Rapid assessment of mental health of Detroit-area health care workers during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic may adversely impact the mental health of health care workers (HCWs). To address this issue, it is essential to determine levels of anxiety, depression, and traumatic stress, and sources of stress, and to identify subgroups of HCWs at a higher risk of adverse mental health outcomes during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study of symptoms of mental illness in HCWs in the area surrounding Detroit, Michigan. The online survey included questions about demographics, health and clinical factors, and sources of stress. Several tools were used to assess psychiatric symptoms among HCWs, including the Perceived Stress Scale, the Patient Health Questionnaire depression scale, the Generalized Anxiety Disorder 7-item assessment, and the Posttraumatic Stress Disorder Checklist for DSM-5. The adequacy of personal protective equipment, patient resources, and training for highly contagious diseases were rated. RESULTS: The sample (N = 129) was predominantly female (51.2%) and White (65.9%), with 30.2% screening positive for clinical follow-up to assess anxiety, 20.9% for moderate to severe depression, and 16.3% for elevated traumatic stress. Differences were found by self-reported psychiatric diagnosis and chronic conditions, and role on treatment teams. CONCLUSIONS: Frontline HCWs demonstrate high levels of stress and trauma symptoms. Timely screening and accommodations may be needed during health care crises, such as the COVID-19 pandemic.

Prescription Opioid Misuse After a Recent Sexual Assault: A Randomized Clinical Trial of a Video Intervention.

BACKGROUND AND OBJECTIVES: Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault. METHODS: Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up. RESULTS: Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse. DISCUSSION AND CONCLUSIONS: Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history. SCIENTIFIC SIGNIFICANCE: This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).

[Trauma-focused psychotherapy: Technique, area of application, and treatment outcome]. / Traumaorientierte Psychotherapie : Technik, Anwendungsmöglichkeiten und Ergebnisse.

Traumatic events may lead to trauma-related disorders such as the posttraumatic stress disorder (PTSD) and constraints in quality of life. Meanwhile, there are different trauma-focused psychotherapies that aim to prevent PTSD shortly after experiencing a traumatic event and interventions that aim to treat PTSD. In Germany, cognitive-behavioral and psychodynamic trauma-focused approaches are commonly applied. While cognitive-behavioral programs aim at early exposure with the traumatic event, psychodynamic approaches emphasize the need of a period of stabilization before undergoing exposure. With regard to empirical evidence, cognitive-behavioral programs were able to prove their efficacy most often and are recommended in national and international guidelines. The German S3 guideline PTSD is currently under revision.

Stigma, American military personnel and mental health care: challenges from Iraq and Afghanistan.

BACKGROUND: Since 2001, more than 2.5 million United States military personnel have been deployed for combat. Over one million have served multiple deployments. Combat generally involved repeated exposure to highly traumatic events. Personnel were also victims of military sexual trauma (MST), a major risk factor for psychiatric illness. Most survivors do not seek or receive mental health care. Stigma is one of the main barriers to that care. AIMS: To explore the impact of stigma on personnel with psychiatric illness, and suggest some innovative ways to potentially reduce stigma and improve care. METHODS: Cinahl and PubMed databases were searched from 2001 to 2014. RESULTS: Anonymity, the use of non-stigmatizing language, peer-to-peer, and stigma-reduction programs help military personnel receive mental health care. Technology offers the opportunity for effective and appropriate education and treatment. CONCLUSIONS: Although stigma is formidable, several innovative services are available or being developed for military victims of trauma. Commitment of resources for program development and further research to explore which interventions offer the best clinical outcomes are needed to increase efforts to combat stigma and ensure quality care.

[Interventions for mental health sequelae of accidents]. / Psychische Folgen von Unfällen und deren Versorgung.

Emergency psychology and psychotraumatology deal with the psychological sequelae of traumatic experiences, i.e., the prevention and early intervention of posttraumatic mental health disorders. Accidents are the most prevalent traumatic events in the general population that may result in a range of severe trauma and adjustment disorders. Accidents happen suddenly, unexpectedly, and can gravely threaten health, personal integrity, and life. The prevalence of intermittent and chronic psychiatric disorders in the aftermath of severe accidents varies between 5 and 30 %. Victims suffer from unknown and frightening posttraumatic symptoms, often irreversible handicaps as a consequence of their injuries, impairments in everyday functioning, and negative impact on the quality of life. The direct and indirect burden for society is high. Comprehensive secondary prevention, starting with early detection and early intervention of post-accident disorders, is not well established in clinical care. In case of severe accidental injuries, emergency and medical treatment has absolute priority. But all too often, severe mental health problems remain undetected in later treatment phases and therefore cannot be addressed adequately. In primary care, knowledge of specific psychodiagnostic and treatment options is still insufficient. Prejudices, denial, and fear of stigmatization in traumatized victims as well as practical constraints (availability, waiting time) in the referral to special evidence-based interventions limit the access to adequate and effective support. This overview presents the objectives, concepts, and therapeutic tools of a stepped-care model for psychological symptoms after accidental trauma, with reference to clinical guidelines.

Secondary traumatic stress in nurses: a systematic review.

BACKGROUND: Is there a "cost of caring" for health care providers of traumatized patients? OBJECTIVES: The aim of this study is to review the literature on secondary traumatic stress in nurses in order to answer the following questions: What studies have been conducted on secondary traumatic stress in nurses in all clinical specialties? What instruments were used to measure secondary traumatic stress in nurses and what psychometric properties were reported? DESIGN: A systematic review. DATA SOURCES: CINAHL, PubMed, and PsycINFO databases were searched for the years 1981 to the present. Keywords used in the database searches included secondary traumatic stress, compassion fatigue, vicarious traumatization, secondary trauma, PTSD, and nurses. REVIEW METHODS: Research studies were reviewed for the following inclusion criteria: the sample included nurses, the secondary traumatic stress symptoms were measured, and the language was English. RESULTS: Seven studies were found in which researchers examined secondary traumatic stress in nurses. The samples in five of these studies consisted of all nurses, whereas in the remaining two studies, nurses were included in the samples but the results were not specifically reported for the subgroup of nurses. Presence of secondary traumatic stress was reported in forensic nurses, emergency department nurses, oncology nurses, pediatric nurses, and hospice nurses. Three instruments were identified that measured secondary traumatic stress in practitioners who care for traumatized populations: Secondary Traumatic Stress Scale, Compassion Fatigue Self Test for Helpers, and the Compassion Fatigue Scale-Revised. CONCLUSIONS: Presence of secondary traumatic stress in nurses was reported in all of the studies included in this literature review. The use of small samples and a number of different instruments to measure secondary traumatic stress symptoms, however, hindered the ability to make comparisons across studies and to draw conclusions. None of the studies conducted to date have focused on secondary traumatic stress in psychiatric nurses. Suggestions for future research and clinical implications for what can be done to protect nurses from secondary traumatic stress are addressed.

Trauma-informed forensic child maltreatment investigations.

Trauma-informed child welfare systems (CWSs) are the focus of several recent national and state initiatives. Since 2005 social work publications have focused on systemic and practice changes within CW which seek to identify and reduce trauma to children and families experiencing child maltreatment or other distressing events, as well as to the agency personnel working with these clients. Within the body of trauma-informed literature, little attention has been devoted specifically to the initial investigative response and its role in controlling for system induced trauma to the child, family, and caseworker. Training child protection services (CPS) workers on the impact of trauma in child maltreatment forensic investigations and the worker's role in anticipating and mitigating the effects of trauma during the investigative process is rarely addressed in the trauma-informed literature. This article reports on a training strategy to infuse trauma information into an existing forensic child maltreatment investigation curriculum with the goal of enhancing CPS caseworker's knowledge, skills, and values concerning the importance of viewing investigations and their associated tasks through a trauma lens.

The role of therapeutic mentoring in enhancing outcomes for youth in foster care.

Effective service interventions greatly enhance the well-being of foster youth. A study of 262 foster youth examined one such intervention, therapeutic mentoring. Results showed that mentored youth improved significantly in the areas of family and social functioning, school behavior, and recreational activities, as well as in the reduction of expressed symptoms of traumatic stress. Study results suggest that therapeutic mentoring shows promise for enhancing treatment interventions.

Trauma adapted family connections: reducing developmental and complex trauma symptomatology to prevent child abuse and neglect.

Families living in urban poverty, enduring chronic and complex traumatic stress, and having difficulty meeting their children's basic needs have significant child maltreatment risk factors. There is a paucity of family focused, trauma-informed evidence-based interventions aimed to alleviate trauma symptomatology, strengthen family functioning, and prevent child abuse and neglect. Trauma Adapted Family Connections (TA-FC) is a manualized trauma-focused practice rooted in the principles of Family Connections (FC), an evidence supported preventive intervention developed to address the glaring gap in services for this specific, growing, and underserved population. This paper describes the science based development of TA-FC, its phases and essential components, which are based on theories of attachment, neglect, trauma, and family interaction within a comprehensive community-based family focused intervention framework.

Evidence of secondary traumatic stress, safety concerns, and burnout among a homogeneous group of judges in a single jurisdiction.

Active judges are likely to face numerous work-related experiences (e.g., traumatic cases) that affect performance of their occupational duties. Three occupational experiences (secondary traumatic stress [STS], safety concerns, and burnout) are outlined and applied to the judiciary. Results from nine case study interviews conducted in a single jurisdiction among a homogeneous cohort suggest that judges are at risk of having these experiences. Although no judge demonstrated extreme symptoms, all had low levels of symptoms associated with STS, safety concerns, and/or burnout. Several recommendations are proposed to prevent or minimize these occupational experiences. Recognizing and addressing the problem are essential for the protection of our nation's judges and the integrity of our judicial system.

Stress response in female veterans: an allostatic perspective.

Women serving in the military face many sources of stress, such as separation from home and family, sexual harassment and assault, and deployment to traumatic war zones. Some women are vulnerable to the effects of these stressors, resulting in deleterious mental and physical health outcomes. Understanding these risks through the theoretical model of allostasis can help identify those who will be most vulnerable and help healthcare providers prevent some negative outcomes and improve rehabilitation for some women when they return stateside. Women may be more likely than men to present with mental health problems such as posttraumatic stress disorder and depression after military service. They also may be at increased risk, based on their war-zone stress response, for disparate illness such as medically unexplained illness, cancer, and heart disease. The need for care for these women is expected to increase as more women are deployed to conflicts.

Casualties of war: compassion fatigue and health care providers.

When exposure to traumatic events accumulates because of caring for the victims of the events, compassion fatigue occurs. Deployed military medical personnel, prone to its development, can prevent or mitigate the condition with individual and organizational intervention.

Age moderates the relationship between source of social support and mental health in racial minority lesbian, gay, and bisexual youth.

We examined the relationship between source of social support and mental health (and the moderating impact of age) in 64 low socioeconomic status, racial minority lesbian, gay, and bisexual adolescents/young adults. Social support from family ( ß = -.302, p = .03; ß = -.364, p = .008), but not friends or significant others, was independently related to posttraumatic stress disorder and depression symptoms, respectively. Family social support was associated with lower posttraumatic stress disorder and depression symptoms in participants aged 16-19 years, while friend social support was associated with lower symptoms for participants aged over 20 years. Friend social support was also associated with lower posttraumatic stress disorder symptoms in participants aged 16-17 years. Interventions should target age-appropriate sources of social support.

Outcomes of psychotherapeutic and psychoeducative group interventions for children exposed to intimate partner violence.

Witnessing violence toward a caregiver during childhood is associated with negative impact on children's health and development, and there is a need for effective interventions for children exposed to intimate partner violence in clinical as well as in community settings. The current effectiveness study investigated symptom reduction after participation in two established group interventions (one community-based psychoeducative intervention; one psychotherapeutic treatment intervention) for children exposed to intimate partner violence and for their non-offending parent. The study included 50 children-24 girls and 26 boys-aged 4-13 years and their mothers. Child and maternal mental health problems and trauma symptoms were assessed pre- and post-treatment. The results indicate that although children showed benefits from both interventions, symptom reduction was larger in the psychotherapeutic intervention, and children with initially high levels of trauma symptoms benefited the most. Despite these improvements, a majority of the children's mothers still reported child trauma symptoms at clinical levels post-treatment. Both interventions substantially reduced maternal post-traumatic stress. The results indicate a need for routine follow-up of children's symptoms after interventions.

The impact of a statewide trauma-informed child welfare initiative on children's permanency and maltreatment outcomes.

This article presents findings of a state-wide trauma informed child-welfare initiative with the goal of improving well-being, permanency and maltreatment outcomes for traumatized children. The Massachuetts Child Trauma Project (MCTP), funded by the Administration of Children and Families, Children's Bureau was a multi-year project implementing trauma-informed care into child welfare service delivery. The project's implementation design included training and consultation for mental health providers in three evidence-based treatments and training of the child-welfare workforce in trauma-informed case work practice. The learning was integrated between child-welfare and mental health with Trauma Informed Leadership Teams which included leaders from both systems and the greater community. These teams developed incremental steps toward trauma-informed system improvement. This study evaluated whether MCTP was associated with reductions in child abuse and neglect, improvements in placement stability, and higher rates of permanency during the first year of implementation. Children in the intervention group had fewer total substantiated reports of maltreatment, including less physical abuse and neglect than the comparison group by the end of the intervention year. However, children in the intervention group had more maltreatment reports (substantiated or not) and total out-of-home placements than did their counterparts in the comparison group. Assignment to MCTP, however, was not associated with an increase in kinship care or adoption. Overall, the results are promising in reinforcing the importance of mobilizing communities toward improvements in child-welfare service delivery.

Alcohol consumption and posttraumatic stress after exposure to terrorism: effects of proximity, loss, and psychiatric history.

OBJECTIVES: We examined the effects of exposure to or interpersonal loss resulting from a terrorist attack on posttraumatic stress and alcohol consumption after we controlled for psychiatric history assessed before the attack. METHODS: At baseline (1991-1992) and at 1- and 10-year follow-ups, an adult community sample of drinkers living approximately 12 mi (19.2 km) from the World Trade Center were evaluated for alcohol dependence and major depression. Of this group, 82.2% were assessed regarding the impact of the September 11, 2001, attacks, including proximity to the World Trade Center, interpersonal loss, posttraumatic stress, and alcohol consumption. RESULTS: In regression models, interpersonal loss and past major depression, but not proximity to the World Trade Center, predicted posttraumatic stress symptoms. Proximity and past alcohol dependence, but not interpersonal loss, predicted high levels of post-September 11 alcohol consumption. Past alcohol dependence did not modify the proximity-drinking relationship, and past major depression did not modify the loss-posttraumatic stress relationship. CONCLUSIONS: Participants' responses to September 11 were specific to their type of exposure and not predetermined by their psychiatric history. A better understanding of responses to traumatic events should assist more-effective prevention and intervention efforts.

The Bali bombings and the evolving mental health response to disaster in Australia: lessons from Darwin.

The Bali bombing in 2002 initiated a new phase of trauma response for public health services in Australia, and the Royal Darwin Hospital in particular. The mental health response to the initial disaster was limited to a debriefing of Royal Darwin Hospital staff some time after the disaster. Following this initial episode, a number of important developments occurred within the Royal Darwin Hospital and nationally to further develop mental health resources. A mental health consultation liaison nursing position was established within the hospital. The Director of Mental Health for the Northern Territory, along with the Director of Psychiatry, was involved with an evolving national mental health response to mass trauma through the National Planning Group of Mental Health Response to Trauma. The improved recognition of mental health in disaster response, along with increased recognition and confidence in the consultation liaison nursing staff, considerably improved the mental health services available to patients and Royal Darwin Hospital staff following the second Bali blast in October 2005.

A peer-based assistance program for officers with the New York City Police Department: report of the effects of Sept. 11, 2001.

Few data on stress symptoms related to the World Trade Center disaster in law enforcement personnel have been reported. Most New York City Police Department (NYPD) officers had significant exposure to the events of Sept. 11, 2001. Approximately 5,000 officers responded within the first 2 days, and more than 25,000 officers worked at ground zero, the morgues, or the Staten Island landfill. Because the police are the first line of defense against terrorist attacks, it is imperative that they maintain optimal health and functioning. Concern for the long-term effects from traumatic exposure is warranted. In partnership with Project Liberty, peer officers and clinicians from the Police Organization Providing Peer Assistance performed outreach, support work, and screening for stress symptoms related to the disaster in the NYPD from December 2002 until December 2003. Psychological issues in law enforcement personnel, a description of the outreach program, and data from these screenings are presented.

The extent and impact of mental health problems after disaster.

Disasters are events that challenge the individual's ability to adapt, which carries the risk of adverse mental health outcomes including serious posttraumatic psychopathologies. While risk is related to degree of exposure to psychological toxins, the unique vulnerabilities of special populations within the affected community as well as secondary stressors play an important role in determining the nature and amount of morbidity. Disasters in developing countries and those associated with substantial community destruction are associated with worse outcome. Although acute responses are ubiquitous, few disasters lead to posttraumatic psychopathology in the majority of people exposed. However, the shortage of human resources in psychiatry, particularly in developing countries, places a considerable burden on psychiatric services even without the additional constraints imposed by disaster. Hence, disasters are events that invite a public health approach to mental health that better serves the needs of the individual and the affected community. Such an approach considers all available human resources and is intended to mitigate the effects of disaster before serious psychopathologic sequelae arise. This community mental health strategy allows peripheral mental health workers to mediate between survivors and specialized mental health professionals while assisting in removing barriers to treatment. To be effective when disaster occurs, this approach requires careful planning in conjunction with community consultation before implementation of formal disaster mitigation policies.

Traumatic stress disorders following first-trimester spontaneous abortion.

Provide counsel and support to women after a spontaneous abortion. Research indicates that many women will talk with their physician about their emotional distress and that physicians provide good information after the spontaneous abortion. Evaluate women for acute stress disorder (ASD) after a spontaneous abortion. Research found that women reporting physical, emotional, or sexual abuse are more likely to experience ASD. Patients should be assessed for post-traumatic stress disorder in follow-up visits 1 month after the initial visit. Research has found that up to 25% of women meet criteria for PTSD 1 month post the spontaneous abortion and 7% met criteria at 4 months. Physicians should refer women who are experiencing traumatic stress to a behavioral health professional.