Adaptation and validation study of the Indonesian version of the Global Psychotrauma Screen in an undergraduate student population.

BACKGROUND: The high incidence of potentially traumatic events (PTEs) in Indonesia warrants early identification of those with probable trauma-related disorders in order to tailor prevention and intervention for trauma-related symptoms. OBJECTIVES: This study aims to adapt and validate a novel brief transdiagnostic screener, the Global Psychotrauma Screen (GPS), in Indonesian undergraduate students. METHODS: An online survey was administered among Indonesian undergraduate students (N = 322). Exploratory factor analysis, reliability analyses, clinical validity analyses, and correlational analyses were performed to evaluate the construct validity, reliability, clinical validity, and convergent-divergent validity of the Indonesian GPS. Hierarchical multiple regression was conducted to assess the relationship between risk factors and trauma-related symptoms. The relationship between four categories of trauma-related symptom severity and social/work functioning was measured using Analysis of Covariance. RESULTS: Exploratory factor analysis yielded a single-factor solution. The Indonesian GPS demonstrated good internal consistency, test-retest correlation, and absolute agreement, indicating good reliability. The Indonesian GPS also had an acceptable area under the curve, sensitivity, and specificity for a probable diagnosis of Post-Traumatic Stress Disorder (PTSD), Complex-PTSD (CPTSD), depression, and generalized anxiety disorder (GAD). We also established evidence for the convergent and divergent validity of GPS. The GPS risk factors (low psychological resilience, other stressful events, history of mental illness, and low social support) contributed to predicting trauma-related symptoms after controlling for gender, age, employment status, and faculty background. Additionally, in comparison to participants from the mild and low categories of GPS symptoms scores, participants from the severe and moderate category reported impaired lowered social/work functioning. CONCLUSION: The current findings indicate that the Indonesian GPS is a valid and reliable transdiagnostic trauma screener for Indonesian undergraduate students. This first comprehensive validation of the GPS in Indonesia calls for more research in Lower-middle Income Countries (LMICs) as a way towards prevention and early intervention for trauma-related symptoms.

Development and validation of the Dimensional Inventory of Stress and Trauma Across the Lifespan (DISTAL): A novel assessment tool to facilitate the dimensional study of psychobiological sequelae of exposure to adversity.

Decades of research underscore the profound impact of adversity on brain and behavioral development. Recent theoretical models have highlighted the importance of considering specific features of adversity that may have dissociable effects at distinct developmental timepoints. However, existing measures do not query these dimensions in sufficient detail to support the proliferation of this approach. The Dimensional Inventory of Stress and Trauma Across the Lifespan (DISTAL) was developed with the aim to thoroughly and retrospectively assess the timing, severity (of exposure and reaction), type, persons involved, controllability, predictability, threat, deprivation, proximity, betrayal, and discrimination inherent in an individual's exposure to adversity. Here, we introduce this instrument, present descriptive statistics drawn from a sample of N = 187 adults who completed the DISTAL, and provide initial information about its psychometric properties. This novel measure facilitates the expansion of research focused on assessing the relative impact of exposure to key dimensions of adversity on the brain and behavior across development.

Screening for Trauma in Pediatric Primary Care.

PURPOSE OF REVIEW: Provided the high prevalence of trauma exposure in childhood as well as the risk for morbidity, this article examines evidence, a recommended approach, and key implementation factors relevant to screening for trauma in pediatric primary care. RECENT FINDINGS: A standardized approach to trauma screening is possible, but previous attempts have relied heavily upon exposure screening and failed to guide an individualized response specific to the impact of trauma on the child and family. Trauma screening tools for pediatric primary care should be brief and inform the care response based on screening for trauma exposure, traumatic stress symptoms, functional impact, and suicidality. Clinicians should use trauma screening to (1) identify if the child has any ongoing risk of harm and report where required; (2) determine risk of suicidality and respond appropriately; (3) assess need for evidence-based trauma treatment based on symptoms and functional impact; and (4) provide a skill or guidance targeting the most severe or pressing traumatic stress symptoms.

Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT) within Employment Services: A Feasibility Trial.

Research suggests that low-income adults accessing employment services have experienced high levels of trauma exposure and associated consequences. Moreover, the health-related effects of trauma undermine employment and employability. A trauma-informed protocol-trauma screening, brief intervention, and referral to treatment or T-SBIRT-was therefore implemented within employment service programs serving low-income urban residents. To assess the feasibility of integrating T-SBIRT within employment services, five domains were explored as follows: suitability, acceptability, client adherence, provider adherence or fidelity, and intended outcomes. With a sample of low-income adults (N = 83), the study revealed that T-SBIRT is suitable for employment service participants given high rates of trauma exposure (90.4% experienced two or more lifetime traumas), along with high rates of positive screening results for post-traumatic stress disorder (48.8%), major depression (35.4%), and generalized anxiety (47.6%). Study participants appeared to find T-SBIRT acceptable as evidenced by an 83% acceptance rate. All participants accepting T-SBIRT services completed them, revealing strong client adherence. Provider adherence or model fidelity was high, that is, 98.5%. Finally, the majority of participants accepted a referral to a mental health care (i.e., 56.6%), and over three-quarters accepted a referral to any outside service including primary or mental health care. Implications of findings are discussed.

Beyond Physical Injury: Routine Screening for Acute Stress Disorder and Posttraumatic Stress Disorder in Pediatric Trauma Patients - A Longitudinal Cohort Pilot Study.

INTRODUCTION: Early identification of children at risk for PTSD is critical for improving mental health outcomes after traumatic injury. Currently, there is no standard PTSD screen for pediatric trauma patients and limited data on long-term quality of life for those who screen positive. METHODS: In 2022, we piloted a comprehensive routine screening program for ASD and PTSD at our Level I PTC. All admitted trauma patients ≥8 years old were eligible for screening. Inpatients were administered the ASC3. Those who screened positive were referred for follow-up and repeat mental health evaluation. PTSD screening (CTSQ, CPSS) and quality-of-life screening (PedsQL™) surveys were administered to eligible discharged trauma patients at 1-month post-injury. Children who screened positive on the CTSQ or CPSS were referred for behavioral health services. RESULTS: 205 children were screened for ASD using the ASC3. 49/205 children (23.9 %) had a positive screen (score ≥3). 56 children completed PTSD screening at 1-month post-discharge. 14/54 children (25.9 %) screened positive on CTSQ, and 8/50 children (16 %) screened positive on CPSS. There was a significant positive correlation between CTSQ and CPSS scores (r 0.76, ∗P<0.0001). When stratified by screening results, patients who screened positive on CTSQ and CPSS were found to have the most significant correlations with poor School and Emotional Functioning on their quality-of-life inventory. CONCLUSION: Early screening for ASD may be predictive of later development of PTSD in children. Screening using previously validated tools (ASC3, CTSQ, CPSS) were effective in identifying children with negative emotional functioning lasting beyond the acute phase of physical recovery following injury. CTSQ and CPSS both performed well for screening at one-month post-discharge. Early identification can facilitate timely referral to mental health services to potentially minimize long-term socioemotional impact of PTSD.

To screen or not to screen: Exploring and addressing effective screening processes for trauma among forced migrants.

Background: Existing literature points to higher rates of trauma disorders for forced migrants than general or immigrant populations. The process of identification and screening for trauma in this population however is not straightforward and is actually controversial in some circles. Furthermore there are no definitive guidelines for mental health and social service providers on the "when" "who", "what" "why", "where", and "how" of trauma screening. Objectives: Importantly, few studies have included insights into the screening process from service providers and forced migrants themselves through participatory research methods. This study investigates effective screening processes for trauma and examines benefits and pitfalls of current practices from the perspectives of both migrants themselves as well as health service providers that serve them. Design: We used a qualitative approach to identify and analyze key themes from focus group interviews with key informants (service providers and trauma experts providing social and medical services in the community) and forced migrants (from Cameroon, Ethiopia, Honduras, and Tanzania). Results: Our results comprise forced migrant definitions of and approaches to coping with trauma, reservations about engaging with providers, positive experiences with and impacts of screening, limitations and negative aspects of screening, helpful screening practices, and effective tools and questions for screening. Conclusions: Drawing on these themes, we offer recommendations that may help inform future screening approaches and trauma-informed service provision. The study ultimately helps those in the field to reflect on current trauma screening practices for forced migrants and consider how new insights derived from rich discussions with migrants and their service providers may alter existing screening processes- which few.

Performance and acceptability of the Stressful Life Events Screening Questionnaire in a chronic pain population: a mixed-methods study.

Introduction: Pain-related fear, anxiety, and avoidance may play key roles in the chronification of pain and related disability. For practitioners, knowledge about the source or drivers of these fears, including patients' exposure to potentially traumatic events (PTEs) and related posttraumatic stress symptoms, could be particularly helpful in guiding their treatment approach. Objectives: We aimed to investigate whether the use of a brief screening for PTEs could help inform chronic pain treatment. Methods: The performance and acceptability of the Stressful Life Events Screening Questionnaire (SLESQ) was assessed among 567 adult patients (59% women, mean age 48.1 years) meeting at a hospital outpatient pain clinic. The sensitivity, specificity, and 20 months temporal stability of the SLESQ, assessing exposure to 14 specific trauma types followed by a 15th item capturing exposure to "other events," were assessed through digital administration and follow-up interviews with 55 participants. The qualitative responses of 158 participants reporting exposure to "other events" were reviewed and assessed based on fulfillment of the A Criterion for traumatic events in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The acceptability of the SLESQ was assessed in clinical interviews with 12 participants. Results: The SLESQ demonstrated acceptable sensitivity (70.0%), high specificity (94.9%), and moderate temporal stability (κ = 0.66, P < 0.001). Participants' qualitative elaborations of "other events" were largely (76.3%) consistent with Criterion A events. The screening was well accepted and welcomed. Conclusion: The results indicate that the use of a brief screening for potential trauma may be helpful to guide clinical practice in chronic pain settings.

Diagnostic profiles and trauma history among treatment-seeking young adults with positive post-traumatic stress disorder screens: Findings and implications for public mental health care.

OBJECTIVES: This study examined diagnostic profiles and trauma history among treatment-seeking young adults with positive PTSD screens in public mental health care. METHODS: Screening for trauma history and PTSD symptoms was implemented in a community mental health service system. 266 treatment-seeking young adults (aged 18-35) endorsed trauma exposure with a score of at least 45 on the DSM-IV PTSD Checklist, indicating probable PTSD. RESULTS: Young adults with positive PTSD screens were predominantly female, minority, and diagnosed with mood disorders. Of those with positive screens, only 15% had a chart diagnosis of PTSD; 17.3% (ages 18-24) versus 14.1% (ages 25-35). Variables significantly associated with a decreased likelihood of PTSD detection included a diagnosis of schizophrenia or bipolar disorder, exposure to fewer types of traumatic events, male gender, and white race. CONCLUSION: Routine PTSD screening for young adults receiving public mental health care should be prioritized to address long-term impacts of trauma.

Trauma-Informed Psychosocial Screening and Care Planning: A Patient-Centered Improvement Project in a Midwife Clinic.

INTRODUCTION: Traumatic stress is associated with increases in preterm birth, low birth weight, and other perinatal complications. Yet the identification of patients with traumatic stress and intervention for traumatic stress prevention or treatment remain low. Locally in this university hospital-based midwife clinic, a health records review found that trauma exposure was documented in 5% of patient records, and no records had a diagnosis of posttraumatic stress disorder (PTSD). This is lower than research-based population estimates of 25% to 50% for trauma exposure and 8% for PTSD during pregnancy. The clinic staff did not screen for posttraumatic stress, and exposure screening was limited to intimate personal violence. Staff had not been trained in trauma-informed care (TIC) as defined by the Substance Abuse and Mental Health Services Administration. The aim for this improvement project was to provide trauma screening and trauma-related care planning, collectively referred to as trauma-informed psychosocial care, to midwifery patients 85% of the time. PROCESS: Interventions were implemented over 4 plan-do-study-act (PDSA) cycles. These included staff training in TIC; written screening at the new prenatal, third trimester, and postpartum visits; verbal broad inquiry at every visit; and bidirectional trauma-specific care planning emphasizing patient and provider input into treatment choice. The clinic flow was changed to create privacy for patient-staff interaction at every visit. Field notes and data were analyzed every 2 weeks and iterative changes applied. OUTCOMES: Trauma disclosure increased from 5% to 30% and identification of PTSD from 0% to 7%. Bidirectional care plan documentation increased from 8% to 67%. Staff rated the workload as reasonable. DISCUSSION: Redesigning psychosocial screening to align with TIC principles increased the discovery of trauma to levels consistent with research-based population estimates. Gains were made in bidirectional care planning. This project illustrates practical methods of implementing TIC principles.

Applying shared decision-making to screening for trauma and adversity in youth.

Youth who have experienced adverse childhood experiences (ACEs) or trauma are at risk for negative outcomes that may be lessened by adversity screening and prevention efforts. However, experts and consumers do not universally embrace adversity screening efforts. Despite significant support for widespread adversity screening, and many guidelines on how to conduct such screening, successful implementation has lagged behind enthusiasm. This paper outlines the challenges of adversity screening and then proposes applying the shared decision-making (SDM) model to improve adversity screening by increasing youths' 1) engagement in adversity screening if doing so is appropriate for them, and 2) disclosure of honest information during screens. Using an SDM approach honors youth preferences and perspectives, which simultaneously accomplishes a third overarching goal: aligning adversity screening with the principles of trauma-informed care.

A Preliminary Study Examining the Validity of Brief Trauma Screening Tools for Young Adolescents in School-Based Health Centers.

BACKGROUND AND PURPOSE: There are very limited brief, validated, open access screening tools for trauma symptoms in adolescent populations. This study aimed to test two brief tools used with adults in primary care settings for use with adolescents. METHODS: Youth (n = 77) completed the Posttraumatic Stress Disorder (PTSD) Checklist (PCLC-2), the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV; PC-PTSD), and the PTSD Reaction Index for DSM-5 (reference tool). Sensitivities and specificities were analyzed. RESULTS: The PCLC-2 and PC-PTSD demonstrated high sensitivity and specificity with adolescents when using lower cutoff scores than those recommended for adults. CONCLUSIONS: The PC-PTSD and PCLC-2 have the potential to be used as brief screens with adolescents. Additional research is needed to further examine their validity with larger, diverse youth samples in primary care and school-based settings.

Screening traumatic life events in preschool aged children: cultural adaptation of Child and Adolescent Trauma Screen (CATS) Caregiver-report 3-6 years version.

BACKGROUND: Given the high prevalence of potentially traumatic events (PTEs), pediatric providers are in a novel position in early identification and referral of the children with PTEs. Yet paucity of culturally adapted instruments to screen PTEs and related symptoms in preschool-aged children limits pediatric providers. This multicenter study aimed to screen the traumatic life events of preschool-aged children admitted to pediatric outpatient clinics at four different cities of Turkey and to determine the socio-demographic risk factors associated with PTEs. Moreover, it was also intended to develop the cultural adaptation of the Child and Adolescent Trauma Screen (CATS) Caregiver-report 3-6 Years version to Turkish and to analyze its reliability. METHODS: Participants of this multicenter study were collected from four different hospitals in three different regions (Central Anatolia, Black Sea, and Southeastern Anatolia regions) of Turkey. All parents of children at the age of 3-6 years who were admitted to the hospital for a clinical visit (sick-child or well-child visits) were invited to the study. In total, 188 preschool-aged children were included in the study. Socio-demographic characteristics of the child and the family were questioned and parents were asked to fill out the Turkish version of the CATS Caregiver-report. RESULTS: Internal consistency (Cronbach`s alpha) of the Turkish version of the CATS Caregiver-report 3-6 Years was found as 0.86. This study revealed that half of the participating children had experienced at least one PTE and more than one fourth experienced more than one event. Strikingly, no association between sociodemographic risk factors and PTE exposure was identified suggesting that PTE exposure is indeed widespread in our study population. CONCLUSION: The findings of this study manifest the importance of routine screening of PTEs and related symptoms in children.

Development and Preliminary Validation of the University of Minnesota's Traumatic Stress Screen for Children and Adolescents (TSSCA).

Child and adolescent exposure to potential trauma experiences is pervasive. Given the prevalence, deleterious mental and physical effects, and economic cost of trauma exposure, child- and family-service systems are adopting trauma-informed approaches, including practices like trauma screening. Although a number of trauma-focused screening and assessment measures exist for youth, the majority are lengthy and inappropriate for universal administration. This study describes the development and preliminary validation of the Traumatic Stress Screen for Children and Adolescents (TSSCA), a six-item screening measure for trauma exposure and traumatic stress symptoms. Using two samples of youth presenting at community practice settings (n1 = 134, n2 = 137), reliability, discriminative validity, and criterion-related validity were calculated for the TSSCA. Results support the TSSCA as an empirically derived, reliable, and valid screening measure for exposure to trauma and symptoms of traumatic stress for youth ages 7 to 18.

Psychological Impact on Maxillofacial Trauma Patients - An Observational Study.

Facial disfigurement due to trauma is very common as the face is a prominent part of the body and is susceptible to injuries. A protocol for the diagnosis and intervention for psychological problems of trauma patients should be implemented in the Indian hospitals as they lack policies for assessing the mental status of such patients. This study was conducted to analyze and determine the psychological implications and need for mental health services of maxillofacial trauma patients. Fifty patients with maxillofacial trauma above 18 years of age were included in this study. The assessment was done using the Hospital Anxiety and Depression Scale (HADS) and Trauma Screening Questionnaire (TSQ), which are considered as the standard tools for assessment of psychological disorders post-trauma. We observed psychological stress in 84% of the patients at the baseline, which reduced to 24% after one month at the first follow-up visit and further reduced to 22% at the second follow-up visit. The reduction in the percentage from the first to the second follow-up visit was less significant. However, the change in HADS and TSQ scores was found to be significant, suggesting that the intensity of trauma decreases with the time-lapse. Anxiety, depression, and post-traumatic stress are prevalent in patients with maxillofacial trauma, which may lead to impaired day-to-day life. Our results suggest that there is a need for psychological care in patients with maxillofacial trauma.

Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study.

OBJECTIVE: The aim of this study was to explore physical and mental consequences and injury mechanisms among bus crash survivors to identify aspects that influence recovery. METHODS: The study participants were the total population of survivors (N=56) from a bus crash in Sweden. The study had a mixed-methods design that provided quantitative and qualitative data on injuries, mental well-being, and experiences. Results from descriptive statistics and qualitative thematic analysis were interpreted and integrated in a mixed-methods analysis. RESULTS: Among the survivors, 11 passengers (20%) sustained moderate to severe injuries, and the remaining 45 (80%) had minor or no physical injuries. Two-thirds of the survivors screened for posttraumatic stress disorder (PTSD) risk were assessed, during the period of one to three months after the bus crash, as not being at-risk, and the remaining one-third were at-risk. The thematic analysis resulted in themes covering the consequences and varying aspects that affected the survivors' recoveries. The integrated findings are in the form of four "core cases" of survivors who represent a combination of characteristics: injury severity, mental well-being, social context, and other aspects hindering and facilitating recovery. Core case Avery represents a survivor who had minor or no injuries and who demonstrated a successful mental recovery. Core case Blair represents a survivor with moderate to severe injuries who experienced a successful mental recovery. Core case Casey represents a survivor who sustained minor injuries or no injuries in the crash but who was at-risk of developing PTSD. Core case Daryl represents a survivor who was at-risk of developing PTSD and who also sustained moderate to severe injuries in the crash. CONCLUSION: The present study provides a multi-faceted understanding of mass-casualty incident (MCI) survivors (ie, having minor injuries does not always correspond to minimal risk for PTSD and moderate to severe injuries do not always correspond to increased risk for PTSD). Injury mitigation measures (eg, safer roadside material and anti-lacerative windows) would reduce the consequences of bus crashes. A well-educated rescue team and a compassionate and competent social environment will facilitate recovery. Doohan I , Björnstig U , Östlund U , Saveman BI . Exploring injury panorama, consequences, and recovery among bus crash survivors: a mixed-methods research study. Prehosp Disaster Med. 2017;32(2):165-174.