The effect of childhood trauma and resilience on psychopathology in adulthood: Does bullying moderate the associations?

BACKGROUND: Exposure to traumatic events in childhood, including bullying, can negatively affect physical and mental health in adulthood. The aim of the present study was to determine the prevalence of bullying in different sociodemographic groups of the Slovak Republic and to assess the moderating effect of bullying on the associations between childhood trauma, resilience, and the later occurrence of psychopathology. METHODS: For the analyses, a representative sample of the population of the Slovak Republic was used (N = 1018, mean age 46.24 years, 48.7% of men). Multivariate linear regression models were used to investigate the predictive ability of childhood trauma (The Childhood Trauma Questionnaire, CTQ) and resilience (The Brief Resilience Scale, BRS) to explain psychopathology (The Brief Symptom Inventory, BSI-53). Bullying (The Adverse Childhood Experiences - International Questionnaire, ACE-IQ) was used as a moderator. RESULTS: In total, 13.5% of respondents have experienced bullying. The most common form of bullying was making fun of someone because of how their body or face looked (46.7%) and excluding someone from activities or ignoring them (36.5%). Higher scores in all types of psychopathology and the Global Severity Index (GSI) were significantly associated with higher scores of emotional and sexual abuse, and some of them with physical neglect. The protective effect of resilience was moderated by bullying in several types of psychopathology, specifically in somatization, obsessive-compulsive, interpersonal sensitivity, depression, psychoticism, and the GSI. CONCLUSION: Understanding the links between childhood trauma, bullying, and later psychopathology can help professionals target policies, resources, and interventions to support children and families at risk. Every child should feel accepted and safe at home and school.

Emotional difficulties, coping strategies, and help-seeking patterns among Czech perinatal women.

OBJECTIVE: To understand both, women´s perception of emotional difficulties in perinatal period and their related coping strategies. Further, we mapped and analysed help-seeking patterns utilized by these women to overcome their emotional difficulties. This study serve as an important piece of information for women-centred innovations in perinatal mental health care in Czechia, and more broadly in the region of Central and Eastern Europe. DESIGN: A qualitative study with an exploratory and descriptive approach using thematic analysis. SETTING: Online survey consisting of open-ended questions mapping women´s perception of emotional difficulties in perinatal period and their related coping strategies and help-seeking patterns. PARTICIPANTS: Two hundred women self-reporting emotional difficulties in perinatal period, from whom 108 (54 %) stated that they had sought professional help with their emotional difficulties. FINDINGS: Two themes were identified in the analysis of women´s perception of emotional difficulties including Experience of symptoms of mental disorders, and Mother-child relationship. Three themes were identified in the analysis of women´s coping with these difficulties (Personal resources, External resources, and No coping strategy used). Four themes were identified in the analysis of help seeking patterns utilized by study participants (Mental health specialists, Physicians of the first line of contact, Midwifes, and Peer consultants). KEY CONCLUSIONS: Emotional difficulties of perinatal women stemmed in both, general symptoms of mental disorders and specific concerns connected to mother-child relationship. Therefore, the perinatal mental health services should cover both topics, preferably by a multidisciplinary team. Women search information about perinatal mental health, so thus, easy to reach valid resources are needed. Finally, Czech perinatal women experiencing emotional difficulties utilize various help-seeking patterns. Some of them naturalistically utilize integrated stepped care even when it is not systematically established.

COVID anxiety and its predictors among Slovak adolescents.

Introduction: The COVID-19 pandemic and its related restrictions, mainly social distancing, had an impact on the mental health of various groups, including adolescents. Methods: The main goal of our study was to explore the impact of gender, age, resilience (measured using the Brief Resilience Scale), attachment anxiety, attachment avoidance (both measured using the Experiences in Close Relationships Revised Scale for adolescents), and mental and general health (measured using items of SF-8 Health Survey) on COVID anxiety (measured using the COVID Anxiety Scale) among a sample of Slovak adolescents (N = 1,786, age 15 to 19, mean age = 16.8, SD = 1.2). The data were collected online between 13 April and 24 May 2021. Results: Four nested linear regression models were fitted to the data and evaluated. The significant predictors that had a greater effect than our smallest effect size of interest (ß = 0.10) were gender (ß = -0.26, p < 0.001, where boys had lower scores in COVID anxiety), general and mental health (ß = -0.13 and ß = -0.14, respectively, both with p < 0.001), resilience (ß = -0.12, p < 0.001), and attachment avoidance (ß = -0.11, p < 0.001). Similarly, age and attachment anxiety were significant predictors with a lower effect size (ß = 0.06, p = 0.003, and ß = 0.09, p < 0.001, respectively). Discussion: Our results are in line with previous research findings highlighting the importance of prevention and interventions programs focused mainly on preventing loneliness and social disconnection, fostering secure attachment with parents and peers, and increasing the resilience of adolescents, especially in the stressful time of a pandemic, to promote their mental health.

Associations of childhood trauma with long-term diseases and alcohol and nicotine use disorders in Czech and Slovak representative samples.

OBJECTIVE: The abuse and neglect of a child is a major public health problem with serious psychosocial, health and economic consequences. The aim of this study was to assess the relationship between various types of childhood trauma, selected long-term diseases and alcohol and nicotine use disorder in Czech and Slovak representative samples. METHODS: Data on retrospective reporting about selected long-term diseases, alcohol and nicotine use disorder (CAGE Questionnaire) and childhood maltreatment (Childhood Trauma Questionnaire; CTQ) in two representative samples (Czech sample: n = 1800, 48.7% men, mean age 46.61 ± 17.4; Slovak sample: n = 1018, 48.7% men, mean age: 46.2 ± 16.6) was collected. Multinomial logistic regression models were used to assess the relationships between childhood maltreatment and long-term diseases. RESULTS: There is a higher occurrence of some long-term diseases (such as diabetes, obesity, allergy, asthma) and alcohol and nicotine use disorder in the Czech sample; however, in the Slovak sample the associations between child maltreatment and long-term diseases are stronger overall. Emotional abuse predicts the occurrence of all the studied long-term diseases, and the concurrent occurrence of emotional abuse and neglect significantly predicts the reporting of most diseases. All types of childhood trauma were strong predictors of reporting the occurrence of three or more long-term diseases. CONCLUSION: The extent of reporting childhood trauma and associations with long-term diseases in the Czech and Slovak population is a challenge for the strengthening of preventive and therapeutic programmes in psychosocial and psychiatric care for children and adolescents to prevent later negative consequences on health.

Posttraumatic Growth and Its Measurement: A Closer Look at the PTGI's Psychometric Properties and Structure.

Despite negative connotations, surviving trauma can result in improvements in some domains of a person's life. This phenomenon is known as posttraumatic growth (PTG), and it is typically measured using the Posttraumatic Growth Inventory (PTGI). Given the ambiguous results of the existing validation studies, the present study aimed to verify the psychometric properties of the Slovak version of the PTGI in a representative sample of Slovak citizens. Although the results suggest that a modified one-factor structure fit the data best, other issues, such as extremely high correlations between the latent factors related to the PTGI's factor structure, were observed. It is likely that the application of the latent variable model does not represent the essence of PTG adequately and the network approach thus appears to be a far more suitable conceptualization of PTG. More detailed information on between-person differences and within-person changes in PTG could help to tailor more effective interventions or preventive programs.

Subjective perception of life stress events affects long-term pain: the role of resilience.

OBJECTIVE: There is evidence that experiencing childhood trauma and life stressors across the lifespan together with lower resilience is associated with chronic pain-related conditions. The aim of this study was to explore the potential mediating role of resilience in the relationship between childhood trauma and long-term pain and to explore a possible moderating role of serious life stressors in the last year. METHODS: The participants, drawn from a representative sample of citizens of the Czech Republic (n = 1800, mean age: 46.6 years, 48.7% male), were asked to report various long-term pain conditions, childhood trauma (Childhood Trauma Questionnaire, CTQ), life stressors (Life Stressor Checklist Revised, LSC-R) and resilience (Brief Resilience Scale, BRS) in a cross-sectional face-to-face study conducted in 2016. A conditional process SEM model of moderated mediation was performed. RESULTS: The occurrence of life stress events affecting the participant's last year moderated the relationship between childhood trauma, resilience and health. In the group of participants who experienced at least one life stress event affecting their last year, resilience fully mediated the effect of past childhood trauma on long-term pain. In participants who did not experience life stressors with an impact on the last year, the direct path from childhood trauma to health through resilience lost its significance. CONCLUSION: The subjective meaning of stress events on one's life has an impact on the trajectory between childhood trauma and health and acts as a moderator. Resilience may buffer the negative effect of trauma on later long-term pain.

How Czecho-Slovakia Bounces Back: Population-Based Validation of the Brief Resilience Scale in Two Central European Countries.

OBJECTIVE: In recent years, resilience has become a focus of research in the medical and behavioral sciences. The Brief Resilience Scale (BRS) was developed to assess the individual ability to recover from stress ("to bounce back") after experiencing adversities. The aim of the study was to validate the Czech and Slovak versions of the BRS. METHODS: A representative sample of the Czech and Slovak populations (NCZ = 1800, mean age MCZ = 46.6, SDCZ = 17.4, 48.7% of men; NSK = 1018, mean age MSK = 46.2, SDSK = 16.6, 48.7% men) completed a survey assessing their health and well-being. Several confirmatory factor analysis (CFA) models of the BRS were compared to find the best fit. Cronbach's alpha and McDonald's omega coefficients of reliability were evaluated. Convergent validity was assessed by correlating resilience (BRS), physical and mental well-being (SF-8) and psychopathology symptoms (BSI-53). Differences in gender and age groups were appraised. RESULTS: A single-factor model with method effects on the reverse items was evaluated to best fit the data in both the Czech and Slovak samples (χ2CZ(6) = 39.0, p < 0.001, CFICZ = 0.998, TLICZ = 0.995, RMSEACZ = 0.055, SRMRCZ = 0.024; χ2SK(6) = 23.9, p < 0.001, CFISK = 0.998, TLISK = 0.995, RMSEASK = 0.054, SRMRSK = 0.009). The reliability was high in both samples (αCZ = 0.80, ωCZ = 0.85; αSK = 0.86, ωSK = 0.91). The BRS was positively associated with physical and mental well-being and negatively associated with somatization, depression and anxiety. In both countries, a lower BRS score was associated with higher age. Czech men reported significantly higher BRS scores than women. No significant difference was found in the mean BRS scores between the two countries. CONCLUSION: This study provides evidence of good psychometric properties, reliability and validity of the Czech and Slovak adaptations of the BRS.

Life Stressors in Patients with Inflammatory Bowel Disease: Comparison with a Population-Based Healthy Control Group in the Czech Republic.

BACKGROUND: Stress has been suggested to play a potential role in inflammatory bowel disease (IBD) pathogenesis, but studies focussing on the occurrence of specific life stress events among IBD patients are scarce. Therefore, the aim of the present study was to explore the association between various life stress events and IBD. METHODS: Patients with IBD (N = 98, mean age: 38.45, 54.1% men) were compared to a group of healthy controls (N = 405, mean age: 36.45, 58.0% men) originating from a health survey conducted on a representative population sample of Czech adults. The Life Stressor Checklist-Revised (LSC-R) was used to assess the stressors. RESULTS: IBD patients had higher odds of reporting life stressors overall (p < 0.001), life stressors before the age of 16 (p < 0.004) and a higher score in traumatic stress (p < 0.005) and interpersonal violence (p < 0.001) when compared to the control group. Gender- and diagnosis-related differences are discussed. CONCLUSION: Reporting life stressors experienced during childhood or adulthood is strongly associated with IBD. This should be considered in illness management, especially in a severe course of IBD.

Validation and Adaptation of the Slovak Version of the Childhood Trauma Questionnaire (CTQ).

BACKGROUND: Previous research has shown a strong relationship between childhood trauma and worsened physical and mental health. The Childhood Trauma Questionnaire (CTQ) is a commonly used tool assessing early traumatic experiences. The aim of this study was to verify the psychometric properties of the Slovak version of the CTQ. METHODS: Data were collected on a representative Slovak sample (N = 1018, mean age 46.24 years, 48.7% of men). The dimensional structure of the CTQ was tested by confirmatory factor analysis (CFA); convergent validity was assessed using the Adverse Childhood Questionnaire (ACE-IQ). RESULTS: CFA confirmed the standard 5-factor CTQ model. The subscales of the CTQ and the ACE-IQ questionnaires showed moderate to high correlations. The internal consistency of the scale was found to be acceptable. Emotional neglect (EN) was reported in 48.1%, physical neglect (PN) in 35.8%, emotional abuse in 15.8%, physical abuse (PA) in 11.0%, and sexual abuse (SA) in 9.1% of the Slovak population, according to the scoring, when even low abuse or neglect is assessed as trauma. CONCLUSION: The CTQ questionnaire fulfilled the validation criteria and appeared to be a suitable method for assessing retrospectively reported childhood trauma experiences in the Slovak population.

When a Head Is about to Burst: Attachment Mediates the Relationship Between Childhood Trauma and Migraine.

BACKGROUND: People exposed to childhood trauma show insecure attachment patterns and are more prone to chronic and pain-related conditions, including migraine. The aim of this study was to explore the mediating role of attachment in the association between childhood trauma and adulthood chronic health conditions, with a focus on migraine. METHODS: Respondents from a representative sample of citizens of the Czech Republic (n = 1800, mean age: 46.6 years, 48.7% male) were asked to report various chronic and pain-related conditions, childhood trauma (The Childhood Trauma Questionnaire, CTQ), and attachment anxiety and avoidance (The Experience in Close Relationships Revised, ECR-R) in a cross-sectional, questionnaire-based survey conducted in 2016. Structural equation models (SEM) adjusted for sociodemographic variables were used to assess the relationship between childhood trauma, adulthood attachment, and adulthood chronic health conditions (migraine, other pain-related conditions, chronic health conditions other than pain, no chronic health complaints). RESULTS: After adjusting for sociodemographic variables, SEM confirmed a significant mediation of the relationship between childhood trauma and migraine through adulthood attachment. There was no mediation effect of adulthood attachment found in other health complaints. CONCLUSION: This study highlights the mediation effect of attachment in the link between childhood trauma and migraine. Attachment-based therapeutic interventions can be useful in the treatment of patients with migraine.

The Unholy Trinity: Childhood Trauma, Adulthood Anxiety, and Long-Term Pain.

BACKGROUND: Childhood trauma is considered to be a risk factor for developing anxiety as well as chronic pain. The aim of this study was to assess the association between childhood trauma and reporting anxiety and long-term pain conditions in the general and clinical populations. METHODS: Respondents from a representative sample in the Czech Republic (n = 1800, mean age: 46.6 years, 48.7% male) and patients with a clinically diagnosed anxiety or adjustment disorder (n = 67, mean age: 40.5 years, 18.0% male) were asked to report anxiety, various chronic and pain-related conditions, and childhood trauma (The Childhood Trauma Questionnaire, CTQ) in a cross-sectional questionnaire-based survey conducted in 2016 and 2017. RESULTS: Reporting emotional abuse (Odds ratio OR from 2.14 to 14.71), emotional neglect (OR from 2.42 to 10.99), or physical neglect (OR from 2.24 to 3.30) was associated with reporting anxiety and long-term pain both in the general and clinical populations and reporting physical abuse moreover with reporting anxiety or adjustment disorder with concurrent long-term pain (OR from 4.04 to 6.39). CONCLUSION: This study highlights the relevance of childhood trauma as a possible factor contributing to anxiety with concurrent pain conditions in adulthood in both the general and clinical populations.

Mental Health Care Gap: The Case of the Slovak Republic.

This study explored unmet mental health and social care needs in the Slovak Republic and their adverse human rights consequences. We estimated treatment gap for persons aged 15-64 years in year 2015 affected by depressive, anxiety, substance use and schizophrenic disorders by comparing local treated prevalence rates with population estimated rates for Europe. Two-thirds of people with depressive disorders and over 80% of those with anxiety disorders and alcohol dependence were not receiving treatment. There was no treatment gap for persons with schizophrenia. Fifty-one percent of those eligible for disability pension on the grounds of mental disorders failed to receive it. We discuss the implications of the estimated gaps in mental health and social care and consequent human rights violations that may result from the current system of mental health care in Slovakia.

Amygdala and emotionality in Parkinson's disease: An integrative review of the neuropsychological evidence.

Parkinson's disease (PD) is often accompanied by significant changes in emotionality, such as apathy, anhedonia, anxiety and depression. The present review summarizes the empirical evidence, including amygdala changes and psychological changes in emotionality in people suffering from PD. Seventeen empirical full-text articles including research on both amygdala and emotionality in PD were reviewed. The changes in amygdala volumes as well as changes in binding potentials, functional connectivity, regional homogeneity and regional cerebral blood flow were found to have various impacts on emotionality in people with PD. The integration of the results showed that some effects of amygdala changes on emotionality were lateralized. Some of the reviewed studies indicated that the volume loss in the left amygdala was found to be related to increased anxiety, whereas bilateral volume loss in amygdala was linked to increased depressivity. The reviewed results also support a hypothesis of bradylimbic affective disturbance in patients with PD. The disturbed activation of amygdala accompanying the evaluation of negative facial expressions implies that the evaluation of the content of affective stimuli in terms of their affective meanings is disturbed in PD patients. Impaired evaluation of affective attributes given by amygdala-based translational deficits is likely to be related to problems in translating the results of cognitive appraisal into somatomotor, arousal and other changes. This mechanism is suggested to be responsible for apathy as well as for other changes in emotionality accompanying PD.

Validation of a 16-Item Short Form of the Czech Version of the Experiences in Close Relationships Revised Questionnaire in a Representative Sample.

The aim of this study was to create a shorter Czech version (ECR-R-16) of the Revised Experiences in Close Relationships (ECR-R) questionnaire and to assess its psychometric properties. Data from a representative sample of the Czech population from 15 to 90 years old (N = 1000, M age = 46.0 years, SD = 17.3) were collected using a face-to-face structured interview in 2014. The developed short form of the Czech version of the ECR-R showed good internal consistency (alphas varied from .84 to .90), and both exploratory and confirmatory factor analyses replicated the two-dimensional model. The results also demonstrated concurrent validity with measures of neuroticism, self-esteem, and positive and negative affect. People living with a partner and people with higher educational levels had significantly lower Avoidance scores than people living alone and people with lower educational levels. It was concluded that the ECR-R-16 questionnaire has good psychometric properties and is a valid assessment method in the Czech cultural context, suitable for research and clinical studies, when the shorter form of a measure is desirable.

Facial expression of fear in the context of human ethology: Recognition advantage in the perception of male faces.

Facial expression is one of the core issues in the ethological approach to the study of human behaviour. This study discusses sex-specific aspects of the recognition of the facial expression of fear using results from our previously published experimental study. We conducted an experiment in which 201 participants judged seven different facial expressions: anger, contempt, disgust, fear, happiness, sadness and surprise (Trnka et al. 2007). Participants were able to recognize the facial expression of fear significantly better on a male face than on a female face. Females also recognized fear generally better than males. The present study provides a new interpretation of this sex difference in the recognition of fear. We interpret these results within the paradigm of human ethology, taking into account the adaptive function of the facial expression of fear. We argue that better detection of fear might be crucial for females under a situation of serious danger in groups of early hominids. The crucial role of females in nurturing and protecting offspring was fundamental for the reproductive potential of the group. A clear decoding of this alarm signal might thus have enabled the timely preparation of females for escape or defence to protect their health for successful reproduction. Further, it is likely that males played the role of guardians of social groups and that they were responsible for effective warnings of the group under situations of serious danger. This may explain why the facial expression of fear is better recognizable on the male face than on the female face.

Biopsychosocial approach to psychological trauma and possible health consequences.

The diagnostic category of posttraumatic stress disorder (PTSD) has its place in the newest American diagnostic system DSM-V. The authors compare its definition with the former manual DSM-IV and the international classification ICD-10. They reflect difficulties in defining the concept of traumatic event. They summarize epidemiological findings, highlight the possible significant role of traumatogenesis in other psychiatric disorders without PTSD symptoms. The biopsychosocial model seems to be the most adequate for the study of trauma-related disorders, while in therapy the specific shaping of psychotherapy seems to be crucial. Good experiences in relationships before the trauma increase resilience and the availability of supportive empathetic relationships may favourably influence the development of the disorder and its therapy.

Attachment in integrative neuroscientific perspective.

Attachment theory is a very influential general concept of human social and emotional development, which emphasizes the role of early mother-infant interactions for infant's adaptive behavioural and stress copying strategies, personality organization and mental health. Individuals with disrupted development of secure attachment to mother/primary caregiver are at higher risk of developing mental disorders. This theory consists of the complex developmental psycho-neurobiological model of attachment and emerges from principles of psychoanalysis, evolutionary biology, cognitive-developmental psychology, ethology, physiology and control systems theory. The progress of modern neuroscience enables interpretation of neurobiological aspects of the theory as multi-level neural interactions and functional development of important neural structures, effects of neuromediattors, hormones and essential neurobiological processes including emotional, cognitive, social interactions and the special key role of mentalizing. It has multiple neurobiological, neuroendocrine, neurophysiological, ethological, genetic, developmental, psychological, psychotherapeutic and neuropsychiatric consequences and is a prototype of complex neuroscientific concept as interpretation of modern integrated neuroscience.

Changing aspects of psychiatric inpatient treatment. A census investigation in five European countries.

This paper presents data obtained in a one-day census investigation in five European countries (Austria, Hungary, Romania, Slovakia, Slovenia). The census forms were filled in for 4191 psychiatric inpatients. Concerning legal status, 11.2% were hospitalised against their will (committed) and 21.4% were treated in a ward with locked doors. There was only a small correlation between commitment and treatment in a locked ward. More frequent than treatment of committed patients in locked wards was treatment of committed patients in open wards (Austria, Hungary) and treatment of voluntary patients in closed wards (Slovakia, Slovenia). Concerning employment, 27.7% of patients aged 18-60 held a job before admission. The vast majority of patients (84.8%) had a length of stay of less than 3 months. A comparison of these data with the results of a study performed in 1996 and using the same method shows a decrease of rates of long-stay patients. In 1996 the rates of employment were significantly higher in Romania (39.3%) and Slovakia (42.5%) compared to Austria (30.7%). These differences disappeared in 1999 due to decreasing rates of employment in Romania and Slovakia. The numbers of mental health personnel varies between types of institution (university or non-university) and countries, being highest in Austria and lowest in Romania. A considerable increase in the numbers of staff was found in Slovakia.