Towards effective screening for paternal perinatal mental illness: a meta-review of instruments and research gaps.

Background: Paternal perinatal mental illness (PPMI), which affects around one in 10 fathers, is under-recognised despite increasing awareness of men's mental health in the perinatal period. Social stigma and men's reluctance to seek help exacerbate this gap. Neglecting the mental health needs of new fathers not only puts them at increased risk for mental illness themselves, but also has a profound and long-lasting impact on their families, children and their own self-esteem as they navigate their new role in the family dynamic. Objective: This meta-review systematically identifies instruments assessing PPMI symptoms, evaluates their psychometric properties and applicability, presents key findings from studies using these tools, and identifies gaps and limitations in the literature on PPMI symptom assessment. Methods: A systematic literature review was conducted using search strategies applied to PubMed, PsycNet APA, Cochrane, and Web of Science, supplemented by hand searches. Relevant information was extracted from each included study. Extracted data were analysed narratively to address the research questions. Results: Findings identified limitations and gaps in current screening practices. While the Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening tool for both fathers and mothers, it inadequately captures atypical depressive symptoms in men. Cutoff scores lack consensus, and instrument sensitivity varies significantly due to cultural and sociodemographic factors. A number of other screening tools have been identified, most of which are more general and not specifically designed for perinatal mental health. Conclusion: This meta-review broadens perspectives on PPMI screening instruments, highlighting key themes, patterns, and differences across the included reviews. While a variety of screening tools are used, the review underscores the necessity for tools specifically tailored to fathers during the perinatal period.

Identifying and synthesizing components of perinatal mental health peer support - a systematic review.

Background: Becoming a parent, while often perceived as a joyous event, can also be a vulnerable life transition, with approximately one in five mothers experiencing perinatal mental illness. Peer support is recommended for its preventive and therapeutic benefits. However, relevant program components of perinatal mental health peer support remain to be identified. Objectives: This review aims to (1) identify peer support programs in perinatal mental health through existing reviews and to (2) synthesize the components of these programs. Methods: A systematic literature review guided by PRISMA was conducted searching four databases, supplemented by hand searches. The Template for Intervention Description and Replication (TIDieR) checklist facilitated the systematic extraction and synthesis of program components. Results: Eleven peer support programs were identified from three reviews, largely conducted in English-speaking countries. The identified reviews highlight the benefits of peer support in perinatal mental health. Key components of individual programs were contextual background, materials, provider training and support, delivery modes and locations, and evaluation. Sharing lived experience and providing flexible support were central to all programs. Conclusion: Aspects of flexibility, authenticity and the challenges of program evaluation in peer support must be considered. Findings can now inform future planning and implementation efforts of peer support programs in periantal mental health.

Corrigendum: Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood.

[This corrects the article DOI: 10.3389/fpsyt.2022.919191.].

Differential constellations of dissociative symptoms and their association with childhood trauma - a latent profile analysis.

Background: While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific dissociative symptoms cluster together among individuals with childhood trauma histories ranging from none to severe.Objective: We aimed to explore symptom constellations across the whole spectrum of dissociative processing from patients with severe dissociative disorders to healthy controls and relate these to maltreatment severity and sociodemographic characteristics.Methods: We employed latent profile analysis to explore symptom profiles based on five subscales, measuring absorption, depersonalization, derealization, somatoform and identity alteration, based on the 20 items of the German short version of the Dissociative Experiences Scale-II (Fragebogen zu Dissoziativen Symptomen-20) in a large aggregate sample (n = 3,128) overrepresenting patients with trauma-related disorders. We then related these profiles to maltreatment severity as measured by the five subscales of the Childhood Trauma Questionnaire as well as sociodemographic characteristics.Results: Based on the five FDS subscales, six clusters differentiated by symptom severity, but not symptom constellations, were identified. Somatoform dissociation varied in accordance with the remaining symptom clusters. The cluster with the highest overall symptom severity entailed nearly all subjects diagnosed with Dissociative Identity Disorder and was characterized by extreme levels of childhood maltreatment. Both abuse and neglect were predictive of cluster membership throughout.Conclusions: The higher the severity of dissociative processing in a cluster, the more subjects reported high severity and multiplicity of childhood maltreatment. However, some subjects remain resilient to the development of dissociative processing although they experience extreme childhood maltreatment.

Dissociative symptoms, including identity alterations, are closely related to the severity of experienced childhood abuse.Somatoform dissociation occurs on all levels of overall dissociation severity.Some subjects with a history extreme childhood maltreatment do not develop dissociative symptoms, while some subjects with extreme dissociative symptoms do not report any childhood maltreatment.

Utilization of Mental Health Provision, Epistemic Stance and Comorbid Psychopathology of Individuals with Complex Post-Traumatic Stress Disorders (CPTSD)-Results from a Representative German Observational Study.

Background: Complex post-traumatic stress disorder (CPTSD) is a severely debilitating recently added symptom cluster in the International Classification of Diseases (ICD-11). So far, only limited information on mental health treatment-uptake and -satisfaction of individuals with CPTSD is available. The aim of this study is to investigate these aspects in a representative sample of the German general population. Methods: Participants completed the International Trauma Questionnaire (ITQ) to identify participants with CPTSD, as well as questionnaires on mental health treatment uptake and satisfaction, adverse childhood experiences, anxiety, depression, working ability, personality functioning, and epistemic trust. Results: Of the included n = 1918 participants, n = 29 (1.5%) fulfilled the criteria for CPTSD. Participants with CPTSD had received mental health treatment significantly more often than participants with PTSD or depression (65.5% vs. 58.8% vs. 31.6%; p = 0.031) but reported significantly less symptom improvement (52.9% vs. 78.0% vs. 80.0%; p = 0.008). Lower levels of epistemic trust were associated with higher CPTSD symptoms (p < 0.001). Conclusions: Our study shows that while the vast majority of individuals with CPTSD had received mental health treatment, subjective symptom improvement rates are not satisfactory. CPTSD was associated with a broad number of comorbidities and impairments in functioning. Lower levels of epistemic trust may partially explain worse treatment outcomes.

To trust or not to trust in the thrall of the COVID-19 pandemic: Conspiracy endorsement and the role of adverse childhood experiences, epistemic trust, and personality functioning.

RATIONALE: Conspiracy endorsement is a public health challenge for the successful containment of the COVID-19 pandemic. While usually considered a societal phenomenon, little is known about the equally important developmental backdrops and personality characteristics like mistrust that render an individual prone to conspiracy endorsement. There is a growing body of evidence implying a detrimental role of adverse childhood experiences (ACEs) - a highly prevalent developmental burden - in the development of epistemic trust and personality functioning. This study aimed to investigate the association between ACEs and conspiracy endorsement in the general population, specifically questioning a mediating role of epistemic trust and personality functioning. METHODS: Based on cross-sectional data from a representative German survey collected during the COVID-19 pandemic (N = 2501), we conducted structural equation modelling (SEM) where personality functioning (OPD-SQS) and epistemic trust (ETMCQ) were included as mediators of the association between ACEs and conspiracy endorsement. Bootstrapped confidence intervals (5000 samples, 95%-CI) are presented for all paths. RESULTS: ACEs were significantly associated with conspiracy endorsement (ß = 0.25, p < 0.001) and explained 6% of its variance. Adding epistemic trust and personality functioning as mediators increased the explained variance of conspiracy endorsement to 19% while the direct association between ACEs and conspiracy endorsement was diminished (ß = 0.12, p < 0.001), indicating an indirect effect of personality functioning and epistemic trust in the association between ACEs and conspiracy endorsement. Fit indices confirmed good model fit. CONCLUSIONS: Establishing an association between ACEs and conspiracy endorsement further increases the evidence for early childhood adversities' far-reaching and detrimental effects. By including epistemic trust and personality functioning, these findings contribute to a deeper understanding of the underlying mechanisms in the way that ACEs may be associated with conspiracy endorsement.

Higher Prevalence of Adverse Childhood Experiences in Transgender Than in Cisgender Individuals: Results from a Single-Center Observational Study.

Adverse childhood experiences (ACE) have been shown to have a tremendous negative impact on health outcomes later in life. This study presents data on the prevalence of ACEs, psychological distress, and trauma-related symptoms in transgender and gender-diverse (TGD) people compared to cisgender people. TGD adults (n = 35) and a matched sample of nonpsychiatric hospital patients (n = 35) were surveyed between September 2018 and March 2019. Participants completed the Maltreatment and Abuse Chronology of Exposure Scale to assess ACEs, as well as the Brief Symptom Inventory and the Essener Trauma Inventory to assess psychological distress and trauma-related symptoms. TGD patients reported a higher number of ACEs than cisgender patients (0.7 vs. 2.4; p < 0.001; d = 0.94). A total of 28.6% of TGD vs. 5.7% cisgender patients reported four or more ACEs (p < 0.001). The most common forms of ACEs were parental abuse (54.3%) and peer abuse (54.3%). No significantly increased prevalence of sexual abuse was found (p > 0.05). TGD patients also reported a higher prevalence of depression (48.4% vs. 5.7%, p < 0.001), posttraumatic stress disorder symptoms (59.4% vs. 13.8%, p < 0.001), and anxiety (58.1% vs. 28.6%, p = 0.016). Health care providers should be aware of and assess ACEs, especially in vulnerable groups such as TGD people, and create a safe place through open-minded, affirming care.

Mentalizing and epistemic trust as critical success factors in psychosomatic rehabilitation: results of a single center longitudinal observational study.

Background: Inpatient psychosomatic rehabilitation is a key treatment for patients with mental health issues. However, knowledge about critical success factors for beneficial treatment outcomes is scarce. The aim of this study was to evaluate the association of mentalizing and epistemic trust with the improvement of psychological distress during rehabilitation. Methods: In this naturalistic longitudinal observational study, patients completed routine assessments of psychological distress (BSI), health-related quality of life (HRQOL; WHODAS), mentalizing (MZQ), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Repeated measures ANOVA (rANOVAs) and structural equation models (SEMs) were calculated to investigate the association of mentalizing and epistemic trust with the improvement in psychological distress. Results: A total sample of n = 249 patients were included in the study. Improvement in mentalizing was correlated with improvement in depression (r = 0.36), anxiety (r = 0.46), and somatization (r = 0.23), as well as improved cognition (r = 0.36), social functioning (r = 0.33), and social participation (r = 0.48; all p < 0.001). Mentalizing partially mediated changes in psychological distress between T1 and T2: the direct association decreased from ß = 0.69 to ß = 0.57 and the explained variance increased from 47 to 61%. Decreases in epistemic mistrust (ß = 0.42, 0.18-0.28; p < 0.001) and epistemic credulity (ß = 0.19, 0.29-0.38; p < 0.001) and increases in epistemic trust (ß = 0.42, 0.18-0.28; p < 0.001) significantly predicted improved mentalizing. A good model fit was found (χ2 = 3.248, p = 0.66; CFI = 0.99; TLI = 0.99; RMSEA = 0.000). Conclusion: Mentalizing was identified as a critical success factor in psychosomatic inpatient rehabilitation. A key component to increase mentalizing in this treatment context is the improvement of epistemic mistrust.

Epistemic Trust Is a Critical Success Factor in Psychosomatic Rehabilitation-Results from a Naturalistic Multi-Center Observational Study.

Knowledge about critical success factors underpinning beneficial treatment outcomes in psychosomatic inpatient rehabilitation is scarce. The aim of this study was to evaluate the influence of patients' epistemic stance in relation to the improvement of psychological distress during rehabilitation. In this naturalistic longitudinal observational study, n = 771 patients completed routine assessments for psychological distress (BSI-18), health-related quality of life (HRQOL; WHODAS), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Patients were grouped as best, average, and worst responders based on their mean BSI-18 changes during treatment, and their mean change in epistemic trust, mistrust, and credulity was compared using repeated measures analyses of variance (rANOVAs). No associations of performance with sex (p = 0.09), age (p = 0.11), or relationship status (p = 0.58) were found. Best responders reported significantly improved epistemic trust (p = 0.001) and reduced epistemic mistrust (p < 0.001), whereas worst responders reported a significant increase in epistemic mistrust (p < 0.001) and credulity (p < 0.001). Average responders did not change for either epistemic trust (p = 0.11), mistrust (p > 0.99), or credulity (p = 0.96). Our results underscore the role of the epistemic stance in psychosomatic and psychotherapeutic treatments. These results help to better understand what might determine psychosomatic rehabilitation outcomes and indicate the role of epistemic trust as a critical success factor.

Gender-Specific Significance of Peer Abuse during Childhood and Adolescence on Physical and Mental Health in Adulthood-Results from a Cross-Sectional Study in a Sample of Hospital Patients.

Peer abuse (PA) is a widespread and gender-sensitive form of Adverse Childhood Experiences (ACEs). However, research on its influence on physical and mental health in adulthood remains scarce. The aim of this study was to investigate gender-specific associations between PA and physical and mental health in adulthood in a sample of general hospital patients. A cross-sectional study at the University Hospital of Innsbruck was conducted. Data on ACEs, physical and mental health were collected using self-report questionnaires. We compared patients with no ACEs, PA only, ACEs without PA, and ACEs with PA using gender-specific binary logistic regressions to investigate the association of PA with physical and mental health. A total of 2,392 patients were included in the analyses. Women reported more emotional PA (13.1% vs. 9.4%; p = 0.006), while men reported more physical PA (8.3% vs. 5.2%; p = 0.003). PA was associated with a higher likelihood for depression (OR = 2.6), somatization (OR = 2.1), as well as worse physical health (OR = 2.1) in women but not in men. This study is the first to present data on the gender-specific detrimental effect of PA on physical and mental health in adulthood. Especially for women, PA poses a significant health risk. Thus, we should be aware of these effects and offer adequate support for affected individuals.

Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood.

Background: Adverse childhood experiences (ACEs) are associated with posttraumatic and complex posttraumatic stress disorder symptoms in adulthood (PTSD/cPTSD), as well as reduced epistemic trust (trust in the authenticity and personal relevance of interpersonally transmitted information) and impaired personality functioning. The present work aims to investigate the predictive value of epistemic trust-the capacity for social learning-on the mediating effect of personality functioning in the association of ACEs and PTSD/cPTSD. Methods: We conducted structural equation modeling (SEM) based on representative data of the German population (N = 2,004). Personality functioning (OPD-SQS) was applied as a mediator between ACEs and PTSD/cPTSD (ITQ), while epistemic trust (ETMCQ) was added as predictor for OPD-SQS. TLI, CFI, and RMSEA (95%-CI) determined the models' fit. Results: N = 477 (23.8%) participants reported at least one ACE and n = 218 (10.9%) reported ≥4 ACEs. Fit indices were good for both PTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.041-0.078) and cPTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.043-0.081). ACEs were significantly associated with cPTSD (ß = 0.44, p < 0.001) and PTSD (ß = 0.29, p < 0.001), explaining 20 and 8% of its variance. Adding personality functioning as a mediator increased the explained variance of cPTSD and PTSD to 47 and 19% while the direct association between ACEs and cPTSD/PTSD decreased (ß = 0.21/ß = 0.17), thus, indicating a partial mediation. Including epistemic trust substantially increased the explained variance for personality functioning (41%) compared to ACEs as a single predictor (16%). Conclusion: We add to previous research emphasizing the association between ACEs and PTSD/cPTSD symptoms. Offering insights on underlying mechanisms, we show that epistemic trust and personality functioning are relevant mediators. Since both are modifiable by psychotherapy, knowledge about the role of these constructs can inform research on psychotherapeutic interventions and prevention.

Measuring Impairments of Mentalization with the 15-Item Mentalization Questionnaire (MZQ) and Introducing the MZQ-6 Short Scale: Reliability, Validity and Norm Values Based on a Representative Sample of the German Population.

Deficits in mentalization are indicated by impaired emotional awareness and self-reflectiveness, and are associated with various mental disorders. However, there is a lack of validated research instruments. In this study, the psychometric properties of the Mentalization Questionnaire (MZQ) were evaluated in a representative German population sample with n = 2487 participants. Analyses included evaluation of the MZQs acceptance, reliability, and validity. Factorial validity was established with exploratory (EFA) and confirmatory factor analyses (CFA) after the dataset was randomly split. Dimensionality was evaluated with a bi-factor model. For convergent validity, correlations with the OPD SQS, PHQ-4, and POMS were calculated. While acceptance was good, internal consistencies (ω = 0.65-0.79) and factor structure of the original four subscales were not acceptable (TLI = 0.87, CFI = 0.91, RMSEA = 0.071). EFA indicated a 3-factor solution, which was not confirmed by CFA (TLI = 0.89, CFI = 0.91, RMSEA = 0.073). Correlations between subscales and bi-factor analyses indicated an underlying general factor (TLI = 0.94, CFI = 0.96, RMSEA = 0.053). A shortened 6-item version was comparable to the original scale. Age and sex-specific representative norm-values are presented. The MZQ is a feasible, reliable and valid self-report instrument to measure representations of inner mental states. However, when applied to non-clinical samples, the total score of the MZQ should be used.

Did domestic violence really increase in the early phase of the COVID-19 pandemic? Results of an interview-based observational study.

Objectives: The COVID-19 lockdown may lead to rising numbers of domestic violence (DV), especially among previously victimized individuals. The aim of this study was to investigate the development and influential factors of DV during the early COVID-19 lockdown. Methods: In this telephone-based study, previous participants with (n = 34) and without (n = 33) DV completed questionnaires on DV, attachment and COVID-19 related stressors. Development of DV and influential factors were investigated with repeated measures ANOVAs and linear regression models. Results: Individuals with prior DV reported significantly higher DV than previously not affected individuals. However, a statistically significant decrease of DV was found in the group with prior DV. Past DV, childlessness and insecure attachment, but not COVID-19 related stressors predicted current DV. Conclusions: In light of an insecure attachment style lockdown measures may have led to a temporary relationship stabilization. However, a reassessment is necessary to evaluate whether this stabilization was a short-time trend only.

Prevalence of adverse childhood experiences (ACEs) and associated physical and mental health problems amongst hospital patients: Results from a cross-sectional study.

BACKGROUND: Adverse childhood experiences (ACEs) can have severe detrimental effects on physical and mental health. This study aimed to present prevalence rates of ACEs amongst a mixed sample of hospital patients. METHODS: In- and outpatients at seven departments of the University Hospital of Innsbruck (Austria) participated in the study. They completed questionnaires regarding retrospective assessments of ACEs, physical and mental health and experience of domestic violence. The impact of ACEs on patients' health was evaluated by calculation of odds ratios (OR) in binary logistic regressions. RESULTS: A total of n = 2392 (74.3% of all approached patients) were included in the analyses. The results showed that 36.1% of them reported at least one form of ACEs, and 6.3% were polyvictimized (i.e. they reported ≥4 forms of ACEs). Most frequent forms of ACE were emotional abuse (18.3%), peer abuse (14.2%), and neglect (12.3%). ACEs were significantly associated with increased ORs for various physical diseases, mental health problems and domestic violence. CONCLUSION: Retrospectively assessed ACEs are highly prevalent amongst hospital patients and exposure to high numbers of ACEs is associated with decreased physical and mental health. The identification of patients with symptoms following ACEs and referral to appropriate treatment is a crucial challenge for health-care professionals.

[Awareness training for domestic violence for medical professionals. Are they efficient too?] / Sensibilisierungstrainings gegenüber häuslicher Gewalt für medizinisches Fachpersonal. Sind diese auch effizient?

BACKGROUND: According to studies conducted by the European Union, 33% of all women over the age of 15 are affected by domestic violence and tend to turn to the health care system to seek help. The experience of violence has serious consequences not only for the psychological, but also for the physical health of those affected. Except direct injury consequences, inexplicable pain, gastrointestinal discomfort or problems in the field of reproductive medicine can be observed, for example. With many of those affected turning to the health care system first in search of support, healthcare professionals also have a key role to play here, making sensitization training for professional groups increasingly important. METHOD: Participants in awareness-raising training on domestic violence were interviewed before and after training with a questionnaire on their perceived safety in dealing with patients affected by violence. RESULTS: The evaluation of a sensitization training at the Landeskrankenhaus Innsbruck showed significant improvements in the subjective sense of security in dealing with patients affected by violence. CONCLUSION FOR PRACTICE: A clear structure of sensitization trainings with basic courses and advanced training seminars, as well as a focus on developing relationships and dealing with emotions, makes sense.

Domestic violence victims in a hospital setting: prevalence, health impact and patients' preferences - results from a cross-sectional study.

Background: Domestic violence (DV) is a widespread yet commonly underdetected problem with severe impact on physical and mental health. To date, only limited information is available on prevalence and detection-rates of victims of DV in hospital settings. Objective: The aim of this study was (a) to assess the prevalence and impact of DV on physical and mental health as well as risk-factors associated with it, (b) to determine how many patients had been asked directly about DV in the hospital and (c) to investigate patients' preferences about being asked about DV in a hospital setting. Methods: Adult inpatients and outpatients at seven somatic departments at the University Hospital Innsbruck (Austria) were included consecutively in this ad-hoc, cross-sectional paper-and-pencil questionnaire-based study. In total, n = 2,031 patients were assessed regarding their experiences with DV. They also reported on whether they had been asked about DV at the hospital and whether they would mind being asked about it. To evaluate the impact of DV on patients' self-reported physical and mental health, odds ratios were calculated using binary logistic regression. Results: DV was reported by 17.4% of patients, with 4.0% indicating current DV exposure. Lifetime DV exposure was associated with a significant risk for both physical and mental health-problems. Only 4.8% of patients with DV exposure had ever been asked about it by hospital staff. While patients with a history of DV were more open to being asked about DV than patients without DV (78.2% vs. 72.9%), overall acceptance was still high (74%). Conclusion: DV is a frequently overlooked problem with detrimental effects on physical and mental health. While high acceptance of DV assessment was found, only a small proportion of affected patients had indeed been assessed for DV. Screening for DV in hospitals may thus increase the number of identified patients.

Antecedentes: La violencia doméstica es un problema extendido, pero poco detectado, que tiene un impacto severo sobre la salud física y mental. A la fecha, únicamente se encuentra disponible información limitada sobre la prevalencia y tasas de detección de víctimas de violencia doméstica en entornos hospitalarios.Objetivo: El propósito de este estudio fue de a) determinar la prevalencia y el impacto de la violencia doméstica sobre la salud física y mental, además de los factores de riesgo a ella asociadas, b) determinar a cuántos pacientes se les ha preguntado directamente en el hospital sobre la violencia doméstica, y c) investigar las preferencias de los pacientes sobre el hecho de preguntarles respecto a la violencia doméstica en un entorno hospitalario.Métodos: Se incluyeron pacientes hospitalizados y ambulatorios de siete departamentos somáticos de la Universidad de Innsbruck (Austria) en este estudio ad-hoc, transversal y basado en un cuestionario resuelto a mano. Se evaluó un total de n = 2031 pacientes respecto a sus experiencias en torno a la violencia doméstica. También reportaron si se les preguntó respecto a la violencia doméstica en el hospital, y si les importaba que se les pregunte sobre ello. Para evaluar el impacto de la violencia doméstica sobre su estado autoreportado de salud física y mental, se calculó la proporción de probabilidades mediante regresión logística binaria.Resultados: La violencia doméstica fue reportada por el 17,4% de los pacientes, con un 4,0% reportando violencia doméstica en curso. La prevalencia de vida de exposición a la violencia doméstica se asoció con un riesgo significativo de problemas de salud tanto físicos como mentales. El personal del hospital preguntó sobre violencia doméstica solo a un 4,8% de pacientes con exposición a ella. Pese a que los pacientes con antecedente de violencia doméstica eran más abiertos a que se les pregunte sobre ella que los pacientes sin antecedente de violencia doméstica (78,2% contra 72,9%), la aceptación general era aún alta (74%).Conclusión: La violencia doméstica es un problema con frecuencia ignorado que presenta consecuencias nocivas sobre la salud física y mental. A pesar de que se encontró una alta aceptación para la evaluación de la violencia doméstica, solo a una pequeña proporción de pacientes en efecto se les evaluó respecto la violencia doméstica. Por tanto, un tamizaje sobre violencia doméstica en hospitales podría incrementar el número de pacientes identificados.

Violence from childhood to adulthood: The influence of child victimization and domestic violence on physical health in later life.

OBJECTIVE: Previous research has shown a detrimental effect of child victimization (CV) on physical disease and mortality. Additionally, individuals with adverse experiences in childhood frequently face domestic violence (DV) in later life. As DV has also been observed to harm physical health, a potential cumulative effect has been proposed. Currently, however, only limited data on such a cumulative effect and its impact on patients' physical health are available. METHODS: A cross-sectional observational study at the University Hospital of Innsbruck was conducted. Data on CV, DV and physical health were collected using self-report questionnaires. To evaluate the impact of CV and DV on patients' health, odds ratios (OR) were calculated using binary logistic regression. RESULTS: A total of 1480 patients from various departments participated in the study. CV was found for 38% and DV for 16% of participants. A significantly higher occurrence of physical disease was observed in patients with poly-victimization (4+ CVs). When accounting for the cumulative effect of CV and DV, the occurrence was further increased for musculoskeletal disorders (OR:5.1), chronic pain (OR:5.0), gastrointestinal diseases (OR:3.0), metabolic diseases (OR:2.8) and respiratory diseases (OR:2.4). CONCLUSION: CV and DV were found to be prevalent and highly correlated in patients treated in a primary care hospital. CV and DV - individually, combined and cumulatively - may thus present risks for physical health. Screening patients for the risk of DV as well as assessing CV may aid in early identification and initiation of psychosocial interventions to avoid further aggravation of physical and psychological problems.

[Genetics of Posttraumatic Stress Disorder (PTSD)]. / Genetische Grundlagen der Posttraumatischen Belastungsstörung (PTBS).

Post-traumatic stress disorder (PTSD) is a mental disorder following a severe traumatic experience and is characterized by high rates of comorbidity with related psychiatric disorders. However, even for individuals experiencing the same trauma, there is considerable inter-individual variability in the risk of PTSD, and this is largely thought to be determined by biological processes, such as genetic predisposition and epigenetic mechanism. In this review we will summarize recent research on genetics of PTSD, primarily focusing on candidate gene-association studies, targeting on functional genetic variants in the monoaminergic system and the hypothalamic-pituitary-adrenal (HPA) axis. In addition, results from recent genome-wide association studies (GWAS) will be reported and we will highlight the interplay of genetic factors with environmental factors, based on evidence from gene-environment interaction analysis and studies on the epigenetic regulation of PTSD. Finally, we will provide a brief outlook towards the potential and perspectives of pharmaco-genetic studies.

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.

Measuring Self-Soothing Ability in Patients with Childhood Trauma - Psychometric Evaluation of the Self-Soothing Scale in a Clinical Sample.

OBJECTIVES: The regulation of strong emotions is an essential skill for traumatized patients. The present instrument was developed for the measurement of the self-soothing ability in traumatized patients. METHODS: The psychometric properties of the SBS were investigated in a clinical sample of patients with childhood trauma (N = 143). In addition, the study explored the factorial structure, internal consistency, retest reliability, convergent validity, and responsiveness of the instrument. RESULTS: Results of an exploratory factor analysis indicated a two-factor structure: 'self-soothing' and 'impulse control', explaining 55% of the variance. The total score showed a good internal consistency (α = .83) and re-test reliability (rtt = .87) as well as good validity and responsiveness. CONCLUSIONS: The 7-item SBS is a suitable instrument for the measurement of self-soothing ability in traumatized patients.