident psychiatric comorbidity following stress disorder diagnoses in Danish school-aged children: prospective population-based study.

BACKGROUND: Prospective population-based studies of psychiatric comorbidity following trauma and severe stress exposure in children are limited. AIMS: To examine incident psychiatric comorbidity following stress disorder diagnoses in Danish school-aged children using Danish national healthcare system registries. METHOD: Children (6-15 years of age) with a severe stress or adjustment disorder (ICD-10) between 1995 and 2011 (n = 11 292) were followed prospectively for an average of 5.8 years. Incident depressive, anxiety and behavioural disorder diagnoses were examined relative to an age- and gender-matched comparison cohort (n = 56 460) using Cox proportional hazards regression models. Effect modification by gender was examined through stratified analyses. RESULTS: All severe stress and adjustment disorder diagnoses were associated with increased rates for all incident outcome disorders relative to the comparison cohort. For instance, adjustment disorders were associated with higher rates of incident depressive (rate ratio RR = 6.8; 95% CI 6.0-7.7), anxiety (RR = 5.3; 95% CI 4.5-6.4), and behavioural disorders (RR = 7.9; 95% CI 6.6-9.3). Similarly, PTSD was also associated with higher rates of depressive (RR = 7.4; 95% CI 4.2-13), anxiety (RR = 7.1; 95% CI 3.5-14) and behavioural disorder (RR = 4.9; 95% CI 2.3-11) diagnoses. There was no evidence of gender-related differences. CONCLUSIONS: Stress disorders varying in symptom constellation and severity are associated with a range of incident psychiatric disorders in children. Transdiagnostic assessments within a longitudinal framework are needed to characterise the course of post-trauma or severe stressor psychopathology.

A validation study of the International Trauma Questionnaire to assess post-traumatic stress disorder in treatment-seeking veterans.

BACKGROUND: Veterans with post-traumatic stress disorder (PTSD) typically report a poorer treatment response than those who have not served in the Armed Forces. A possible explanation is that veterans often present with complex symptoms of PTSD. ICD-11 PTSD and complex PTSD (CPTSD) have not previously been explored in a military sample. AIMS: This study aimed to validate the only measure of ICD-11 PTSD and CPTSD, the International Trauma Questionnaire, and assess the rates of the disorder in a sample of treatment-seeking UK veterans. METHOD: A sample of help-seeking veterans (N = 177) was recruited from a national charity in the UK that provides clinical services to veterans. Participants completed measures of ICD-11 PTSD and CPTSD as well as childhood and adult traumatic life events. Confirmatory factor analysis was used to assess the latent structure of PTSD and CPTSD symptoms, and rates of the disorders were estimated. RESULTS: The majority of the participants (70.7%) reported symptoms consistent with a diagnosis of either PTSD or CPTSD. Results indicated the presence of two separate disorders, with CPTSD being more frequently endorsed (56.7%) than PTSD (14.0%). CPTSD was more strongly associated with childhood trauma than PTSD. CONCLUSIONS: The International Trauma Questionnaire can adequately distinguish between PTSD and CPTSD within clinical samples of veterans. There is a need to explore the effectiveness of existing and new treatments for CPTSD in military personnel.

Annual Research Review: Rethinking childhood trauma-new research directions for measurement, study design and analytical strategies.

Childhood trauma is a key modifiable risk factor for psychopathology. Despite significant scientific advances, traumatised children still have poorer long-term outcomes than nontraumatised children. New research paradigms are, thus, needed. To this end, the review examines three dominant assumptions about measurement, design and analytical strategies. Current research warns against using prospective and retrospective measures of childhood trauma interchangeably; against interpreting cross-sectional differences in putative mediating mechanisms between adults with or without a history of childhood trauma as evidence of longitudinal changes from pre-trauma conditions; and against directly applying explanatory models of resilience or vulnerability to psychopathology in traumatised children to forecast individual risk in unseen cases. The warnings equally apply to research on broader measures of adverse childhood experiences (ACEs). Further research examining these assumptions can generate new insights on how to prevent childhood trauma and its detrimental effects.

Validation of ICD-11 PTSD and complex PTSD in foster children using the International Trauma Questionnaire.

OBJECTIVE: ICD-11 introduces post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct trauma-related disorders. Using the International Trauma Questionnaire (ITQ) as disorder-specific measure, this study is the first to examine the factorial and construct validity of ICD-11 PTSD, CPTSD and the ITQs' applicability in children. METHODS: Two hundred and eight Austrian foster children completed a set of standardized measures. Excluding participants who reported not having experienced any kind of trauma, a final sample of 136 children completed the ITQ. Factorial and construct validity of ICD-11 CPTSD and psychometric properties of ITQ scales were assessed by factor analysis and latent class analysis. RESULTS: Confirmatory factor analysis supported the two-factor higher-order model of ICD-11 CPTSD in children by high factor loadings and excellent model fit. Reliability and regression analysis evidenced psychometric adequacy and discriminant validity of ITQ scales. Latent class analysis substantiated construct validity of ICD-11 CPTSD, identifying a CPTSD (22.8%), PTSD (31.6%) and low symptoms class (45.6%). The CPTSD class showed highest rates of childhood trauma, comorbid psychopathology and functional impairment. CONCLUSION: Factorial and construct validity of ICD-11 CPTSD was evidenced in children for the first time using precise descriptions of ICD-11 symptom content, supporting the reliability and validity of the ITQ in children.

Symptomatology following loss and trauma: Latent class and network analyses of prolonged grief disorder, posttraumatic stress disorder, and depression in a treatment-seeking trauma-exposed sample.

BACKGROUND: Although bereavement is likely a common stressor among patients referred to a psychotrauma clinic, no study has yet examined the co-occurrence and relationships between symptoms of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder symptoms in this population. METHOD: In a sample of patients seeking treatment following psychological trauma (n = 458), we used latent class analysis to identify classes of patients sharing the same profile of PGD, PTSD, and depression symptoms. We then used network analysis to investigate the relationships among these symptoms and with loss-related variables. RESULTS: Most participants (65%) were members of a class that exhibited elevated endorsement of PGD symptoms. PGD, PTSD, and depression symptoms hung together as highly overlapping but distinguishable communities of symptoms. Symptoms related to social isolation and diminished sense of self bridged these communities. Violent loss was associated with more difficulty accepting the loss. The loss of close kin was most strongly associated with difficulty moving on in life. CONCLUSIONS: PGD symptoms are common in trauma-exposed bereaved adults and closely associated with symptoms of PTSD and depression, illustrating the importance of assessing bereavement and PGD symptoms in those seeking treatment following trauma.

Evaluation of LiNES: A New Measure of Trauma, Negative Affect, and Relationship Insecurity Over the Life Span in Persons With FND.

OBJECTIVE: The authors evaluated potential predisposing vulnerabilities and perpetuating factors among individuals with functional neurological disorder (FND) by using the novel Lifespan Negative Experiences Scale (LiNES), which assesses retrospective self-report of interpersonal trauma, negative affect, and relationship insecurity at three developmental stages: childhood, adolescence, and adulthood. METHODS: The LiNES, Childhood Abuse and Trauma Scale (CATS), Relationship Scales Questionnaire (RSQ), and Positive and Negative Affect Schedule (PANAS) were administered to 71 individuals with FND. The reliability and validity of LiNES were examined by correlation with the other measures. FND patients' responses on LiNES were compared with those of 170 healthy control subjects. RESULTS: LiNES scores in the FND group were internally consistent and correlated highly with CATS, RSQ, and PANAS scores. At each developmental stage, LiNES trauma scores were higher among patients with FND, compared with control subjects. The FND subgroup, which comprised patients who also had nonepileptic attack disorder, had higher trauma scores, compared with the FND-only subgroup. Compared with control subjects, patients with FND reported greater negative affect and relationship insecurity in adulthood. Lifetime LiNES scores for interpersonal trauma and relationship insecurity predicted FND group classification with >80% accuracy. CONCLUSIONS: This study provides further support for the links between FND and trauma, negative affect, and insecure attachment. Recognition of these factors is likely to be important for treatment and stratification of important subpopulations in research. These findings provide new insights into the association between the timing of negative experiences and their effect, with LiNES emerging as a potentially useful measure for patients presenting with FND.

Application of group smoothly clipped absolute deviation method in identifying correlates of psychiatric distress among college students.

BACKGROUND: College students are at an increased risk of psychiatric distress. So, identifying its important correlates using more reliable statistical models, instead of inefficient traditional variable selection methods like stepwise regression, is of great importance. The objective of this study was to investigate correlates of psychiatric distress among college students in Iran; using group smoothly clipped absolute deviation method (SCAD). METHODS: A number of 1259 voluntary college students participated in this cross-sectional study (Jan-May 2016) at Hamadan University of Medical Sciences, Iran. The data were collected using a self-administered questionnaire consisting of demographic information, a behavioral risk factors checklist and the GHQ-28 questionnaire (with a cut-off of 23 to measure psychiatric distress, recommended by the Iranian version of the questionnaire). Penalized logistic regression with a group-SCAD regularization method was used to analyze the data (α = 0.05). RESULTS: The majority of students were aged 18-25 (87.61%), and 60.76% of them were female. About 41% of students had psychiatric distress. Significant correlates of psychiatric distress among college students selected by group-SCAD included the average grade, educational level, being optimistic about future, having a boy/girlfriend, having an emotional breakup, the average daily number of cigarettes, substance abusing during previous month and having suicidal thoughts ever (P < 0.05). CONCLUSIONS: Penalized logistic regression methods such as group-SCAD and group-Adaptive-LASSO should be considered as plausible alternatives to stepwise regression for identifying correlates of a binary response. Several behavioral variables were associated with psychological distress which highlights the necessity of designing multiple factors and behavioral changes in interventional programs.

Pilot of a screening, brief intervention and referral to treatment process for symptoms of trauma among primary care patients.

BACKGROUND: For populations with high rates of trauma exposure yet low behavioural health service use, identifying and addressing trauma in the primary care setting could improve health outcomes, reduce disability and increase the efficiency of health system resources. OBJECTIVE: To assess the acceptability and feasibility of a screening, brief intervention and referral to treatment (SBIRT) process for trauma and symptoms of posttraumatic stress disorder (PTSD) among American Indian and Alaska Native people. We also examine the short-term effects on service utilization and the screening accuracy of the Primary Care Posttraumatic Stress Disorder Screen. METHODS: Cross-sectional pilot in two tribal primary care settings. Surveys and interviews measured acceptability among patients and providers. Health service utilization was used to examine impact. Structured clinical interview and a functional disability measure were used to assess screening accuracy. RESULTS: Over 90% of patient participants (N = 99) reported the screening time was acceptable, the questions were easily understood, the right staff were involved and the process satisfactory. Ninety-nine percent would recommend the process. Participants screening positive had higher behavioural health utilization in the 3 months after the process than those screening negative. The Primary Care Posttraumatic Stress Disorder Screen was 100% sensitive to detect current PTSD with 51% specificity. Providers and administrators reported satisfaction with the process. CONCLUSIONS: The SBIRT process shows promise for identifying and addressing trauma in primary care settings. Future research should explore site specific factors, cost analyses and utility compared to other behavioural health screenings.

Alexithymia, Emotion-Regulation Strategies, and Traumatic Experiences in Prenatally Cocaine-Exposed Young Adults.

BACKGROUND AND OBJECTIVES: Exposure to early-life trauma may lead to maladaptive characteristics such as alexithymia, and thus to poorer emotional regulation. This relationship may also be influenced by exposure to substances prenatally. We hypothesized that increased alexithymia would be seen in those with prenatal cocaine exposure (PCE). Additionally, we hypothesized that early-life trauma would be associated with alexithymia, and that alexithymia would be associated with poor emotional reappraisal and emotional suppression. METHODS: A moderated mediation model was developed to examine whether the hypothesized indirect relationship between trauma and emotional reappraisal through alexithymia was different in young adults with and without PCE (Total N = 57). Thirty-seven young adults with PCE and 20 with no such exposure, all of whom were members of a longitudinal cohort, were recruited for the study, and data concerning childhood trauma, alexithymia, and emotional regulation were collected. Intercorrelations were performed between the scores on each measure and moderated mediation models were constructed separately with emotional neglect or emotional abuse as the independent variable and emotional reappraisal or emotional suppression as the dependent variable. RESULTS: PCE status was associated with alexithymia, and alexithymia mediated the relationship between emotional neglect and emotional reappraisal in individuals with PCE but not those without. DISCUSSION AND CONCLUSIONS: The data suggest that alexithymia is a mechanism underlying poor use of emotional reappraisal in PCE individuals. SCIENTIFIC SIGNIFICANCE: Individuals with early-life trauma and substance exposure may represent a vulnerable population, and alexithymia may play a key role in the development of emotional regulation skills in this population. (Am J Addict 2020;29:492-499).

[Identify psychotraumatisms in people with addictive problems]. / Dépister les psychotraumatismes chez les personnes ayant une problématique addictive.

Frequently overlooked during the patient's treatment, psychological trauma can constitute a significant part of the addiction problem. Clinical data reveal a high incidence of post-traumatic stress disorder for which addictive behaviours may be a way of repressing the anxiety caused by the trauma. Systematic screening for trauma would help to ensure an appropriate treatment plan is put in place.

The symptomatology of psychological trauma in the aftermath of war (1945-1980): UK army veterans, civilians and emergency responders.

BACKGROUND: UK veterans suffering from a psychological or psychiatric illness as a consequence of service in the Second World War were entitled to a war pension. Their case files, which include regular medical assessments, are a valuable resource to investigate the nature, distribution and duration of symptoms. METHODS: A standardised form was used to collect data from pension records of a random sample of 500 UK army veterans from the first presentation in the 1940s until 1980. Data were also gathered from 50 civilians and 54 emergency responders with a pension for post-traumatic illness following air-raids. RESULTS: The 10 most common symptoms reported by veterans were anxiety, depression, sleep problems, headache, irritability/anger, tremor/shaking, difficulty completing tasks, poor concentration, repeated fears and avoidance of social contact. Nine of the 10 were widely distributed across the veteran population when symptoms were ranked by the number of subjects who reported them. Nine symptoms persisted significantly longer in the veteran sample than in emergency responders. These included seven of the most common symptoms, together with two others: muscle pain and restlessness. The persistence of these symptoms in the veteran group suggests a post-traumatic illness linked to lengthy overseas service in combat units. CONCLUSIONS: The nature and duration of symptoms exhibited by veterans may be associated with their experience of heightened risks. Exposure to severe or prolonged trauma seems to be associated with chronic multi-symptom illness, symptoms of post-traumatic stress and somatic expressions of pain that may delay or complicate the recovery process.

Practitioner Review: Posttraumatic stress disorder and its treatment in children and adolescents.

Important advances in understanding traumatic stress reactions in children and young people have been made in recent years. The aim of this review was to synthesise selected recent research findings, with a focus on their relevance to clinical practice. We therefore address: findings on the epidemiology of trauma exposure and Posttraumatic Stress Disorder (PTSD); recent changes to diagnostic classification; implications for screening and assessment of traumatic stress reactions; and treatment outcome studies including interventions for acute and chronic PTSD, dissemination of effective treatments into community settings, and early interventions. We conclude with recommendations for clinical practice and suggestions for future areas of research.

Psychological trauma, somatization, dissociation, and psychiatric comorbidities in patients with psychogenic nonepileptic seizures compared with those in patients with intractable partial epilepsy.

OBJECTIVE: The objective of this study was to compare patients with intractable epilepsy with patients with psychogenic nonepileptic seizures (PNES) on the presence of psychological traumas, clinical factors, and psychological measures of somatization and dissociation. BACKGROUND: Several studies have reported a high prevalence of psychological trauma in patients with PNES, while less have examined the prevalence of psychological trauma in patients with epilepsy and compared both groups. Reports have been somewhat divergent with some describing significantly higher prevalence in physical abuse, others, in emotional abuse/neglect, and others, in sexual abuse in patients with PNES compared with those in patients with epilepsy. METHODS: This is a retrospective study of 96 patients (61 women, 35 men) with intractable epilepsy (2009 to 2017) and 161 patients (107 women, 54 men) with PNES (2008 to 2018). Demographic and clinical (psychological trauma, depression, anxiety, seizure frequency, and number of antiepileptic drugs) data were collected. The Trauma Symptom Inventory II and the Minnesota Multiphasic Personality Inventory 2RF were administered. RESULTS: Patients with PNES differed significantly from those with intractable epilepsy on sexual trauma (χ2 (5df, N = 257) =9.787, p < .002) and "other" trauma (χ2 (5df, N = 257) = 17.9076, p < .000). On psychological measures, there was a significant difference on Somatization scores in patients with PNES (M = 59.63, SD = 11.47) and patients with intractable epilepsy (M = 53.98, SD = 11.31); t(173) = 2.8396, p = .0051, but no difference was noted on a measure of Dissociation. Subsequent principal components analysis revealed that the first 3 principal components (sexual, physical, and other trauma) explained 74.19% of the variability, and that one principal component (dissociation, somatization, demoralization) explained 61.57% of the variability. However, after adjusting for the effects of covariates, only the presence of trauma discriminated between epilepsy and PNES. CONCLUSIONS: Patients with PNES diagnoses differed from those with epilepsy on a Somatization scale but not on Dissociation or Intrusive Experiences and exhibited significantly higher rates of sexual and "other" trauma compared with those with intractable epilepsy. However, subsequent analyses revealed that a history of psychological trauma was the only condition found to discriminate between patients with PNES and those with epilepsy. These findings suggest that during initial workup and diagnosis, when patients report a history of psychological trauma (sexual or otherwise) a psychogenic nonepileptic etiology should be strongly considered in the differential diagnosis.

Assessing the special need for protection of vulnerable refugees: testing the applicability of a screening method (RHS-15) to detect traumatic disorders in a refugee sample in Germany.

Objectives: Although EU member states are obligated to take special account of the situation of particularly vulnerable refugees, appropriate and specific measures to detect affected asylum seekers are not yet available. This study tries to pave the way for the implementation of an adequate instrument which at the same time assesses these needs of suffering people whilst responding to the need for mental health assessments specifically designed for refugees. This was done by testing the implementation of a screening method (Refugee Health Screener RHS-15) for trauma related mental health problems in refugees. Design: Two refugee samples in Germany (differing in arrival time: 126 applicants for asylum residing in the initial reception center and 116 living in long term communal accommodations) were assessed with the culturally sensitive Refugee Health Screener (RHS-15) to detect the incidence of mental health problems amongst them. Test fairness, reasonableness, susceptibility, transparency, acceptance, external design, utility and economy of the instrument were examined to check the applicability of the RHS-15 standardization test. Results: The RHS-15 indicates a good practical feasibility as the examination of the focused psychometric characteristics suggests. It became apparent, that implementing a screening procedure depends on political, legal and medical context factors that need to be considered. 2/3 of the participants had a positive screening result, which needs further diagnostic clarification in a second step. Conclusion: The RHS-15 seems to be practicable, economical, and rapidly deployable for the widespread detection of traumatic disorders in refugees living in Europe. The tool proved useful to aid diagnostic assessments and provide treatment to individuals in need, however the time of examination (resp. the duration of staying in the target land) influences the results.

Trauma and anxious attachment influence the relationship between suggestibility and dissociation: a moderated-moderation analysis.

INTRODUCTION: Hypnotic suggestibility is elevated in the dissociative disorders but the relationship between dissociative tendencies and suggestibility in the general population seems to be constrained by additional factors. The diathesis-stress (DS) model stipulates that suggestibility interacts with trauma exposure to augment the propensity for dissociative states whereas the dual pathway to suggestibility (DPS) model proposes two developmental routes involving either dissociation preceded by trauma, or a healthy cognitive profile characterised by superior imagination. METHODS: This study sought to discriminate between these partially competing accounts and further considered the moderating role of anxious attachment. 209 participants completed psychometric measures of dissociative tendencies, trauma, and attachment, and a behavioural measure of suggestibility. RESULTS: In support of the DS model, trauma moderated the relationship between suggestibility and dissociation and, as predicted by the DPS model, dissociation moderated the relationship between trauma and suggestibility. Anxious attachment additionally moderated both effects. Model comparisons indicated that the DS model consistently provided a superior fit to the data. Further analyses showed that secure attachment independently predicted suggestibility, thereby supporting the non-dissociative pathway in the DPS model. CONCLUSIONS: These results suggest that high suggestibility confers vulnerability to dissociative states in individuals exposed to trauma and displaying an anxious attachment style.

Displaced Rohingya children at high risk for mental health problems: Findings from refugee camps within Bangladesh.

BACKGROUND: The 2017 political violence against the Rohingya people in the state of Rakhine resulted in a large influx of displaced populations into Bangladesh. Given harsh conditions and experiences in Myanmar, and the harrowing journey to the border, raised levels of child neurodevelopmental disorders (NDDs) and mental health problems were expected. METHODS: A team of child development professionals, physicians, psychologists, and developmental therapists screened 622 children in clinics within the refugee camps using the Developmental Screening Questionnaire (DSQ; 0-<2 years), and the Ten Questions Plus (TQP) for NDDs, and Strengths and Difficulties Questionnaire (SDQ; 2-16 years) for mental health problems. Any child positive on the DSQ or the TQP was assessed for NDDs. RESULTS: Only 4.8% children aged 0-<2 years and 7.3% children aged >2-16 years screened positive for NDDs, comparable with a local Bangladesh population. However, 52% of children were in the abnormal range for emotional symptoms on the SDQ, and 25% abnormal for peer problems. Significant risk factors were being parentless and having lost one or more family members in the recent crisis. CONCLUSIONS: This screening study provides objective evidence of the urgent need for psychosocial support of Rohingya children within camps, with special attention to those without parents, including monitoring of their well-being and counselling of families and other care providers.