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1.
Nurs Res ; 71(1): 66-74, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34644271

RESUMO

BACKGROUND: Potentially traumatic experiences throughout the life course are associated with poor cardiovascular health among women. However, research on the associations of trauma with cardiovascular health among Latino populations is limited. Understanding the impact of trauma on cardiovascular health within marginalized populations may provide guidance on developing interventions with a particular focus on preventative care. OBJECTIVE: The purpose of this descriptive cross-sectional study was to examine the associations of lifetime trauma with cardiovascular health among middle-aged and older Latina women. METHODS: Participants were recruited from an existing study in New York City. All participants completed a structured questionnaire to assess lifetime trauma, demographic characteristics (such as age and education), financial resource strain, and emotional support. The Trauma History Questionnaire was used to assess lifetime exposure to potentially traumatic experiences (range 0-24). Cardiovascular health was measured with a validated measure of cardiovascular health from the American Heart Association (Life's Simple 7). We used self-reported and objective data to calculate cardiovascular health scores (range 0-14). Multiple linear regression was used to examine the associations of lifetime trauma with cardiovascular health, adjusted for age, education, financial resource strain, and emotional support. RESULTS: The sample included 50 Latina women with a mean age of 63.1 years, 88% were Dominican, and only 6% had completed a college degree. Women reported an average of 4.8 traumatic experiences. Mean cardiovascular health score was 6.5 (SD = 1.6, range 3-10). Linear regression models found that, after adjusting for age, education, financial resource strain, and emotional support, a higher count of lifetime trauma was associated with worse cardiovascular health. However, this association did not reach statistical significance. DISCUSSION: Women with a higher count of lifetime trauma had worse cardiovascular health scores; this association was not statistically significant. Future studies should investigate associations of lifetime trauma and cardiovascular health in larger and more diverse samples of Latinas. Nurses and other clinicians should incorporate trauma-informed approaches to cardiovascular disease risk reduction to improve the cardiovascular health of Latina women who are survivors of trauma.


Assuntos
Doenças Cardiovasculares/etnologia , Hispânico ou Latino/estatística & dados numéricos , Transtornos Relacionados a Trauma e Fatores de Estresse/etnologia , Idoso , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Hispânico ou Latino/psicologia , Humanos , Acontecimentos que Mudam a Vida , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Cidade de Nova Iorque/etnologia , Transtornos Relacionados a Trauma e Fatores de Estresse/epidemiologia , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia
2.
PLoS Med ; 18(6): e1003664, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34111122

RESUMO

BACKGROUND: Anxiety, obsessive-compulsive, and stress-related disorders frequently co-occur, and patients often present symptoms of several domains. Treatment involves the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), but data on comparative efficacy and acceptability are lacking. We aimed to compare the efficacy of SSRIs, SNRIs, and placebo in multiple symptom domains in patients with these diagnoses over the lifespan through a 3-level network meta-analysis. METHODS AND FINDINGS: We searched for published and unpublished randomized controlled trials that aimed to assess the efficacy of SSRIs or SNRIs in participants (adults and children) with diagnosis of any anxiety, obsessive-compulsive, or stress-related disorder in MEDLINE, PsycINFO, Embase, and Cochrane Library from inception to 23 April 2015, with an update on 11 November 2020. We supplemented electronic database searches with manual searches for published and unpublished randomized controlled trials registered in publicly accessible clinical trial registries and pharmaceutical companies' databases. No restriction was made regarding comorbidities with any other mental disorder, participants' age and sex, blinding of participants and researchers, date of publication, or study language. The primary outcome was the aggregate measure of internalizing symptoms of these disorders. Secondary outcomes included specific symptom domains and treatment discontinuation rate. We estimated standardized mean differences (SMDs) with 3-level network meta-analysis with random slopes by study for medication and assessment instrument. Risk of bias appraisal was performed using the Cochrane Collaboration's risk of bias tool. This study was registered in PROSPERO (CRD42017069090). We analyzed 469 outcome measures from 135 studies (n = 30,245). All medications were more effective than placebo for the aggregate measure of internalizing symptoms (SMD -0.56, 95% CI -0.62 to -0.51, p < 0.001), for all symptom domains, and in patients from all diagnostic categories. We also found significant results when restricting to the most used assessment instrument for each diagnosis; nevertheless, this restriction led to exclusion of 72.71% of outcome measures. Pairwise comparisons revealed only small differences between medications in efficacy and acceptability. Limitations include the moderate heterogeneity found in most outcomes and the moderate risk of bias identified in most of the trials. CONCLUSIONS: In this study, we observed that all SSRIs and SNRIs were effective for multiple symptom domains, and in patients from all included diagnostic categories. We found minimal differences between medications concerning efficacy and acceptability. This three-level network meta-analysis contributes to an ongoing discussion about the true benefit of antidepressants with robust evidence, considering the significantly larger quantity of data and higher statistical power when compared to previous studies. The 3-level approach allowed us to properly assess the efficacy of these medications on internalizing psychopathology, avoiding potential biases related to the exclusion of information due to distinct assessment instruments, and to explore the multilevel structure of transdiagnostic efficacy.


Assuntos
Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Transtornos Relacionados a Trauma e Fatores de Estresse/tratamento farmacológico , Adulto , Idoso , Ansiolíticos/efeitos adversos , Ansiedade/diagnóstico , Ansiedade/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metanálise em Rede , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos , Transtornos Relacionados a Trauma e Fatores de Estresse/diagnóstico , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia , Resultado do Tratamento
3.
Gerontology ; 67(1): 17-24, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33254165

RESUMO

INTRODUCTION: Falls among older people are a major health issue and the first cause of accidental death after 75 years of age. Post-fall syndrome (PFS) is commonly known and yet poorly studied. OBJECTIVE: Identify risk factors for PFS and do a follow-up 1 year later. METHODS: We included all patients over 70 years of age hospitalized after suffering a fall in a case-control study, and then followed them in a cohort study. PFS was retained in case of functional mobility decline (transferring, walking) occurring following a fall in the absence of an acute neurological, orthopedic or rheumatic pathology directly responsible for the decline. The data initially collected were: clinical (anamnestic, emergency and departmental/ward evolution, medical history, lifestyle, treatments, clinical examination items); and imaging if the patient had been subjected to brain imaging in the last 3 years prior to inclusion. Regarding the follow-up at 1 year, we collected from the general physician the occurrence and the characteristics of new falls, functional mobility assessment, hospitalization and death. RESULTS: Inclusion took place from March 29, 2016 to June 7, 2016 and follow-up until June 30, 2017. We included 70 patients. A total of 29 patients exhibited a PFS (41.4 %). Risk factors for PFS included age, walking disorder prior to the fall, the use of a walking aid prior to the fall, no unaccompanied outdoor walk in the week before the fall, visual impairment making close reading impossible, stiffness in ankle dorsiflexion, grip strength and the fear of falling. Among patients with PFS, 52.9% could still perform a transfer at 1 year and 64.7% could still walk against 80.7% and 85.2%, respectively, for patients without PFS. CONCLUSION: The study showed the existence of body functions/structure impairments and activity limitations prior to the fall among patients exhibiting a PFS. This suggests the existence of a pre-fall syndrome, i.e., a psychomotor disadaptation syndrome existing prior to the fall. Among the 8 risk factors, fear of falling, vision impairment and muscle strength could be targeted for improvement. The diagnosis of PFS could be a marker of loss of functional mobility at 1 year.


Assuntos
Acidentes por Quedas , Transtornos Neurológicos da Marcha , Força Muscular , Transtornos Psicomotores , Transtornos Relacionados a Trauma e Fatores de Estresse , Transtornos da Visão , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Idoso , Feminino , Seguimentos , França/epidemiologia , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/epidemiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Limitação da Mobilidade , Transtornos Psicomotores/diagnóstico , Transtornos Psicomotores/epidemiologia , Transtornos Psicomotores/fisiopatologia , Desempenho Psicomotor/fisiologia , Medição de Risco/métodos , Fatores de Risco , Transtornos Relacionados a Trauma e Fatores de Estresse/epidemiologia , Transtornos Relacionados a Trauma e Fatores de Estresse/fisiopatologia , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia , Transtornos da Visão/complicações , Transtornos da Visão/prevenção & controle
4.
J Korean Med Sci ; 36(15): e96, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33876585

RESUMO

BACKGROUND: Suicide is one of the leading causes of death in the military as in the general population. To mitigate such a serious public health problem, identifying the risk or protective factors of suicide behaviors is crucial. METHODS: We analyzed the representative data of the 2014 Korean Armed Forces to explore the relationship between past year adverse events (PAE), accumulated lifetime trauma (ALT), mental illness vulnerability, perceived social support, and suicidal ideation in the previous year. RESULTS: Among the 6,377 subjects, 3.7% of males and 6.2% of females reported suicidal ideation in the previous year. Multivariate analytic models identified significant associations of PAE and ALT with suicidal ideation with a dose-response pattern. The mental illness vulnerability showed the most significant association with suicidal ideation even after controlling PAE or ALT. We found that perceived social support may be potentially linked with a reduced risk of suicidal ideation. CONCLUSION: This Korean military representative data demonstrates mental illness vulnerability; PAE; and lifetime trauma as significant risk factors of suicidal ideation, while perceived social support was found as a potential protective factor. Given the importance of the prevention of suicide in the military, those risk and protective factors may be used to screen soldiers at risk of suicide and provide further support on mental health services as needed.


Assuntos
Transtornos Mentais/patologia , Militares/estatística & dados numéricos , Apoio Social , Ideação Suicida , Adolescente , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Angústia Psicológica , República da Coreia , Fatores de Risco , Transtornos Relacionados a Trauma e Fatores de Estresse/patologia , Adulto Jovem , Prevenção do Suicídio
6.
J Gen Intern Med ; 35(7): 2240-2242, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32410125

RESUMO

The use of personal protective equipment (PPE) has skyrocketed, as providers don masks, glasses, and gowns to protect their eyes, noses, and mouths from COVID-19. Yet these same facial features express human individuality, and are crucial to nonverbal communication. Isolated ICU patients may develop "post intensive-care syndrome," which mimics PTSD with sometimes debilitating consequences. While far from a complete solution, PPE Portraits (disposable portrait picture stickers - 4" × 5") have the potential to humanize care. Preparing for a larger effectiveness evaluation on patient and provider experience, we collected initial qualitative implementation insights during Spring 2020's chaotic surge preparation. Front-line providers reported more comfort with patient interactions while wearing PPE Portraits: "It makes it feel less like a disaster zone [for the patient]." A brief pilot showed signs of significant adoption: a participating physician requested PPE Portraits at their clinic, shift nurses had taken PPE Portraits with them to inpatient services, and masked medical assistant team-members requested PPE Portraits to wear over scrubs. We believe PPE Portraits may support patient care and health, and even potentially healthcare team function and provider wellness. While we await data on these effects, we hope hospitals can use our findings to speed their own implementation testing.


Assuntos
Infecções por Coronavirus , Pessoal de Saúde , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Retratos como Assunto , Roupa de Proteção , Identificação Social , Transtornos Relacionados a Trauma e Fatores de Estresse/prevenção & controle , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Humanos , Relações Interpessoais , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/tendências , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , SARS-CoV-2
7.
Neuropsychobiology ; 79(2): 131-140, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31574505

RESUMO

BACKGROUND: Despite much evidence that season of birth (SOB) my influence the vulnerability to psychiatric disorders, divergence has been reported, in particular between populations born in the northern and southern hemispheres. We analyzed the potential modified risk by SOB to psychiatric disorder or drug addiction comorbidity in a population born in the Triângulo Mineiro region, a southern hemisphere Köppen tropical savanna region in Brazil. METHOD: We accessed the records of 98,457 of patients and healthy controls of the National Datacenter of Medical Promptuary to evaluate the influence of SOB as a modifying factor on the occurrence of mental disorders and drug abuse conditions among individuals born from the year 2000 to 2016. RESULTS: The data revealed significant modification of the relative incidence of major depressive disorder (MDD) (F11, 72 = 2.898; p = 0.003; eta-squared, ES = 0.313; ⍺ = 0.97), anxiety-related disorder (ARD) (F11, 81 =2.389; p = 0.013; ES = 0.241; ⍺ = 0.932), and schizophrenia (SZ) (F11, 83 = 2.764; p = 0.005; ES = 0.303; α = 0.963), while there was no increase in the number of healthy controls born in any month of the year (F11, 71 = 1.469; p = 0.163). Post hoc analyses indicated a significant higher vulnerability to MDD or ARD if the patient was born in August, or October to December, respectively. A relative increase in the incidence of SZ was also observed in patients born from August to October, compared to patients born from November to January. CONCLUSIONS: SOB may influence the risk for psychiatric disorders in the TMR population. Regional particularities associated with the climatic regime may account for the apparent divergence between studies.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Suscetibilidade a Doenças/epidemiologia , Esquizofrenia/epidemiologia , Estações do Ano , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados a Trauma e Fatores de Estresse/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Comorbidade , Bases de Dados Factuais , Feminino , Pradaria , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Int Rev Psychiatry ; 32(3): 189-201, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31814465

RESUMO

Preschoolers are presenting in increasing numbers to primary care providers and mental health clinics with emotional and behavioural impairment. Preschoolers in the US have the highest rates of school expulsion of all age groups. Because young children are limited in their capacity to convey distress and internal states, impairment is most often expressed behaviourally. Disruptive behaviour, frequently in the form of aggression or dysregulation, is a final common pathway for many disorders in this age group. Tools and training to diagnose pre-school disorders are limited, and while some effective non-medication interventions exist, the evidence base for medication use in this age group is extremely limited. This article reviews approaches to assessing common pre-school disorders including attention deficit hyperactivity disorder (ADHD), disruptive behaviour disorders, anxiety and mood disorders, perceptual disturbances and psychosis, and trauma related disorders. The evidence base for both therapeutic and psychopharmacologic interventions for these disorders is discussed.


Assuntos
Transtornos de Ansiedade , Transtornos de Deficit da Atenção e do Comportamento Disruptivo , Transtornos do Comportamento Infantil , Transtornos do Humor , Transtornos da Percepção , Transtornos Psicóticos , Transtornos Relacionados a Trauma e Fatores de Estresse , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/diagnóstico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/terapia , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/terapia , Pré-Escolar , Humanos , Transtornos do Humor/diagnóstico , Transtornos do Humor/terapia , Transtornos da Percepção/diagnóstico , Transtornos da Percepção/terapia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia , Transtornos Relacionados a Trauma e Fatores de Estresse/diagnóstico , Transtornos Relacionados a Trauma e Fatores de Estresse/terapia
9.
Nurs Res ; 69(5): 358-366, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555008

RESUMO

BACKGROUND: Very few studies have conducted an economic assessment of brief motivational intervention (BMI) in patients experiencing traumatic injuries related to alcohol and/or substance use. Furthermore, findings concerning the potential long-term economic benefits of BMI applied in nursing are promising but very scarce. OBJECTIVE: The purpose of this study was to analyze the costs and benefits associated with the application of a BMI program by nursing staff to patients hospitalized for trauma related to substance use. METHODS: An analysis of costs and benefits was conducted in a nonrandomized study of a retrospective cohort of patients. An intervention and follow-up (of 10-52 months) of patients between 16 and 70 years of age admitted for traumatic injuries in University Hospital of Granada were carried out with a cohort of 294 patients (intervention = 162 vs. no intervention = 132) between 2011 and 2016. The National Health Service's perspective on the use of medical resources and the costs associated with intervention and recidivism was considered. A cost analysis with a 5-year time frame and a subsequent analysis of sensitivity were conducted. RESULTS: Direct medical costs associated with trauma recidivism were significantly lower in patients who received BMI, as compared to patients who did not receive it, &OV0556;751.82 per patient (95% CI &OV0556;13.15 to &OV0556;1,490.48) in the first year. The cost-benefit ratio of &OV0556;74.92 at 4 years reflects National Health Service savings for each euro invested in BMI. DISCUSSION: The implementation of BMI programs in nursing care may be profitable from an economic standpoint, justifying the inclusion of these programs in hospitals both because of their efficacy and the potential savings incurred by the health system. This study addresses the lack of evidence regarding the economic implications linked to the effectiveness of the intervention to reduce substance use and trauma recidivism. Results identify BMI delivered in hospitals by nurses as a technique that offers the potential for reducing costs linked to trauma recidivism. The research has important practical implications for hospital nurses and doctors.


Assuntos
Alcoolismo/complicações , Entrevista Motivacional/normas , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados a Trauma e Fatores de Estresse/terapia , Adolescente , Adulto , Idoso , Alcoolismo/psicologia , Estudos de Coortes , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional/economia , Entrevista Motivacional/métodos , Estudos Retrospectivos , Espanha , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados a Trauma e Fatores de Estresse/economia , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia
10.
Child Psychiatry Hum Dev ; 51(6): 934-942, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32086665

RESUMO

Previous research suggests that rural Latinx youth are more likely to experience traumatic events and are at higher risk for developing subsequent psychopathology compared to non-Latinx white youth. The aim of this study is to understand how family processes and values affect risk for internalizing and externalizing symptoms among rural Latinx youth (N = 648, mage = 15.7 (SD = 1.2)) who are exposed to trauma. Multiple mediation analyses were performed to understand if family variables such as familism and family conflict explain the relationship between trauma exposure and psychopathology. Results suggest that familism partially mediates the relationship between trauma exposure and internalizing and externalizing symptoms, whereas family conflict partially mediates the relationship between trauma exposure and externalizing symptoms. These findings show that family variables are differentially impacted by trauma and have a separate and unique impact on mental health outcomes among rural Latinx youth. Specifically, our findings suggest that familial support or closeness may constitute a nonspecific protective factor for psychopathology among Latinx youth, whereas family conflict creates a stressful home environment that may deter adolescent trauma recovery and lead specifically to externalizing symptoms.


Assuntos
Conflito Familiar/etnologia , Relações Familiares/etnologia , Relações Familiares/psicologia , Hispânico ou Latino/psicologia , Transtornos Mentais/diagnóstico , Transtornos Mentais/etnologia , População Rural , Transtornos Relacionados a Trauma e Fatores de Estresse/diagnóstico , Adolescente , Conflito Familiar/psicologia , Feminino , Humanos , Controle Interno-Externo , Masculino , Transtornos Mentais/psicologia , Poder Familiar/etnologia , Poder Familiar/psicologia , Psicopatologia , Fatores de Risco , Transtornos Relacionados a Trauma e Fatores de Estresse/etnologia , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia
11.
J Perinat Neonatal Nurs ; 34(4): E23-E31, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33079811

RESUMO

Adverse childhood experiences and trauma significantly impact physical and mental health. Increased maternal perinatal depression/anxiety, preterm labor, and low birth weight, as well as infant morbidity and mortality, are some examples of the impact of trauma on perinatal health. Trauma-informed care begins with knowledge about trauma, the ability to recognize signs of a trauma response, responding to patients effectively, and resisting retraumatization. As holistic providers, perinatal nurses can create safe care environments, establish collaborative patient relationships based on trust, demonstrate compassion, offer patients options when possible to support patient autonomy, and provide resources for trauma survivors. This can prevent or reduce the negative impact of trauma and improve the health and well-being of infants, mothers, and future generations. This clinical article outlines key strategies for implementation of patient-centered trauma-informed perinatal nursing care.


Assuntos
Experiências Adversas da Infância/prevenção & controle , Enfermagem Holística/métodos , Enfermagem Materno-Infantil/métodos , Enfermagem Neonatal/métodos , Complicações na Gravidez , Transtornos Relacionados a Trauma e Fatores de Estresse , Depressão Pós-Parto/complicações , Depressão Pós-Parto/enfermagem , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Efeitos Adversos de Longa Duração/enfermagem , Efeitos Adversos de Longa Duração/prevenção & controle , Saúde Mental , Trabalho de Parto Prematuro/enfermagem , Trabalho de Parto Prematuro/psicologia , Assistência Centrada no Paciente , Gravidez , Complicações na Gravidez/enfermagem , Complicações na Gravidez/psicologia , Transtornos Relacionados a Trauma e Fatores de Estresse/etiologia , Transtornos Relacionados a Trauma e Fatores de Estresse/enfermagem , Transtornos Relacionados a Trauma e Fatores de Estresse/prevenção & controle
12.
Psychother Psychosom Med Psychol ; 70(9-10): 371-377, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32252120

RESUMO

This article provides an insight into novel approaches and perspectives using digital technologies in the treatment of trauma-related disorders. Therapy options for patients with trauma-related disorders are not easily available on a global scale and there is a search for new specific therapeutic strategies. In the first part of this article, examples of digital approaches are provided that are based on established analogue treatments and are designed mainly to increase availability and cost-effectiveness of these treatments. In the second part, the focus lies on digital treatments that employ novel approaches, which are e. g. informed by cognitive science, to specifically target particular symptoms in clinical populations after their development in lab studies. Examples given are visuospatial interventions used to reduce intrusive symptoms, or training programmes to increase levels of interference control (to control trauma-related stimuli), or to change automatic dysfunctional cognitions. These interventions will be presented with their respective theoretical frameworks, along with results from first (partially clinical) studies, which are promising concerning acceptance, applicability and effectiveness.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Tecnologia Digital/métodos , Psicoterapia/métodos , Transtornos Relacionados a Trauma e Fatores de Estresse/terapia , Humanos , Internet , Transtornos de Estresse Pós-Traumáticos/terapia
13.
J Trauma Dissociation ; 21(4): 452-467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584705

RESUMO

Trauma psychologists seeking to engage in evidence-based advocacy and action may benefit from methods that prioritize public problem solving. Community-engaged research (CEnR) is one such method, characterized by reciprocal and mutually beneficial partnerships between academic researchers and community organizations to address public problems. The CEnR framework is designed and implemented in the context of researcher-community partnership; as such, the findings from this approach promise to be responsive to the real-world concerns of communities seeking to address trauma. This manuscript first articulates the rationale for CEnR in evidence-based advocacy and action. Next, we provide illustrations from our research team's CEnR focus on access to victim service and legal information following interpersonal traumas. We describe how CEnR positioned our team to be responsive in a quickly evolving sociopolitical context while providing data needed for community partners and trauma researchers alike to advocate for survivors and victim services. With this example as a jumping-off point, we discuss potential systemic changes that could foster increased use of CEnR strategies to address trauma-related problems in our communities.


Assuntos
Relações Comunidade-Instituição , Defesa do Paciente , Projetos de Pesquisa , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia , Transtornos Relacionados a Trauma e Fatores de Estresse/terapia , Feminino , Humanos , Masculino
14.
J Trauma Dissociation ; 21(4): 437-451, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584709

RESUMO

There is increasing recognition of the value of consumer participation in advocacy and community activism. Among trauma survivors, finding a sense of purpose and a way to make meaning from the trauma experience has been termed "survivor mission," and may include a call to social action, involvement in social justice activities, or public speaking. The current study describes the development of a trauma-informed trauma-survivor speakers' bureau (CHATT) and presents quantitative and qualitative outcome findings. The CHATT program encompasses (1) a speaker training component, (2) public speaking activities, and (3) speaking support groups. Trauma survivors (N = 27) who received trauma mental health (MH) services and were in the later stages of recovery completed the two-part seven-hour speaker training and subsequently presented talks at 13 venues to 192 audience members during a three-year study period. Speakers completed baseline measures prior to the training, and follow-up measures at six months and one year to assess posttraumatic growth (PTG) and self-efficacy. Audience members completed an assessment of change in beliefs about key speaker advocacy goals, as well as emotional reactions and satisfaction with talks. Results revealed PTG and speaking self-efficacy increased for speakers after one-year post-training. Audience ratings of talks averaged in the high range except for one domain. Ratings differed by audience type and number of speakers, and increased as the program matured. Key speaker advocacy successes including state policy changes, limitations, and implications for future research and development are discussed.


Assuntos
Aconselhamento , Educação em Saúde , Defesa do Paciente , Sobreviventes/psicologia , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia , Feminino , Humanos , Masculino , Justiça Social
15.
J Natl Compr Canc Netw ; 17(8): 911-920, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31390590

RESUMO

BACKGROUND: This study evaluated the effectiveness of a screening and stepped care program (the TES program) in reducing psychological distress compared with care as usual (CAU) in patients with metastatic colorectal cancer starting with first-line systemic palliative treatment. PATIENTS AND METHODS: In this cluster randomized trial, 16 hospitals were assigned to the TES program or CAU. Patients in the TES arm were screened for psychological distress with the Hospital Anxiety and Depression Scale and the Distress Thermometer/Problem List (at baseline and 10 and 18 weeks). Stepped care was offered to patients with distress or expressed needs, and it consisted of watchful waiting, guided self-help, face-to-face problem-solving therapy, or referral to specialized mental healthcare. The primary outcome was change in psychological distress over time, and secondary outcomes were quality of life, satisfaction with care, and recognition and referral of distressed patients by clinicians. Linear mixed models and effect sizes were used to evaluate differences. RESULTS: A total of 349 patients were randomized; 184 received the TES program and 165 received CAU. In the TES arm, 60.3% of the patients screened positive for psychological distress, 26.1% of which entered the stepped care program (14.7% used only watchful waiting and 11.4% used at least one of the other treatment steps). The observed low use of the TES program led us to pursue a futility analysis, which showed a small conditional power and therefore resulted in halted recruitment for this study. No difference was seen in change in psychological distress over time between the 2 groups (effect size, -0.16; 95% CI, -0.35 to 0.03; P>.05). The TES group reported higher satisfaction with the received treatment and better cognitive quality of life (all P<.05). CONCLUSIONS: As a result of the low use of stepped care, a combined screening and treatment program targeting psychological distress in patients with metastatic colorectal cancer did not improve psychological distress. Our results suggest that enhanced evaluation of psychosocial concerns may improve aspects of patient well-being.


Assuntos
Neoplasias Colorretais/complicações , Angústia Psicológica , Estresse Psicológico , Transtornos Relacionados a Trauma e Fatores de Estresse/etiologia , Transtornos Relacionados a Trauma e Fatores de Estresse/terapia , Idoso , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/terapia , Gerenciamento Clínico , Feminino , Humanos , Masculino , Futilidade Médica , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Países Baixos/epidemiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Relacionados a Trauma e Fatores de Estresse/diagnóstico , Transtornos Relacionados a Trauma e Fatores de Estresse/epidemiologia
16.
Eur Child Adolesc Psychiatry ; 28(12): 1597-1606, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30972580

RESUMO

Psychosocial problems during adolescence are heterogenic, rather common, and unstable. At the same time, they are associated with an elevated risk of developing psychiatric disorders later in life. We aimed to describe the trajectories of psychosocial problems during adolescence and examine potential markers of persistence as compared to remission of these problems. At baseline, 1841 adolescents (51.4% female) were included. Of these adolescents, 1512 (mean age = 12.6 [range 11-14 years]; 52.8% female) completed the first and second self-report questionnaires on psychosocial problems (measured with the Strengths and Difficulties Questionnaire), psychotic experiences, trauma, self-esteem and somatic symptoms at two time points over a 1-year period. Regression analyses were used to examine the association between potential predictors and the trajectory of psychosocial problems (remitting versus persistent). Four trajectories were distinguished: 75.6% of the sample showed no problems (the 'none' trajectory), 11.9% were in a 'remitting' trajectory, 9.7% were in an 'incident' trajectory and 2.8% were in the 'persistent' trajectory. Hallucinatory experiences and trauma at baseline were significantly associated with persistence of psychosocial problems compared to those with remitting psychosocial problems. Low rather than high self-esteem was associated with lower risk for persistent problems. Risk of persistence of psychosocial problems increased with accumulation of predictors. Psychotic, especially hallucinatory, experiences and trauma predict persistence of psychosocial problems in adolescents. This underlines the need to assess psychotic experiences and trauma in mental health screening programs.


Assuntos
Transtornos Psicóticos/psicologia , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia , Criança , Feminino , Humanos , Masculino , Transtornos Mentais , Autorrelato , Inquéritos e Questionários
17.
Community Ment Health J ; 55(3): 487-492, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29427054

RESUMO

This study examined the rates and types of trauma reported by consumers utilising an inner city mental health service in Sydney, Australia. The study also explored whether consumers felt that it had been helpful to be asked about their experience of trauma, whether they thought that these questions should be asked routinely and if they wanted to talk about these experiences. Ninety-one consumers from an inner city mental health service were assessed. Eighty-eight percent of the consumers assessed reported that they had experienced at least one traumatic event, while 79% reported having experienced two or more events. A majority of consumers identified that they thought it was helpful to be asked about trauma and that it should be part of an assessment. However, less than one-third of these consumers surveyed wanted to talk about the trauma at the time of assessment. Concerns that clinicians may have in regards to addressing trauma in mental health assessment are not matched by consumers' expressed beliefs on the issue.


Assuntos
Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Transtornos Relacionados a Trauma e Fatores de Estresse/epidemiologia , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Adulto Jovem
18.
Community Ment Health J ; 55(3): 467-475, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29705979

RESUMO

As evidence continues to accumulate for the association between childhood trauma and long-term adverse outcomes, Trauma-Informed Care (TIC) approaches are emerging as fundamental to contemporary mental health services. To evaluate a workshop designed to influence mental health practitioners in TIC principles and practices. Nursing, medical and allied health professionals completed pre and post measures of confidence, awareness and attitudes towards TIC practice. The workshop was rated as highly relevant and useful to clinician's practice. Participants' self-reported confidence, awareness and attitudes towards TIC significantly increased (p < .001) and the perceived number of barriers to working within a TIC framework significantly decreased (p < .05). Child and Adolescent Mental Health clinicians routinely screened for trauma and 80% had received training in a trauma specific intervention at follow-up. This brief training provides an important foundation for the development of trauma-informed, evidence-based mental health services.


Assuntos
Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Serviços de Saúde Mental , Saúde Mental/educação , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia , Adolescente , Adulto , Atitude do Pessoal de Saúde , Criança , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Assistência ao Paciente/métodos , Autoeficácia , Inquéritos e Questionários
19.
Community Ment Health J ; 55(3): 385-393, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29574531

RESUMO

Vietnamese Americans are a heterogeneous group with varied migration histories. The life course perspective (LCP) suggests that different migration histories (immigrant vs. refugee) may affect their psychological health. Using Vietnamese refugee (n = 291) and immigrant (n = 211) subsamples from the National Latino and Asian American Study, selected LCP factors relevant to foreign-born Vietnamese were examined for their associations with psychological distress. Two separate regressions were conducted to examine differential factors across the subgroups. Results showed that sex, age at immigration, and pre- and post-migration traumas were significant factors for refugees. Among immigrants, only racial discrimination was significant factor. The results suggest that applying LCP among Vietnamese Americans helps to discern factors associated with their psychological distress outcomes depending on their initial immigration status. The results also indicate that healthcare professionals should consider the migration background of foreign-born Vietnamese in screening for potential psychological issues, particularly around their trauma history and discriminatory experiences.


Assuntos
Asiático/psicologia , Emigrantes e Imigrantes/psicologia , Angústia Psicológica , Racismo/psicologia , Refugiados/psicologia , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Asiático/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Emigração e Imigração , Feminino , Humanos , Acontecimentos que Mudam a Vida , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Racismo/etnologia , Refugiados/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários , Transtornos Relacionados a Trauma e Fatores de Estresse/etnologia , Vietnã/etnologia , Adulto Jovem
20.
Child Psychiatry Hum Dev ; 50(3): 459-472, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30483922

RESUMO

This study examines the prevalence of trauma exposure and its association with psychiatric symptoms, substance use, and sexual activity among First-Time Offending, Court-Involved Non-Incarcerated (FTO-CINI) Latinx youth. Latinx youth (N = 181), ages 12-18, were recruited from a family court in the Northeastern region of the United States as part of a longitudinal cohort study of 423 FTO-CINI youth. Baseline data on trauma exposure and symptoms, psychiatric symptoms, substance use (alcohol/marijuana), and sexual activity among the Latinx sample were analyzed by age, gender, and offense type (status versus delinquent). Almost three-quarters of Latinx FTO-CINI youth reported lifetime trauma exposure. Almost half of Latinx youth reported lifetime marijuana use, 30% reported lifetime alcohol use, and 33% reported lifetime sexual activity. Females reported higher rates of internalizing symptoms and greater affect dysregulation. Trauma-exposed youth were more likely than their non-exposed peers to have reported more externalizing symptoms; trauma-exposed females compared to trauma-exposed males reported more severe internalizing symptoms. Latinx FTO-CINI females may have different behavioral health needs than their male counterparts. Court-based screening and assessment practices should attend to the specific behavioral needs of this unique, underserved population.


Assuntos
Criminosos , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias , Transtornos Relacionados a Trauma e Fatores de Estresse , Adolescente , Comportamento do Adolescente/psicologia , Criminosos/legislação & jurisprudência , Criminosos/psicologia , Feminino , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Avaliação das Necessidades , Fatores Sexuais , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados a Trauma e Fatores de Estresse/diagnóstico , Transtornos Relacionados a Trauma e Fatores de Estresse/etnologia , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia , Estados Unidos/epidemiologia , Populações Vulneráveis/psicologia
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