Psychological adaptation among health care workers who work with trauma-exposed refugees in Greece.

Greek health care workers (HCWs) working with refugee and asylum-seeker populations may be at risk of trauma exposure and related distress. The current study sought to further understand the factors that may promote or hinder psychological adaptation among HCWs working with trauma-exposed refugee populations in Greece. Participants were HCWs (N = 20) who completed semistructured interviews. Thematic analysis procedures identified three main themes: vicarious traumatization, (b) mismatch of expectations, and (c) difficulty coping. Our study findings highlight the need to provide adequate training, supervision, and mental health support for HCWs to prevent mental health issues in this population. Additional studies are necessary to understand the long-term consequences of working with refugee populations and explore ways to assist HCWs with self-care.

Clinical profiles and factors associated with treatment initiation in survivors of sex trafficking: A comparison with survivors of domestic violence and sexual assault.

OBJECTIVE: Little is known about formal help-seeking for mental health issues in survivors of human sex trafficking (ST) and if their experiences are different from those initiating treatment for sexual assault (SA) or domestic violence (DV). This study sought to characterize the clinical and trauma profiles of treatment-seeking survivors of ST as compared with DV and SA and the predictors of mental health treatment initiation in these three groups. METHOD: The research was based on a secondary data analysis of data gathered from 1,264 treatment-seeking adults from a community mental health treatment facility in the United States. RESULTS: Compared with DV and SA survivors, ST survivors were significantly younger, female, Black, single, unemployed, completed less than high school, and were from the United States. Despite the presence of clinical symptoms among all three groups, findings suggest significant differences in clinical and trauma profiles, with ST survivors reporting lower levels of mental health symptomology compared to DV and SA survivors. Older age (OR = 1.03, 95% CI [1.01, 1.05]), female sex (OR = 3.03, 95% CI [1.89, 4.88]), employment (OR = 0.40, 95% CI [0.24, 0.66]), and better social relationships (OR = 1.09, 95% CI [1.01, 1.16]) were significantly associated with treatment initiation. CONCLUSIONS: This research highlights some important predictors of formal help-seeking, including perceived social relationships. Assessing for support systems in these three groups of survivors of interpersonal violence early when engaging survivors is recommended. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Dropout from evidence-based trauma treatment in a community mental health clinic serving victims of interpersonal violence.

Trauma-focused psychotherapies are increasingly offered in community-based mental health centers, but little is known about treatment dropout in these settings. The current study explored dropout at different stages of treatment in a treatment-seeking sample of 1,186 adults who experienced interpersonal violence and were offered trauma-focused and non-trauma-focused therapies. A total of 31.6% of participants dropped out before treatment initiation, 28.0% dropped out after treatment initiation and completed a mean of 4.02 (SD = 2.41) sessions, and 40.4% completed a full course of PTSD treatment. Being unemployed, p < .001, and scoring lower on measures of environment factors, p = .045, were significant predictors of pretreatment dropout. Being female, p < .001; Latinx, p = .032; and scoring higher on a measure of social relationships, p = .024, were independent predictors of postinitiation dropout. Individuals who completed nine sessions of treatment displayed significantly lower levels of posttraumatic stress disorder, depression, and anxiety symptoms. The present study provides preliminary evidence that survivors of interpersonal violence who seek therapy tend to drop out early during treatment, and most who complete treatment attain symptom reduction.

Identity-based hate and violence as trauma: Current research, clinical implications, and advocacy in a globally connected world.

Hate-based violence is increasingly recognized as an urgent social justice and human rights issue that is pervasive across geographical and socioeconomic boundaries. There is a growing body of research that demonstrates the traumatic impact of hate-based violence on the victim's mental and physical health. This review focuses on examining scientific knowledge and prevalence data on identity-based hate and violence exposure. A framework for conceptualizing hate-based violence as a traumatic event or series of traumatic events is offered as a means to understand research findings and intervention approaches. The importance of research, advocacy, and human rights training is highlighted in the efforts to address the traumatic impact of identity-based hate and violence.

Predictors of Treatment Access and Initiation Among Diverse, Low-Income Victims of Violence Offered a Trauma-Focused Evidence-Based Psychotherapy.

Many victims of violence may benefit from trauma-focused evidence-based psychotherapies (EBPs), but fail to utilize treatment. The current study investigated factors associated with treatment access and treatment initiation in a low-income, racially and ethnically diverse, urban population of victims of violence who were screened for EBPs. The sample consisted of 941 adults, mean age = 35.87 (SD = 12.8), who were screened for mental health treatment and offered an EBP. Overall, 55.7% of individuals accessed treatment by attending an in-person screening appointment and intake, and 79.0% of the individuals who accessed treatment then initiated treatment by attending the first EBP session. Analysis revealed higher age (odds ratio [OR] = 1.05, 95% confidence interval (CI) = [1.04, 1.09]) and lower expression of posttraumatic stress disorder (PTSD) symptoms predicted higher rates of accessing treatment (OR = 0.20, 95% CI = [0.05, 0.82]). Higher global severity of distress (OR = 3.22, 95% CI = [1.14, 9.10]), poor quality of life in the area of psychological health (OR = 0.90, 95% CI = [0.81, 1.00]), and better quality of life in the area of physical health significantly predicted initiation of treatment (OR = 1.11, 95% CI = [0.998, 1.24]). Findings suggest that low-income, ethnically and racially diverse victims of violence may effectively utilize trauma-focused EBPs offered in a community setting.

A Pilot Study of Racial and Ethnic Differences in Mental Health Outcomes During the First 6 Weeks of Trauma-Focused Treatment.

The objective of this research was to investigate the relationship between race/ethnicity, intervention type, and mental health outcomes at 6 weeks into treatment in a low-income, diverse community-based sample of adults seeking treatment for traumatic stress. Adult patients (N = 163) received either prolonged exposure (PE) or present centered therapy (PCT). Results suggest significant within group differences with moderate to large effect sizes after six sessions of PE or PCT by race/ethnicity. Logistic regression analyses indicated that after adjusting for significant sociodemographic covariates, at the 6-week time-point the White group had increased likelihood of: probable PTSD compared to the Latinx group; probable anxiety compared to the Black group, Latinx group, and Other group; and probable depression compared to the Other group. Covariate adjusted models also found that at 6 weeks individuals in the PCT group had significantly greater odds of probable PTSD compared to those in the PE group. Implications for behavioral healthcare in a community-based setting are discussed.

Examining attitudes towards mental health treatment and experiences with trauma: Understanding the needs of trauma-exposed middle-aged and older adults.

Middle-aged and older adults who have been exposed to traumatic events may have specific developmental needs with respect to engagement in mental health treatment. The current study examined factors that potentially facilitate or inhibit attitudes towards mental health service use (ATMHSU) in a trauma-exposed sample of treatment-seeking adults of age 50 years and older. In this mixed-methods study, quantitative data (N = 165) were analyzed to examine relationships with trauma exposure, posttraumatic stress disorder, quality of life (QOL), and ATMHSU. Semi-structured interviews were conducted assessing similar constructs with a subsample of the data (n = 12). Regression analysis revealed higher QOL-environmental well-being as associated with more positive ATMHSU and higher QOL-social support with more negative ATMHSU. Qualitative themes emerged around perceived distress in managing lifelong traumas due to challenges with functioning, coping, and accessing services. Emphasizing resources to help manage the impact of distress on daily life needs may support aging trauma-exposed populations.

Psychological adaptation and posttraumatic stress disorder among Syrian refugees in Germany: a mixed-methods study investigating environmental factors.

Background: Considering the exposure to potentially traumatic events among the growing refugee population worldwide, there is an urgent need to better understand potential risk and protective factors that may be associated with psychological adaptation in Syrian refugees residing in Germany Objective: The present study examined trauma-related coping self-efficacy, resilience, and environmental factors as predictors of psychological adaptation and posttraumatic stress disorder (PTSD). Method: The present study used a mixed-methods convergent parallel design examining 127 quantitative self-report questionaires and ten qualitative semi-structured interviews.. Results: Quantitative findings showed that nearly half the sample (N = 127) met criteria for probable PTSD (n = 59, 46.5%). Logistic regression models found that lower trauma-related coping self-efficacy (CSE) was independently associated with probable PTSD in unadjusted models (OR = 0.92, 95% CI, 0.88, 0.96, p < .001) and adjusted models (OR = 0.87, 95% CI, 0.82, 0.93, p < .001). Specific environmental factors were significantly inversely related with probable PTSD. Qualitative findings indicated five main themes that were associated with psychological adaptation: 1) language, 2) socioeconomic living conditions, 3) family, 4) discrimination, and 5) asylum procedures. Conclusion: This study suggests that higher perceived ability to deal with the consequences of having experienced potentially traumatic events as well as access to certain environmental factors were associated with better perceived psychological adaptation to German society and better mental health.

Antecedentes: Considerando la exposición aeventos potencialmente traumáticos entre la creciente población de refugiados anivel mundial, existe una necesidad urgente de una mejor comprensión de los potenciales factores de riesgo yprotectores que pueden estar asociados con la adaptación psicológica en refugiados Sirios que residen en Alemania.Objetivo: El presente estudio examinó la autoeficacia, resistencia y Factores ambientales como predictores de adaptación psicológica y estrés postraumático trastorno (TEPT).Método: Este estudio utilizó una aproximación demétodos mixtos con un diseno paralelo convergente para examinar mecanismos de afrontamiento de autoeficacia relacionadas con el trauma, resiliencia yfactores ambientales como predictores de adaptación psicológicos yde trastorno de estrés postraumático (TEPT).Resultados: Los hallazgos cuantitativos mostraron que cerca de la mitad de la muestra (N= 127) reunía los criterios para un probable TEPT (n= 59, 46.5%). Los modelos de regresión logística encontraron que un menor mecanismo de afrontamiento de autoeficacia relacionado al trauma (CSE por sus siglas en ingles) estuvo independientemente asociado con probable TEPT en los modelos no ajustados (OR= 0.92, 95% CI, 0.88, 0.96, p˂ .001) ymodelos ajustados (OR= 0.87, 95% CI, 0.82, 0.93, p˂ .001). Los factores ambientales específicos estuvieron inversamente relacionados con probable TEPT en forma significativa. Los hallazgos cualitativos indicaron cinco temas principales que estuvieron asociados con la adaptación psicológica:1) Lenguaje,2) condiciones de vida socioeconómicas,3) Familia,4) discriminación, y5) procedimientos de asilo.Conclusiones: Este estudio sugiere que una mayor capacidad percibida para lidiar con las consecuencias de haber experimentado eventos potencialmente traumáticos así como el acceso aciertos factores ambientales se asociaron con una mejor adaptación psicológica percibida ala sociedad Alemana yuna mejor salud mental.

Predictors of treatment initiation, completion, and selection among youth offered trauma-informed care.

OBJECTIVE: Few studies have investigated determinants of trauma-informed care (TIC) in vulnerable youth populations. The purpose of the present study was to investigate factors associated with initiation, completion, and selection of type of TIC treatment among a sample of 128 treatment-seeking youth who experienced crime or violence. METHOD: This retrospective medical record review study used data collected through routine clinical care at an outpatient, no-cost community mental health clinic. RESULTS: We found that 69.5% of treatment-seeking youth (n = 89) initiated treatment, defined as attending at least 1 TIC session. Among youth who initiated treatment, 61.8% (n = 55) completed a TIC treatment. Predisposing and need characteristics were not significantly associated with initiating or completing treatment in adjusted models. Youth assigned to trauma-focused cognitive-behavioral therapy (TF-CBT) were more likely to complete treatment compared with those assigned to child-centered therapy (CCT) approaches (odds ratio [OR] = 4.48, 95% CI [1.35, 14.91], p = .014). Logistic regression analyses suggested therapists were less likely to select TF-CBT for children with higher externalizing symptoms (OR = 0.92, 95% CI [0.85, 0.99], p = .035). CONCLUSIONS: Findings suggest among youth who called in for treatment, many successfully initiated treatment, and of those who initiated, most completed treatment. Empirically supported treatments such as TF-CBT may further promote treatment completion. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A naturalistic study exploring mental health outcomes following trauma-focused treatment among diverse survivors of crime and violence.

BACKGROUND: Although considerable research has tested evidence-based practices in clinical trials, research is needed on the use of trauma-focused treatments by victims of crime and violence in naturalistic settings. This study investigated four trauma-focused treatments, prolonged exposure therapy (PE), cognitive behavioral therapy (CBT), eclectic therapy, and person-centered therapy (PCT), and assessed treatment dropout and symptom improvement over five assessment time-points. METHODS: Descriptive comparisons and pattern mixture multigroup growth models were used to assess differences between treatments on time in treatment, rate of dropout, and improvement in posttraumatic stress (PTSD) and depression symptoms in an outpatient sample of 526 clients seeking routine clinical care. RESULTS: PCT was significantly associated with the highest number of therapy sessions completed and the lowest rate of dropout (41.75%) compared to CBT and eclectic treatments. All treatment groups reported PTSD symptom improvement with no significant differences based on therapy type. For depression, the rate of improvement for clients in PCT who dropped out of treatment after session 3 was significantly steeper than the rate of improvement for clients in eclectic treatment who dropped out of treatment after session 3. Clients who stayed in treatment longer generally had larger decreases in symptoms compared to those who dropped out earlier. LIMITATIONS: The small sample size in each of the treatment groups may have limited power to detect change. CONCLUSIONS: Several trauma-focused treatments offered in a community-based setting may result in significant symptomatic improvement.

Feasibility of Training Frontline Therapists in Prolonged Exposure: A Randomized Controlled Pilot Study of Treatment of Complex Trauma in Diverse Victims of Crime and Violence.

The study aims were to determine whether prolonged exposure (PE) improved mental health and was feasible to implement by frontline clinicians in a culturally diverse sample with complex trauma. Seventy-one individuals were randomly assigned to PE or person-centered therapy (PCT). Outcome measures were administered at baseline and sessions 3, 6, 9, and 12. Mixed modeling was used to regress outcome measures on time, treatment group, and number of visits. Individuals who received PE showed significant moderate association with decline in reported posttraumatic stress disorder (PTSD) symptoms as noted by the PTSD Checklist for DSM-5 (p = 0.05) compared with PCT. Results indicated improved scores on all measures at each follow-up time point compared with baseline (p ≤ 0.01). PE was feasible, shown by positive recruitment and ability of clinicians to effectively implement and maintain treatment fidelity. Findings suggest that PE can be effective for treating complex trauma when used by clinicians in community settings.

Correlates of psychological distress among urban trauma-exposed adults: Influence of age and coping preferences.

OBJECTIVE: This article examines direct and moderating effects of age on coping preferences for psychological distress among a sample of trauma-exposed adults to inform treatment approaches for this population. METHOD: Using data from a community survey of trauma-exposed, urban-dwelling adults (n = 181), direct and moderating effects of coping preferences on the relationship between age and psychological distress were examined using hierarchical linear regression. RESULTS: Direct effects with distress were supported for age, gender, and coping preferences of avoidance and positive reframing. No direct effects with problem-focused coping were present; however, a significant interaction resulted with the relationship between age and level of reported distress. DISCUSSION: Problem-focused coping may provide a buffering effect on experiences with distress for older trauma-exposed adults. Findings highlight the benefits of directive and action-oriented approaches to care for aging adults. Implications for future intervention research and clinical considerations for treating trauma over the life course are discussed. (PsycINFO Database Record

A Randomized, Controlled Pilot Study of a Single-Session Psychoeducation Treatment for Urban, Culturally Diverse, Trauma-Exposed Adults.

This randomized pilot study aimed to determine whether a single session of psychoeducation improved mental health outcomes, attitudes toward treatment, and service engagement among urban, impoverished, culturally diverse, trauma-exposed adults. Sixty-seven individuals were randomly assigned to a single-session psychoeducation treatment or a delayed treatment comparison control group. The control group was found to be superior to the treatment group at posttest with respect to symptoms of posttraumatic stress disorder, anxiety, and occupational and family disability. At follow-up, all participants had completed the psychoeducation treatment, and a mixed-effects model indicated significant improvements over time in symptoms of posttraumatic stress disorder, anxiety, depression, somatization, and attitudes toward treatment. Ninety-eight percent of the participants reported the psychoeducation was helpful at follow-up. Participants also reported a 19.1% increase in mental health service utilization at follow-up compared with baseline. Implications for treatment and future research are discussed.

Factors associated with mental health service use in urban, impoverished, trauma-exposed adults.

This study utilized the Expanded Behavioral Model of Health Service Use Among Vulnerable Populations to investigate disparities in mental health care use among a community sample of urban, impoverished, trauma-exposed adults. Self-report questionnaires were completed by 135 adults with a lifetime history of traumatic stress exposure. Results suggested approximately 20% of the sample were receiving mental health services, and these individuals were primarily getting services at outpatient mental health facilities. Social support, positive attitudes toward treatment seeking, and occupational disability were significantly associated with current mental health service use. Logistic regression analyses indicated that after controlling for significant covariates, occupational disability was the only need variable that predicted current mental health service utilization (OR = 1.25, 95% CI = 1.08 to 1.45, p < .01). Improving attitudes toward treatment seeking as well as identifying occupational difficulties may be important avenues for improving willingness to seek care and decreasing disparities in care for trauma-exposed adults. Implications for mental health policy and practice are discussed.

Mental health service use among trauma-exposed adults: a mixed-methods study.

Research findings indicate that many urban trauma-exposed individuals do not access needed mental health care; therefore, it is critical to identify factors associated with the use of mental health services for this group. This study used a mixed-methods approach to examine predictors of mental health service use and barriers to care. Quantitative findings showed that significantly more adults who were male and black with a lower education and income did not report current mental health service use. After controlling for covariates, individuals with lower trauma exposure (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.5-0.9) and higher depression symptom scores (OR, 1.0; 95% CI, 1.0-1.1) were significantly more likely to report current mental health service use. Qualitative findings indicated that fear, low mental health literacy, helplessness, and psychosocial issues were identified as barriers to mental health treatment. Implications for treatment and future research are discussed.

Gender Disparities in the Mental Health of Urban Survivors of Trauma.

Women who experience traumatic events are at higher risk for mental health problems compared to men; however, gaps remain in our understanding of this disparity. A sample of 170 urban adults completed self-report measures. Women were significantly more likely to experience sexual assault and domestic violence compared to men, and they were significantly less likely to experience a robbery or mugging, being threatened with a weapon, or witnessing a death or assault compared to men. Also, women were more likely than men to meet criteria for probable post-traumatic stress disorder (PTSD) and depression after controlling for covariates and trauma level. Our findings suggest a possible differential vulnerability to the development of PTSD and depressive symptoms in women.

Racial and ethnic differences in symptom severity of PTSD, GAD, and depression in trauma-exposed, urban, treatment-seeking adults.

Urban, socially disadvantaged individuals are at high risk for traumatic event exposure and its subsequent psychiatric symptomatology. This study examined the association between race/ethnicity and symptom severity of posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and depression in an urban clinical sample of 170 trauma-exposed adults. In addition, this study investigated the role of socioeconomic position (SEP) and coping style in the relationship between race/ethnicity and posttrauma psychiatric symptom severity. Hierarchical regression analyses indicated that Blacks had lower depression symptom severity compared to Whites. No significant relationship was found between racial/ethnic group status and indices of SEP, PTSD, or GAD symptom severity. Adjustment for trauma exposure, gender, positive reframe coping, avoidance coping and negative coping accounted for 3%, 3%, 8%, 4%, and 3% of the variance in depression severity, respectively; however, Black race remained significantly associated with decreased depression symptom severity accounting for a statistically significant 5% of the variance in lower depression symptom severity. These preliminary findings and their clinical implications are discussed.

Screening for generalized anxiety disorder symptoms in the wake of terrorist attacks: a study in primary care.

Little is known about the mental health impact of terrorism beyond posttraumatic stress disorder (PTSD) and depression. The associations between exposure to the September 11, 2001 (9/11) attacks in New York City and generalized anxiety disorder (GAD) symptoms were examined in a sample of 929 primary care patients. After controlling for PTSD, depression, panic and substance use disorders, and pre-9/11 trauma, patients who screened positive (vs. negative) for GAD symptoms were roughly twice as likely to report having a loved one at the 9/11 disaster site, twice as likely to know someone who was killed by the attacks, and twice as likely to know someone who was involved with the rescue/recovery efforts after the disaster. Implications for treatment and future research are discussed.

The role of adult attachment, parental bonding, and spiritual love in the adjustment to military trauma.

In order to prevent the development of posttraumatic stress disorder (PTSD) and to effectively treat it in active-duty and veteran populations, it is important to identify factors that may protect individuals exposed to significant traumas during military service. This pilot investigation conceptualized significant relationships in terms of attachment theory and explored the salutogenic role of adult attachment, parental bonding, and divine love as protective factors in adjustment to and completed self-report attachment measures. Associations of attachment and perceptions of important relationships with PTSD status were investigated in a convenience sample of 102 veterans. The findings suggest that veterans with current PTSD had lower secure attachment and higher insecure attachment compared to those without PTSD. Hierarchical regression analyses indicated that after controlling for demographics, secure attachment explained an additional 11.2% of the variance and made the greatest predictive contribution to PTSD in this investigation. Group differences (PTSD versus no PTSD) were examined on measures of important relationships, and no significant differences were found related to parental bonding or perceptions of love by God. Veterans with current PTSD had significantly higher insecure romantic attachment compared to the no PTSD group; however, romantic attachment did not make a significant predictive contribution to current PTSD severity. Implications of the results for the treatment of individuals exposed to combat trauma are discussed.

Use of a religious hymn in remission of symptoms of social phobia (social anxiety disorder): a case study.

This case report described a veteran with social anxiety disorder who reported fears of negative evaluation by others, social avoidance, and accompanying physiological symptoms of heart palpitations, gastrointestinal discomfort, muscle tension and mental confusion. The symptoms of social anxiety disorder subsided with the use of a Christian hymn "Be Still My Soul" and its accompanying musical poem, in Finlandia. The veteran attributed the symptom remission to the feeling of stillness and surrender to God conveyed by the words and music of the hymn. Although previous studies have shown that both music and religious beliefs can affect mental health, the findings in this case cannot be generalized without conducting further prospective empirical studies.