Mediators and Moderators of Active Music Engagement to Reduce Traumatic Stress Symptoms and Improve Well-being in Parents of Young Children With Cancer.

OBJECTIVE: This trial examined the effects of proximal/distal mediators and moderators of an Active Music Engagement (AME) intervention on young child/parent distress, quality of life, and family function outcomes. METHODS: Child/parent dyads (n = 125) were randomized to AME or Audio-storybooks attention control condition. Each group received 3 sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention (T2), and 30-days later (T3). Potential proximal mediators included within session child and parent engagement. Potential distal mediators included changes in perceived family normalcy, parent self-efficacy, and independent use of play materials. Potential moderators included parent/child distress with prior hospitalizations, parent traumatic stress screener (PCL-6), and child age. Outcomes included child emotional distress and quality of life; parent emotion, traumatic stress symptoms (IES-R), well-being; and family function. Mediation effects were estimated using ANCOVA, with indirect effects estimated using the percentile bootstrap approach. Moderation effects were tested by including appropriate interaction terms in models. RESULTS: No significant mediation effects were observed. Child distress with prior hospitalizations moderated AME effects for IES-R intrusion subscale scores at T2 (P = .01) and avoidance subscale scores at T3 (P = .007). Traumatic stress screener scores (PCL-6) moderated intervention effects for IES-R hyperarousal subscale scores at T2 (P = .01). There were no moderation effects for child age. CONCLUSIONS: AME is a promising intervention for mitigating traumatic stress symptoms and supporting well-being in parents of children with cancer, particularly for parents who screen high for traumatic stress and whose children are more highly distressed with hospitalization.

History of the term 'appeasement': a response to Bailey et al. (2023).

This letter to the editor aims to address claims made by Bailey et al. [2023. Appeasement: Replacing Stockholm syndrome as a definition of a survival strategy. European Journal of Psychotraumatology, 14(1), 2161038] about the history of the concept of appeasement in relation to mammalian survival responses as well as the fawn response, by offering a brief overview and analysis of the literature.

Appeasement in political and foreign policy, social justice, ethology, psychology, and communication studies (multiple mammalian and avian species) feature elements of coregulation.The original conceptualisation of the fawn response may result in the misperception that it is unrelated to coregulation.Appeasement and coregulation can occur whether the vulnerable party initiating the appeasement is in a state that supports affiliative, distress, or shutdown behaviour.

Exploring Pathways and Obstacles to Well-Being in Victims of Terrorism: A Qualitative Approach

On March 11, 2004, Madrid suffered one of the worst terrorist attacks in the history of Spain, leaving more than 190 dead and 2,000 injured. For years, the psychological consequences of the attacks have been studied; however, its long-term effects on symptomatology and especially on well-being remains unknown. This study aims to explore, through a qualitative approach, pathways and obstacles to the well-being of those affected directly or indirectly by the attacks of March 11 in Madrid. Two focus groups were held, one for indirect victims and one for direct victims. Subsequently, a thematic analysis of the materials obtained was carried out. More than 10 years after the attacks, most of the participants reported great difficulty in achieving well-being. Acceptance and victims’ associations seemed to act as key facilitators, while symptoms, political institutions and the media were the main obstacles. Direct and indirect victims presented similar data although aspects such as guilt and family relationships played a different role in their well-being. (AU)

The association between peritraumatic distress, perceived stress, depression in pregnancy, and NR3C1 DNA methylation among Chinese pregnant women who experienced COVID-19 lockdown.

Prenatal stress can affect pregnant women in an epigenetic way during the critical period of conception of their offspring. The study aims to investigate the relationship between peritraumatic distress, prenatal perceived stress, depression, and glucocorticoid receptor (NR3C1) DNA methylation among pregnant women who experienced COVID-19 lockdown in China. Study data were collected from 30 pregnant women in Wuhan and Huanggang, China. The Peritraumatic Distress Inventory was used to measure peritraumatic distress, the Edinburgh Postnatal Depression Scale was used to measure depressive symptoms, and the Perceived Stress Scale was used to measure perceived stress. DNA methylation in the exon 1F promoter region of NR3C1 gene from the venous blood mononuclear cell genome was characterized by bisulfite sequencing. Correlation and linear regression were used for data analysis. The mean level of peritraumatic distress, perceived stress, and depression was 6.30 (SD = 5.09), 6.50 (SD = 5.41), and 6.60 (SD = 4.85), respectively, with 23.33% of pregnant women being depressed. The mean NR3C1 methylation was 0.65 (SD = 0.22). Prenatal depression was positively correlated with the degree of methylation in venous blood from the mother (r = 0.59, p = 0.001), and depression predicted methylation of NR3C1 gene at the CpG 8 site (ß = 0.05, p = 0.03). No association was found between peritraumatic distress as well as perceived stress and methylation of NR3C1. NR3C1 gene was susceptible to epigenetic modification of DNA methylation in the context of prenatal stress, and maternal depression was associated with increased NR3C1 methylation among women who experienced COVID-19 lockdown.

Evaluación y satisfacción del debriefing facilitado por un instructor frente al facilitado por iguales / Assessment and satisfaction regarding the debriefing provided by an instructor vs. the one provided by peers

Objetivo: comparar la evaluación y la satisfacción de las personas participantes del debriefing facilitado por iguales frente al realizado por instructores en simulación clínica de alta fidelidad en un postgrado en Enfermería en Emergencias Extrahospitalarias. Método: estudio cuasiexperimental realizado en 2019 en la Universidad Rey Juan Carlos (Madrid). La población fueron todos los enfermeros matriculados por primera vez. Se asignaron a grupo control (debriefing facilitado por instructoras experimentadas - GC) o grupo intervención (facilitado por iguales a quienes se formó dos horas en debriefing - GI). Tras cada simulación (cuatro en total) se evaluaron los debriefing mediante el cuestionario EDSS© (29 ítems de mín. 1 a máx. 7 puntos) y la satisfacción (mín. 1 a máx. 7 puntos). Se efectuó estadística descriptiva y comparación de los resultados globales de las cuatro sesiones en ambos grupos. Resultados: participaron las 30 personas matriculadas. La evaluación con el cuestionario EDSS© fue similar en ambos grupos, excepto en la capacidad del facilitador para establecer un ambiente de aprendizaje estimulante (GC = 6,61; GI = 6,23; p= 0,019) y en el nivel de conocimientos de este y su empleo para ayudar al participante a mejorar su rendimiento futuro (GC = 6,74; GI = 6,33; p= 0,003). La satisfacción global fue similar en ambos grupos (GC = 6,63; GI = 6,55; p= 0,374). Conclusiones: el debriefing facilitado por un igual supone una alternativa al debriefing tradicional en la formación de enfermeras de postgrado en relación con los resultados de evaluación de participantes y su satisfacción, si bien han de evaluarse también otros aspectos.(AU)

Objective: to compare the assessment and satisfaction by participants for the debriefing provided by peers vs. the one conducted by instructors in a high fidelity clinical simulation at a post-graduate Nursing course on Out-of-Hospital Emergencies. Method: a quasi-experimental study conducted in 2019 at the Universidad Rey Juan Carlos (Madrid). The population consisted in nurses who had been enrolled for the first time. They were assigned to a control arm (debriefing provided by experienced instructors – CA) or an intervention arm (provided by peers who received a 2-hour training on debriefing – IA). After each simulation (four in total) debriefings were assessed through the EDSS© questionnaire (29 items from 1 to 7 scores), and satisfaction (from 1 to 7 scores). Descriptive statistics was conducted as well as comparison for the overall results of the four sessions in both arms. Results: all the 30 persons enrolled participated in the study. The evaluation with the EDSS© questionnaire was similar in both arms, except in the ability of the facilitator to establish a stimulating learning environment (CA = 6.61; IA = 6.23; p= 0.019) and in the level of knowledge of the facilitator and how they used it to help the participants to improve their future performance (CA = 6.74; IA = 6.33; p= 0.003). Overall satisfaction was similar in both arms (CA = 6.63; IA = 6.55; p= 0.374). Conclusions: debriefing facilitated by a peer represents an alternative to traditional debriefing in post-graduate nurse training, based on the evaluation results of participants and their satisfaction; however, other aspects should also be assessed.(AU)

Desarrollo de la Escala de Actitudes Disfuncionales Traumáticas (EADT) para víctimas de terrorismo / Development of the traumatic dysfunctional attitude scale (EADT) for victims of terrorism

Introduction and objectives. Post-traumatic stress disorder (PTSD) is the most common psychological disorder in victims of terrorism. Cognitive models of PTSD postulate that dysfunctional attitudes play a fundamental role in its etiology, maintenance, and treatment. The objective of this study was to develop a self-report instrument to assess traumatic dysfunctional attitudes typical of victims of terrorism: the Traumatic Dysfunctional Attitude Scale (EADT by its original Spanish acronym). Materials and method. The EADT items were extracted from 480 recorded hours of trauma-focused cognitive-behavioral therapy administered to 59 victims of terrorism with PTSD and after an analysis of items’ content and intelligibility by a group of psychologists. A preliminary 84-item version was administered to a sample of 253 victims of terrorism along with measures of PTSD, depression, and depressive dysfunctional attitudes. Results. A series of factorial and reliability analyses on the preliminary version allowed one to arrive at a definitive version composed of 34 items and three correlated factors: dangerous world, negative view of society and the human being, and chronicity of distress. The psychometric analyses of the definitive version revealed good evidence concerning the internal structure of the test, score internal consistency, the differentiation of known groups, and the relationships with conceptually related constructs. Conclusions. The EADT is a simple instrument whose scores have good psychometric properties and can be useful to assess, both in research and applied contexts, the dysfunctional attitudes that victims of terrorism may present.

Introducción y objetivos. El trastorno de estrés postraumático (TEPT) es el trastorno psicológico más frecuente en las víctimas del terrorismo. Los modelos cognitivos del TEPT postulan que las actitudes disfuncionales desempeñan un papel fundamental en su etiología, mantenimiento y tratamiento. El objetivo de este estudio fue desarrollar un instrumento de autoinforme para evaluar las actitudes disfuncionales traumáticas específicas de las víctimas del terrorismo: la Escala de Actitudes Disfuncionales Traumáticas (EADT). Materiales y método. Los ítems de la EADT fueron extraídos de 480 horas grabadas de terapia cognitivo-conductual centrada en el trauma aplicada a 59 víctimas del terrorismo con TEPT y tras un análisis del contenido e inteligibilidad de los ítems por un grupo de psicólogos. Una versión preliminar de 84 ítems se aplicó a una muestra de 253 víctimas del terrorismo junto con medidas de TEPT, depresión y actitudes disfuncionales depresivas. Resultados. Una serie de análisis factoriales y de fiabilidad sobre la versión preliminar permitió llegar a una versión definitiva compuesta por 34 ítems y tres factores correlacionados: mundo peligroso, visión negativa de la sociedad y del ser humano, y cronificación del malestar. Los análisis psicométricos de la versión definitiva revelaron buenos datos empíricos para la estructura interna de la EADT, la consistencia interna de sus puntuaciones, la diferenciación de grupos contrastados y las relaciones con constructos conceptualmente relacionados. Conclusiones. La EADT es un instrumento sencillo cuyas medidas presentan buenas propiedades psicométricas y pueden ser útiles para evaluar, tanto en contextos de investigación como aplicados, las actitudes disfuncionales que pueden presentar las víctimas del terrorismo.

Psychological state of a sample of patients with mood disorders during the first French COVID-19 lockdown.

Since the beginning of the COVID-19 pandemic, evidence shows the negative psychological impact of lockdown measures in the general population. It is also important to identify predictors of psychological distress in vulnerable people, particularly patients with history of depressive episodes (the most prevalent psychiatric disorder), in order to adapt mental health strategies for future lockdown measures. This study aim was to (1) compare in 69 healthy controls (HC) and 346 patients with a major depressive episode in the two previous years (PP) self-reported psychological symptoms (depression, anxiety, insomnia, suicidal ideation, traumatic stress, anger) and living conditions during the first national French lockdown, and (2) identify predictors of significant psychological distress in PP. The levels of psychological symptoms were very low in HC compared with PP, independently of the living conditions. Half of PP had no psychiatric contact during the lockdown. Loneliness and boredom were independent predictors of depression, anxiety and insomnia, whereas daily physical activity was a protective factor. Virtual contacts protected against suicidal ideation. Our results highlight the need of specific strategies to target loneliness and boredom and to improve care access, including telepsychiatry. Longitudinal studies must investigate the COVID-19 pandemic psychological impact in clinical samples.

Estrutura interna da versão brasileira do Questionário de Estresse Traumático Secundário / Internal structure of the Secondary Traumatic Stress Questionnaire in Brazil / Estructura interna de la versión brasileña del Cuestionario de Estrés Traumático Secundario

O Estresse Traumático Secundário caracteriza-se por um conjunto de sintomas e condutas que se manifestam após a exposição indireta ao trauma. Profissionais que cuidam de pessoas traumatizadas estão susceptíveis ao transtorno. Este estudo examinou a estrutura interna da versão brasileira do Cuestionario de Estrés Traumático Secundario. Participaram 624 profissionais da saúde, acessados on-line. Para realização das análises fatoriais, a amostra foi dividida em dois grupos. Na análise exploratória, foram retidos 12 componentes, com cargas fatoriais entre 0,312 e 0,999. Os resultados da análise confirmatória revelaram que o modelo de doze fatores para 50 itens forneceu o melhor ajuste possível para os dados (RMSEA = 0,044; IC = 10%-90%; CFI = 0,949; TLI = 0,904) e índice de consistência interna geral do modelo foi de 0,91. Esses doze fatores foram distribuídos em quatro escalas (Antecedentes, Síndrome de Trauma Secundário, Personalidade e Consequências), com índices psicométricos relativamente baixos e uma nova organização dos itens das escalas do QETS, em contraste com a versão teórica original do instrumento. Sugere-se que novos estudos psicométricos analisem as escalas do questionário, separadamente, e investiguem outras categorias profissionais, especialmente na área dos serviços de emergências, além de estudos comparativos com amostras clínicas. (AU)

Secondary Traumatic Stress is characterized by a set of symptoms and behaviors that manifest themselves after the indirect exposure to the trauma. Professionals caring for traumatized people are susceptible to the disorder. This study examined the internal structure of the Brazilian version of the Cuestionario de Estrés Traumático Secundario. 624 health professionals participated, accessing the online questionnaire. To perform the factorial analysis, the sample was divided into two groups. In the exploratory analysis, 12 components were retained, with factorial loads between 0.312 and 0.999. The confirmatory analysis revealed a twelve-factor model for 50 items provided the best possible fit for the data (RMSEA = 0.044; CI = 10% -90%; CFI = 0.949; TLI = 0.904). However, at the end of the data discussion, 48 items remained in the model, and the overall internal consistency index of the model was 0.91. These twelve factors were distributed on four scales (Background, Secondary Trauma Syndrome, Personality and Consequences), with relatively low psychometric indices and a new organization of the items on the QETS scales in contrast to the theoretical framework in the the original instrument. It is suggested that new psychometric studies analyze the scales of the questionnaire separately and investigate other professional categories, especially in the area of emergency services and comparative studies with clinical samples. (AU)

El estrés traumático secundario se caracteriza por un conjunto de síntomas y conductas que se manifiestan después de la exposición indirecta al trauma. Los profesionales que cuidan a las personas traumatizadas son susceptibles al trastorno. Este estudio examinó estructura interna de la versión brasileña del Cuestionario de Estrés Traumático Secundario. Participaron 624 profesionales de la salud, accediendo al cuestionario online. Para la realización de los análisis factoriales la muestra fue dividida en dos grupos. En el análisis exploratorio, se retuvieron 12 componentes, con cargas factoriales entre 0.312 y 0.999. El análisis confirmatorio reveló que el modelo de doce factores para 50 ítems proporcionó el mejor ajuste posible para los datos (RMSEA = 0.044; IC = 10% -90%; CFI = 0.949; TLI = 0.904). Sin embargo, al final de la discusión de los datos quedaron 48 ítems en el modelo. El índice de consistencia interna general del modelo fue de 0,91. Estos doce factores se distribuyeron en cuatro escalas (Antecedentes, Síndrome de Trauma Secundario, Personalidad y Consecuencias), con índices psicométricos relativamente bajos y una nueva organización de los ítems en las escalas QETS, en contraste con la versión teórica original del instrumento. Se sugiere que nuevos estudios psicométricos analizan las escalas del cuestionario por separado e investiguen otras categorías profesionales, especialmente en el área de los servicios de emergencias y estudos comparativos con amostras clínicas. (AU)

Leveraging the Biology of Adversity and Resilience to Transform Pediatric Practice.

Advances in science are fundamentally changing the way we understand how inextricable interactions among genetic predispositions, physical and social environments, and developmental timing influence early childhood development and the foundations of health and how significant early adversity can lead to a lifetime of chronic health impairments. This article and companion article illustrate the extent to which differential outcomes are shaped by ongoing interactive adaptations to context that begin at or even before conception and continue throughout life, with increasing evidence pointing to the importance of the prenatal period and early infancy for the developing brain, the immune system, and metabolic regulation. Although new discoveries in the basic sciences are transforming tertiary medical care and producing breakthrough outcomes in treating disease, this knowledge is not being leveraged effectively to inform new approaches to promoting whole-child development and preventing illness. The opportunity for pediatrics to serve as the leading edge of science-based innovation across the early childhood ecosystem has never been more compelling. In this article, we present a framework for leveraging the frontiers of scientific discovery to inform new strategies in pediatric practice and advocacy to protect all developing biological systems from the disruptive effects of excessive early adversity beyond providing information on child development for parents and enriched learning experiences for young children.

PTSD Coach Online-Arabic: A Randomized Controlled Pilot Trial to Examine Feasibility, Acceptability, and Preliminary Effectiveness.

The Egyptian Revolution of 2011 resulted in high-level exposure to sociopolitical violence, placing a large burden on the mental health care system that cannot be effectively met given the small number of available providers in Egypt. We conducted a nonblinded, randomized controlled pilot trial of an online, self-directed tool for managing posttraumatic stress symptoms (PTSS). The study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of the PTSD Coach Online-Arabic. Trauma-exposed Egyptian adults with clinically significant PTSS (N = 87; intervention group: n = 41) completed assessments at baseline, weekly over the treatment period, posttest, and 3-month follow-up. Of participants who completed weekly surveys, 88.9% used the program; 22.0% of participants reported regular, weekly use. Most tools received good likeability and perceived benefit scores, but lower perceived benefit scores on three tools suggest that some content may require additional adaptation. Intent-to-treat analyses using multilevel modeling with multiple imputation to account for missing data were conducted. Effect sizes for PTSS were below the cutoff for small effects at posttest, d = -0.14, but demonstrated a small positive effect at 3-months, d = -0.25. There was a small positive effect of treatment on anxiety at posttest, d = -0.37, and a medium effect at 3-month follow-up, d = -0.49. Treatment effects for depressed mood were below the cutoff for small effects at posttest and 3-months, ds = -0.14 and -0.18. These findings suggest that the PTSD Coach Online-Arabic may be a promising supplemental resource for support in this setting.

Barriers and facilitators to implementation of trauma support services at a large HIV treatment center in the Southern United States.

The high prevalence of trauma among people living with HIV underscore the need for tailored, integrated trauma management ("trauma-informed care" or TIC) to improve retention, adherence to care, and overall well-being. Although TIC has been identified as a priority area for HIV care, uptake has been limited. To investigate barriers and facilitators to integrating trauma support services within HIV primary care, surveys (n=94) and interviews (n=44) were administered to providers, staff, and patients at a large HIV treatment center. Results highlighted the availability of several trauma services, including psychotherapy and support groups, but also revealed the absence of provider training on how to respond to patient trauma needs. Identified gaps in TIC services included written safety and crisis prevention plans, patient education on traumatic stressors, and opportunities for creative expression. Providers and staff supported implementation of trauma support services and employee trainings, but expressed a number of concerns including resource and skill deficiencies. Patient-reported barriers to TIC services included lack of awareness of services and difficulties navigating the healthcare system. This assessment revealed support and methods for strengthening integration of trauma support services within HIV primary care, which future TIC implementation efforts should address.

Peritraumatic reactions during the COVID-19 pandemic - The contribution of posttraumatic growth attributed to prior trauma.

Trauma survivors who suffer from posttraumatic stress disorder (PTSD) symptoms may be particularly vulnerable when facing the COVID-19 pandemic. Yet trauma exposure may also lead to salutogenic outcomes, known as posttraumatic growth (PTG). Nevertheless, the implications of PTG attributed to prior trauma, for trauma survivors' adjustment when facing additional stressors, are unclear. Addressing this gap, 528 Israeli trauma survivors were assessed for PTG and PTSD symptoms attributed to prior trauma, as well as peritraumatic stress symptoms related to the pandemic, as part of an online survey. Analyses revealed that being younger, female, quarantined, negatively self-rating one's health status, and suffering from PTSD symptoms were associated with elevated peritraumatic stress symptoms. Furthermore, PTG attributed to prior trauma made a significant contribution in explaining elevated intrusion, avoidance, and hyperarousal symptoms. The present results point to the need for clinicians to take into account reports of PTG attributed to prior trauma when treating trauma survivors during the current pandemic.

Caregiver satisfaction with their child's trauma-focused cognitive behavioral therapy.

Background: Despite the value trauma-focused cognitive-behavioral therapy (TF-CBT) places on caregivers being included in treatment, limited qualitative research has examined their experience with treatment. Thus, this research aimed to assess (a) overall caregiver satisfaction; (b) aspects of TF-CBT caregivers found most and least useful or thought could be improved; and (c) if satisfaction differed between caregivers of completers and noncompleters. Methods: In total, 1,778 caregiver/child dyads were included. Caregivers of children receiving TF-CBT completed the Caregiver Satisfaction Questionnaire. To assess overall satisfaction, descriptive statistics were compiled. To assess what aspects of TF-CBT were most/least helpful or could be improved, thematic analysis was conducted. Finally, a t test was conducted to determine whether overall satisfaction with TF-CBT differed between caregivers who had children who did and did not complete treatment. Results: Overall satisfaction with TF-CBT was high. Qualitatively, caregivers reported PRACTICE components, communication between parties in treatment, the child learning coping skills, and the child experiencing positive outcomes as most helpful. Least helpful aspects included scheduling, not seeing positive outcomes, and the child and outside factors impeding treatment. When making suggestions for improvement, caregivers suggested changes in scheduling and session length/frequency, and an increase in their involvement. Quantitatively, caregivers of children who completed treatment experienced significantly higher total mean satisfaction scores than caregivers of noncompleters. Conclusions: Caregiver satisfaction should be assessed during TF-CBT, with efforts made to identify and address key areas of concern caregivers may be experiencing. Focusing on caregiver satisfaction may prevent treatment attrition, allowing children to increasingly receive evidence-based care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perda gestacional de repetição: aspectos psíquicos e terapias comportamentais / Recurrent pregnancy loss: psychic aspects and behavioral therapies

A perda gestacional de repetição (PGR) é definida classicamente como três perdas consecutivas antes de 20 semanas de gestação. Ela afeta aproximadamente 3% dos casais que tentam conceber, quando se consideram pelo menos duas perdas, e cerca de 1%, quando acima de três perdas. A PGR está associada a diferentes fatores causais. Algumas mulheres não terão nenhuma anormalidade identificável nos protocolos investigativos atuais. O aborto pode causar doenças mentais, tais como depressão e ansiedade, e ser responsável por sentimentos como medo, raiva e culpa. Embora existam intervenções já estabelecidas para pacientes com perda gestacional com fator causal determinado, não existe nenhum tratamento comprovadamente efetivo em mulheres com perda gestacional inexplicada. O oferecimento do chamado Tender Loving Care pode levar a melhores resultados gestacionais nessas pacientes. Este artigo irá fazer uma revisão sobre os aspectos psíquicos em PGR e o cuidado suportivo que poderá ser realizado nessas pacientes.(AU)

Recurrent pregnancy loss (RPL) is classically defined as three consecutive losses before 20 weeks of gestation. It affects approximately 3% of couples who try to conceive, when considering at least two losses, and about 1%, when considering three or more. RPL is associated with different causal factors. Some women will have no identificable abnormalities in current investigative protocols. Abortion can cause mental illness, such as depression and anxiety, and be responsible for feelings like fear, anger and guilt. Although there are interventions already established for patients with pregnancy loss with a determined causal factor, there is no proven effective treatment for women with unexplained pregnancy loss. The offer of the so-called Tender Loving Care can lead to better pregnancy results in these patients. This article will review the psychic aspects of recurrent pregnancy losses and the supportive care that can be performed in these patients.(AU)

Shook Ones: Understanding the Intersection of Nonfatal Violent Firearm Injury, Incarceration, and Traumatic Stress Among Young Black Men.

Violent injury is a leading cause of death and disability among young Black men, with the highest rates occurring in low-income urban populations. Hospital-based violence intervention programs (HVIPs) offer a promising opportunity to address the biopsychosocial factors that adversely affect this population. However, there are major gaps between the needs of young Black male survivors of violent injury and the forms of care provided by HVIPs. Patient-centered outcomes research provides a useful mode of inquiry to develop strategies to decrease these differences. Care for survivors, including treatment for traumatic stress disorders, must be reconceptualized to center the lived experiences of young Black men. This paper qualitatively explores how these survivors of gun violence express symptoms of traumatic stress and the ways in which their narratives can inform the implementation of the biopsychosocial model in HVIPs. A phenomenological variant ecological systems theory framework was used to analyze participant narratives to aid in understanding their symptoms of traumatic stress and post-injury affective changes as both psychologically and socially important experiences. Such insight may inform changes to HVIP practice to address persistent health disparities related to violence.

Perceived Stress, Stigma, Traumatic Stress Levels and Coping Responses amongst Residents in Training across Multiple Specialties during COVID-19 Pandemic-A Longitudinal Study.

This study aimed to explore changes in psychological responses (perceived stress, traumatic stress, stigma, coping) over time in residents, as well as their predictors. The level of perceived stress, traumatic stress, stigma, and coping responses were assessed using the Perceived Stress Scale, Impact of Event-Revised, Healthcare Workers Stigma Scale, and Brief Coping Orientation to Problems Experienced (COPE) Inventory, respectively. We collected responses from 274 residents at baseline and 221 residents at 3 months follow-up (timepoint 2) from the National Healthcare Group (NHG) residency programs in Singapore. All residents reported lower perceived stress and lower perceived stigma compared to baseline. Use of avoidance coping was associated with all three psychological responses (perceived stress, traumatic stress, and stigma) across the two timepoints. Compared to baseline, specific factors associated with perceived stress and traumatic stress at timepoint 2 were living alone, less problem solving, and seeking social support. Residency programs should encourage active coping strategies (e.g., seeking social support, positive thinking, problem solving) among residents, and proactively identify residents who may be at higher risk of psychological sequelae due to circumstances that contribute to isolation.

Past Epidemics, Natural Disasters, COVID19, and Mental Health: Learning from History as we Deal with the Present and Prepare for the Future.

As cases of the coronavirus disease (COVID-19) continue to rise, psychological endurance is a challenge many people will face. For mental health, heightened stress responses to the pandemic, is likely to manifest in three ways: 1) development of a new episode of a disorder in those with a predisposition to a major psychiatric disorder or an acute exacerbation in those who already have such a disorder, 2) development of a trauma or stressor related disorder, such as acute stress disorder, Post Traumatic Stress Disorder (PTSD), or adjustment disorders, and 3) development of a symptomatic stress response that does not meet the diagnostic criteria of a psychiatric disorder. The authors reviewed existing literature on past epidemics, natural disasters, and COVID-19 with a focus on psychiatry and mental health. Psychological effects of past epidemics (Severe Acute Respiratory Syndrome CoV-1, Ebola, Middle East Respiratory Syndrome, the Anthrax threat), past natural disasters, and current COVID-19 data suggest numerous psychological effects following the pandemic. Alcohol use, PTSD, anxiety, anger, fear of contagion, perceived risk, uncertainty, and distrust are a few of the immediate and long-term effects that are likely to result from the COVID-19 pandemic. Identifying people in need of mental health care and determining the appropriate psychiatric services and therapy needed will be important. Increasing the use and availability of telehealth, group meetings, and online resources are some ways that health care workers can prepare for the increasing demand of psychiatric services during and following the pandemic.

Impact of COVID-19 on Public Mental Health and the Buffering Effect of a Sense of Coherence.

INTRODUCTION: It is claimed that the coronavirus disease 2019 (COVID-19) pandemic has had a negative impact on mental health. However, to date, prospective studies are lacking. Moreover, it is important to identify which factors modulate the stress response to the pandemic. Previously, sense of coherence (SOC) has emerged as a particularly important resistance factor. OBJECTIVE: This prospective study aimed to assess the impact of the COVID-19 outbreak on mental health and to investigate the ability of pre-outbreak SOC levels to predict changes in psychopathological symptoms. METHODS: This study assessed psychopathological symptoms and SOC before and after the COVID-19 outbreak as well as post-outbreak COVID-19-related traumatic distress in a German-speaking sample (n =1,591). Bivariate latent change score (BLCS) modeling was used to analyze pre- to post-outbreak changes in psychopathological symptoms and the ability of SOC to predict symptom changes. RESULTS: Overall, there was no change in psychopathological symptoms. However, on an individual-respondent level, 10% experienced a clinically significant increase in psychopathological symptoms and 15% met cut-off criteria for COVID-19-related traumatic distress. Using BLCS modeling, we identified a high-stress group experiencing an increase in psychopathological symptoms and a decrease in SOC and a low-stress group showing the reversed pattern. Changes in SOC and psychopathological symptoms were predicted by pre-outbreak SOC and psychopathological symptom levels. CONCLUSIONS: Although mental health was stable in most respondents, a small group of respondents characterized by low levels of SOC experienced increased psychopathological symptoms from pre- to post-outbreak. Thus, SOC training might be a promising approach to enhance the resistance to stressors.

Sources of functioning, symptoms of trauma, and psychological distress: A cross-sectional study with Palestinian health workers operating in West Bank and Gaza strip.

Health-care workers operating in conflict zones are at severe risk of psychological consequences, given their extended exposure to traumatic events under conditions of stress and violence. This quantitative, cross-sectional study was designed to explore the relationships between personal resources (sources of functioning)-operationalized as sense of coherence, posttraumatic growth, and perceived well-being-psychological distress, and trauma symptoms in a specific population of health workers exposed to war and violence. Palestinian health professionals (N = 181) completed quantitative measures of well-being, posttraumatic growth, sense of coherence, psychological distress, and traumatic response. The data were analyzed using structural equation modeling (SEM). The outcomes suggest that sources of psychological functioning consistently play a role in the mental health of different types of health professionals. Health-care workers in an environment characterized by instability and ongoing risk need to protect their own mental health by mobilizing sources of resistance and resilience, such as a sense of coherence, subjective well-being, and growth. We discuss the clinical implications of these findings and offer recommendations for training and supervision. (PsycInfo Database Record (c) 2020 APA, all rights reserved).