Validation of the International Adjustment Disorder Questionnaire in Israel and Switzerland.

The ICD-11 has introduced a new conceptualization of adjustment disorder (AjD) as a stress response syndrome with core symptoms of preoccupations and failure to adapt to the stressor. The current study aimed to assess the reliability and validity of the International Adjustment Disorder Questionnaire (IADQ) in two culturally distinct samples from Israel and Switzerland. Two samples were recruited in Israel (N = 1142) and Switzerland (N = 699) during the initial stages of the COVID-19 pandemic. Confirmatory factor analysis indicated that a correlated two-factor model provided an excellent fit to the Israeli and Swiss sample data. The IADQ scores correlated strongly with another measure of AjD symptoms and with symptoms of depression, anxiety, acute stress and negative emotions, whereas correlations with posttraumatic stress disorder, complex posttraumatic stress disorder and positive emotions were weaker. In the Swiss sample, 18.8% met diagnostic criteria for probable AjD and 10.2% in the Israeli sample. The current study provides the first evidence of the validity of the German and Hebrew versions of the IADQ and can be used for the screening of this debilitating condition.

Network structure of ICD-11 adjustment disorder: a cross-cultural comparison of three African countries.

BACKGROUND: Adjustment disorder is one of the most widespread mental disorders worldwide. In ICD-11, adjustment disorder is characterised by two main symptom clusters: preoccupation with the stressor and failure to adapt. A network analytic approach has been applied to most ICD-11 stress-related disorders. However, no study to date has explored the relationship between symptoms of adjustment disorder using network analysis. AIMS: We aimed to explore the network structure of adjustment disorder symptoms and whether its structure replicates across questionnaire versions and samples. METHOD: A network analysis was conducted on adjustment disorder symptoms as assessed by the Adjustment Disorder-New Module (ADNM-8) and an ultra-brief version (ADNM-4) using data from 2524 participants in Nigeria (n = 1006), Kenya (n = 1018) and Ghana (n = 500). RESULTS: There were extensive connections between items across all samples in both ADNM versions. Results highlight that preoccupation symptoms seem to be more prominent in terms of edges strengths (i.e. connections) and had the highest centrality in all networks across samples and ADNM versions. Comparisons of network structure invariance revealed one difference between Nigeria and Ghana in both ADNM versions. Importantly, the ADNM-8 global strength was similar in all networks whereas in the ADNM-4 Kenya had a higher global strength score compared with Nigeria. CONCLUSIONS: Results provide evidence of the coherence of adjustment disorder in ICD-11 as assessed by the ADNM questionnaire. The prominence of preoccupation symptoms in adjustment disorder highlights a possible therapeutic target to alleviate distress. There is a need to further replicate the network structure of adjustment disorder in non-African samples.

Families in the Shadow of Traumatic Experiences: Negative World Assumptions and Family Relationships.

World assumptions (WAs) are cognitive schemas concerning an individual's views of themselves, the world, and others. Although it is well established that WAs are negatively distorted by trauma exposure and strongly associated with posttraumatic psychopathology, the potential impact of WAs on close interpersonal relationships remains largely uninvestigated. The current study explored the implications of veterans' and their spouses' WAs on their marital and parental relationships. Male Israeli veterans (N = 213) from the 1973 Yom Kippur War and their wives were assessed for WAs, marital adjustment, and positive parenting 35-37 years postwar. Analyses included actor-partner interdependence modeling with mediators (APIMem) and were conducted separately for the three domains of WAs: world benevolence, world meaningfulness, and self-worth. The results indicated that both husbands' and wives' lower scores for all domain-specific WA scales were associated with lower scores on measures of marital adjustment and positive parenting. Lower scores for both spouses on scales measuring world benevolence and self-worth were associated with a spillover from lower marital adjustment to lower positive parenting. Finally, associations between one spouse's lower WA scores and the other spouse's spillover from lower marital adjustment to lower positive parenting (i.e., cross-spillover effects) were identified for wives' world benevolence ratings and husbands' self-worth, ds = 0.14-0.72. These results point to the detrimental ramifications of negative WAs on family relationships and the dynamics between the marital and parental family subsystems.

Trajectories of depression in aging veterans and former prisoners-of-war: The role of social support and hardiness.

OBJECTIVES: Depression is a prevalent outcome of traumatic experiences, such as combat and war captivity. This study explores the heterogeneity of changes over time and assesses the contribution of trauma exposure (combat vs. war captivity), hardiness, and social support for depression trajectories. METHODS: Two groups of Israeli veterans were assessed in 1991, 2003, 2008, and 2015: 149 former prisoners-of-war (ex-POWs) and 107 combat veterans. Protective factors were evaluated in 1991. Group-based trajectory modeling was conducted to identify latent trajectories of change. RESULTS: Four trajectories of "resiliency" (62.8%), "delayed onset" (25.1%), "exacerbation" (6.2%), and "chronicity" (5.9%) were found. The majority of the resilient group were combat veterans whereas the clinical groups consisted primarily of ex-POWs. Lower hardiness and social support were related to more deleterious trajectories. CONCLUSIONS: Spirals of loss involving hardiness and social support, normative experiences, and contextual factors may present explanations for the various depression trajectories.

Posttraumatic Stress and Sexual Satisfaction in Husbands and Wives: A Dyadic Analysis.

Trauma survivors who suffer from posttraumatic stress symptoms (PTSS) are known to experience impairments in sexual satisfaction. However, the negative effects of PTSS are not limited to the primary survivors, as they can lead to secondary PTSS in their spouses as well. The implications of secondary PTSS in the sexuality of couples remain unknown. This study aimed to investigate whether specific symptom clusters of PTSS (i.e., intrusions, hyperarousal, and avoidance) are implicated in the sexual satisfaction of couples. We assessed a sample of primarily exposed Israeli veterans from the Yom Kippur War and their wives who had been secondarily exposed (N = 191). The dyadic data were analyzed in an Actor-Partner Independence Model. When scrutinizing specific PTSS clusters, the husbands' avoidance related to their own sexual satisfaction. The wives' hyperarousal related to their own and their spouses' sexual satisfaction, whereas their intrusions were associated only with their husbands' sexual satisfaction. In conclusion, PTSS in one spouse is related to both spouses' sexual satisfaction; it is therefore recommended that clinicians adopt a dyadic approach when delivering interventions.

The role of parental negative world assumptions in the intergenerational transmission of war trauma.

PURPOSE: Among the most prevalent and adverse sequalae of traumatic experiences are negative world assumptions (WAs), which describe trauma-related negative cognitions regarding the self, the world, and others. Even though a wealth of studies has shown intrapersonal associations between negative WAs and posttraumatic stress symptoms (PTSS), there has been little research on how WAs may affect family systems. This study examined the intergenerational associations between parental WAs, paternal PTSS, and maternal secondary traumatic stress (STS) on adult-children's STS in veterans' families. It was hypothesized that negative paternal WAs would mediate the association between parental PTSS/STS and adult-children's STS. METHODS: Three domains of WAs (benevolence of the world, meaningfulness of the world, and self-worth) and PTSS were prospectively assessed in 123 father-mother-offspring triads of former Israeli veterans of the 1973 Yom Kippur War, their wives and adult offspring. Data were collected in 2003, 2008, and 2014, and analyzed using triadic path modeling. RESULTS: Mothers' STS was associated with children's STS via negative maternal WAs on world benevolence. Fathers' PTSS was related to children's STS via fathers' WAs on world benevolence and self-worth. Moreover, fathers' WAs on world benevolence and self-worth mediated the intergenerational transmission of STS from mothers to offspring. No effects were found for meaningfulness WAs. CONCLUSION: Findings suggest that parental WAs related to world benevolence and paternal self-worth contribute to intergenerational trauma transmission. Clinical implications favor cognitive and systemic approaches to therapy that address negative benevolence and self-worth assumptions and involve the entire family system.

Psychiatric distress among aging decorated and non-decorated veterans: The role of impostorism and loneliness.

Objectives: The aging process may be affected by negative life events as well as social factors. Though psychological aspects of the aging process in veterans have been the focus of considerable research, decorated veterans have been scarcely investigated in this domain. The current study sought to assess psychiatric distress (PD) levels among aging decorated and non-decorated veterans' (DVs and n-DVs, respectively) and examine its association with the maladaptive perception that others will identify a high-achieving person as an impostor (i.e. impostorism) and perceived social isolation (i.e. loneliness).Methods: Two groups of Israeli veterans of the 1973 Yom Kippur War, DVs (n = 75) and n-DVs (n = 73), were assessed for PD and combat exposure in middle adulthood (1991; T1); in later life (2018; T2) they were assessed for negative life events, impostorism, loneliness and PD.Results: Impostorism, loneliness and PD were all inter-correlated. DVs evinced less PD at T1 and T2 than n-DVs but similar levels of impostorism and loneliness at T2. Nevertheless, negative life events, impostorism and loneliness explained PD at T2, with loneliness being more significant, especially among the n-DVs. Combat exposure did not explain variances in late-life PD.Conclusion: Aging DVs seem to be less vulnerable to late-life PD than n-DVs, and impostorism and loneliness may be important factors in this respect. Being the first study to investigate aging DVs' mental health and impostorism among aging veterans, the findings further underscore the clinical imperative of psychosocial factors in understanding aging veterans' mental health.

Trajectories of attachment in older age: interpersonal trauma and its consequences.

Previous studies suggest that attachment insecurities may increase after trauma exposure, an effect documented only at a group level. This study explores the heterogeneity of changes over time and examines the associations of the nature of the traumatic event (interpersonal and nonpersonal), and its consequences (posttraumatic stress disorder [PTSD] and loneliness) with attachment trajectories. Two groups of Israeli veterans participated: 164 former prisoners-of-war and 185 combat veterans. Attachment was assessed at four points (1991-2015). Risk factors were evaluated in 1991. Using latent growth mixture modeling, trajectories of attachment insecurities were explored. Three avoidance trajectories (stability, decrease, inverse u-shaped) and two anxiety trajectories (stability, decrease) were identified. The inverse u-shaped avoidance trajectory was associated with captivity, humiliation, loneliness, and PTSD, and stable avoidance was associated with loneliness. Stable anxiety was associated with captivity and loneliness. Attachment insecurities can change during aging and persist decades after a trauma. Trauma-related risk factors are related to more deleterious trajectories.

Longitudinal Development of Primary and Secondary Posttraumatic Growth in Aging Veterans and Their Wives: Domain-Specific Trajectories.

Posttraumatic growth (PTG), the positive psychological transformations that follow traumatic events, affects both direct survivors (primary PTG) and their significant others (secondary PTG). Though primary and secondary PTG have been widely investigated in the literature, their long-term trajectories decades after a traumatic event, especially as survivors enter older age, remain largely uninvestigated. Furthermore, it remains contested whether PTG adds up to a monolithic construct or rather consists of relatively independent components. Addressing these issues, we assessed a sample of Israeli male veterans from the 1973 Yom Kippur war (N = 349) and their wives (N = 156) at three time points over the course of nearly three decades. Both the veterans (primary survivors) and their wives (secondary survivors) reported PTG relating to the veterans' experiences during the war and/or captivity. Latent growth mixture modeling was conducted to identify trajectories of PTG on the five subscales of the Posttraumatic Growth Inventory. Long-term trajectories of PTG followed heterogeneous patterns of fluctuation over time and particularly as participants entered older age. On most subscales, decreasing PTG scores were evident, a trend that was more pronounced among the primary survivors than the secondary survivors as primary and secondary PTG fluctuate considerably in the long-term and seem to decrease as individuals enter older age. Furthermore, it would seem that PTG should not be considered a holistic concept but rather a conglomeration of positive changes. Implications of the findings are discussed within the context of limitations and potential intervening factors.

Secondary Traumatization and Differentiation Among the Wives of Former POWs: A Reciprocal Association.

Repercussions of war captivity may transmit to spouses of former prisoners of war (POW) via posttraumatic stress symptoms (PTSS). Overidentification with their partners underlies the PTSS experienced by former wives of POWs, thus implying impaired self-differentiation. Although wives' indirect exposure to their husbands' captivity and subsequent PTSS has been associated with the wives' PTSS and differentiation, the combined effects remain unclear. Furthermore, previous cross-sectional studies could not illuminate directionality. This prospective study investigates (a) the moderating role of indirect exposure to captivity in the association between husbands' PTSS and wives' PTSS and differentiation; and (b) the directionality of the association between wives' differentiation and PTSS over time. The wives of both former POWs (n = 143) and combatants (n = 102) were assessed 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. The wives of former POWs endorsed higher PTSS and fusion differentiation, η2p = .06 to .14. Indirect exposure to captivity moderated the associations between husbands' PTSS and wives' PTSS, Cohen's f2 = .01 to .03. The association between the wives' differentiation and PTSS over time was bidirectional, ß = -0.18 to 0.68; R2 = .54 to .73. Results suggest a vicious cycle between PTSS and differentiation, and the need for clinical interventions that further differentiation for spouses of prolonged trauma victims.

Traumatization, Marital Adjustment, and Parenting among Veterans and Their Spouses: A Longitudinal Study of Reciprocal Relations.

Despite considerable research on secondary traumatization, the ramifications of veterans' and their wives' posttraumatic stress symptoms (PTSS) for the family system remain largely uninvestigated. Beginning to fill this gap, the current study aims to investigate the reciprocal relations between both spouses' PTSS and marital adjustment, and the implications these bear for their parental functioning. Two hundred and twenty-five Israeli veterans (mean age = 58.62, SD = 7.6) from the 1973 Yom Kippur War and their wives (mean age = 58.28, SD = 5.79) were examined at two points in time: 30 (T1) and 35-37 years after the war (T2). Analysis included longitudinal actor-partner interdependence modeling and sequential mediation analyses. The results show that higher PTSS among the wives at T1 predicted higher PTSS among husbands at T2, and vice versa, and predicted their husbands' marital adjustment at T2. Moreover, wives' PTSS at T1 had a significant effect on parental overinvolvement of both parents at T2, but neither their PTSS nor their husbands' PTSS had an impact on positive parenting. In the intrapersonal domain, better marital adjustment at T1 predicted positive parenting among both spouses in subsequent measurement. Interpersonally, wives' lower marital adjustment at T1 predicted husbands' higher parental functioning, but not vice versa. Furthermore, marital adjustment mediated the association between PTSS and positive parenting for both spouses. The results emphasize the detrimental ramifications of war trauma on the interpersonal domains in veterans' families. Hence, both marital and parental consequences of trauma should be considered in clinical family interventions.

Prolonged grief disorder symptomology in three African countries: A network analysis and comparison.

Background: Bereavement is a globally prevalent life stressor, but in some instances, it may be followed by a persistent condition of grief and distress, codified within the 11th edition of the International Classification of Diseases (ICD-11) as prolonged grief disorder (PGD). Network analysis provides a valuable framework for understanding psychological disorders at a nuanced symptom-based level. Aim: This study novelly explores the network structure of ICD-11 PGD symptomology in a non-Western sample and assesses the replication of this across three African country sub-samples in these data. Methodology: Network models were estimated using the "Inventory of Complicated Grief-Revised" in a sample of trauma-exposed individuals who experienced bereavement throughout life (N = 1,554) from three African countries (Ghana, n = 290; Kenya, n = 619; Nigeria, n = 645). These networks were statistically evaluated using the network comparison test. Results: It was found that "Feelings of Loss" and "Difficulty moving on" were the most central symptoms in the combined sample network. These findings were largely consistent for the Ghana and Nigeria sub-samples, however, network structure differences were noted in the Kenya sub-sample. Conclusion: The identified PGD network highlights particular indicators and associations across three African samples. Implications for the assessment and treatment of PGD in these cultural contexts warrant consideration.

The association between dissociative symptoms and schizophrenia-related negative symptoms: A transdiagnostic approach.

Negative symptoms of schizophrenia remain clinically and theoretically understudied and represent an unmet psychiatric need. Negative symptoms are assumed to be related to other psychiatric disorders, but their association with dissociative symptoms is yet to be explored, particularly in light of depression and anxiety symptoms. We examined the five domains of negative symptoms (anhedonia, asociality, avolition, blunted affect and alogia) in an Israeli national sample of 1930 participants of whom 645 (33.4%) were with increased risk for dissociative disorder. The results show that anhedonia, blunted affect and alogia significantly associated with risk for dissociative disorder, above and beyond depression and anxiety. When assessing for negative symptoms it may be worth screening for dissociation and vice versa and thus make a more accurate clinical picture of the interplay between them.

The Dual Burden of Emerging Adulthood: Assessing Gambling Severity, Gambling-Related Harm, and Mental Health Challenges.

Growing concerns over gambling problems across age groups have sparked research in public health and psychology. During emerging adulthood, individuals are more susceptible to mental health problems and more likely to develop gambling problems than in other age groups. This study explored the potential differences between emerging adults and adults aged 30+ in terms of problem gambling severity (PGS), gambling-related harm (GRH), depression and anxiety, and the mediating role of depression and anxiety in the association between age, PGS, and GRH. A representative online sample of 3244 Israelis aged 18 and over was divided into two groups: 740 emerging adults aged 18-29 and 2504 adults aged 30+. Gambling behaviors, the Problem Gambling Severity Index, the Short Gambling Harm Screen, and the Patient Health Questionnaire-4 assessing depression and anxiety were administered. Emerging adults had significantly higher levels of GRH, PGS, and depression-anxiety than their older counterparts, above and beyond gender and education. Depression-anxiety fully mediated the associations between age and gambling-related outcomes. These findings underscore the importance of considering psychological well-being in efforts to address problem gambling and gambling-related harms, especially in emerging adults.

The relationship between specific auditory hallucinations and acute PTSD vs. complex PTSD following direct and indirect exposure to the October 7 events in Israel.

This preliminary study examines the link between war-related auditory (pseudo)hallucinations and symptoms of acute ICD-11 posttraumatic stress disorder (PTSD) and Complex PTSD (CPTSD) amidst ongoing conflict, with a specific focus on CPTSD. The research, which analyzed data from 2028 Israeli residents following the traumatic events of October 7, 2023, investigated the perception of non-existent sirens and their association with acute PTSD and CPTSD symptoms. The findings reveal that (pseudo)hallucinations were more prevalent among individuals with acute CPTSD symptoms compared to those with PTSD symptoms alone. Additionally, auditory (pseudo)hallucinations were significantly associated with a higher likelihood of CPTSD versus PTSD. These results were consistent for those directly and indirectly exposed individuals to the October 7 attack. Despite its cross-sectional nature, the study provides valuable insights into trauma-related auditory (pseudo)hallucinations in wartime contexts.

The role of maternal postmigration living difficulties in intergenerational trauma transmission among asylum-seeker mother-child dyads: Exploring complex posttraumatic stress disorder as a mechanism.

OBJECTIVE: Among forcibly displaced people, maternal trauma and stress have been implicated in poor child socioemotional outcomes via intergenerational trauma transmission. This study explored the role of maternal postmigration living difficulties (PMLD) in the pathway linking maternal trauma, trauma-related psychopathology, and child socioemotional outcomes among mother-child dyads seeking asylum in a high-risk urban setting. METHOD: Participants were East African (Eritrean) mothers (N = 127) of preschool-aged children seeking asylum in Israel. Using moderated mediation analysis, we tested whether and how PMLD may moderate the mediating role of current maternal International Classification of Diseases, 11th revision (ICD-11) posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder disturbances in self-organization (DSO) symptoms between past maternal trauma exposure and current postdisplacement child internalizing and externalizing difficulties. Children's direct exposure to adverse life experiences was controlled for. RESULTS: Maternal PTSD symptoms mediated the association between past maternal trauma exposure and child internalizing difficulties, but not externalizing difficulties, across all levels of current maternal PMLD. However, maternal DSO symptoms mediated internalizing and externalizing child outcomes, but only among mothers reporting high levels of current PMLD. CONCLUSION: This study provides novel evidence that PMLD may amplify the toxicity of past maternal trauma exposure for poor child socioemotional outcomes via ICD-11 DSO symptoms. The intergenerational transmission pathway via the narrower fear-based ICD-11 PTSD, however, is independent of the degree of maternal PMLD. Findings suggest that policies designed to buffer intergenerational trauma transmission among forcibly displaced people may need to consider the toxicity of PMLD as well as enable mothers to heal from PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The association between negative war-related beliefs and probable PTSD and complex PTSD among Ukrainians during the 2022 Russian invasion.

The ongoing Ukraine-Russia war triggered significant mental health consequences, particularly posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). A population study with 1895 Ukrainians explored the association between negative war-related beliefs and risk for PTSD and CPTSD. Negative war-related beliefs were shown to be significantly linked to increased risks for PTSD and more so for CPTSD. Interventions that address negative war-related beliefs could mitigate the mental health impact of war.

Complex posttraumatic stress disorder in intergenerational trauma transmission among Eritrean asylum-seeking mother-child dyads.

Background: Traumatic stress among forcibly displaced people has a variety of adverse consequences beyond individual mental health, including implications for poor socioemotional developmental outcomes for their children post-displacement.Objective: This study explored the intergenerational transmission of maternal ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) and depression among asylum-seeking mothers for their children's internalizing and externalizing difficulties.Method: Participants were 127 trauma-affected Eritrean mothers of preschool-aged children in Israel. The severity of child difficulties was compared between mothers with probable ICD-11 CPTSD (94.5% comorbid depression), ICD-11 PTSD (48.5% comorbid depression), unimorbid depression, and healthy mothers, using multivariate analyses of variance, while controlling for children's direct exposure to adverse life experiences.Results: Probable ICD-11 CPTSD and PTSD were present in 23.6% and 26.0% of mothers, respectively. Relative to maternal PTSD, CPTSD was significantly and strongly associated with elevated child internalizing symptoms (d = 2.44) and marginally significantly, although strongly, associated with child externalizing symptoms (d = 1.30). Post-hoc exploratory analyses documented that, relative to maternal PTSD and depression, CPTSD and depression comorbidity was marginally significantly but strongly associated with child internalizing (SMD = .67), but not externalizing symptoms (SMD = .35).Conclusions: Findings implicate maternal CPTSD and comorbid depression in child socio-emotional development and inform clinical assessment, prevention, and intervention to attenuate poor development among children in unstable post-displacement settings.

Trauma among forcibly displaced people has a variety of aversive multisystemic consequences, compromising the socioemotional development of non-exposed children.ICD-11 complex posttraumatic stress disorder (CPTSD) and comorbid depression may be functionally important to elevated risk for maternal intergenerational trauma transmission, even relative to ICD-11 posttraumatic stress disorder (PTSD).To effectively attenuate intergenerational transmission of trauma post-displacement, efforts and resources should be invested in maternal mental health care as well as socio-culturally adapted, trauma-sensitive parenting training.