A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic.

Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder.Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment.Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression.Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure.Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.

We longitudinally examined predictors of symptoms of adjustment disorder in 15,563 adults during the COVID-19 pandemic.We found stressors, risk, and protective factors predicting adjustment disorder symptom levels at different stages of the pandemic.For some predictors, the effects appear to change in different phases of a pandemic.

Trajectories of Adjustment Disorder and Well-Being in Austria and Croatia during 20 Months of the COVID-19 Pandemic.

The present study aimed to investigate the trajectories of adjustment disorder (AD) symptoms and well-being over 20 months of the COVID-19 pandemic in Austria and Croatia. Further objectives of this study were to examine whether sociodemographic characteristics and the symptoms of anxiety and depression could predict these trajectories. As part of the pan-European ESTSS ADJUST study, N = 1144 individuals were recruited using convenience sampling and assessed four times between June 2020 and January 2022 through an online survey. Latent growth curve modelling was applied to estimate the trajectories of AD symptoms and well-being. Over time, the prevalence of probable AD varied between 9.8% and 15.1%. The symptoms of AD tended to increase, whereas well-being tended to decrease. According to the majority of the models tested, women, participants from Austria and those with lower income had higher initial AD symptoms, whereas older participants and those from Croatia had higher initial well-being. In all models and at all timepoints, anxiety and depression significantly predicted AD and well-being scores. Overall, our study points to several predictors of AD and well-being and indicates high variability in people's reactions to the pandemic. Psychosocial support for the general population is needed during pandemics and similar crises, with a special focus on vulnerable groups.

Psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) in 9230 adults across seven European countries: Findings from the ESTSS ADJUST study.

BACKGROUND: The four-item Patient Health Questionnaire-4 (PHQ-4) is a widely used screening measure for depression and anxiety. OBJECTIVES: This study aimed to test factor structure and measurement invariance in an adult sample of the general population across seven European countries. METHOD: A total sample of 9230 adults, 71.3 % female, Mage = 44.35 (SD = 14.11) from seven countries (Austria, Croatia, Georgia, Germany, Lithuania, Portugal, and Sweden) participated in the study. We applied confirmatory factor analysis (CFA) to examine the factor structure and measurement invariance testing to evaluate measurement equivalence across countries, gender, and age groups. RESULTS: The CFA yielded that a two-factor PHQ-4 model with separate depression and anxiety factors had the best fit. Partial scalar measurement invariance was established across different groups based on gender, age, and country. CONCLUSIONS: The PHQ-4 is a valid and reliable measure that can be applied to screen for depression and anxiety in the general population. LIMITATIONS: The limitation of the study includes the sampling, which resulted in the sample structure with the majority of females, predominantly of high education and from urban communities.

Shaped by the COVID-19 pandemic: Psychological responses from a subjective perspective-A longitudinal mixed-methods study across five European countries.

BACKGROUND: Contextual factors are essential for understanding long-term adjustment to the COVID-19 pandemic. Therefore, the present study investigated changes in mental health outcomes and subjective pandemic-related experiences over time and across countries. The main objective was to explore how psychological responses vary in relation to individual and environmental factors. METHODS: The sample consisted of N = 1070 participants from the general population of Austria, Croatia, Georgia, Greece, and Portugal. We applied a longitudinal mixed-methods approach, with baseline assessment in summer and autumn 2020 (T1) and follow-up assessment 12 months later (T2). Qualitative content analysis by Mayring was used to analyse open-ended questions about stressful events, positive and negative aspects of the pandemic, and recommendations on how to cope. Mental health outcomes were assessed with the Adjustment Disorder-New Module 8 (ADNM-8), the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), the Patient Health Questionnaire-2 (PHQ-2), and the 5-item World Health Organization Well-Being Index (WHO-5). The analyses were performed with SPSS Statistics Version 26 and MAXQDA 2022. RESULTS: The mental health outcomes significantly differed over time and across countries, with e.g. Greek participants showing decrease in adjustment disorder symptoms (p = .007) between T1 and T2. Compared with other countries, we found better mental health outcomes in the Austrian and the Croatian sample at both timepoints (p < .05). Regarding qualitative data, some themes were equally represented at both timepoints (e.g. Restrictions and changes in daily life), while others were more prominent at T1 (e.g. Work and finances) or T2 (e.g. Vaccination issues). CONCLUSIONS: Our findings indicate that people's reactions to the pandemic are largely shaped by the shifting context of the pandemic, country-specific factors, and individual characteristics and circumstances. Resource-oriented interventions focusing on psychological flexibility might promote resilience and mental health amidst the COVID-19 pandemic and other global crises.

You can't do anything about it, but you can make the best of it: a qualitative analysis of pandemic-related experiences in six European countries.

Background: The complex system of stressors related to the coronavirus disease 2019 (COVID-19) pandemic has affected the global population, provoking a broad range of psychological reactions. Although numerous studies have investigated the mental health impact of COVID-19, qualitative research and cross-country comparisons are still rare. Objective: This qualitative study aimed to explore self-perceived challenges and opportunities related to COVID-19 across six European countries. The overall objective was to provide a differentiated picture of individual subjective experiences in the early stages of the pandemic. Method: The present study included 7309 participants from Austria, Croatia, Georgia, Greece, Poland, and Portugal. We performed qualitative content analysis according to Mayring analyse open-ended questions regarding stressful events, positive and negative aspects of the pandemic, and recommendations to cope with the pandemic situation. MAXQDA software was used for data management and analysis. Results: Participants' accounts were moderately consistent across the countries. The most prominent themes regarding stressful and negative pandemic aspects included: Restrictions and changes in daily life, Emotional distress, and Work and finances. Answers about positive pandemic consequences were mainly centred around the themes Reflection and growth, Opportunity for meaningful/enjoyable activities, and Benefits on interpersonal level. Key themes identified from participants' recommendations to cope with the pandemic included Beneficial behavioural adjustment, Beneficial cognitive-emotional strategies, and Social support. Conclusions: Participants experienced various challenges, but also shared several positive pandemic consequences and recommendations to cope with the pandemic. These first-hand data could inform mental health practices to promote well-being during COVID-19 and similar global challenges in the participating countries and possibly beyond. HIGHLIGHTS: We examined COVID-19-related experiences in 7309 adults from six European countries.Besides challenges, participants identified many positive pandemic consequences.Participants' recommendations to cope with COVID-19 included behavioural and cognitive-emotional strategies.

Mental Health in the Transit Context: Evidence from 10 Countries.

Most interventions for mental health and psychosocial support (MHPSS) have been developed in contexts and with populations that differ significantly from the realities of migration. There is an urgent need for MHPSS in transit; however, transit-specific aspects of MHPSS provision are often neglected due to the inherent challenges transit poses to traditional conceptualizations of practice. The Delphi method, which consisted of three iterative rounds of surveys, was applied with the goal of identifying challenges to and adaptations of MHPSS in the transit context. Twenty-six MHPSS providers working with refugees in 10 European transit countries participated; 69% of participants completed all three survey rounds. There was consensus that a flexible model of MHPSS, which can balance low intensity interventions and specialized care, is needed. Agreement was high for practice-related and sociopolitical factors impacting MHPSS in transit; however, the mandate of MHPSS providers working in the transit context achieved the lowest consensus and is yet to be defined. There is a need to rethink MHPSS in the refugee transit context. Providing MHPSS to refugees on the move has specificities, most of which are related to the instability and uncertainty of the context. Future directions for improving mental health protection for refugees, asylum seekers, and migrants in transit are highlighted.

Building Capacity for Prevention of Gender-Based Violence in the School Context.

School-related gender-based violence (SRGBV) is highly prevalent worldwide which calls for a range of early prevention and innovative solutions. The presence of GBV in the school context is well-documented and it highlights the importance of building competencies of teachers and other school professionals for recognizing and intervening in SRGBV cases. This paper analyses the current and future teachers' training needs, and their level of preparedness for detecting and intervening in cases of GBV in the school context, with the objective of developing a targeted training program. The participants in this study were 597 current and future teachers and other school professionals from Croatia, Finland, and Spain. An ad-hoc built questionnaire was distributed in the three participating countries. Results show that the interest in receiving training is related to the perceived importance of coping with GBV in the (future) work and that the main topics of the training should focus on addressing parties of SRGBV, guidelines for prevention and intervention in schools as well as online GBV. These findings were similar in three countries, and they provided user-generated topics and tools that served as a guideline for the development of a training program that aims to increase the knowledge about SRGBV and to develop skills for coping with GBV in the school context regarding victims, bystanders and perpetrators.

Resilience after natural disasters: the process of harnessing resources in communities differentially exposed to a flood.

Background: Disasters negatively impact mental health and well-being. Studying how people adapt and recover after adversity is crucial for disaster preparedness and response. Objective: This study examined how differentially affected communities harness their resources to adapt to the aftermath of a flood. We predicted that stronger individual, interpersonal, and community resources protect against psychosocial resource loss and, through that, are related to fewer symptoms of posttraumatic stress and depression and higher life satisfaction. We also predicted that these effects would be stronger in a flooded community, compared to a threatened, but non-flooded community. Method: Participants were randomly sampled community members from two neighbouring municipalities. One municipality was severely flooded during the 2014 floods in South East Europe (affected community, na = 223), the other was threatened but not flooded (comparison community, nc = 224). Interviews were conducted one and a half years after the disaster using the Connor-Davidson Resilience Scale 10-item version, the Multidimensional Scale of Perceived Social Support, the Community Resources Scale, the Psychosocial Resource Loss Scale, the PTSD Checklist for DSM-5, the Center for Epidemiological Studies Depression Scale Revised and the Satisfaction with Life Scale. Results: Stronger individual, interpersonal, and community resources were found to be related to better post-disaster outcomes directly and indirectly through psychosocial resource loss. In the affected community, interpersonal resources and community social capital and engagement were stronger predictors of positive adaptation. In the comparison community, community economic development and trust in community leadership were more important. Conclusion: This study provides evidence that people affected by disasters can harness their individual, interpersonal, and community resources to recover and adapt. Post-disaster interventions should aim to strengthen family and community ties, thus increasing available social support and community connectedness.

Antecedentes: Las catástrofes tienen un impacto negativo en la salud mental y el bienestar. Estudiar cómo se adaptan y se recuperan las personas tras la adversidad es crucial para la preparación y la respuesta ante los desastres.Objetivo: Este estudio examinó cómo las comunidades afectadas de forma diferencial aprovechan sus recursos para adaptarse a las secuelas de una inundación. Predecimos que contar con recursos individuales, interpersonales y comunitarios más fuertes protegen contra la pérdida de recursos psicosociales y, a través de ello, se relacionan con menos síntomas de estrés postraumático y depresión y una mayor satisfacción vital. También predijimos que estos efectos serían más fuertes en una comunidad inundada, en comparación con una comunidad amenazada, pero no inundada.Método: Los participantes fueron miembros de la comunidad seleccionados al azar de dos municipios vecinos. Uno de los municipios sufrió graves inundaciones durante las inundaciones del 2014 en el sureste de Europa (comunidad afectada, na = 223), el otro, estuvo amenazado pero no se inundó (comunidad de comparación, nc = 224). Las entrevistas se realizaron un año y medio después del desastre, utilizando la versión de 10 ítems de la Escala de Resiliencia de Connor-Davidson, la Escala Multidimensional de Apoyo Social Percibido, la Escala de Recursos Comunitarios, la Escala de Pérdida de Recursos Psicosociales, la Lista de Verificación del TEPT para el DSM-5, la Escala de Depresión Revisada del Centro de Estudios Epidemiológicos y la Escala de Satisfacción con la Vida.Resultados: Los recursos individuales, interpersonales y comunitarios más fuertes se relacionaron con mejores resultados después de la catástrofe, directamente e indirectamente a través de la pérdida de recursos psicosociales. En la comunidad afectada, los recursos interpersonales y el capital social y el compromiso de la comunidad fueron los mayores predictores de una adaptación positiva. En la comunidad de comparación, el desarrollo económico de la comunidad y la confianza en el liderazgo comunitario fueron más importantes.Conclusión: Este estudio aporta pruebas de que las personas afectadas por catástrofes pueden aprovechar sus recursos individuales, interpersonales y comunitarios para recuperarse y adaptarse. Las intervenciones posteriores a las catástrofes deberían tener como objetivo reforzar los lazos familiares y comunitarios, aumentando así el apoyo social disponible y la conectividad de la comunidad.

Risk and protective factors, stressors, and symptoms of adjustment disorder during the COVID-19 pandemic - First results of the ESTSS COVID-19 pan-European ADJUST study.

Background: The COVID-19 pandemic exposes individuals to multiple stressors, such as quarantine, physical distancing, job loss, risk of infection, and loss of loved ones. Such a complex array of stressors potentially lead to symptoms of adjustment disorder. Objective: This cross-sectional exploratory study examined relationships between risk and protective factors, stressors, and symptoms of adjustment disorder during the first year of the COVID-19 pandemic. Methods: Data from the first wave of the European Society of Traumatic Stress Studies (ESTSS) longitudinal ADJUST Study were used. N = 15,563 participants aged 18 years and above were recruited in eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. Associations between risk and protective factors (e.g. gender, diagnosis of a mental health disorder), stressors (e.g. fear of infection, restricted face-to-face contact), and symptoms of adjustment disorder (ADNM-8) were examined using multivariate linear regression. Results: The prevalence of self-reported probable adjustment disorder was 18.2%. Risk factors associated with higher levels of symptoms of adjustment disorder were female gender, older age, being at risk for severe COVID-19 illness, poorer general health status, current or previous trauma exposure, a current or previous mental health disorder, and longer exposure to COVID-19 news. Protective factors related to lower levels of symptoms of adjustment disorder were higher income, being retired, and having more face-to-face contact with loved ones or friends. Pandemic-related stressors associated with higher levels of symptoms of adjustment disorder included fear of infection, governmental crisis management, restricted social contact, work-related problems, restricted activity, and difficult housing conditions. Conclusions: We identified stressors, risk, and protective factors that may help identify individuals at higher risk for adjustment disorder.

Antecedentes: La pandemia de COVID-19 expone a las personas a múltiples factores estresantes, como la cuarentena, el distanciamiento físico, la pérdida del trabajo, el riesgo de infección, y la pérdida de seres queridos. Esta compleja serie de factores estresantes puede potencialmente conducir a síntomas del trastorno de adaptación.Objetivo: Este estudio exploratorio transversal examinó las relaciones entre los factores de riesgo y de protección, los factores estresantes, y los síntomas del trastorno de adaptación durante el primer año de la pandemia de COVID-19.Métodos: Se utilizaron datos de la primera ola del estudio longitudinal ADJUST de la Sociedad Europea de Estudios de Estrés Traumático (ESTSS en su sigla en inglés). N = 15.563 participantes de 18 años o más fueron reclutados en once países (Austria, Croacia, Georgia, Alemania, Grecia, Italia, Lituania, Países Bajos, Polonia, Portugal, y Suecia) de junio a noviembre de 2020. Se examinaron mediante regresión lineal multivariante las asociaciones entre los factores de riesgo y de protección (p. ej., género, diagnóstico de un trastorno de salud mental), factores estresantes (p. ej., miedo a la infección, contacto restringido cara a cara), y síntomas del trastorno de adaptación (ADNM-8 en su sigla en inglés).Resultados: La prevalencia del trastorno de adaptación probable autoinformado fue del 18,2%. Los factores de riesgo asociados con niveles más altos de síntomas del trastorno de adaptación fueron género femenino, edad avanzada, riesgo de enfermedad grave por COVID-19, peor estado de salud general, exposición a un trauma actual o anterior, un trastorno de salud mental actual o anterior, y una exposición más prolongada a las noticias de COVID-19. Los factores de protección relacionados con niveles más bajos de síntomas del trastorno de adaptación fueron mayores ingresos, estar jubilado, y tener más contacto cara a cara con sus seres queridos o amigos. Los factores estresantes relacionados con la pandemia que se asociaron con niveles más altos de síntomas del trastorno de adaptación incluyeron miedo a la infección, manejo gubernamental de crisis, contacto social restringido, problemas relacionados con el trabajo, actividad restringida, y condiciones de vivienda difíciles.Conclusiones: Identificamos factores estresantes, de riesgo, y protectores que pueden ayudar a identificar a las personas con mayor riesgo de trastorno de adaptación.

Mental health status and risk factors during Covid-19 pandemic in the Croatia's adult population.

Background: The Covid-19 pandemic is associated with adverse mental health outcomes for people worldwide.Objective: The study aimed to assess mental health during the Covid-19 pandemic and the key risk factors from the human ecology perspective in Croatia's adult population.Method: An online panel survey with 1,201 adult participants (50.1% women) was done with a nationally representative sample in terms of gender, age, and country region four months after the nation lockdown began and two months after most of the restrictions were lifted. Indicators of mental health included symptoms of adjustment disorder (ADNM-8); depression, anxiety, and stress (DASS-21); symptoms of post-traumatic stress disorder (PC-PTSD-5); and well-being (WHO-5).Results: In the entire sample, 9.8% (95% confidence interval [CI]: 7.9%, 14.0%) of the participants were at risk of adjustment disorder, 7.7% (95% CI: 6.7%, 11.9%) were at risk of depression disorder, and 7.8% (95% CI: 5.3%, 10.3%) were at risk of anxiety disorder. In addition, 7.2% (95% CI: 5.3%, 10.2%) were experiencing high levels of stress. The average well-being score was 56.5 (SD = 21.91) on a scale from 0 to 100. Among the participants who have lifetime traumatic experience (n = 429), 14% (95% CI: 10.6%, 17.2%) were at risk for PTSD. Key risk factors for specific mental health outcomes differed, but the common ones included: current health status, previous mental health diagnosis, and psychological resilience. Being younger, having a below-average income, and excessively following news about Covid-19 were predictive for some of the mental health problems.Conclusions: Together, the key risk factors identified in this study indicate the need for public health interventions addressing the general population's mental health, but also for specific risk groups. Lower rates of mental health symptoms assessed soon after lifting quarantine measures that have been found in other studies may indicate human resilience capacity.

Key risk factors for mental health disorders during the Covid-19 pandemic in Croatia were: current health status, previous mental health diagnosis, psychological resilience, younger age, below-average income, and excessively following news about the pandemic.

Stressors, coping and symptoms of adjustment disorder in the course of the COVID-19 pandemic - study protocol of the European Society for Traumatic Stress Studies (ESTSS) pan-European study.

BACKGROUND: During the current COVID-19 pandemic, the people in Europe are exposed to self-isolation, quarantine, job loss, risk of contracting COVID-19, or grief of loved ones. Such a complex array of stressors may lead to symptoms of adjustment disorder or posttraumatic stress disorder. This research protocol describes a study launched by the European Society of Traumatic Stress Studies (ESTSS) to investigate the impact of the COVID-19 pandemic on symptoms of adjustment disorder across European countries. OBJECTIVE: The longitudinal online cohort study aims (1) to explore psychosocial reactions to the COVID-19 pandemic across ten European countries; (2) to examine the relationships between risk and resilience factors, stressors and symptoms of adjustment disorder during the pandemic; and (3) to investigate whether these relationships are moderated by coping behaviours. METHOD: In ten countries (Austria, Croatia, Georgia, Germany, Italy, Lithuania, Netherlands, Poland, Portugal, and Sweden), between 1,000 and 2,000 participants will be recruited, depending on the size of the country. Participants will be assessed at two timepoints with a six-month interval. Following a conceptual framework based on the WHO's social framework of health, an assessment of risk and resilience factors, COVID-19 related stressors and pandemic-specific coping behaviours will be measured to estimate their contribution to symptoms of adjustment disorder. The Adjustment Disorder New Module 8 (ADNM-8) will be used to assess symptoms of adjustment disorder. As a secondary measure, symptoms of posttraumatic stress disorder will be measure using the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). DATA ANALYSIS: The relative contribution of risk factors, resilience factors, and stressors on symptoms of adjustment disorder or symptoms of posttraumatic stress disorder will be estimated using multilevel analysis. To determine the moderating effects of different types of coping behaviours on these relationships, a multilevel mediation analysis will be carried out.

Antecedentes: Durante la actual pandemia de COVID-19, las personas en Europa están expuestas a autoaislamiento, cuarentena, pérdida de empleo, riesgo de contraer COVID-19 o duelo de sus seres queridos. Un conjunto tan complejo de factores estresantes puede provocar síntomas de trastorno de adaptación o trastorno de estrés postraumático. Este protocolo de investigación describe un estudio lanzado por la Sociedad Europea de Estudios de Estrés Traumático (ESTSS) para investigar el impacto de la pandemia COVID-19 en los síntomas del trastorno de adaptación en países europeos.Objetivo: El estudio longitudinal de cohorte en línea tiene como objetivo (1) explorar las reacciones psicosociales a la pandemia de COVID-19 en diez países europeos; (2) examinar las relaciones entre los factores de riesgo y resiliencia, estresores y síntomas de trastorno de adaptación durante la pandemia; e (3) investigar si estas relaciones son moderadas por comportamientos de afrontamiento.Método: En diez países (Austria, Croacia, Georgia, Alemania, Italia, Lituania, Países Bajos, Polonia, Portugal y Suecia) serán reclutados entre 1,000 y 2,000 participantes, dependiendo del tamaño del país. Los participantes serán evaluados en dos momentos con un intervalo de seis meses. Siguiendo un marco conceptual basado en el marco social de salud de la OMS, una evaluación de los factores de riesgo y resiliencia, factores estresantes relacionados con COVID-19 y el comportamiento de afrontamiento específico de la pandemia serán medidos para estimar su contribución a los síntomas de trastorno de adaptación. El nuevo módulo de trastorno de adaptación 8 (ADNM-8) se utilizará para medir los síntomas del trastorno de adaptación. Como medida secundaria, se evaluarán síntomas de trastorno de estrés postraumático usando el cribaje de TEPT en atención primaria para DSM-5 (PC-PTSD-5).Análisis de datos: La contribución relativa de los factores de riesgo, factores de resiliencia y los estresores sobre los síntomas de trastorno de adaptación o síntomas de trastorno de estrés postraumático se estimará mediante análisis multinivel. Para determinar los efectos moderadores de diferentes tipos de conductas de afrontamiento en estas relaciones, se llevará a cabo un análisis de mediación multinivel.

Screening for consequences of trauma - an update on the global collaboration on traumatic stress.

This letter provides an update on the activities of "The Global Collaboration on Traumatic Stress" (GC-TS) as first described by Schnyder et al. in 2017. It presents in further detail the projects of the first theme, in particular the development of and initial data on the Global Psychotrauma Screen (GPS), a brief instrument designed to screen for the wide range of potential outcomes of trauma. English language data and ongoing studies in several languages provide a first indication that the GPS is a feasible, reliable and valid tool, a tool that may be very useful in the current pandemic of the coronavirus disease 2019 (COVID-19). Further multi-language and cross-cultural validation is needed. Since the start of the GC-TS, new themes have been introduced to focus on in the coming years: a) Forcibly displaced persons, b) Global prevalence of stress and trauma related disorders, c) Socio-emotional development across cultures, and d) Collaborating to make traumatic stress research data "FAIR". The most recent theme added is that of Global crises, currently focusing on COVID-19-related projects.

Parental competitive victimhood and interethnic discrimination among their children: The mediating role of ethnic socialization and symbolic threat to the in-group.

Links between competitive victimhood and discrimination are well documented. However, the mechanisms how victimhood beliefs remain relevant for decades and how conflict survivors can shape attitudes and behaviours of the post-conflict generations are little understood. Following the Transgenerational Transmission Hypothesis and the Integrated Threat Theory, we propose that the link between parental competitive victimhood and discrimination among their children is mediated through family ethnic socialization and symbolic threat to the in-group. Participants were families that included youth (N = 227) and their parents (172 mothers, 150 fathers) in Vukovar, Croatia. A multiple group, chain mediation model was conducted with parental competitive victimhood as the predictor; youth ethnic socialization and symbolic threat as sequential mediators; and youth tendency to discriminate against the outgroup and perceived ethnic in-group discrimination as outcomes. The findings revealed significant indirect effects of the competitive victimhood on both outcomes, via the proposed mediators. The only difference in the model between majority Croats and minority Serbs was the path from symbolic threat to tendency to discriminate, which was positive and significant for both groups, but stronger among Croats. The findings imply that interventions in post-conflict settings need to address family ethnic socialization processes in addition to directly working with youth.

Stability and change post-disaster: dynamic relations between individual, interpersonal and community resources and psychosocial functioning.

Conservation of Resources (COR) theory defines psychological stress as the result of a threat or actual loss of resources, or lack of resource gain. Given that disasters present a significant risk for resource loss, the aim of this study was to examine the dynamic relationship between the change in different levels of resources and the change in psychosocial functioning. A random sample of N= 224 community members from a municipality affected by the 2014 Southeast Europe floods were interviewed one and a half and two and a half years post-disaster, using the Connor-Davidson Resilience Scale 10-item version, the Multidimensional Scale of Perceived Social Support, the Community Resources Scale - the Social Capital and Community Engagement subscale, the PTSD Checklist for DSM-5, the Center for Epidemiological Studies Depression Scale-Revised and the Satisfaction with Life Scale. The results of the Latent Difference Scores modelling indicate that the increase in resources was related to a decline in post-traumatic stress (PTS) and depression symptoms and increase in life satisfaction, and vice versa. Interpersonal resources were significantly related to all measured psychosocial outcomes, individual resources to PTS and life satisfaction and community resources to life satisfaction only. The mean level of resources remained the same, but a significant inter-individual variability in resource change was found: for some, they have increased, and for some decreased over time. Furthermore, resources changed independently: an increase in one was not related to an increase in another. These findings highlight the importance of resource gain and loss for psychosocial outcomes and call for targeted post-disaster interventions that can, by increasing the levels of resources in affected communities, decrease the levels of symptoms and increase well-being.

La Teoría de Conservación de Recursos (COR) define el estrés psicosocial como el resultado de una amenaza o efectiva pérdida de recursos, o falta de ganancia de éstos. Dado que los desastres presentan un riesgo significativo de pérdida de recursos, el objetivo de este estudio fue examinar la relación dinámica entre el cambio en diferentes niveles de recursos y el cambio en el funcionamiento psicosocial. Una muestra aleatoria de N=224 miembros de la comunidad de un municipio afectado por las inundaciones de 2014 en el Sudeste de Europa fueron entrevistados uno y medio y dos y medio años post-desastre, usando la versión de 10 ítems de la Escala de Resiliencia de Connor-Davidson, La Escala Multidimensional de Apoyo Social Percibido, la Escala de Recursos Comunitarios ­ la subescala de Capital Social y Compromiso Social, la Lista de Chequeo para TEPT del DSM-5, la Escala Revisada de Depresión del Centro de Estudios Epidemiológicos y la Escala de Satisfacción con la Vida. Los resultados del modelo de Puntajes de Diferencia Latente indican que el incremento en recursos se relacionó a una disminución de síntomas de estrés postraumático (EPT) y depresión y a un incremento en la satisfacción vital, y viceversa. Los recursos interpersonales se relacionaron significativamente a todos los resultados psicosociales medidos, los recursos individuales a EPT y satisfacción vital, y los recursos comunitarios sólo a satisfacción vital. El nivel promedio de recursos se mantuvo igual, pero se encontró una significativa variabilidad inter-individual en el cambio de recursos: para algunos aumentó y para otros disminuyó en el tiempo. Más aún, los recursos cambiaron independientemente: un incremento en uno no se relacionó a un incremento en otro. Estos hallazgos destacan la importancia de la ganancia y pérdida de recursos para los resultados psicosociales y llaman a realizar intervenciones post-desastre dirigidas que puedan, a través del incremento de los niveles de recursos en las comunidades afectadas, disminuir el nivel de síntomas e incrementar el bienestar.

Development and evaluation of a web-based capacity building course in the EUR-HUMAN project to support primary health care professionals in the provision of high-quality care for refugees and migrants.

BACKGROUND: The ongoing refugee crisis has revealed the need for enhancing primary health care (PHC) professionals' skills and training. OBJECTIVES: The aim was to strengthen PHC professionals in European countries in the provision of high-quality care for refugees and migrants by offering a concise modular training that was based on the needs of the refugees and PHC professionals as shown by prior research in the EUR-HUMAN project. METHODS: We developed, piloted, and evaluated an online capacity building course of 8 stand-alone modules containing information about acute health issues of refugees, legal issues, provider-patient communication and cultural aspects of health and illness, mental health, sexual and reproductive health, child health, chronic diseases, health promotion, and prevention. The English course template was translated into seven languages and adapted to the local contexts of six countries. Pre- and post-completion knowledge tests were administered to effectively assess the progress and knowledge increase of participants so as to issue CME certificates. An online evaluation survey post completion was used to assess the acceptability and practicability of the course from the participant perspective. These data were analyzed descriptively. RESULTS: A total of 390 participants registered for the online course in 6 countries with 175 completing all modules of the course, 47.7 % of them medical doctors. The mean time for completion was 10.77 hours. In total, 123 participants completed the online evaluation survey; the modules on acute health needs, legal issues (both 44.1%), and provider-patient communication/cultural issues (52.9%) were found particularly important for the daily practice. A majority expressed a will to promote the online course among their peers. CONCLUSION: This course is a promising learning tool for PHC professionals and when relevant supportive conditions are met. The course has the potential to empower PHC professionals in their work with refugees and other migrants.

[Primary care of refugees and migrants. Lesson learnt from the EUR-HUMAN project]. / Menekültek, migránsok az alapellátásban. Mit tanulhattunk az EUR-HUMAN projekt eredményeibol?

In 2015, local wars, starvation and misery in some Middle Eastern, Asian and African countries forced millions of people to leave their homelands. Many of these people migrated toward Europe, reaching Hungary as well. The refugee crisis created significant challenges for all national healthcare systems across Europe. Limited attention has been given to the extent to which health service provision for refugees and migrants has become a task for primary health care (PHC), which has been unprepared as a profession and pressured by the enormous workload. Hungarian primary care was involved only to an extent in the refugees' health care, as most of the migrants entering Hungary wanted to move forward to other countries. The need for evidence-based patient-centred interventions to assess refugee healthcare needs, and for training programmes for rapid capacity-building for integrated PHC was addressed by the EUropean Refugees - HUman Movement and Advisory Network (EUR-HUMAN) project, which 7 European countries developed together. The overall aim of the EUR-HUMAN project is to enhance the knowledge and expertise of European member states who accept refugees and migrants in addressing their health needs, safeguarding them from risks, while at the same time to minimize cross-border health risks. This initiative focuses on addressing the early arrival period, transition and longer-term settlement of refugees in European host countries. A primary objective of this project is to identify, design and assess interventions to improve PHC delivery for refugees and migrants with a focus on vulnerable groups. The structure, the main focus and outputs of the project are described and summarized in this paper, providing relevant information and access to educational materials for Hungarian (primary care) physicians. The EUR-HUMAN project was operated in 2016 under the auspices of the European Commission and funded by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). Orv Hetil. 2018; 159(35): 1414-1422.

Measuring and modelling the quality of 40 post-disaster mental health and psychosocial support programmes.

Disasters can have an enormous impact on the health and well-being of those affected. Internationally, governments and service providers are often challenged to address complex psychosocial problems. Ideally, the potentially broad range of support activities include a coherent, high-quality mental health and psychosocial support (MHPSS) programme. We present a theory-driven quantitative analysis of the quality of 40 MHPSS programmes, mostly implemented in European disaster settings. The objective is to measure quality domains recognized as relevant in the literature and to empirically test associations. During the EU project "Operationalizing Psychosocial Support in Crisis" (OPSIC) an evaluation survey was designed and developed for this purpose and completed by 40 MHPSS programme coordinators involved in different mass emergencies and disasters. We analysed the survey data in two steps. Firstly, we used the data to operationalize quality domains of a MHPSS programme, tested constructs and assessed their internal consistency reliability. A total of 26 out of 44 survey items clustered into three of the four domains identified within the theoretical framework: "planning and delivery system" (Cronbach's alpha 0.82); "general evaluation criteria" (Cronbach's alpha 0.82); and "essential psychosocial principles" (Cronbach's alpha 0.75). "Measures and interventions applied", theoretically a potential fourth domain, could not be confirmed to empirically cluster together. Secondly, several models with associations between domains and measures and interventions were tested and compared. The model with the best fit suggests that in MHPSS programmes with a higher planning and delivery systems score, a larger number of measures and interventions from evidence-informed guidelines are applied. In such programmes, coordinators are more positive about general evaluation criteria and the realization of essential psychosocial principles. Moreover, the analyses showed that some measures and interventions are more likely to be applied in programmes with more evolved planning and delivery systems, yet for most measures and interventions the likelihood of being applied is not linked to planning and delivery system status, nor to coordinator perceptions concerning psychosocial principles and evaluation criteria. Further research is necessary to validate and expand the findings and to learn more about success factors and obstacles for MHPSS programme implementation.

Assessing refugee healthcare needs in Europe and implementing educational interventions in primary care: a focus on methods.

The current political crisis, conflicts and riots in many Middle Eastern and African countries have led to massive migration waves towards Europe. European countries, receiving these migratory waves as first port of entry (POE) over the past few years, were confronted with several challenges as a result of the sheer volume of newly arriving refugees. This humanitarian refugee crisis represents the biggest displacement crisis of a generation. Although the refugee crisis created significant challenges for all national healthcare systems across Europe, limited attention has been given to the role of primary health care (PHC) to facilitate an integrated delivery of care by enhancing care provision to refugees upon arrival, on transit or even for longer periods. Evidence-based interventions, encompassing elements of patient-centredness, shared decision-making and compassionate care, could contribute to the assessment of refugee healthcare needs and to the development and the implementation of training programmes for rapid capacity-building for the needs of these vulnerable groups and in the context of integrated PHC care. This article reports on methods used for enhancing PHC for refugees through rapid capacity-building actions in the context of a structured European project under the auspices of the European Commission and funded under the 3rd Health Programme by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). The methods include the assessment of the health needs of all the people reaching Europe during the study period, and the identification, development, and testing of educational tools. The developed tools were evaluated following implementation in selected European primary care settings.

Trauma and trauma care in Europe.

The European countries have a long history of exposure to large-scale trauma. In the early 1990s the increasing awareness of the consequences of trauma within the mental health community led to the foundation of local societies for psychotraumatology across Europe and the European Society of Traumatic Stress Studies (ESTSS), which celebrated its 25th anniversary in 2018. The focus of this article is to describe the current state of care for survivors of trauma in the 15 European countries where ESTSS member societies have been established. Brief descriptions on the historical burden of trauma in each country are followed by an overview of the care system for trauma survivors in the countries, the state-of-the-art of interventions, current challenges in caring for survivors and the topics that need to be most urgently addressed in the future. The reports from the different countries demonstrate how important steps towards a better provision of care for survivors of trauma have been made in Europe. Given the cultural and economic diversity of the continent, there are also differences between the European countries, for instance with regard to the use of evidence-based treatments. Strategies to overcome these differences, like the new ESTSS training curricula for care-providers across Europe, are briefly discussed.

Los países Europeos tienen una larga historia de exposición a traumas de larga escala. A principios de la década de 1990, la creciente conciencia de las consecuencias del trauma dentro de la comunidad de salud mental condujo a la fundación de las sociedades locales para la psicotraumatología en Europa y la Sociedad Europea de Estudios de Estrés Traumático (ESTSS), la cual celebra en el 2018 su 25° aniversario. El enfoque de este artículo es describir el estado actual de la atención de los sobrevivientes de traumas en los 15 países Europeos, donde las sociedades miembros de la ESTSS se han establecido. Las descripciones breves sobre la carga histórica de trauma en cada país son seguidas por una descripción general del sistema de atención para sobrevivientes de trauma en el país, el estado de la técnica de las intervenciones, los desafíos actuales en el cuidado de sobrevivientes y los temas que necesitan ser abordados con mayor urgencia en el futuro. Los reportes de los diferentes países demuestran los pasos importantes que se han dado en Europa en la entrega de atención para los sobrevivientes de trauma. Dada la diversidad cultural y económica del continente, hay también diferencias entre los países Europeos, por ejemplo en relación al uso de tratamientos basados en la evidencia. Las estrategias para resolver estas diferencias, como el nuevo curriculum de entrenamiento de la ESTSS para los proveedores de atención a lo largo de Europa son discutidas brevemente.

Primary care for refugees and newly arrived migrants in Europe: a qualitative study on health needs, barriers and wishes.

Background: In order to provide effective primary care for refugees and to develop interventions tailored to them, we must know their needs. Little is known of the health needs and experiences of recently arrived refugees and other migrants throughout their journey through Europe. We aimed to gain insight into their health needs, barriers in access and wishes regarding primary health care. Methods: In the spring of 2016, we conducted a qualitative, comparative case study in seven EU countries in a centre of first arrival, two transit centres, two intermediate-stay centres and two longer-stay centres using a Participatory Learning and Action research methodology. A total of 98 refugees and 25 healthcare workers participated in 43 sessions. Transcripts and sessions reports were coded and thematically analyzed by local researchers using the same format at all sites; data were synthesized and further analyzed by two other researchers independently. Results: The main health problems of the participants related to war and to their harsh journey like common infections and psychological distress. They encountered important barriers in accessing healthcare: time pressure, linguistic and cultural differences and lack of continuity of care. They wish for compassionate, culturally sensitive healthcare workers and for more information on procedures and health promotion. Conclusion: Health of refugees on the move in Europe is jeopardized by their bad living circumstances and barriers in access to healthcare. To address their needs, healthcare workers have to be trained in providing integrated, compassionate and cultural competent healthcare.