It matters what you see: Graphic media images of war and terror may amplify distress.

Media exposure to graphic images of violence has proliferated in contemporary society, particularly with the advent of social media. Extensive exposure to media coverage immediately after the 9/11 attacks and the Boston Marathon bombings (BMB) was associated with more early traumatic stress symptoms; in fact, several hours of BMB-related daily media exposure was a stronger correlate of distress than being directly exposed to the bombings themselves. Researchers have replicated these findings across different traumatic events, extending this work to document that exposure to graphic images is independently and significantly associated with stress symptoms and poorer functioning. The media exposure-distress association also appears to be cyclical over time, with increased exposure predicting greater distress and greater distress predicting more media exposure following subsequent tragedies. The war in Israel and Gaza, which began on October 7, 2023, provides a current, real-time context to further explore these issues as journalists often share graphic images of death and destruction, making media-based graphic images once again ubiquitous and potentially challenging public well-being. For individuals sharing an identity with the victims or otherwise feeling emotionally connected to the Middle East, it may be difficult to avoid viewing these images. Through a review of research on the association between exposure to graphic images and public health, we discuss differing views on the societal implications of viewing such images and advocate for media literacy campaigns to educate the public to identify mis/disinformation and understand the risks of viewing and sharing graphic images with others.

Intergenerational Transmission of Ethnoracial Historical Trauma in the United States.

Throughout time, ethnoracial groups have endured a range of traumatic experiences as historically marginalized members of the United States. The consequences of these experiences have been referred to as historical trauma (HT): a collective trauma, inflicted on a group of people who share a specific identity, that has psychological, physical, and social impacts on succeeding generations. In this review, we examine the literature on HT in relation to US ethnoracial groups by defining HT, providing a background for its development, and describing critiques of the concept. We then review the literature on HT in relation to Indigenous Americans, African Americans, and Asian Americans. For each group, we address the nature of HT, the transmission of HT and its impacts, and healing strategies. We conclude with a summary of the benefits, limitations, and complexities of HT research as well as recommendations for future work in this area.

Lessons Learned About Trauma Related to Racial Discrimination During COVID-19 in the United States.

Race scholars have discussed how the pandemic has disproportionately burdened marginalized communities and exacerbated pre-existing inequities, particularly for Black Indigenous People of Color (BIPOC) in the United States (U.S.). One glaring social determinant during the time of the COVID-19 is racial discrimination. This chapter will discuss lessons learned regarding the negative impact of discrimination on BIPOC, especially as it pertains to their experiences of trauma. Some of these lessons include (1) the need for clinical psychologist to improve access to treatment through increased research on culturally adaptive interventions, (2) increased research on the effects of race-based trauma on mental health symptomatology, (3) policy and institutional changes that reduce disparities in access to care, and (4) increased education for psychologists around billing procedures for individuals with race-based stress.

COVID-19 and collective trauma: Implementing a trauma-informed model of care for post-COVID patients.

AIM: To describe the implementation of a trauma-informed model of care in the Post COVID Respiratory Clinic of a large tertiary referral centre in NSW. DESIGN: Discussion paper. DATA SOURCES: Evidence gathered from a literature search (2008-2022) was used to develop a framework for management of patients presenting to this Post COVID Respiratory Clinic. This paper outlines the personal reflections of the clinic staff as they developed and implemented this framework. Ethical approval was obtained to report the data collected from patient reviews. DISCUSSION: The literature highlights the high prevalence of trauma in patients following COVID-19 infection, as well as the larger population both during and after the pandemic. This experience of trauma was observed in patients seen within the clinic, indicating a need for specialized care. In response, a trauma-informed model of care was implemented. CONCLUSION: Reconceptualizing COVID-19 as a 'collective trauma' can help healthcare workers understand the needs of post-COVID patients and enable them to respond empathetically. A trauma-informed model is complementary to this cohort as it specifically addresses vulnerable populations, many of whom have been further marginalized by the pandemic. IMPLICATIONS FOR NURSING AND PATIENT CARE: Frontline healthcare workers, particularly nurses, are well positioned to implement trauma-informed care due to their high-level of patient contact. Adequate allocation of resources and investment in staff is essential to ensure such care can be provided. IMPACT: The COVID-19 pandemic has led to adverse physical and mental health outcomes for many. Trauma-informed care is a way to promote reengagement with the healthcare system in this group. Post COVID patients globally may benefit from this approach, as it aims to build trust and independence. PATIENT OR PUBLIC CONTRIBUTION: Feedback was sought from a patient representative to ensure this paper adequately reflected the experience of the post-COVID patient.

The Correlates of Collective and Individual Trauma on Mental Health Outcomes Among Afghan Refugees: A Study of Sociodemographic Differences.

Following the U.S. military's departure from Afghanistan, a significant number of Afghan refugees have resettled in the United States, presenting complex mental health challenges exacerbated by extensive traumatic exposure. This demographic is particularly affected by collective trauma due to war, genocide, and the loss of homeland. However, detailed investigations into the correlations between collective trauma and mental health outcomes among Afghan refugees are limited. This study sought to explore the relationship between collective trauma and mental health outcomes within the Afghan refugee population in the United States, paying particular attention to the influence of sociodemographic factors. Identifying subgroups at greater risk allows for the development of more targeted mental health interventions. The study surveyed 173 Afghan refugees employing snowball sampling, utilizing a cross-sectional design. Data collection was facilitated through online and in-person surveys in English, Dari, and Pashto. Key measures included the Harvard Trauma Questionnaire for individual trauma experiences, the Historical Loss Scale for collective trauma, the Historical Loss Associated Symptoms Scale for collective trauma symptoms, the Afghan Symptom Checklist-22 for mental health symptoms, and the Post-Migration Living Difficulties Scale for post-migration stressors. Statistical analyses involved Pearson's correlation for variable associations, with nonparametric Mann-Whitney U and Kruskal-Wallis tests conducted to assess sociodemographic impacts due to data's non-normal distribution. The analysis revealed significant variations in collective trauma and mental health outcomes across subgroups. Afghan women, minoritized ethnic groups, those who experienced extended displacement, and refugees with uncertain visa statuses reported higher collective trauma levels and worse mental health outcomes. Statistical significance was noted in the correlations between collective trauma and mental health symptoms (r = .53, p < .01) and between post-migration difficulties and mental health (r = .33, p < .01). The disparities in mental health outcomes based on sociodemographic characteristics were significant, with nonparametric tests showing clear distinctions across different groups (Kruskal-Wallis H = 14.76, p < .05 for trauma experience by visa status). This study emphasizes the critical need for mental health interventions that account for the complex experiences of collective trauma among Afghan refugees, especially among identified subgroups. Tailoring mental health services to address the specific needs highlighted through disaggregated data can enhance support for Afghan refugees in the United States. This research contributes to a deeper understanding of the relationship between collective trauma and refugee mental health, advocating for nuanced care strategies in resettlement environments.

Finding voice in a year of collective trauma: Case study of an online photovoice project with youth.

In this article, we share findings from a qualitative case study of a virtual youth photovoice program implemented across three regions of the United States. The purpose of the program was to engage youth in research on a social issue relevant to them during an unprecedented year marked by two public health crises, COVID-19 and anti-Black racial violence. Results of an analysis of curriculum and archival program materials lend support for online strategies for youth engagement including individualized support and online audiovisual presentations with avatars. Racial justice and trauma-informed adaptations were designed to be responsive to youth needs for flexible programming and safe spaces. Themes captured in the first online gallery of youth photos include (1) tools for mental health, (2) meaningful connection, and (3) community advocacy, bringing attention to structural issues as well as family and community strengths. Findings suggest photovoice can be thoughtfully adapted for youth researchers and support individual and group storytelling in response to collective trauma.

University students' experience of the Beirut port explosion: associations with subjective well-being and subjective symptoms of mental strain.

BACKGROUND: On 4 August 2020, an explosion shook Beirut, killing more than 200 people and leaving thousands injured or homeless. AIMS: This study examined mental health of university students through a cross-sectional online survey between December 2020 and January 2021. METHODS: The questionnaire consisted of the WHO-5, sense of coherence (SoC), future anxiety, self-developed subjective symptoms of mental strain (SSMS), and items assessing proximity to explosion, extent of injury and house damage. Gender, study level and social status were used as sociodemographic characteristics. RESULTS: Of 1042 participants, 30.8% were at 0-7 km from explosion; 38.1% reported physical injuries; and 12.4% saw their home damaged. Two third (60.3%) reported ≥3 SSMS, and 73.4% reported low well-being. Students with low well-being were more often female and master students (p < 0.001). Females were more often affected by ≥3 SSMS (p < 0.001). Regression analysis with low well-being as dependent variable revealed significant associations with study level (OR: 2.30-2.94), future anxiety (OR: 2.72-4.34) and SoC (OR: 1.81-5.61). For ≥3 SSMS, females (OR: 3.09), moderate/very close distance (OR: 2.13-4.98), injury/death of family member or friend (OR: 2.07-2.06), house damage (OR: 1.72) future anxiety (OR: 1.97-3.11) and SoC (1.79-2.88) were significant predictors. DISCUSSION: Preventive mental health strategies that strengthen SoC and outlook on future could protect against SSMS and low well-being following major trauma.

COVID-19-related posttraumatic stress disorder in adults with lived experience of psychiatric disorder.

BACKGROUND: Prevalence estimates of COVID-19-related posttraumatic stress disorder (PTSD) have ranged from 1% to over 60% in the general population. Individuals with lived experience of a psychiatric disorder may be particularly vulnerable to COVID-19-related PTSD but this has received inadequate attention. METHODS: Participants were 1571 adults with lived experience of psychiatric disorder who took part in a longitudinal study of mental health during the COVID-19 pandemic. PTSD was assessed by the International Trauma Questionnaire (ITQ) anchored to the participant's most troubling COVID-19-related experiencevent. Factors hypothesised to be associated with traumatic stress symptoms were investigated by linear regression. RESULTS: 40.10% of participants perceived some aspect of the pandemic as traumatic. 5.28% reported an ICD-11 PTSD qualifying COVID-19 related traumatic exposure and 0.83% met criteria for probable ICD-11 COVID-19-related PTSD. Traumatic stress symptoms were associated with younger age, lower income, lower social support, and financial worries, and lived experience of PTSD/complex PTSD. Depression and anxiety measured in June 2020 predicted traumatic stress symptoms at follow-up approximately 20 weeks later in November 2020. CONCLUSIONS: We did not find evidence of widespread COVID-19-related PTSD among individuals with lived experience of a psychiatric disorder. There is a need for future research to derive valid prevalence estimates of COVID-19-related PTSD.

"The Global Sense of Disaster was Synchronized With my Own Disaster": Implications of the COVID-19 Crisis on the Wellbeing of Survivors of Sexual Violence.

The present study is designed to improve our understanding of the impact of the COVID-19 pandemic, as collective trauma, on the wellbeing of survivors of sexual violence (SV). The data are based on an online qualitative survey about the experiences of 39 survivors and a thematic analysis of ten in-depth interviews with service providers in Israel. The findings reveal that the pandemic and restrictive measures are associated with increased risk for participants' wellbeing, caused directly by pandemic characteristics, as well as indirectly through the denial of access to coping resources. Paradoxically, the pandemic also offers relief, given the widespread restrictions imposed on the entire population and the general crisis atmosphere. The service providers' perspective indicates an increased demand for services as well as for their adjustment. These findings highlight the vulnerability of individuals with a history of SV and the need for accommodation of frontline SV services for health crises.

The Comprehensive Communal Trauma Intervention Model (CCTIM), an Innovative Transdisciplinary Population-Level Model for Treating Trauma-Induced Illness and Mental Health in Global Vulnerable Communities: Palestine, a Case Study.

This paper explores how Western medicine may not fully understand and address post-traumatic stress disorder (PTSD) and other trauma-induced illnesses in a culturally appropriate manner in marginalized communities and offers a theoretical framework to develop comprehensive, effective, and sustainable solutions that comprehensively address and treat the trauma on both a collective and individual level. Focused on Palestinians, this paper discusses the collective trauma Palestinians experienced and how it manifests in transgenerational effects on the body and mind that may be post-traumatic stress disorder (PTSD) or perhaps another distinct condition that is yet to be codified in the Western medical lexicon. It describes local alternatives to Western medical diagnostic tools like the "ease to disease" diagnostic scale and the sociopolitical context-in this case, the Palestinian fight for karamah, or dignity-from which such alternatives arise. Based on these findings, a novel theoretical framework, the comprehensive communal trauma intervention model (CCTIM), a truly transdisciplinary population-level model for treating mental health in vulnerable communities globally, is proposed. It articulates the need to address the root cause of collective trauma, make modifications to the healthcare system, and cultivate strategic equity-oriented and research-based partnerships.

Hiding under the Color of Authority: Eric Wess Uller and his Decades-Long Rampage of Child Sexual Abuse.

There are uniform characteristics of perpetrators of child sexual abuse; two of which stand out. Perpetrators generally put themselves in positions that provide easy access to children or adolescents, and they exploit the power or authority of those positions to sexually coerce their victims. There are nonetheless characteristics of perpetrators that are assuredly unique. Effectively posing as a police officer, while also claiming to be a medically trained practitioner capable of performing physical examinations, is an example of such. Relying on both of these misrepresentations, Eric Wess Uller grievously sexually abused over ninety underprivileged adolescent boys who were participants in a youth serving organization (YSO). Arrested after a twenty-year rampage, Mr. Uller then killed himself following his release on bail. Though anomalous in some respects, this case is best understood as a vital underscoring of the vulnerability of underprivileged teenage boys. Where the shortcomings of YSO's are concerned, the commitment to vigilance must be sustained irrespective of the hierarchical status of the personnel involved. Policy recommendations, informed by the limitations of diagnostic predictions, are included.

MENTAL HEALTH AFTER TRAUMA: INDIVIDUAL AND COLLECTIVE DIMENSIONS.

OBJECTIVE: The aim: The article is devoted to uncovering the essence of the trauma, identifying the cause of its formation, and investigating the consequences for the person and the community. PATIENTS AND METHODS: Materials and methods: The methodological basis of the given study is the interdisciplinary and hermeneutic approach, which was used in combination with the methods of retrospective, analysis, synthesis, and extrapolation, as well as the methodological apparatus of memory studies with its inherent intention of the problem of group identity formation. A prominent place in the process of writing the work played the method of critical literature review. Sources reflecting research on individual and collective dimensions of trauma were found in PubMed, Scopus, and Google Scholar. Research articles were found using the keywords "trauma", "traumatic experience", "victim", "violence", "collective trauma", "cultural trauma", "memory", etc. CONCLUSION: Conclusions: Modern studies of traumatic experience are inextricably linked with the scientific work of Sigmund Freud, who was one of the first to explicate trauma as a destroyer of "protection". This gave reason to modern researchers to consider it an emotional reaction of the psyche to mental, physical, or cultural violence directed against the identity of an individual or an entire community. Whether inflicted on an individual or a community as a whole, trauma invariably seeks testimony in order to produce meanings and mechanisms capable of preventing violence and preserving the mental health of both the individual and the community as a whole.

Collective Emotion During Collective Trauma: A Metaphor Analysis of the COVID-19 Pandemic.

This study provides insight into lived experiences of the COVID-19 pandemic in the United States. Participant metaphors of the pandemic were collected by conducting in-depth semi-structured interviews (N = 44). Participants were asked to compare the pandemic with an animal and with a color, and to provide contextual sensemaking about their metaphors. A metaphor analysis revealed four convergent mental models of participants' pandemic experiences (i.e., uncertainty, danger, grotesque, and misery) as well as four primary emotions associated with those mental models (i.e., grief, disgust, anger, and fear). Through metaphor, participants were able to articulate deeply felt, implicit emotions about their pandemic experiences that were otherwise obscured and undiscussable. Theoretical and practical implications of these collective mental models and associated collective emotions related to the unprecedented collective trauma of the COVID-19 pandemic are discussed.

Traumatic Experiences of the Living Disappeared in Argentina: A Review.

Between 1976 and 1983, in Argentina, among the 30,000 individuals kidnapped and killed by armed forces, several pregnant women delivered their children in captivity, who were illegally adopted by families with close military ties. To date, 130 of these children have been identified (named Living Disappeared, LDs) and reunited with their biological families. The aim of this review was to analyze the peculiarity of their traumatic experiences the specific factors of trauma resolution. We conducted a comprehensive search of the articles that specifically deal with Argentinean LDs. Fifteen records met the inclusion criteria. Symptoms of Post-Traumatic Stress Disorder and traumatic memories were reported by LDs, both after and before learning the truth; the processing of trauma was found to be facilitated by verbalizing traumatic experiences, listening to others' narratives, and recognizing the belonging to a political community. The pathogenic relevance of the early exposure to trauma, the climate of lies, secrets, and doubts which characterized the life with the illegally adoptive parents and the conflict between two identities have been found. The findings come out on the side of the influence of the context in trauma resolution.

Después de la tormenta: Collective trauma following Hurricane Maria in a northeastern Puerto Rican community in the United States.

Hurricane Maria was the largest disaster in Puerto Rico's history, affecting Puerto Rican communities throughout the United States. We conducted focus groups using a grounded theory approach with adults displaced from Puerto Rico to a northeastern community 12 (n = 5) and 17 months (n = 7) postdisaster. Key informant interviews were also conducted with nine community advocates working with displaced hurricane survivors. Emerging themes reflect narrative and social identity processes following collective trauma. Findings emphasize the need for timely and long-term disaster responses that build on community strengths without leaving communities to cope on their own. We discuss how incorporating group storytelling in postdisaster research is a culturally sensitive practice that can promote resiliency among survivors.

Coping with COVID-19: An Examination of the Role of (Non)Religiousness/(Non)Spirituality.

Psychological distress and coping strategies employed during collective trauma events may vary for theists and atheists, as well as others along the (non)religious spectrum. The present study explored these differences via data collected from a US-based sample during the COVID-19 pandemic. Statistical models suggested relationships between maladaptive coping and distress for all participants and potential differences in coping and, in turn, distress between participants high and low in institutional religiousness and individual spirituality. Additionally, all participants, though especially nonreligious participants, appeared less able to engage in adaptive emotion-focused coping strategies. Implications for future research are provided.

COVID-19 Interconnectedness: Health Inequity, the Climate Crisis, and Collective Trauma.

The COVID-19 pandemic brings to the forefront the complex interconnected dilemmas of globalization, health equity, economic security, environmental justice, and collective trauma, severely impacting the marginalized and people of color in the United States. This lack of access to and the quality of healthcare, affordable housing, and lack of financial resources also continue to have a more significant impact on documented and undocumented immigrants. This paper aims at examining these critical issues and developing a framework for family therapists to address these challenges by focusing on four interrelated dimensions: cultural values, social determinants of health, collective trauma, and the ethical and moral responsibility of family therapists. Given the fact that family therapists may unwittingly function as the best ally of an economic and political system that perpetuates institutionalized racism and class discrimination, we need to utilize a set of principles, values, and practices that are not just palliative or after the fact but bring forth into the psychotherapeutic and policy work a politics of care. Therefore, a strong call to promote and advocate for the broader continuum of health and critical thinking preparing professionals to meet the challenges of health equity, as well as economic and environmental justice, is needed. The issues discussed in this paper are specific to the United States despite their relevance to family therapy as a field. We are mindful not to generalize the United States' reality to the rest of the world, recognizing that issues discussed in this paper could potentially contribute to international discourse.

La pandemia de la COVID-19 ha puesto en primer plano los dilemas complejos e interconectados de la globalización, la equidad sanitaria, la seguridad económica, la justicia ambiental y el trauma colectivo, afectando gravemente a las personas marginadas y de color de los Estados Unidos. Esta falta de acceso a asistencia sanitaria de calidad, a viviendas asequibles, y la falta de recursos económicos también continúan teniendo un efecto más significativo en los inmigrantes documentados e indocumentados. Este artículo tiene como finalidad analizar estas cuestiones críticas y desarrollar un marco para que los terapeutas familiares aborden estas dificultades centrándose en cuatro dimensiones interrelacionadas: valores culturales, determinantes sociales de salud, trauma colectivo, y responsabilidad ética y moral de los terapeutas familiares. Teniendo en cuenta el hecho de que los terapeutas familiares pueden funcionar inconscientemente como los mejores aliados de un sistema económico y político que perpetúa el racismo institucionalizado y el clasismo, necesitamos utilizar un conjunto de principios, valores y prácticas que no sea solo paliativo o a posteriori, sino que genere en el trabajo político y psicoterapéutico una política de asistencia. Por lo tanto, es necesario un reclamo firme de promover y abogar por un continuo más amplio de la salud y un pensamiento crítico que prepare a los profesionales para responder a las dificultades de la equidad sanitaria, así como de la justicia económica y ambiental, si fuera necesario. Las cuestiones tratadas en este artículo son específicas de los Estados Unidos a pesar de su relevancia para la terapia familiar como área. Somos conscientes de no generalizar la realidad de los Estados Unidos para el resto del mundo, y reconocemos que las cuestiones tratadas en este artículo podrían contribuir al discurso internacional.

Family Therapy and COVID-19: International Reflections during the Pandemic from Systemic Therapists across the Globe.

The COVID-19 pandemic has convulsed human communities across the globe like no previous event in history. Family therapists, paradoxically, given the core of their work is with systems, are also experiencing upheaval in professional and personal lives, trying to work amidst a society in chaos. This paper offers a collection of reflections by systemic and family therapists from diverse cultures and contexts penned in the midst of the pandemic. The main intention in distilling these narratives is to preserve the 'cultural diversity' and 'ecological position' of the contributors, guided by phenomenology, cultural ecology, and systemic worldviews of 'experiencing.' The second intention is to 'unite' promoting solidarity in this isolating situation by bringing each story together, creating its own metaphor of a family: united, connected, stronger. As a cross-cultural family practitioner, with a strong mission for collaboration, the lead author acknowledges the importance of Context - the nation and location of the experience; Culture - the manner in which culture impacts on experience; Collaboration - enhancing partnership, enriching knowledge, and mapping the journey's direction; and Connectedness - combating isolation while enhancing unity. Since the key transmission of culture is through language, raw reflections were sought initially in the practitioners' own language, which were translated for an English-speaking readership. These narratives are honest and rich descriptions of the authors' lived experiences, diverse and distinctive. The contributors trust colleagues will find these reflections helpful, validating and acknowledging the challenges of this unique period in history.

The aftermath of resilience in the global world.

Just as there is an aftermath of trauma, there is reason to think of an aftermath of resilience, different from the resilience capacities developed after a trauma. The aftermath of resilience reflects the ability to activate resilient memory in response to traumatic memory in order to rebuild oneself. This is a major challenge for the global mental health of our fragile societies. The challenge is significant for France, Europe and the world. Beyond the overuse of the word resilience in scientific literature and the media, it contributes to the methodology, epistemology and politics of resilience.

[Disclosure and silence, protecting the baby from trauma transmission?] / Dévoilement et silence, protéger le bébé de la transmission traumatique.

The differences in how parents communicate their traumatic experience, through silence or by disclosure, play a fundamental role in the transgenerational transmission of trauma. Research into the transmission of trauma from mother to baby, in a humanitarian context, shows the importance of adapting the disclosure of the narrative of the mother's traumatic experience, which appears to be the most appropriate solution for protecting babies.