Prevalence and concordance of International Classification of Diseases-11th Revision and Diagnostic and Statistical Manual-Fifth Edition posttraumatic stress diagnostics among Northern Irish military veterans.

BACKGROUND: There are two primary competing diagnostic criteria for posttraumatic stress disorder (PTSD); the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM). These systems differ in terms of the number and nature of PTSD symptoms, the implied latent structure of the disorder, and associated posttraumatic diagnostic classifications. OBJECTIVE: To investigate the prevalence and concordance of ICD-11th Revision (ICD-11) and DSM-Fifth Edition (DSM-5) PTSD, complex-PTSD (C-PTSD), and dissociative subtype of PTSD (D-PTSD) criteria in a sample of Northern Irish military veterans. METHODOLOGY: Data were collected from a community sample of military veterans living in Northern Ireland (NI). Prevalence rates of ICD-11 PTSD and C-PTSD and DSM-5 PTSD and D-PTSD were estimated using validated self-report measures for each system. Concordance of caseness determined by diagnostic criteria was compared using Cohen's kappa. RESULTS: The DSM-5 algorithm criteria produced significantly higher prevalence estimates of PTSD (39.26%) relative to the ICD-11 algorithm criteria (32.09%). Both C-PTSD and D-PTSD were identified for subgroups within the sample (24.66% and 27.96%, respectively). There was moderate agreement between the diagnostic systems regarding PTSD caseness, and between C-PTSD and D-PTSD caseness. CONCLUSIONS: These findings have implications regarding the measurement of PTSD and associated diagnostic groupings for the wider literature, suggesting that the choice of diagnostic screening framework may influence classification. Both C-PTSD and D-PTSD may be relevant diagnostic considerations for the NI military veteran group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

EHealth for Sexual Assault: A Systematic Scoping Review.

Providing efficient psychosocial support for survivors of sexual assault is of critical societal importance. Around the globe, technology-based solutions (eHealth) are increasingly being used to accomplish this task, especially following COVID-19. Despite increased importance and reliance on eHealth for sexual assault, minimal efforts have been made to systematically synthesize research in this area. The present study therefore sought to synthesize what is known about eHealth targeting sexual assault survivors' psychosocial needs using a systematic scoping review methodology. To this end, five databases (CINAHL, Embase, PsycINFO, MEDLINE, and Scopus) were systematically searched for studies published from 2010 onwards using terms such as "sexual assault", "eHealth", "digital health", "telehealth", and variations thereof. Of the 6,491 records screened for eligibility, 85 studies were included in the review. We included empirical studies from all countries pertaining to eHealth for sexual assault for survivors 13 years or older. Many innovative eHealth applications for sexual assault exist today, and the included studies suggested that survivors generally experience eHealth positively and seem to benefit from it. Nevertheless, much more clinical and empirical work is needed to ensure accessible and effective solutions for all.

Experience and usability of a website containing research-based knowledge and tools for pain self-management: a mixed-method study in people with high-impact chronic pain.

OBJECTIVES: Smerteinfo.dk is a freely accessible Danish website containing research-based, up-to-date knowledge on chronic pain, written in lay language, with a focus on information, guidance and self-management tools, developed in collaboration between health professionals and persons with high-impact chronic pain. This mixed-method study explored experiences, perceived usability, and challenges of Smerteinfo among patients with high-impact chronic pain. METHODS: Semi-structured interviews enabling thinking-aloud and participant observation while using Smerteinfo were performed in 11 patients with high-impact chronic pain. Survey data were collected three months after being invited to use Smerteinfo among 200 patients on waiting-list at a Pain Center in Denmark. RESULTS: Three themes captured the depth and variation in patterns of experiences, usability and challenges using Smerteinfo during interviews: 1) Appreciated easy access to new knowledge yet strived for more personalized information, 2) Experienced incentives as well as challenges when navigating the website, and 3) Suggested earlier introduction to the website. Challenges concerned the unknown update frequency of the website, information consisting of mostly text and many links, lack of material to improve self-management and too general information. Survey data revealed that 87 % found the language in the articles easy to understand and 73 % could recognize themselves and their challenges in the articles. A proportion of the respondents reported improved understanding of their pain condition (56 %), improved coping (33 %), and that they had made changes in their everyday life after reading on the website (33 %). CONCLUSIONS: Patients with high-impact chronic pain found Smerteinfo valuable. The results suggest attention towards spreading knowledge of the website to general practitioners, who could introduce the site at an earlier stage of illness. Continuously improving the site and expand the applicable tools based on scientific evidence and in collaboration with end-users are crucial to ensure the usability of the website in the future.

Validation of the Danish PTSD Checklist for DSM-5 in trauma-exposed chronic pain patients using the Clinician-Administered PTSD Scale for DSM-5.

Background: Validation of post-traumatic stress disorder (PTSD) screening tools across various populations to ensure accurate PTSD estimates is important. Because of the high symptom overlap between PTSD and pain, it is particularly important to validate PTSD screening tools in trauma-exposed chronic pain patients.Objective: The present study is the first seeking to validate the PTSD Checklist for DSM-5 (PCL-5) in a sample of trauma-exposed, treatment-seeking chronic pain patients.Method: The validation and optimal scoring of the PCL-5 were investigated using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) in chronic pain patients exposed to traffic or work-related traumas (n = 84). Construct validity was investigated using confirmatory factor analyses testing six competing DSM-5 models in a sample of mixed trauma-exposed chronic pain patients (n = 566), and a subsample of chronic pain patients exposed to traffic or work-related trauma only (n = 202). Furthermore, concurrent validity and discriminant validity were investigated using correlation analysis.Results: The results showed moderate (κ = .46) diagnostic consistency between the PCL-5 and the CAPS-5 using the DSM-5 symptom cluster criteria, and the overall accuracy of the scale (area under the curve = .79) was highly acceptable. Furthermore, the Danish PCL-5 showed excellent construct validity both in the full sample and in the subsample of traffic and work-related accidents, with superior fit of the seven-factor hybrid model. Excellent concurrent validity and discriminant validity were also established in the full sample.Conclusion: The PCL-5 appears to have satisfactory psychometric properties in trauma-exposed, treatment-seeking chronic pain patients.

The present study is the first seeking to validate the PCL-5 using the CAPS-5 in chronic pain patients following traffic and work-related injury.The results showed moderate diagnostic consistency and acceptable overall accuracy using the DSM-5 criteria.Excellent construct, concurrent, and discriminant validity was established in chronic pain patients following mixed traumatic exposure and traffic and work-related trauma only.

Investigating the DSM-5 and the ICD-11 PTSD symptoms using network analysis across two distinct samples.

OBJECTIVE: Posttraumatic stress disorder (PTSD) has long been debated with a recent focus on the consequences of having two different diagnostic descriptions of PTSD (i.e., the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition [DSM-5] and the International Classification of Diseases-11th Edition [ICD-11]). Research has modeled PTSD as a network of interacting symptoms according to both diagnostic systems, but the relations between the two systems remain unclear regarding which symptoms are more central or interconnected. To answer this question, the present study is the first study to investigate the combined network structure of PTSD symptoms according to both systems using validated measurements (i.e., the International Trauma Questionnaire [ITQ] and the Posttraumatic Stress Disorder Checklist 5 [PCL-5] across two distinct trauma samples [a community sample, N = 2,367], and a military sample, N = 657). METHOD: We estimated two Gaussian Graphical Models of the combined ICD-11 and DSM-5 PTSD symptoms across the two samples. RESULTS: Five of the six most central symptoms were the same across both samples. CONCLUSIONS: The results underline that a combination of five symptoms representing both diagnostic systems may hold central positions and potentially be important for treatment. However, the implications depend on if the different diagnostic descriptions can be reconciled in an indexical rather than constitutive perspective. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adverse experiences and mental health problems in perpetrators of intimate partner violence in Northern Ireland: A latent class analysis.

BACKGROUND: Trauma and adverse experiences among perpetrators of intimate partner violence (IPV) have been associated with more serious patterns of offending. OBJECTIVE: To examine 1) how traumatic and adverse experiences cluster together and co-occur among IPV perpetrators, and 2) whether different patterns of trauma exposure are associated with specific mental health problems. PARTICIPANTS AND SETTING: The sample consisted of 405 convicted IPV perpetrators from Northern Ireland. METHODS: Data was collected between 2018 and 2019. Latent class analysis identified typologies of exposure to traumatic and adverse experiences. A series of binary logistic regression analyses explored associations between the identified classes and five categories of probable mental health problems. RESULTS: Three adversity classes were identified: a baseline class (59.2%), characterised by relatively low levels of exposure to most types of adversity; a 'childhood adversity' class (32.9%), with high levels of childhood adversity; and a 'community violence and disadvantage' class (7.9%), which had high probabilities of endorsing adversities related to economic hardship and community violence. Regression analyses showed that the childhood adversity class was significantly associated with increased likelihood of all categories of mental health problems, except for neurodevelopmental disorders (ORs = 1.77-3.25). The community violence and disadvantage class was significantly associated with probable mood and anxiety disorder (ORs 3.92 and 8.42, respectively). CONCLUSIONS: Different patterns of exposure to adversities were associated with distinct mental health problems in the present sample. Early intervention to prevent poly-victimisation, the clustering of adversities in childhood and the resulting accumulation of risk may be a useful component of preventive responses for IPV in Northern Ireland.

Trauma Exposure and Domestic Violence Offending Severity in a Probation Sample From Post-conflict Northern Ireland.

Domestic violence is more common in post-conflict settings such as Northern Ireland. However, the extent to which trauma and related mental health problems are associated with domestic violence perpetration in the region has not yet been quantitatively assessed. The present study examines relationships between multiple traumas, mental health problems, and five indicators of domestic violence perpetration severity (causing injury, use of a weapon, breach of nonmolestation order, sexual violence, and previous police involvement). The unique risk associated with distinct types of trauma (i.e., childhood maltreatment or conflict related) was also investigated. Perpetrators' case file data (n = 405) were analyzed using hierarchical logistic regression. The rates of recorded trauma exposure and mental health difficulties were 72.3% and 63.5%, respectively. The first logistic regression analyses showed that exposure to multiple traumas was associated with increased likelihood of perpetrating injurious and sexual violence, when controlling for the covariates (odds ratios [ORs] = 1.24-1.28). The second logistic regression analyses showed that childhood maltreatment was the only trauma type to confer unique risk, a relationship that was significant only for the outcome of perpetrating injurious violence (OR = 3.06). Substance misuse was also significantly associated with perpetration of injurious violence, use of weapons, and having past police involvement (ORs = 2.49-3.50). The accumulation of traumatic experiences and substance abuse appear to act as risk factors for some indicators of offending severity. Childhood maltreatment appears to confer particularly strong risk. The findings may support a focus on trauma and substance abuse as intervention targets in post-conflict settings.

What Characterizes Vulnerability? Interdisciplinary Perspectives on Service Provision for Survivors of Sexual Assault.

Although research indicates that specialized sexual assault (SA) services are effective in terms of promoting postassault recovery and improving legal outcomes, little is known about how to best support survivors facing co-occurring difficulties and inequalities (e.g., preexisting mental health issues, substance abuse, poverty). This deficiency in knowledge was also expressed by service providers at Danish SA centers (SACs), who described this using the term "vulnerable survivors." Therefore, the present study aims to address this knowledge gap by exploring (a) how service providers understand vulnerability in the context of SA and (b) how service provision is currently approached for these survivors. Interviews were conducted with 18 service providers representing five professional groups (psychologists, social workers, forensic doctors, nurses, police) and analyzed using Interpretative Phenomenological Analysis. A total of eight themes emerged from the analysis, including service providers' descriptions of what characterizes vulnerability in survivors and broader perspectives on service provision for these survivors. Survivors considered least likely to attain desired supports were also those perceived to be most vulnerable with regards to risk and experiences surrounding sexual victimization (e.g., individuals with preexisting mental health issues). Service providers also believed that a large proportion of those served experience ongoing vulnerabilities that are difficult to manage within existing support models. The results thus suggest that survivors' needs cannot be met if vulnerabilities are overlooked or ignored. At the same time, the concept of vulnerability warrants caution since vulnerabilities are often placed within individual survivors, but the formal support system also appears vulnerable in its ability to meet the diverse needs and priorities of those served. The implications for SA services across the globe are discussed, including a need for more individually tailored and trauma-informed responses to SA that simultaneously address co-occurring difficulties and inequalities in survivors.

The association of probable PTSD at baseline and pain-related outcomes after chronic pain rehabilitation: A comparison of DSM-5 and ICD-11 criteria for PTSD.

BACKGROUND: There is a high prevalence of posttraumatic stress disorder (PTSD) in patients with chronic pain. However, different patients are identified depending on the diagnostic system used. Moreover, it is unclear if the conceptualizations of PTSD are differently associated with outcomes of pain rehabilitation. Hence, the aims of the present study were first to explore the prevalence rates and diagnostic agreement of probable PTSD according to the ICD-11 and the DSM-5 screening tools (International Trauma Questionnaire [ITQ] vs. PTSD Checklist [PCL-5]), and secondly, to explore the associations of probable PTSD determined by ITQ and PCL-5 with psychological distress measures at baseline, and thirdly, the associations with pain and disability after pain rehabilitation adjusting for psychological covariates. METHODS: A consecutive cohort of patients with chronic non-malignant pain (n = 152) referred to a Danish interdisciplinary pain center was assessed at baseline prior to their first visit and at follow-up three days after completed treatment. RESULTS: The estimated probable PTSD baseline prevalence rates were 15.8% (ITQ) and 16.4% (PCL-5). However, the diagnostic agreement between the PCL-5 and the ITQ was only moderate (k = 0.64). Overall, compared to the ITQ probable PTSD according to the PCL-5 correlated more strongly with psychological distress. Only the ITQ was associated with poorer outcomes after rehabilitation, explaining alone 7-8% of the variance in disability and pain intensity adjusted for covariates. CONCLUSIONS: The results underline the importance of taking the conceptualization and assessment of PTSD into consideration when investigating the impact of PTSD on pain rehabilitation. SIGNIFICANCE: There is a high prevalence of probable PTSD in patients with chronic pain. However, different patients with probable PTSD are identified depending on the diagnostic system used. Although similar probable PTSD prevalence rates (about 16%) were found using DSM-5 and ICD-11 PTSD screening tools (PCL-5 and ITQ, respectively), the diagnostic agreement between the systems was only moderate (k = 0.64). At the same time, only probable PTSD estimated according to the ITQ and not the PCL-5 was a significant predictor of disability after pain rehabilitation.

Patterns of childhood adversity and their associations with internalizing and externalizing problems among at-risk boys and girls.

BACKGROUND: Different types of childhood adversity often cluster and overlap, underlining the importance of studying likely patterns of adversity co-occurrences and their impact on child functioning. Further sex-specific investigations of adversity co-occurrences and their associations with child mental health are warranted. OBJECTIVE: To investigate if different sex-specific patterns of childhood adversity exist among at risk-children living in Denmark and to explore if divergent constellations of adversity are differentially associated with externalizing and internalizing problems. PARTICIPANTS AND SETTING: Participants (N = 2198) were a sample of children ages 1-17 who have been in contact with the Danish child protection system due to suspected child abuse. The study included existing data collected as a part of child case procedures. METHOD: Latent class analysis was used to identify patterns of adversity co-occurrences among girls and boys, respectively. Inter-class differences on age and child mental health were assessed using ANOVAs. RESULTS: Greater variation and complexity in adversity exposure was found among girls (5 classes) compared to boys (3 classes). The female classes differed on age (p < .001, η2 = 0.06), internalizing (p < .001, η2 = 0.05), and externalizing problems (p = .002, η2 = 0.02). The male classes differed on internalizing (p < .001, η2 = 0.02) and externalizing problems (p < .001, η2 = 0.04). Overall, classes characterized by multiple adversities displayed higher scores of mental health problems compared to less exposed classes. CONCLUSIONS: Exposure to multiple adversities is common among at-risk children. Information on different sex-specific patterns of adversity co-occurrences can guide intervention planning for affected children.

Validation of the Danish International Trauma Questionnaire for posttraumatic stress disorder in chronic pain patients using clinician-rated diagnostic interviews.

Background: The estimated prevalence rate of comorbid posttraumatic stress disorder (PTSD) is high in trauma-exposed chronic pain patients. At the same time, self-report measures of PTSD tend to be over-inclusive within this specific population due to the high symptom overlap resulting in potential false positives. There is a need for an updated PTSD screening tools with a proper validation against clinical interviews according to the recently published 11th revision of the World Health Organization's International Classification of Diseases (ICD-11). Objective: The present study aimed to validate the Danish International Trauma Questionnaire (ITQ) PTSD part in a sample of trauma-exposed chronic pain patients. Method: The ITQ was validated using a clinician-rated diagnostic interview of ICD-11 PTSD among chronic pain patients exposed to accident or work-related trauma (N = 40). Construct validity, concurrent and discriminant validity was investigated using confirmatory factor analyses (CFA) and correlation analysis, respectively. Three CFA models of ITQ PTSD part were tested in a sample of trauma-exposed chronic pain patients (N = 1,017) and a subsample of chronic pain patients exposed to accident or work-related trauma only (n = 367). Results: Diagnostic consistency between the six ICD-11 PTSD symptoms derived from the ITQ and the clinical interview (κ = .59) and the overall accuracy of the scale (AUC = .90) were good. The Danish ITQ showed excellent construct, concurrent and discriminant validity. The ICD-11 three factor PTSD model had excellent fit in both the full sample and the subsample of traffic and work-related accidents. Conclusions: The results indicate that the ITQ also has good psychometric properties in patients with chronic pain.

Antecedentes: La prevalencia estimada del trastorno de estrés postraumático (TEPT) como comorbilidad es alta en los pacientes con dolor crónico expuestos a trauma. Asimismo, las mediciones por autorreporte del TEPT suelen ser en exceso incluyentes para este tipo de población debido a que existe una alta superposición de los síntomas, lo que resulta en potenciales resultados falsos positivos. Existe la necesidad de actualizar las herramientas de tamizaje del TEPT con una validación adecuada y acorde con las entrevistas clínicas basadas en la recientemente publicada 11° revisión de la Clasificación Internacional de Enfermedades de la Organización Mundial de la Salud (CIE-11).Objetivo: El objetivo de este estudio fue el de validar la sección del TEPT del Cuestionario Internacional de Trauma danés (ITQ, por sus siglas en inglés) en una muestra de personas con dolor crónico expuestas a trauma.Método: Se validó el ITQ empleando una entrevista diagnóstica para el TEPT según la CIE-11 calificada por un clínico en pacientes con dolor crónico expuestos a accidentes o a traumas relacionados con el trabajo (N = 40). Se investigaron la validez del constructo y la validez concurrente y discriminativa mediante el empleo de análisis confirmatorios de factor (ACF) y análisis de correlación, respectivamente. Los tres modelos realizados mediante ACF de la sección del TEPT del ITQ fueron luego evaluados en una muestra de pacientes con dolor crónico expuestos a trauma (N = 1.017) y en un grupo de esta muestra de pacientes con dolor crónico expuestos únicamente a accidentes o a traumas relacionados con el trabajo (N = 367).Resultados: Tanto la consistencia diagnóstica entre seis síntomas del TEPT basados en la CIE-11 obtenidos mediante el ITQ y la entrevista diagnóstica (k = .59) como la precisión general de la escala (AUC = .90) fueron buenas. El ITQ danés mostró tanto una validez del constructo como una validez concurrente y discriminativa excelentes. El modelo de tres factores para el TEPT según la CIE-11 tiene una excelente adaptación tanto en la muestra completa como en el grupo tomado de la muestra para accidentes o traumas relacionados con el trabajo.Conclusiones: Los resultados indican que el ITQ también posee propiedades psicométricas buenas en pacientes con dolor crónico.

Underserved survivors of sexual assault: a systematic scoping review.

Background: Despite knowledge about the extensive and often long-lasting consequences of sexual assault, many survivors remain underserved by formal support systems (e.g. medical, mental health and criminal justice systems). Reasons for underutilizing services are as diverse as the survivors themselves, and little is known about which survivors are most underserved and why they are underserved. Objective: To help organize existing findings on this topic, a systematic scoping review was conducted to identify adult survivors of sexual assault, who may be particularly underserved when attempting to obtain services in Western countries. Method: Five databases (PsycINFO, Embase, MEDLINE, Scopus and CINAHL) were systematically searched for studies published in English from 2000 onwards using terms such as 'sexual assault', 'help seeking', 'formal support', 'barriers' and variations thereof. Results: A total of 41 studies were included in the present scoping review, resulting in seven main categories of underserved survivors: Ethnic and cultural minorities, Disabilities, Financial vulnerability, Sexual and gender minorities, Mental health conditions, Problematic substance use, and Older age. Barriers encountered by survivors with these characteristics included limited access to formal supports and insufficient training and awareness among service providers about how to best support survivors. Conclusions: Recommendations include the need for more survivor-centred, culturally appropriate and trauma-informed services and more attention to survivors belonging to underserved groups in policy, practice and research.

Antecedentes: A pesar del conocimiento acerca de las consecuencias extensas y a menudo duraderas de la agresión sexual, muchos sobrevivientes permanecen desatendidos por los sistemas de apoyo formales (ej., sistemas médicos, salud mental y de justicia criminal). Las razones para la subutilización de los servicios son tan diversas como los propios sobrevivientes, y se conoce poco acerca de qué sobrevivientes son los más desatendidos y las razones de por qué lo son.Objetivo: Para ayudar a organizar los hallazgos existentes en este tema, se realizó una revisión sistemática del alcance para identificar, en países occidentales, a sobrevivientes adultos de agresión sexual, quienes pueden ser particularmente desatendidos cuando intentan obtener apoyo.Método: Se buscó sistemáticamente en cinco bases de datos (PsycINFO, Embase, MEDLINE, Scopus y CINHAL) estudios publicados en Inglés desde el 2000 en adelante, usando los términos 'agresión sexual', 'búsqueda de ayuda', 'apoyo formal', 'barreras' y variaciones de los mismos.Resultados: Se incluyó un total de 41 estudios en la presente revisión del alcance, resultando en siete categorías principales de sobrevivientes desatendidos: Minorías étnicas y culturales, Discapacidades, Vulnerabilidad económica, Minorías sexuales y de género, Condiciones de salud mental, Uso problemático de sustancias y mayor edad. Las barreras encontradas por los sobrevivientes con estas características fueron acceso limitado a los apoyos formales e insuficiente entrenamiento y conocimiento entre los proveedores de los servicios acerca de cuál es la mejor forma de apoyar a los sobrevivientes.Conclusiones: Las recomendaciones incluyen la necesidad de servicios más centrados en el sobreviviente, adecuados culturalmente e informados en trauma y mayor atención a los sobrevivientes que pertenecen a los grupos desatendidos en relación a las políticas, práctica clínica e investigación.

The effectiveness of interventions to prevent recidivism in perpetrators of intimate partner violence: A systematic review and meta-analysis.

BACKGROUND: Previous reviews of interventions to prevent recidivistic intimate partner violence (IPV) have cited minimal benefits and have been critical of interventions adopting a 'one-size-fits-all' approach to a heterogenous category of offenders. The present systematic review and meta-analysis assesses evidence for interventions situated in a risk-need-responsivity framework, in comparison with the more traditional 'one-size-fits-all' intervention approach. METHOD: Six databases (PsycINFO, Web of Science, PubMed, EMBASE, SCOPUS, PILOTS) were searched for studies examining effectiveness of IPV interventions. RESULTS: Thirty-one studies met the inclusion criteria. Studies were analysed separately depending on whether they compared two treatments (n = 17) or used a no-treatment control group (n = 14). In the meta-analysis, overall effect sizes were OR = 0.52, 95% CI [0.35-0.78] for interventions with follow-up of ≤ one year (p < 0.001) and OR = 0.60, 95% CI [0.46-0.78] for interventions with follow-up between one and two years (p < 0.001). The pooled effects from the studies using follow-up of greater than two years did not reach statistical significance. Subgroup analyses suggested that effect sizes differed across treatment types, with risk-need-responsivity treatments performing well against other modalities. CONCLUSIONS: Risk-need-responsivity treatments showed promise in the short-to-medium term, but the challenge of sustaining effects into the longer term remains.

Crossing borders: a systematic review identifying potential mechanisms of intergenerational trauma transmission in asylum-seeking and refugee families.

Background: As displacement and forced migration continue to exhibit global growth trends, new and surviving generations of children are being born and spending their formative years in host countries. Refugee children who have not been exposed to traumatic events may still be at risk for adverse developmental and mental health outcomes via intergenerational trauma transmission. Objective: To identify and synthesize potential mechanisms of intergenerational trauma transmission in forcibly displaced families where parents have experienced direct war-related trauma exposure, but children have no history of direct trauma exposure. Methods: PRISMA systematic review guidelines were adhered to. Searches were conducted across seven major databases and included quantitative, qualitative and mixed methods literature from 1945 to 2019. The search resulted in 752 citations and 8 studies (n = 1,684) met review inclusion criteria. Results: Findings suggest that parental trauma exposure and trauma sequelae indirectly affect child well-being via potential mechanisms of insecure attachment; maladaptive parenting styles; diminished parental emotional availability; decreased family functioning; accumulation of family stressors; dysfunctional intra-family communication styles and severity of parental symptomology. Conclusion: Further research is needed to assess independent intergenerational effects and mechanisms of trauma transmission in this population.

Antecedentes: A medida que el desplazamiento y la migración forzada exhiben de manera continua tendencias de crecimiento global, las nuevas y sobrevivientes generaciones de niños nacen y pasan sus años de formación en los países de acogida. Los niños refugiados que no han estado expuestos a eventos traumáticos aún pueden estar en riesgo de consecuencias adversas para el desarrollo y la salud mental a través de la transmisión intergeneracional del trauma.Objetivo: Identificar y sintetizar mecanismos potenciales de transmisión intergeneracional de traumas en familias desplazadas por la fuerza donde los padres han experimentado una exposición directa al trauma relacionada con la guerra, pero los niños no tienen antecedentes de exposición directa al trauma.Métodos: Se siguieron las pautas de revisión sistemática PRISMA. Las búsquedas se realizaron en siete bases de datos principales e incluyeron literatura sobre métodos cuantitativos, cualitativos y mixtos desde 1945 al 2019. La búsqueda resultó en 752 citas y 8 estudios (n = 1.684) cumplieron con los criterios de inclusión de la revisión.Resultados: Los resultados sugieren que la exposición al trauma parental y las secuelas del trauma afectan indirectamente el bienestar del niño a través de mecanismos de apego inseguro; estilos de parentalidad maladaptativos; disminución de la disponibilidad emocional parental; disminución del funcionamiento familiar; acumulación de estresores familiares; estilos de comunicación intrafamiliar disfuncionales y gravedad de la sintomatología parental.Conclusión: existe una clara necesidad de apoyar a los padres y a sus hijos que han estado expuestos a traumas de guerra. Se necesita más investigación para evaluar los efectos intergeneracionales independientes de la transmisión del trauma en esta población.

No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings.

BACKGROUND: Despite the widely recognised importance of cultural adaptation to increase the effectiveness of psychological interventions, there is little guidance on its process. Developed based on existing theory, we applied a four-step process to culturally adapt a low-intensity psychological intervention for use in humanitarian settings. METHODS: The four-step process was applied to adapt a WHO low-intensity psychological intervention (i.e. Problem Management Plus, or PM+) for use with displaced Venezuelans and Colombians in Colombia. First, a rapid desk review was used as an (1) information gathering tool to identify local population characteristics. Next, the results were taken forward for the (2) formulation of adaptation hypotheses, whereby PM+ protocols were screened to identify components for adaptation, drawing on the Ecological Validity Model. Third, the elements flagged for adaptation were taken forward for (3) local consultation to firstly, verify the components identified for adaptation, to identify other areas in need of adaptation, and thirdly, to adapt the intervention protocols. Finally, the adapted intervention protocols were reviewed through (4) external evaluations with local experts. RESULTS: The information gathering phase yielded key information on the socioeconomic aspects of the groups targeted for intervention, the availability and need for mental health and psychosocial support, and existing barriers to accessing care. The adaptation hypotheses phase further identified the need for clearer explanations of key concepts, the need for sensitive topics to match local attitudes (e.g., domestic violence, thoughts of suicide), and the identification of culturally appropriate social supports. Building on these first two phases, local consultation subsequently resulted in revised PM+ protocols. The adapted protocols differed from the original format in their focus on the problems unique to these population groups, the way that psychological distress is expressed in this context, and the inclusion of locally available supports. The results of the external evaluation supported the adaptations made to the protocols. CONCLUSION: The proposed four-step process offers a useful guide for how to adapt low-intensity psychological intervention within humanitarian settings. Despite some limitations, we show that even when time and resources are scarce it is possible and necessary to culturally adapt psychological interventions. We invite further testing, replication, and improvements to this methodology.

Polyvictimization and psychopathology among children and adolescents: A systematic review of studies using the Juvenile Victimization Questionnaire.

BACKGROUND: Exposure to child abuse can lead to lasting mental health problems. Extant research has found that different types of child abuse tend to co-occur and overlap, which merits the investigation of the effects of exposure to multiple types of childhood mistreatment. OBJECTIVE: The aim of this study was to systematically review the evidence on the associations between multiple different types of interpersonal victimization or polyvictimization, and indicators of psychopathology among children ages 0-17. METHODS: The review included studies across all economic strata and research on nationally representative, community, and at-risk samples, using the same standardized assessment tool (i.e. the Juvenile Victimization Questionnaire or JVQ). The review was conducted using peer-reviewed evidence published up until August 2019 from Scopus, EMBASE, PsycINFO, Medline, CINAHL, and ERIC. Out of 4998 relevant references screened, 255 met the inclusion criteria, 22 of which aimed to address childhood polyvictimization and psychopathology. RESULTS: A total of 21 of the 22 included studies identified a significant positive association between polyvictimization and various indicators of psychopathology comprising both externalizing (e.g. anger), internalizing problems (e.g. depression) and total psychological distress. A range of studies demonstrated that polyvictimization was a stronger risk factor for psychopathology than individual (sub)types of victimization. Based on the study findings, we provide a set of recommendations for future research on polyvictimization and psychopathology. CONCLUSION: The present systematic review was the first to review the evidence on the associations between polyvictimization (as measured by the JVQ) and child and adolescent psychopathology in the global research literature. As a novel approach, the present review included both normative and high-risk samples. The results showed that polyvictimization is a substantial risk factor for mental health problems spanning both inner-directed and outer-directed mental health difficulties. However, the inconsistency in methods of defining and measuring polyvictimization severely undermines the scientific impact of this body of work. Additional well-designed, longitudinal studies that take account of the context-specific nature of polyvictimization are required to better establish the causal relationships between childhood polyvictimization and psychopathology so as to improve prevention and intervention efforts.

Lesbian, gay or bisexual identity as a risk factor for trauma and mental health problems in Northern Irish students and the protective role of social support.

Background: People identifying as lesbian, gay or bisexual (LGB) have been shown to experience more trauma and poorer mental health than their heterosexual counterparts, particularly in countries with discriminatory laws and policies. Northern Ireland is a post-conflict region with high rates of trauma and mental health problems, as well as significant levels of prejudice against the LGB community. To date, no studies in Northern Ireland have compared trauma exposure, social support and mental health status of LGB students to their heterosexual peers. Objective: The present study aimed to assess whether LGB status was associated with more trauma exposure and poorer mental health, and whether social support mediated these associations. Method: The sample was comprised of 1,116 university students. Eighty-nine percent (n = 993) identified as heterosexual and 11% (n = 123) identified as LGB. Path analysis was used to test the hypotheses. Results: LGB status was significantly associated with increased trauma exposure and with symptoms of PTSD, depression and anxiety, but not with problematic alcohol use. These associations were mediated by social support from family only. Conclusions: These results evidence vulnerabilities among Northern Irish students identifying as LGB in relation to trauma and mental health compared with their heterosexual peers. However, social support from family has the potential to mitigate risk. Educational initiatives should raise awareness of the importance of familial support for LGB youth, and those young people who lack family support should be considered an at-risk group, warranting particularly intensive targeting by relevant supports.

Antecedentes: Se ha demostrado que las personas que se identifican como lesbianas, gays o bisexuales (LGB) experimentan más traumas y peor salud mental que sus contrapartes heterosexuales, particularmente en países con leyes y políticas discriminatorias. Irlanda del Norte es una región post-conflicto con altas tasas de trauma y problemas de salud mental, así como niveles significativos de delitos de odio dirigidos a la comunidad LGB. Hasta la fecha, ningún estudio en Irlanda del Norte se ha propuesto específicamente comparar la exposición al trauma y el estado de salud mental de los estudiantes LGB con sus pares heterosexuales.Objetivo: El presente estudio tuvo como objetivo evaluar si la condición LGB estaba asociada con tasas más altas de exposición al trauma y peor salud mental, y si el apoyo social mediaba estas asociaciones.Método: La muestra estuvo compuesta por 1.116 estudiantes universitarios de Irlanda del Norte. El ochenta y nueve por ciento (n = 990) se identificó como heterosexual y el 11% restante (n = 126) identificándose como LGB. El análisis de pautas se usó para probar las hipótesis de estudio.Resultados: el estado LGB se asoció con una mayor exposición al trauma y síntomas de TEPT, depresión y ansiedad, pero no con el consumo problemático de alcohol. Las asociaciones significativas fueron mediadas solamente por el apoyo social de miembros de la familia. El apoyo familiar se asoció con niveles más bajos de exposición al trauma y síntomas de salud mental para los jóvenes LGB.Conclusiones: los estudiantes de Irlanda del Norte que se identifican como LGB tienen vulnerabilidades en relación con el trauma y la salud mental en comparación con sus compañeros heterosexuales. Sin embargo, el apoyo social de la familia tiene el potencial de mitigar esta relación. Las iniciativas educativas deberían crear conciencia sobre la importancia del apoyo familiar para los jóvenes LGB, y aquellos jóvenes que carecen de apoyo familiar deberían considerarse un grupo en riesgo, garantizándoles un apoyo particularmente intensivo por terceros significativos.

Females have more complex patterns of childhood adversity: implications for mental, social, and emotional outcomes in adulthood.

Background: Adverse childhood experiences (ACEs) have been identified as an important public health problem with serious implications. Less well understood is how distinct configurations of childhood adversities carry differential risks for mental health, emotional, and social outcomes later in life. Objective: To determine if distinct profiles of childhood adversities exist for males and females and to examine if unique associations exist between the resultant latent profiles of childhood adversities and multiple indicators of mental health and social and emotional wellbeing in adulthood. Method: Participants (N = 1,839) were a nationally representative household sample of adults currently residing in the USA and the data were collected via online self-report questionnaires. Latent class analysis was used to identify the optimal number of classes to explain ACE co-occurrence among males and females, separately. ANOVAs, chi-square tests, and t-tests were used to compare male and female classes across multiple mental health, emotional, and social wellbeing variables in adulthood. Results: Females were significantly more likely than males to report a range of ACEs and mental health, social, and emotional difficulties in adulthood. Two- and four-class models were identified as the best fit for males and females, respectively, indicating more complexity and variation in ACE exposures among females. For males and female, ACEs were strongly associated with poorer mental health, emotional, and social outcomes in adulthood. Among females, growing up in a dysfunctional home environment was a significant risk factor for adverse social outcomes in adulthood. Conclusions: Males and females have distinct patterns of childhood adversities, with females experiencing more complex and varied patterns of childhood adversity. These patterns of ACEs were associated with numerous negative mental, emotional, and social outcomes among both sexes.

Antecedentes: Las experiencias adversas infantiles (ACEs en su sigla en inglés) se han identificado como un problema de salud pública importante, con serias implicaciones. Menos comprendido es el cómo distintas configuraciones de adversidades infantiles acarrean riesgos diferenciales para los resultados de salud mental, emocional y social.Objetivo: Determinar si existen distintos perfiles de adversidades infantiles para hombres y para mujeres y examinar si existen asociaciones únicas entre los perfiles latentes resultantes de adversidad infantil y múltiples indicadores de salud mental y bienestar social y emocional en la adultez.Método: Los participantes (N = 1,839) fueron una muestra representativa de hogares de adultos actualmente residiendo en los Estados Unidos y los datos se recolectaron en cuestionarios de auto-reporte vía online. El análisis de clases latentes se utilizó para identificar el número óptimo de clases que explican la co-ocurrencia de ACEs entre hombres y mujeres, separadamente. Se empleó pruebas de ANOVA, chi-cuadrado y t para comparar clases de hombres y mujeres a través de múltiples variables de salud mental y bienestar social y emocional en la adultez.Resultados: Las mujeres fueron significativamente más propensas que los hombres a reportar un rango de ACEs y dificultades de salud mental y dificultades sociales y emocionales en la adultez. Modelos de dos y cuatro clases se identificaron como los de mejor ajuste para hombres y mujeres, respectivamente, indicando mayor complejidad y variación de exposición a ACEs en las mujeres. Para hombres y mujeres, las ACEs se asociaron fuertemente a resultados más pobres en salud mental, emocionales y sociales en la adultez. En las mujeres, crecer en un ambiente de hogar disfuncional fue un factor de riesgo significativo para resultados sociales adversos en la adultez.Conclusiones: Los hombres y mujeres tienen distintos patrones de adversidad infantil, en tanto las mujeres experimentan más complejos y variados patrones de adversidad infantil. Estos patrones de ACEs se asociaron con numerosos resultados negativos mentales, emocionales y sociales entre ambos sexos.

Revealing what is distinct by recognising what is common: distinguishing between complex PTSD and Borderline Personality Disorder symptoms using bifactor modelling.

Background: Despite concerns of conceptual similarity, increasing evidence supports the discriminant validity of Complex Posttraumatic Stress Disorder (CPTSD) and Borderline Personality Disorder (BPD). However, all studies to date have assumed a categorical model of psychopathology. In contrast, dimensional models of psychopathology, such as the Hierarchical Taxonomy of Psychopathology model (i.e. HiTOP model), recognise shared vulnerability across supposedly discrete disorders. Accounting for shared vulnerability between CPTSD and BPD symptoms may help to better reveal what is unique about these constructs. Objective: To identify the distinct and shared features of CPTSD and BPD via the application of dimensional modelling procedures. Method: Confirmatory bifactor and confirmatory factor analysis were employed to identify the optimal latent structure of CPTSD and BPD symptoms amongst a convenience sample of Israeli adults (N = 617). Additionally, structural equation modelling was used to identify risk factors associated with these constructs. Results: The latent structure of CPTSD and BPD symptoms was best explained by a bifactor model including one 'general' factor (i.e. vulnerability to all symptoms) and three 'specific' correlated factors (i.e. vulnerability to PTSD, DSO, and BPD symptoms, respectively). CPTSD symptoms were more readily distinguished from the general factor whereas BPD symptoms were not as easily distinguished from the general factor. CPTSD symptoms reflecting a negative self-concept and BPD symptoms reflecting an alternating self-concept were the most distinctive features of CPTSD and BPD relative to the general factor, respectively. Most of the risk factors were associated with the general vulnerability factor, consistent with the predictions of dimensional models of psychopathology regarding shared risk across supposedly distinct psychiatric constructs. Conclusion: Consistent with a dimensional model of psychopathology, CPTSD and BPD shared a common latent structure but were still distinguishable. CPTSD and BPD symptoms may be most effectively distinguished based on the phenomenology of self-concept symptoms.

Antecedentes: A pesar de las consideraciones sobre la similitud conceptual, cada vez hay más pruebas que respaldan la validez para diferenciar el trastorno de estrés postraumático complejo (TEPT-C) del trastorno límite de personalidad (TLP). Sin embargo, todos los estudios hasta la fecha han asumido un modelo categórico de psicopatología. Por el contrario, los modelos dimensionales de psicopatología, como el modelo de taxonomía jerárquica de psicopatología (el modelo HiTOP), reconocen la vulnerabilidad compartida entre trastornos supuestamente distintos. Tener en cuenta la vulnerabilidad compartida entre los síntomas de TEPT-C y TLP puede ayudar a revelar mejor qué es lo particular de estos constructos.Objetivo: Identificar las características distintivas y compartidas de TEPT-C y TPL mediante la aplicación de procedimientos de modelado dimensional.Método: Se emplearon análisis de factores confirmatorios y bifactoriales para identificar la estructura latente óptima de los síntomas de TEPT-C y TLP entre una muestra por conveniencia de adultos israelíes (N = 617). Además, se utilizó el modelado de ecuaciones estructurales para identificar los factores de riesgo asociados con estos constructos.Resultados: La estructura latente de los síntomas de TEPT-C y TLP se explicó mejor mediante un modelo bifactorial que incluye un factor 'general' (es decir, vulnerabilidad a todos los síntomas) y tres factores correlacionados 'específicos' (es decir, vulnerabilidad a los síntomas de TEPT, DSO y TLP respectivamente). Los síntomas de TEPT-C se distinguieron más fácilmente del factor general, mientras que los síntomas de TLP no se distinguieron tan fácilmente del factor general. Los síntomas de TEPT-C que reflejan un autoconcepto negativo y los síntomas de TLP que reflejan un autoconcepto alterno fueron las características más distintivas de TEPT-C y TLP en relación con el factor general, respectivamente. La mayoría de los factores de riesgo se asociaron con el factor de vulnerabilidad general, en consonancia con las predicciones de los modelos dimensionales de psicopatología con respecto al riesgo compartido entre constructos psiquiátricos supuestamente distintos.Conclusión: De acuerdo con un modelo dimensional de psicopatología, el TEPT-C y el TLP compartían una estructura latente común, pero aún eran distinguibles. Los síntomas de TEPT-C y TLP se pueden distinguir de manera más efectiva según la fenomenología de los síntomas del autoconcepto.

Caring for the mental health of humanitarian volunteers in traumatic contexts: the importance of organisational support.

Background: Humanitarian workers operate in traumatic contexts, putting them at an increased risk of adverse mental health outcomes. The quality of the support they receive from their organization, their supervisor, and team members are proposed as determinants of mental illness and well-being, via the stress-appraisal process. Objective: Grounded in organizational support theory, we sought to understand the relationship between organizational factors, including perceived organizational support, supervisor support, and team support, and indicators of both adverse mental health and mental well-being among humanitarian volunteers. This relationship is hypothesized to be mediated by the perceived psychological stress. Methods: A sample of 409 humanitarian volunteers from the Sudanese Red Crescent Society completed an online, anonymous, survey comprised of the Perceived Supervision, Perceived Organizational Support, Team Support, and Perceived Psychological Stress scales, as well as the Generalized Anxiety Disorder and Patient Health Questionnaire scales, (GAD-7 and PHQ- 8), and the Warwick-Edinburgh Mental Well-being Scale. Study objectives were tested using structural equation modelling (SEM) procedures. Results: Perceived helplessness (PH) and perceived self-efficacy (PSE), as measures of psychological stress, were both found to fully mediate the relationship between perceived organizational support and mental health outcomes. Perceived organizational support was associated with PSE and inversely with PH. PH was associated with adverse mental health and inversely related to mental well-being. PSE was only associated with mental well-being. Perceived supervision was negatively associated with PSE. Conclusions: Perceived organizational support is a key determinant of the mental health of humanitarian volunteers, with greater perceived support associated with lower distress symptomology and greater mental well-being. Humanitarian agencies should take actions to improve their internal organization support systems to mitigate the stress associated with working in traumatic contexts. Specifically, more attention should be paid to the organizational support of the volunteers as front-line workers in humanitarian settings.

Antecedentes: Los trabajadores humanitarios operan en contextos traumáticos, lo que los pone en un mayor riesgo de resultados adversos para la salud mental. La calidad del apoyo que reciben de su organización, su supervisor, y los miembros del equipo han sido propuestos como determinantes importantes de las enfermedades mentales y el bienestar, a través del proceso de evaluación del estrés.Objetivo: Basados en la teoría del apoyo organizacional, buscamos comprender la relación entre los factores organizacionales, incluyendo el apoyo organizacional percibido, el apoyo del supervisor, y el apoyo del equipo, y los indicadores de salud mental adversa y bienestar mental entre los voluntarios humanitarios. La hipótesis es que esta relación está mediada por el estrés psicológico percibido.Métodos: Una muestra de 409 voluntarios humanitarios de la Sociedad de la Media Luna Roja Sudanesa completó una encuesta en línea, anónima, compuesta por las escalas de Supervisión Percibida, Apoyo Organizacional Percibido, Apoyo del Equipo, y Estrés Psicológico Percibido, así como las escalas de Trastorno de Ansiedad Generalizada y el Cuestionario de Salud del Paciente, (GAD-7 y PHQ-8 en sus siglas en inglés) y la Escala de Bienestar Mental Warwick-Edinburgh. Los objetivos del estudio se probaron utilizando procedimientos de modelo de ecuaciones estructurales (SEM en su sigla en inglés).Resultados: Se encontró que la desesperanza percibida (DP) y la autoeficacia percibida (AP), como medidas de estrés psicológico, mediaron completamente la relación entre el apoyo organizacional percibido y los resultados de salud mental. El apoyo organizacional percibido se asoció con la DP (b = −0.60) y la AP (b = 0.56). La DP se asoció con salud mental adversa (b = 0.88) y se relacionó inversamente con el bienestar mental (b = −0.43). La AP solo se asoció con el bienestar mental (b = 0.41). La supervisión percibida se asoció negativamente con la AP (b = −0.33).Conclusiones: El apoyo organizacional percibido es un determinante clave de la salud mental de los voluntarios humanitarios, con mayor apoyo percibido asociado con menor sintomatología de angustia y mayor bienestar mental. Las agencias humanitarias deberían tomar medidas para mejorar los sistemas de apoyo de su organización interna para mitigar el estrés asociado con el trabajo en contextos traumáticos. Específicamente, se debe prestar más atención al apoyo organizacional de los voluntarios como trabajadores de primera línea en entornos humanitarios.