Assessing the health status of migrants upon arrival in Europe: a systematic review of the adverse impact of migration journeys.

BACKGROUND: Numerous studies have explored the impact of pre- and post-migration factors on the overall health of migrant populations. The objective of this study is to enhance our understanding of additional determinants affecting migrants' health by examining the impact of the migration phase and related journeys in the European context. METHODS: We conducted a systematic review of studies published in the MEDLINE, Embase, and Scopus databases from 2003 up to January 5, 2024. We included observational studies reporting information on the health status of migrant populations recorded upon arrival in a country situated in Europe, and on the transit phase, including specific risk factors experienced during the journey or its characteristics. Title and abstract screening were performed using active learning techniques provided by ASReview software. The results of the included studies were presented qualitatively, with a focus on publications that formally assessed the association between the journey and the investigated health outcomes. The systematic review was registered on PROSPERO, CRD42024513421. RESULTS: Out of 11,370 records screened, we ultimately included 25 studies, all conducted since 2017. Most adopted a cross-sectional design and a quantitative approach, with relatively small sample sizes. The majority of the studies were conducted in Serbia and Italy. Only 14 of them formally assessed the association between different exposures in the transit phase and health outcomes, including mental health, well-being and quality of life, infectious and non-communicable diseases. CONCLUSION: Epidemiological research focusing on the transit phase in Europe remains limited, with few available studies facing challenges related to data collection, study design and analysis, thereby limiting the interpretability and generalisability of their results. These findings underscore the need for action, prompting the development of adequate and feasible strategies to conduct additional studies focusing on migrant populations during migration journeys.

Six of one, half a dozen of the other? Examining measurement properties of different potentially traumatic event polyvictimization operationalizations using a multiverse analysis framework.

Numerous differences exist between and within research projects related to assessment and operationalization of potentially traumatic events (PTEs) for youth, especially when measuring polyvictimization. However, few studies have systematically examined how polyvictimization measurement differences influence PTE's relation to functioning. This study sought to address these knowledge gaps by conducting a secondary data multiverse replication (SDMR) to systematically (re)evaluate PTE polyvictimization measurement approaches. Participants included 3297 adolescents (Mage = 14.63; 50.59% female; 65.15% white) from the National Survey of Adolescents-Replication study who completed a structured interview on PTE exposure and emotional and behavioral health (i.e., posttraumatic stress and major depressive disorder, drug and alcohol use, and delinquency). Results indicated that PTE operationalizations using a count variable tended to demonstrate better model performance and prediction of youth at-risk of emotional and behavioral health challenges, compared to models using a binary (yes/no) PTE operationalization. Differences in model performance and prediction were less distinct between models examining multiple forms of a single type of PTE (e.g., maltreatment, community violence), compared to models examining multiple PTE types. These findings emphasize the importance of using multidimensional approaches to PTE operationalization and the need for more multiverse analyses to improve PTE evidence-based assessment.

Analysis of traumatic event emergency department visits among care home residents aged 65 + years in Southern Jutland, Denmark: implications for comprehensive care and subsequent hospital admissions - a register-based cohort study.

BACKGROUND: Care home residents aged 65 + years frequently experience acute health issues, leading to emergency department visits. Falls and associated injuries are a common cause of these visits and falls in a geriatric population can be a symptom of an incipient acute illness such as infection. Conversely, the traumatic event can cause illnesses to arise due to consequences of the fall, e.g. delirium or constipation due to opioid use. We hypothesised that a traumatic event treat-and-release emergency department visit serves as an indicator for an upcoming acute hospital admission due to non-trauma-related conditions. METHODS: We studied emergency department visits for traumatic events among all care home residents aged 65+ (n = 2601) living in Southern Jutland, Denmark, from 2018 to 2019. Data from highly valid national registers were used to evaluate diagnoses, mortality, and admissions. Cox Regression was used to analyse the hazard of acute hospital admission following an emergency department treat-and-release visit. RESULTS: Most visits occurred on weekdays and during day shifts, and 72.0% were treated and released within 6 h. Contusions, open wounds, and femur fractures were the most common discharge diagnoses, accounting for 53.3% of all cases (n = 703). In-hospital mortality was 2.3%, and 30-day mortality was 10.4%. Among treat-and-release visits (n = 506), 25% resulted in a new hospital referral within 30 days, hereof 13% treat-and-release revisits (duration ≤ 6 h), and 12% hospital admissions (duration > 6 h). Over half (56%) of new hospital referrals were initiated within the first seven days of discharge. Almost three-fourths of subsequent admissions were caused by various diseases. The hazard ratio of acute hospital admissions was 2.20 (95% CI: 1.52-3.17) among residents with a recent traumatic event treat-and-release visit compared to residents with no recent traumatic event treat-and-release visit. CONCLUSION: Traumatic event treat-and-release visits among care home residents serve as an indicator for subsequent hospitalisations, highlighting the need for a more comprehensive evaluation, even for minor injuries. These findings have implications for improving care, continuity, and resource utilisation. TRIAL REGISTRATION: Not relevant.

A longitudinal study of potentially traumatic events and binge-purge eating disorder onset in children.

Although the association between childhood trauma and subsequent binge-purge spectrum eating disorders (BP-EDs) is established in adult samples, little is known about the temporal association between potentially traumatic life events and BP-ED onset in children. Using longitudinal data from the U.S.-nationwide Adolescent Brain Cognitive Development (ABCD) study with children aged 9-10 at baseline, logistic regression with complex sampling assessed the longitudinal association of exposure to potentially traumatic events (PTEs) at baseline and meeting BP-ED criteria one year later. Children exposed to PTEs prior to baseline had 1.91 times greater odds of being diagnosed with a BP-ED one year later (95% CI: 1.26 - 2.90; p = .004), compared to those who had not experienced a PTE. The current study extends previous cross-sectional research to show a significant temporal association between childhood PTEs before ages 9-10 and the subsequent onset of BP-EDs one year later. Future research should consider specific timing of PTE exposure as well as examining children diagnosed with restrictive eating disorders.

Protective Factors as Mediators Between Trauma and Internalizing Difficulties Among Male and Female Young Adults.

The goal of this study was to examine the indirect effect of protective factors (i.e., resilience, coping, and self-esteem) on the association between exposure to traumatic events in childhood and internalizing difficulties for men and women. We surveyed 583 young adults aged 18 to 25 years about past exposure to traumatic events and current internalizing difficulties. The results suggest that there is a significant indirect effect of protective factors on the association between lifetime traumatic event exposure and internalizing distress. Furthermore, there was a gender difference between groups for the indirect effect of protective factors; protective factors had a mediating effect for women but not for men. This study highlights the importance of protective factors in understanding why some individuals experience internalizing difficulties after exposure to traumatic events. When working with victims of traumatic events, it is essential to consider their sex and the presence of protective factors such as coping, resilience, and self-esteem.

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.

Cumulative trauma and perceived community resilience: A serial mediation model.

Communities affected by cumulative trauma can experience negative psychological reactions but also posttraumatic growth and community resilience, which promote adaptation and preparation for future traumatic events. This study aims to investigate the mechanisms that mediate the relationship between traumatic events and perceived community resilience. Participants were 118 Italian adults who experienced cumulative trauma and were recruited to complete an online survey. A serial multiple mediation model was estimated to assess whether the impact of the Morandi bridge collapse and posttraumatic growth mediated the relationship between the psychological impact of the Covid-19 pandemic and perceived community resilience. The impact of the collapsed bridge and posttraumatic growth in serial partially mediated the relationship between the impact of the Covid-19 pandemic and perceived community resilience. The impact of cumulative trauma can be considered through an ecological perspective that considers the consequences of these events in relation to community resilience.

Historical and regional particularities in the prevalence of traumatic events and posttraumatic stress disorder in East and West Germany.

BACKGROUND: Epidemiological research on the prevalence of traumatic events and PTSD has shown that there are significant differences between countries, due to their different history and socialization processes. In the case of Germany, this is particularly relevant. Germany was divided into two states from 1949 to 1990. This study examines the prevalence of traumatic events and PTSD in the formerly divided East and West Germany. METHODS: For the prevalence of traumatic events, we used data from four representative surveys (years 2005, 2007, 2008, and 2016) with a total of N = 9,200 respondents. For the analyses of PTSD prevalence, we used data from three representative surveys (years 2005, 2007, 2008) with a total of N = 6676 respondents. We compared different birth cohorts, persons living in the former West vs. East Germany, and the application of different diagnostic criteria using a chi-square test. RESULTS: The overall one-month prevalence rate for PTSD was 3.4% (3.0% for men and 3.8% for women). We found significant differences in the occurrence of traumatic events between genders, different age cohorts as well as between people who live in East and West Germany. Significant differences in the prevalence of PTSD can only be observed for different age cohorts. Most of the age effects are due to traumatic events related to World War II (WWII). Prevalence rates for PTSD were higher when the diagnostic criterions of the DSM-V were applied compared to the criterions of the DSM-IV. CONCLUSIONS: Our data suggests that socio-political factors may need to be considered when accounting for differences in occurrence rates of traumatic events, but not for prevalence rates of PTSD, between East and West Germany. People who have experienced WW II have a higher risk of suffering from PTSD. Future epidemiological trauma research should take historical and regional peculiarities of countries into account.

Challenging memories reduces intrusive memories and the memory amplification effect.

This study scrutinizes the influence of attenuating beliefs about the veracity of traumatic experiences on the manifestation of intrusive recollections and the memory amplification effect. Participants were exposed to distress-inducing visual stimuli, subsequently rating their emotional status pre and post exposure. They engaged in a recognition task, identifying scenarios within the stimuli. Participants' recall was contested, casting doubt about the occurrence of certain scenes. Subsequently, they maintained a daily log of intrusive memories over a week. A second session reiterated the same process. This method effectively diminished the certainty in the participants' traumatic memories. Scenes whose occurrence was contested demonstrated a significant decline in both intrusive memories and memory amplification when juxtaposed with uncontested ones. Interestingly, no significant correlation emerged between the diminished belief in traumatic incidents and reductions in intrusive memory or memory amplification. Thus, this study advocates that interrogating the veracity of traumatic recollections can mitigate the prevalence of intrusive memories and the memory amplification effect, suggesting a novel potential therapeutic approach for trauma-related disorders.

Potential traumatic events and symptoms of post-traumatic stress in unaccompanied refugee minors-a comparison with youth in foster care.

Building knowledge on how child welfare services (CWS) should tailor services for unaccompanied refugee minors (URMs) is important. URMs and youth in foster care are high-risk groups taken care of by the CWS in Norway. Little is known on whether knowledge gained from youth in foster care can inform services for URMs, and if these groups are comparable in terms of experiences of potential traumatic events (PTEs) and post-traumatic stress disorder (PTSD) symptom load. Eighty-one URMs reported PTEs and PTSD-symptoms using an adapted version of the Child and Adolescent Trauma Screen (CATS). Responses were described and compared with a sample of 303 youth in foster care in linear regression models. We present relative risks (RR) and standardized mean differences (SMD) for the PTEs and the PTSD subscale and total score between the groups in forest plots. URMs had experienced a mean (standard deviation) of 6.4 (3.4) PTEs and 43.9% reported to have PTSD-symptoms at or above the clinical cut off. Compared to the foster youth, URMs reported more exposures of interpersonal violence outside of the family (RRs ranging from 66.4 [95%CI 18.1; 243.5) to 1.3 (1.0, 1.5)], and more PTSD-symptoms in the re-experiencing subscale [SMD = 0.3 (95% CI 0.1, 0.6)]. The frequency and types of PTEs and the PTSD-symptom load and profile among URMs and youth in foster care differed. Findings underscore the importance of qualified and targeted care for URMs, and that this care should differ to that of other high-risk groups in the CWS.

Trajectories of parental posttraumatic stress disorder and children's mental health following Super Typhoon Lekima: The mediating role of feeling of safety.

INTRODUCTION: Several studies have examined the impact of parents' posttraumatic stress disorder (PTSD) on their children's mental health, but few have evaluated the role of parents' specific PTSD trajectories. The aim of this study was to assess the mechanisms underlying distinct trajectories of parental PTSD that affect children's PTSD and depression through the feeling of safety. METHODS: The final sample comprised 242 dyads of parents and their children who experienced Super Typhoon Lekima in 2019. All participants were surveyed at three time points after the typhoon: 3 months (T1), 15 months (T2), and 27 months (T3). Parental PTSD symptoms at three time points and children's PTSD, depression, and feeling of safety at T3 were analyzed. RESULTS: Four parental PTSD trajectories were identified: recovery, resilience, delayed, and coping. Compared with the resilient group, children of parents with delayed PTSD trajectories reported higher levels of depression at T3, while children of parents in the coping group were more likely to experience severe PTSD at T3. Children of parents in the recovery group, with a reduced feeling of safety, exhibited more severe depression and PTSD at T3, whereas children of parents in the delayed group were at an increased risk of PTSD at T3. CONCLUSIONS: These findings highlight the heterogeneity of parental PTSD trajectories following natural disasters and their distinct effects on children's PTSD and depression. Furthermore, feeling of safety emerges as a crucial mechanism in this process.

Childhood traumatic events, alexithymia and perceived stress in patients with rheumatoid arthritis during the COVID-19 pandemic.

Rheumatoid arthritis (RA) is a chronic inflammatory disease, causing joint-swelling and pain. International literature highlights that patients with RA are more likely to report high levels of alexithymia, adverse childhood events (ACEs) and stress, but studies investigating the association between these dimensions are lacking. The general aim of the present study is to investigate the association between alexithymia, ACEs, and stress in RA patients and to highlight possible predictors of greater perceived stress. One hundred and thirty-seven female patients with RA (mean age = 50.74; SD = 10.01) participated in an online survey between April and May 2021. Participants completed a questionnaire for the collection of sociodemographic and clinical information, the 20-item Toronto Alexithymia Scale, the Adverse Childhood Events questionnaire and the 10-item Perceived Stress Scale. The correlational analysis highlighted several significant associations between the dimensions evaluated. Regression analyses showed that alexithymia, ACEs and the perceived health status have a predictive effect on the perceived stress of RA patients. More specifically, the role of difficulty in identifying feelings, and the physical and emotional neglect, has been highlighted. ACEs and high levels of alexithymia are common in RA clinical populations and seem to affect the wellbeing of these patients. The use of a biopsychosocial approach to RA treatment appears essential in achieving a better quality of life and illness control in this specific clinical population.

Traumatic Events Exposure and Post Traumatic Stress Disorder in Caregivers of Patients with Bipolar Disorder, Bipolar Disorder and Comorbid Post Traumatic Stress Disorder and Multiple Sclerosis.

Background: Chronic diseases affect the lives of the patient and caregiver. Caring for a patient with a chronic psychiatric illness, such as bipolar disorder, is a stressful and challenging activity. Caregivers of severe psychiatric patients are the primary victims of violence by patients. Caring for these patients can be very stressful for the caregiver to the extent of experiencing post-traumatic stress symptoms. This study compares the frequency of trauma exposure and PTSD in the caregivers of patients with bipolar disorder type 1(BD-1), bipolar disorder type 1, comorbid post-traumatic stress disorder (BD-1+PTSD), and multiple sclerosis (MS).The MS group served as the control group. Methods: This cross-sectional study with convenient sampling was conducted at three hospitals in Tehran, Iran, from April 2020 to January 2022. One hundred eighty caregivers answered a clinical demographic questionnaire. We then used the Trauma History Questionnaire (THQ) to assess the frequency of exposure to different types of trauma. Then, the Persian version of the SCID-5, a valid and reliable instrument for psychiatric diagnoses, was used to diagnose PTSD. Chi-square was used for analyzing data. Results: Exposure to trauma has a significant difference between the groups. BD-1 + PTSD patients' caregivers were exposed to more physical assaults than others (P < 0.0001) There was a significant difference between sexual harassment in the MS group (P = 0.010). There was a significant difference between the three groups in the development of PTSD (P = 0.003). PTSD prevalence in the BD-1 + PTSD caregiver group is more than in other groups. In the caregivers of BD-1+PTSD, the caregiving experience caused traumatic exposure and the development of PTSD in all caregivers. Conclusion: This study shows that the prevalence of exposure to traumatic events and PTSD is higher in the caregivers of BD-1 patients, especially if the patient has comorbid PTSD. Detecting these symptoms early and using intervention can make the caregiving burden more tolerable.

Healthcare workers' heterogeneous mental-health responses to prolonging COVID-19 pandemic: a full year of monthly follow up in Finland.

BACKGROUND: The COVID-19 pandemic strained healthcare workers but the individual challenges varied in relation to actual work and changes in work. We investigated changes in healthcare workers' mental health under prolonging COVID-19 pandemic conditions, and heterogeneity in the mental-health trajectories. METHODS: A monthly survey over a full year was conducted for employees of the HUS Helsinki University Hospital (n = 4804) between 4th June 2020 to 28th May 2021. Pandemic-related potentially traumatic events (PTEs), work characteristics (e.g., contact to COVID-19 patients), local COVID-19 incidence, and demographic covariates were used to predict Mental Health Index-5 (MHI-5) and Insomnia Severity Index (ISI) in generalized multilevel and latent-class mixed model regressions. RESULTS: Local COVID-19 log-incidence (odds ratio, OR = 1.21, with 95% CI = 1.10-1.60), directly caring for COVID-19 patients (OR = 1.33, CI = 1.10-1.60) and PTEs (OR = 4.57, CI = 3.85-5.43) were all independently associated with psychological distress, when (additionally) adjusting for age, sex, profession, and calendar time. Effects of COVID-19 incidence on mental health were dissociable from calendar time (i.e., evolved in time) whereas those on sleep were not. Latent mental-health trajectories were characterized by a large class of "stable mental health" (62% of employees) and minority classes for "early shock, improving" (14%) and "early resilience, deteriorating" mental health (24%). The minority classes, especially "early shock, improving", were more likely to live alone and be exposed to PTEs than the others. CONCLUSIONS: Healthcare workers faced changing and heterogeneous mental-health challenges as the COVID-19 pandemic prolonged. Adversity and mental ill-being may have accumulated in some employees, and factors like living arrangements may have played a role. Knowledge on employees' demographic and socioeconomic background, as well as further research on the factors affecting employees' resilience, may help in maintaining healthy and efficient workforce in the face of a prolonging pandemic.

Racial disparities in psychological distress in post-apartheid South Africa: results from the SANHANES-1 survey.

PURPOSE: South Africa has long endured a high prevalence of mental disorders at the national level, and its unique social and historical context could be a contributor to an increased risk of mental health problems. Our current understanding is limited regarding the relative importance of various social determinants to mental health challenges in South Africa, and how existing racial inequities may be explained by these determinants. METHODS: This study attempted to elucidate potential social determinants of mental health in South Africa using data from the nationally representative South African National Health and Nutrition Examination Survey (SANHANES-1). The main outcome of interest was psychological distress, measured with the Kessler-10 scale. Hierarchical linear regression models included covariates for demographic and socioeconomic factors, count of traumatic events, and a series of stress-related constructs. Analyses were conducted on two populations: the entire sample (n = 15,981), and the African subpopulation (n = 10,723). RESULTS: Regression models on the entire sample indicated racial disparities in psychological distress, with Africans experiencing higher distress than White and Coloured individuals. Results within the African sub-population indicated geo-spatial disparities, with Africans in formal urban settings experiencing higher psychological distress than those living in formal and informal rural locales. Across both samples, results indicated a cumulative association between count of stressors and traumatic events and distress. CONCLUSION: We found racial disparities across several mental health-related domains. Africans had greater exposure to traumatic events, social stressors, and psychological distress. This research is a necessary foundation for public health interventions and policy change to effectively reduce inequities in psychological distress.

Work-related potential traumatic events and job burnout among operating room nurses: Independent effect, cumulative risk, and latent class approaches.

AIMS: The objective of this study is to explore and compare the strength of associations between work-related potential traumatic events and burnout among operating room nurses based on three different approaches. DESIGN: The study followed a multisite cross-sectional design. METHODS: A stratified sampling method was conducted. Cities in the Shandong Province were divided into four groups, and two tertiary hospitals were randomly selected from all tertiary hospitals in cities of each group. A total of 361 eligible operating room nurses provided valid questionnaires between June and November 2019. Work-related potential traumatic events questionnaire and the Chinese version of the Maslach Burnout Inventory were conducted. Associations between individual, cumulative potential traumatic events, as well as latent class analysis-derived patterns of potential traumatic experiences with burnout were examined using logistic regression analysis. RESULTS: Specific traumatic events (e.g., patients' sudden death, bullying and ostracism from colleagues) were independently associated with an increased risk of burnout. Work-related potential traumatic events had a cumulative effect on burnout, whereby operating room nurses exposed to cumulative potential traumatic events carried a higher risk for burnout than others. The "multiple work-related potential traumatic events" pattern derived by latent class analysis was related to an increased risk of high depersonalization. CONCLUSION: Operating room nurses who reported specific or multiple work-related potential traumatic events were at high risk for burnout. It is of great significance to provide qualified and timely counselling or support. IMPACT: This study is the first to focus on work-related potential traumatic events among operating room nurses and examine their relationship with burnout based on three perspectives. The findings could help identify those operating room nurses who are at high risk of burnout in clinical practice. Hospital managers should develop targeted interventions to prevent or mitigate the harmful impact of potential traumatic events on occupational health.

A qualitative, cross-cultural investigation into the impact of potentially traumatic work events on Saudi and UK ambulance personnel and how they cope.

BACKGROUND: Post-traumatic stress disorder (PTSD) is common among ambulance personnel, but its prevalence varies between developed and developing countries. This study aimed to investigate the lived experience of potentially traumatic work events between Saudi and UK ambulance personnel. METHODS: Semi-structured interviews with 16 ambulance workers from Saudi Arabia and the United Kingdom (8 participants from each country) were conducted to explore their lived experiences of potentially traumatic events at work. Data were analyzed using thematic analysis. RESULTS: Four key themes were identified from interviews: (1) some events are inherently more stressful than others; (2) pressure of organizational and interpersonal stressors; (3) convergence and divergence in cross-cultural coping strategies; and (4) preferring formal and confidential support. CONCLUSIONS: There were differences in the nature of traumatic events and the ways of coping between the two cultures, but paramedics in both cultures had an agreement about their preference for individual and formal support. The results of this study may help inform the development of interventions and PTSD prevention programs for ambulance personnel.

Genetic associations with resilience to potentially traumatic events and vantage sensitivity to social support.

INTRODUCTION: Stress responses and mental health outcomes greatly vary when individuals are exposed to potentially traumatic events (PTEs). The Differential Susceptibility Model (DSM) (Pluess, 2015) suggests individual differences in stress responses are influenced by gene-environment interactions, with genes conferring reactivity. While individuals can be resilient (or vulnerable) to PTEs, they can also have vantage sensitivity (or resistance) to social support. This study examined whether selected genotypes moderated the effect of PTEs and social support on mental health. METHODS: This cross-sectional candidate gene study included 450 college students (M age = 20.4, 79.3 % women) who provided buccal cells for genotyping and completed measures of psychosocial variables. DNA was genotyped for 12 genetic variants. RESULTS: Hierarchical regression revealed that the Mental Health Inventory (MHI) was associated with the Trauma History Questionnaire (THQ), rs1800795 in IL-6, and THQ × rs1800795 [R2 = 0.10, F(3, 418) = 15.68, p < .01]. The MHI was associated with the Social Support Survey (SSS), rs4680 in COMT, and SSS × rs4680 [R2 = 0.24, F(3, 429) = 44.19, p < .01]. Only THQ and SSS survived multiple testing corrections. DISCUSSION: Findings partially support the DSM that the G/G genotype of rs1800795 in IL-6 is associated with resilience to PTEs, and the Met/Met genotype of rs4680 in COMT is associated with vantage sensitivity to social support. Limitations include cross-sectional design, limited PTE measurement, small convenience sample, and noncorrection for multiple significance test. Clinicians need to view resilience holistically and understand resilience is associated with psychosocial and genetic factors.

Posttraumatic stress disorder among adolescents in Brazil: a cross-sectional study.

BACKGROUND: The frequency of trauma and different types of violence exposure in urban areas and their effects on the mental health of adolescents in developing countries are poorly investigated. Most information about traumatized young people comes from war scenarios or disasters. This study aimed to determine the prevalence of PTSD in trauma-exposed students in a low-resource city of the state of Rio de Janeiro, Brazil. The effects of sociodemographic and individual and family factors in the development of PTSD were also investigated. METHODS: Through multi-stage cluster sampling, 862 adolescents (Mage = 15 years old, 65% female) from public and private schools in the city of São Gonçalo were selected for the study. Self-rating structured questionnaires were applied to assess sociodemographic profile, exposure to physical and psychological violence (family, school, community), sexual abuse, social support, social functional impairment, resilience, and posttraumatic stress disorder. The data were grouped in blocks regarding sociodemographic, individual, family, and community variables. For statistical analysis, chi-square, Fisher's exact test, and logistic regression were performed. RESULTS: The PTSD prevalence was 7.8% among adolescents. Boys were exposed to significantly higher number of events of community violence, while girls to family violence. The adjusted odds ratio (OR) for PTSD were statistically significant for age (OR, 1.45, [95% CI, 1.043-2.007]), social functional impairment (OR, 4.82, [95% CI, 1.77-13.10]), severe maternal physical violence (OR, 2.79, [95% CI, 0.79-9.93]), psychological violence by significant people (OR, 3.96, [95% CI, 1.89-8.31]) and a high number of episodes of community violence (OR, 3.52, [95% CI, 1.47-8.40). CONCLUSIONS: There was a high prevalence of PTSD within this population associated with exposure to violence. Not only physical, but also psychological violence contributed to PTSD. The results also raise awareness to the differences in life trajectories between boys and girls regarding violence. These differences need to be better understood in order to enable the development of effective preventative interventions. Treating and preventing mental health disorders presents a challenge for countries, especially those with a lower degree of social and economic development and high community violence.

Burnout and posttraumatic stress symptoms in police officers exposed to traumatic events: the mediating role of ruminations.

PURPOSE: Police work carries the risk of burnout in the form of exhaustion and disengagement from work. Police officers are also exposed to traumatic events and the development of PTSD. The main aim of the cross-sectional study was to determine the mediating role played by rumination in the relationship between burnout and PTSD among police officers. It also examines whether burnout is a significant prognostic factor for PTSD symptoms. METHODS: Data were obtained from a sample of 120 police officers. Of these one hundred, mostly men (83%), aged 23-47 years (M = 33.06, SD = 5.61), confirmed the experience of traumatic events in connection with their professional work. Three standard measuring tools were used: The Posttraumatic Checklist for DSM-5, The Oldenburg Burnout Inventory OBI, and The Event-Related Rumination Inventory. RESULTS: The introduction of intrusive ruminating as an intermediary variable made the relationship between job burnout and PTSD non-significant, which indicates full mediation. The introduction of deliberate rumination as a mediator weakens the relationship between burnout and PTSD, which indicates partial mediation. It indicates that police officers who are burnout and who additionally tend to ruminate about experienced traumatic events are more likely to PTSD than police officers who are only burned out. CONCLUSION: Intervention programs for police officers should focus on strengthening stress management resources in the form of developing deliberate ruminations, thus allowing the experienced situations to be given a new meaning and to allow better coping.