Indirect effect of race-related stress on traumatic stress and depression symptoms via subjective social status in a Black community sample.

Experiencing racism is linked to lower subjective social status (SSS), defined as one's perception of their position in society. SSS is influenced by power, prestige, and objective socioeconomic status (SES). Previous findings suggest that race-related stress may be related to adverse mental health outcomes through SSS in Black Americans, a population that has been deeply affected by continuing legacies of oppression. The current study examines the indirect association between race-related stress and posttraumatic stress disorder (PTSD) and depression symptoms through SSS in a community sample of largely trauma-exposed Black Americans (N = 173). Hierarchical regression analyses indicated that overall race-related stress significantly predicted lower SSS, higher PTSD symptoms, and higher depression symptoms. Analyses also revealed indirect effects of cultural race-related stress on PTSD and depression symptoms through SSS after controlling for SES. Results suggest that the experience of race-related stress, particularly cultural race-related stress, which involves the degradation and disparagement of one's culture and worldview, is associated with more severe PTSD and depression symptoms potentially due to these experiences decreasing Black Americans' SSS. Findings support the need for systemic intervention strategies to disrupt the cultural oppression of Black Americans and improve the societal value and mental health of this population.

Trauma and female reproductive health across the lifecourse: motivating a research agenda for the future of women's health.

The aetiology behind many female reproductive disorders is poorly studied and incompletely understood despite the prevalence of such conditions and substantial burden they impose on women's lives. In light of evidence demonstrating a higher incidence of trauma exposure in women with many such disorders, we present a set of interlinked working hypotheses proposing relationships between traumatic events and reproductive and mental health that can define a research agenda to better understand reproductive outcomes from a trauma-informed perspective across the lifecourse. Additionally, we note the potential for racism to act as a traumatic experience, highlight the importance of considering the interaction between mental and reproductive health concerns, and propose several neuroendocrinological mechanisms by which traumatic experiences might increase the risk of adverse health outcomes in these domains. Finally, we emphasize the need for future primary research investigating the proposed pathways between traumatic experiences and adverse female reproductive outcomes.

Psychological trauma as a transdiagnostic risk factor for mental disorder: an umbrella meta-analysis.

This umbrella review is the first to systematically examine psychological trauma as a transdiagnostic risk factor across psychiatric conditions. We searched Pubmed, Scopus, and PsycNET databases from inception until 01/05/2021 for systematic reviews/meta-analyses evaluating the association between psychological trauma and at least one diagnosed mental disorder. We re-calculated the odds ratio (OR), then classified the association as convincing, highly suggestive, suggestive, or weak, based on the number of cases and controls with and without psychological trauma, random-effects p value, the 95% confidence interval of the largest study, heterogeneity between studies, 95% prediction interval, small-study effect, and excess significance bias. Additional outcomes were the association between specific trauma types and specific mental disorders, and a sensitivity analysis for childhood trauma. Transdiagnosticity was assessed using TRANSD criteria. The review was pre-registered in Prospero CRD42020157308 and followed PRISMA/MOOSE guidelines. Fourteen reviews met inclusion criteria, comprising 16,277 cases and 77,586 controls. Psychological trauma met TRANSD criteria as a transdiagnostic factor across different diagnostic criteria and spectra. There was highly suggestive evidence of an association between psychological trauma at any time-point and any mental disorder (OR = 2.92) and between childhood trauma and any mental disorder (OR = 2.90). Regarding specific trauma types, convincing evidence linked physical abuse (OR = 2.36) and highly suggestive evidence linked sexual abuse (OR = 3.47) with a range of mental disorders, and convincing evidence linked emotional abuse to anxiety disorders (OR = 3.05); there were no data for emotional abuse with other disorders. These findings highlight the importance of preventing early traumatic events and providing trauma-informed care in early intervention and psychiatric services.

Prevalence and Characterization of Psychological Trauma in Patients with Fibromyalgia: A Cross-Sectional Study.

Background: Preliminary evidence suggests that psychological trauma, especially childhood trauma, is a risk factor for the onset of fibromyalgia (FM). Objective: The main objective of this study consisted of evaluating the prevalence and detailed characteristics of psychological trauma in a sample of patients with FM, the chronology of trauma across the lifespan, and its clinical symptoms. We also calculated whether childhood trauma could predict the relationship with different clinical variables. Method: Eighty-eight females underwent an interview to assess sociodemographic data, psychiatric comorbidities, level of pain, FM impact, clinical symptoms of anxiety, depression, insomnia, quality of life, and psychological trauma. Results: The majority of participants (71.5%) met the diagnostic criteria for current post-traumatic stress disorder (PTSD). Participants reported having suffered traumatic events throughout their lifespan, especially in childhood and early adolescence, in the form of emotional abuse, emotional neglect, sexual abuse, and physical abuse. Traumatic events predict both poor quality of life and a level of pain in adulthood. All patients showed clinically relevant levels of anxiety, depression, insomnia, suicidal thoughts, and pain, as well as somatic comorbidities and poor quality of life. Pain levels predicted anxiety, depression, dissociation, and insomnia symptoms. 84% of the sample suffered one or more traumatic events prior to the onset of pain. Conclusions: Our data highlight the clinical complexity of patients with FM and the role of childhood trauma in the onset and maintenance of FM, as well as the high comorbidity between anxiety, depression, somatic symptoms, and FM. Our data also supports FM patients experiencing further retraumatization as they age, with an extremely high prevalence of current PTSD in our sample. These findings underscore the need for multidisciplinary programs for FM patients to address their physical pain and their psychiatric and somatic conditions, pay special attention to the assessment of psychological trauma, and provide trauma-focused interventions. Trial registration: ClinicalTrials.gov NCT04476316. Registered on July 20th, 2020.

Coronavirus disease 2019 aftermath: psychological trauma in ICU healthcare workers.

PURPOSE OF REVIEW: We aim to describe the extent of psychological trauma and moral distress in healthcare workers (HCW) working in the intensive care unit (ICU) during the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we review reports on prevalence of mental health symptoms, highlight vulnerable populations and summarize modifiable risk factors associated with mental health symptoms in ICU HCW. RECENT FINDINGS: The pandemic has resulted in a multitude of closely intertwined professional and personal challenges for ICU HCW. High rates of posttraumatic stress disorder (14-47%), burnout (45-85%), anxiety (31-60%), and depression (16-65%) have been reported, and these mental health symptoms are often interrelated. Most studies suggest that nurses and female HCW are at highest risk for developing mental health symptoms. The main personal concerns associated with reporting mental health symptoms among ICU HCW were worries about transmitting COVID-19 to their families, worries about their own health, witnessing colleagues contract the disease, and experiencing stigma from their communities. Major modifiable work-related risk factors were experiencing poor communication from supervisors, perceived lack of support from administrative leadership, and concerns about insufficient access to personal protective equipment, inability to rest, witnessing hasty end-of-life decisions, and restriction of family visitation policies. SUMMARY: The COVID-19 pandemic has severely impacted ICU HCW worldwide. The psychological trauma, manifesting as posttraumatic stress disorder, burnout, anxiety, and depression, is substantial and concerning. Urgent action by lawmakers and healthcare administrators is required to protect ICU HCW and sustain a healthy workforce.

Suicidal Histories in Adults Experiencing Psychological Trauma: Exploring Vulnerability and Protective Factors.

OBJECTIVE: This study aimed to identify vulnerability and protective factors for suicidal histories among adults experiencing psychological trauma. METHOD: Adults seeking treatment for psychological trauma (N = 113) completed self-report questionnaires measuring childhood trauma history, self-concept, relational functioning, emotion regulation, living arrangements, employment status, marital status, and suicidal history. Independent samples t-tests were used to determine variables on which those with and without suicidal histories differed significantly. These variables were then entered into a binary logistic regression model to identify factors which independently distinguished between those with and without a suicidal history. RESULTS: Univariate differences were found for childhood emotional abuse (CEA), childhood emotional neglect (CEN), emotion deactivation, and employment status, with those in the suicidal history group scoring higher on all of these. CEA (OR = 1.13, 95% CI = 1.01-1.27) and employment status (OR = 4.12, 95% CI = 1.23-13.73) remained significant predictors of suicidal status in the multivariable logistic regression. CONCLUSIONS: CEA was an independent vulnerability factor for suicidal risk, highlighting the need for clinicians to assess exposure to such trauma in those presenting with proximal traumatic experiences. Being in employment was an independent protective factor against suicidal risk, highlighting the importance of social buffers or networks when faced with traumatic situations.

Prevalence and correlates of depression among rural and urban Rwandan mothers and their daughters 26 years after the 1994 genocide against the Tutsi.

Background: In the past 26 years since the genocide against the Tutsi, mental illness continues to be the greatest challenges facing the Rwandan population. In the context of the 1994 genocide against Tutsi, there are three different survival status within Rwandan women. Those who were targeted by the genocide referred to as 'survivors', those who were in the country during the genocide but were not targeted referred to as 'non-targeted', and those who were outside the country referred to as '1959 returnees'. All these groups experienced the traumatic events differently. The literature shows that traumatic stress exposure is associated with depression. Objectives: To demonstrate differences in trauma exposure in a sample of mothers and daughters according to their genocide survival status. To examine differences in depression prevalence between these three groups of mothers and daughters as a function of their genocide survival status and place of residence. To examine the relationship between major depression, survival status, place of residence, and trauma exposure in sample of mothers and daughters, including the relationship between mothers' depression and daughters' depression. Methods: A sample of 309 dyads of mothers and daughters was recruited. Data were collected using the Mini International Neuropsychiatric Interview, Life Events Questionnaire and the Social Demographics Questionnaire. Data were analysed using descriptive statistics, chi-square test, logistic regression, and one-way ANOVA. Results: There is a significant difference in trauma exposure in three survival categories of mothers and daughters. A 23% of mothers and 18.4% of daughters met criteria for major depression, with urban participants twice as likely to meet criteria as participants from rural areas. Depression was associated with trauma exposure and place of residence in mothers' and daughters' samples. Maternal depression was associated with depression in daughters. Conclusions: Family support counselling services and research to identify factors of intergenerational depression are needed.

Antecedentes: En los últimos 26 años, desde el genocidio contra los tutsi, la enfermedad mental continúa siendo uno de los grandes retos que enfrenta la población de Ruanda. En el contexto del genocidio de 1994 contra los tutsi, existen tres categorías de sobrevivencia diferentes entre las mujeres de Ruanda. Aquellas que fueron objetivo del genocidio se denominaron 'supervivientes'; las que estuvieron en el país durante el genocidio, pero no fueron objetivo de este, se les denominó como 'no objetivo'; y las que estuvieron fuera del país fueron denominados como los 'repatriados de 1959'. Todos estos grupos experimentaron los eventos traumáticos de manera diferente. La literatura muestra que la exposición al estrés traumático está asociada con la depresión.Objetivos: Demostrar las diferencias en la exposición a trauma en una muestra de madres e hijas según su estado de supervivencia al genocidio. Examinar las diferencias en la prevalencia de la depresión entre estos tres grupos de madres e hijas en función de su estado de supervivencia al genocidio y el lugar de residencia. Examinar la relación entre la depresión mayor, el estado de supervivencia, el lugar de residencia, y la exposición al trauma en una muestra de madres e hijas, incluyendo la relación entre la depresión de las madres y la depresión de las hijas.Métodos: Se reclutó una muestra de 309 díadas de madres e hijas. Los datos fueron recopilados utilizando los cuestionarios MINI Entrevista Neuropsiquiátrica Internacional, el Cuestionario de Sucesos Vitales y el Cuestionario Demográfico Social. Los datos fueron analizados utilizando la estadística descriptiva, la prueba de chi cuadrado, la prueba de regresión logística y la prueba de ANOVA unifactorial.Resultados: Hay una diferencia significativa en la exposición al trauma en las tres categorías de madres e hijas sobrevivientes. El 23% de las madres y el 18,4% de las hijas cumplieron los criterios de depresión mayor, teniendo las participantes de zonas urbanas el doble de probabilidades de cumplir con tales criterios en comparación con las participantes de las áreas rurales. La depresión estuvo asociada a la exposición al trauma y al lugar de residencia en las muestras de madres e hijas. La depresión materna se asoció a la depresión en las hijas.Conclusiones: Se necesitan servicios de asesoramiento y apoyo familiar, así como investigación para identificar los factores relacionados a la depresión intergeneracional.

COVID-19-related institutional betrayal associated with trauma symptoms among undergraduate students.

Individuals are dependent on institutions (e.g., universities, governments, healthcare systems) to protect their safety and advocate for their needs. When institutions harm the individuals who depend on them, they commit institutional betrayal, which has been associated with numerous negative outcomes in prior research. Throughout the COVID-19 pandemic, students have entrusted universities to protect both their health and their educational opportunities. However, many universities have failed to meet these expectations, and it is likely that many students experience COVID-19-related institutional betrayal. In two similar studies, we examined the prevalence and correlates of institutional betrayal among undergraduate students at a large, public university in the Northwest United States during the fall 2020 and winter 2021quarters. In both studies, more than half of students endorsed at least one type of COVID-19-related institutional betrayal, and higher institutional betrayal ratings were significantly correlated with both current trauma symptoms and COVID-19-related avoidance and intrusion cognitions. In Study 2, the relationship between COVID-19-related institutional betrayal and current trauma symptoms remained significant, even when controlling for gender, personal and familial COVID-19 infection, and past trauma history. These results indicate that COVID-19 institutional betrayal is common and may be uniquely associated with distress among undergraduate students. We suggest it would behoove university institutions to reduce COVID-19-related institutional betrayal.

Vicarious traumatization in healthcare providers in response to COVID-19 pandemic in Kelantan, Malaysia.

BACKGROUND: In the fight against the COVID-19 pandemic, frontline healthcare providers who are engaged in the direct diagnosis, treatment, and care of patients face a high risk of infection yet receive inadequate protection from contamination and minimal support to cope with overwork, frustration, and exhaustion. These problems have created significant psychological and mental health concerns for frontline healthcare providers. This study aimed to compare the levels of vicarious traumatization between frontline and non-frontline healthcare providers in response to the COVID-19 pandemic. METHODOLOGY: All the subjects who met the inclusion criteria were recruited for this comparative cross-sectional study, which was conducted from May to July 2020 in two hospitals in Kelantan, Malaysia. A self-administered questionnaire, namely, the Malay-version Vicarious Traumatization Questionnaire and the Medical Outcome Study Social Support Survey were utilized. A descriptive analysis, independent t-test, and analysis of covariance were performed using SPSS Statistics version 26. RESULTS: A total of 160 frontline and 146 non-frontline healthcare providers were recruited. Vicarious traumatization was significantly higher among the non-frontline healthcare providers (estimated marginal mean [95% CI]: 79.7 [75.12, 84.30]) compared to the frontline healthcare providers (estimated marginal mean [95% CI]: 74.3 [68.26, 80.37]) after adjusting for sex, duration of employment, and social support. CONCLUSION: The level of vicarious traumatization was higher among non-frontline compared to frontline healthcare providers. However, the level of severity may differ from person to person, depending on how they handle their physical, psychological, and mental health. Hence, support from various resources, such as colleagues, family, the general public, and the government, may play an essential role in the mental health of healthcare providers.

[,,It overtook my body and soul": The experience of individuals receiving health-promoting service, of psychological trauma and health-related problems].

INTRODUCTION: Accumulating evidence shows that those having experienced psychological trauma have increased risk of complex health problems. In primary health care health-promoting services are offered to individuals with complex health problems, based on an individualized approach. Trauma focused approach in healthcare help individuals increase quality of life after psychological trauma. Trauma focused services are important to help improve quality of life after psychological trauma. To examine the experience of psychological trauma and health-related problems in individuals receiving health-promoting services. METHOD: Qualitative research based on the Vancouver School of phenomenology. Participants were ten, five male and five female, selected through health-promoting services. Two interviews were taken with each participant. The ACE questionnaire was used, as a screening tool for childhood psychological trauma, combined with interview-frame with open questions. RESULTS: The results were divided into six main themes: Experience of trauma; Repeated trauma; Childhood neglect; Health-related problems in child- and adulthood; Psychiatric problems in child- and adulthood; Processing and trauma-focused approach. Participants had experienced conciderable trauma as well as complex health problems in child- and adulthood. CONCLUSIONS: It is of importance that healthcare professionals pay attention to psychological traumas in relation to complex health problems to provide support for recovery. Primary health care is the first place of contact within the health care system and therefore it is important that patients' experience of trauma is taken into account. It is key to identify the signs of lifetime trauma in relation to health problems and focus the care according to the individual needs of the patient.

Pain and Trauma: The Role of Criterion A Trauma and Stressful Life Events in the Pain and PTSD Relationship.

Chronic pain and post-traumatic stress disorder (PTSD) frequently co-occur, and research suggests that these 2 conditions exacerbate one another producing greater impact on normal functioning in combination than separately. The influence of traumatic experiences on both pain and PTSD has been shown, but the nature of this interplay remains unclear. Although Criterion A trauma is required for the diagnosis of PTSD, whether the association between PTSD and chronic pain is dependent on Criterion A is underexplored. In this observational cohort study, we examined the association between pain and PTSD-like symptoms in the context of Criterion A trauma in 5,791 men from the Vietnam Era Twin Registry. Correlations and mixed-effects regression models were used to evaluate the relationship between PTSD Checklist-Civilian Version symptoms and multiple indicators of pain from the Short Form McGill Pain Questionnaire across trauma history and chronic pain conditions. 53.21% of the participants experienced trauma consistent with DSM-IV Criterion A for PTSD. The associations between pain indicators and PTSD-like symptoms was stronger for individuals with a history of trauma but remained robust for individuals without trauma history. Small but significant interactions between past trauma and pain indicators and PTSD-like symptoms were observed. Findings were similar in a subsample of participants with history of chronic pain conditions. The relationship between PTSD-like symptoms and indicators of pain were largely independent of trauma consistent with Criterion A, highlighting the need to better understand and address stressful life events in chronic pain patients and pain concerns in individuals reporting trauma. PERSPECTIVE: This article demonstrates that the relationship between PTSD-like symptoms and indicators of pain is largely independent of trauma consistent with Criterion A. This finding highlights the need to better understand and address stressful life events in chronic pain patients and pain concerns in individuals reporting trauma.

Early childhood trauma, substance use and complex concurrent disorders among adolescents.

PURPOSE OF REVIEW: To highlight the interdependence between early childhood trauma, substance use and complex concurrent disorders among adolescents and discuss the delayed response and gaps in the healthcare system. RECENT FINDINGS: High-risk behavior such as suicidality, self-harm and hazardous substance use including overdose and the use of psychotropic substances for self-medication of mental health challenges is a growing concern. These symptoms are often related to early childhood trauma, substance use and complex concurrent disorders. Most countries do not have a youth mental healthcare system, there are no specific guidelines and only few programs addressing high-risk substance use are in place. SUMMARY: In addition to the significance of traumatic experience for high-risk substance use and addiction, most parts of the system of care ignore the trauma aspect in treatment of substance use and focus on abstinence. There are hardly any early intervention programs, broader prevention strategies or evidence-based or target-group-oriented treatment offers.

Early Trauma Is Associated With Suicidal Ideation in Patients With Panic Disorder.

ABSTRACT: There are several predictors of suicidality in patients with panic disorder (PD). Being a woman, younger age, low education level, unmarried status, and symptom severity have been suggested. This study aimed to examine whether early trauma is associated with suicidal ideation in patients with PD. Our study included 267 patients with PD and 105 controls. Data on sociodemographic variables and data from the Early Trauma Inventory Self Report-Short Form, Beck Depression Inventory, Panic Disorder Severity Scale, Anxiety Sensitivity Inventory-Revised, Coping Scales, and Scale for Suicide Ideation were collected, and correlation and regression analyses were performed. This study suggests that clinicians should consider early trauma when assessing suicidal ideation in patients with PD. Clinicians could consider alternative treatments, such as trauma-focused cognitive-behavioral therapy, eye movement desensitization, reprocessing approaches, and classical pharmacological and psychological treatments for patients with PD who have a history of early trauma and are expected to be at high risk for suicide.

Psychosocial risk factors associated with esophageal cancer in Chinese cohort: A systematic review and meta-analysis.

ABSTRACT: Previous studies were controversial about the role of psychosocial factors in the pathogenesis of esophageal cancer (EC). This study aimed to systematically evaluate the effect size of psychosocial risk factors for EC in Chinese cohort.A literature search was conducted in both English and Chinese databases, and odds ratios (OR) with the corresponding 95% confidence intervals (CI) were pooled using a random-effects model.28 studies were identified with a total of 6951 EC cases and 7469 controls. The meta-analysis indicated a higher risk of EC among the individuals with psychological trauma (OR: 2.36, 95% CI: 1.71-3.26), Type A behavior (OR: 1.40, 95% CI: 1.17-1.67), depression (OR: 4.00, 95% CI: 2.44-6.55), melancholy (OR: 2.06, 95% CI: 1.32-3.20), always in sulks (OR: 2.49, 95% CI: 1.21-5.12), and irritable personality (OR: 2.13, 95% CI: 1.58-2.89). A lower EC risk was found in the individuals with good interpersonal relationship (OR: 0.35, 95% CI: 0.17-0.70) and outgoing personality (OR: 0.39, 95% CI: 0.19-0.78).This meta-analysis suggested a potential association between psychosocial factors and EC risk. For the individuals with psychosocial risk factors, physicians should pay more attention to EC screening.

Exposure to stressful and traumatic life events in hoarding: Comparison to clinical controls.

BACKGROUND: Individuals with hoarding report stressful and traumatic life events at an elevated rate compared with those with obsessive-compulsive disorder and healthy controls, but have not been compared with other clinical groups. This study compared rates of traumatic life events between those with clinically significant hoarding, anxiety disorders, or posttraumatic stress disorder (PTSD), hypothesizing that rates would be higher in the hoarding and PTSD groups than the anxiety group. METHODS: Rates of traumatic and stressful events were compared across groups. RESULTS: All comparisons across groups on types of events were significant (partial-eta squared 0.051-0.162). The hoarding group endorsed significantly more crime-related events but similar rates of other events as compared to the PTSD and anxiety disorder groups. CONCLUSION: These findings suggest that many stressful and traumatic life events are not uniquely elevated in hoarding when compared with other clinical populations.

Specific Phobia: Risk Factor of Other Psychiatric Disorders.

ABSTRACT: Predicting the onset and persistence of psychopathology and limited functioning might enable personalized care. Specific phobia (SP) might serve as a predictor, but this needs further evaluation. Participants of the Netherlands Mental Health Survey and Incidence Study-2 were divided into three groups: no-SP (n = 6094), history of SP (n = 204), and current SP (n = 348). Results showed that current SP was associated with a higher prevalence of other anxiety disorders, mood and substance use disorders, and lower levels of functioning. The 6-year onset of other anxiety disorders was associated with history and current SP. Current-SP was also associated with the onset of mood disorders. Neuroticism and childhood trauma only partly accounted for these associations. To conclude, SP was independently associated with presence and onset of other disorders and with limited functioning over time. The presence of SP may serve as an identifier of persons vulnerable to the development of other psychopathologies.

A trauma-informed approach to the pediatric COVID-19 response.

To effectively care for children during COVID-19, pediatricians need to appreciate the stress and potential traumatic effect of the pandemic. By employing the "CARES" framework, pediatric providers can openly discuss the pandemic with patients and families, collaborate to build resiliency, and encourage engagement in activities and resources that are protective. This approach could potentially prevent both the short and long term health consequences resulting from the toxic stress and traumatic exposure of COVID-19. Pediatricians are uniquely positioned to mitigate the extent to which the pandemic affects the nation's children and we believe it is our responsibility to do so, to uphold the health and wellness of pediatric patients across their lifespan.

Positive Emotion Dysregulation Identifies Trauma-Exposed Community Individuals at Risk for Suicide and Nonsuicidal Self-Injury.

ABSTRACT: Emotion dysregulation is associated with increased risk for suicidal thoughts and behaviors (STBs) and nonsuicidal self-injury (NSSI). However, research in this area has focused almost exclusively on dysregulation stemming from negative emotions. The present study aimed to address this gap in the literature by examining the associations between the specific domains of positive emotion dysregulation and both STBs and NSSI. Participants included 397 trauma-exposed community adults (Mage = 35.95; 57.7% female; 76.8% White). Results demonstrated significant associations between positive emotion dysregulation and both STBs and NSSI. In particular, higher levels of nonacceptance of positive emotions were found to be significantly related to risk for STBs (versus no risk), higher severity of STBs, and history of NSSI (versus no history). Findings suggest positive emotion dysregulation may play an important role in the etiology and treatment of both STBs and NSSI among trauma-exposed individuals.