European Journal of Psychotraumatology最新文献

Background: Lifetime trauma exposure is associated with higher-severity depression and anhedonia. Neural reward regions develop in adolescence and influence depression and anhedonia. Reward regions may enhance the impact of trauma exposure on depression. This naturalistic, 6-month longitudinal study examined how individual differences in the function of reward regions impact associations between lifetime trauma exposure and the development of depression and anhedonia in adolescents.Methods: 82 participants aged 13-19 years varying in risk for depression and anhedonia reported lifetime trauma exposure, depression, and anhedonia and underwent a monetary reward fMRI task at baseline, then reported symptoms 6 months later. Neural reward activity to reward > neutral outcome (p_FWE<.05) was measured within the Neurosynth 'reward' mask. Univariate models examined whether activity in neural reward regions moderated the impact of lifetime trauma on the development of depression and anhedonia after 6 months, correcting for baseline symptoms.Results: Lifetime trauma exposure was associated with higher baseline depression (β = 1.676, p = .019) and anhedonia (β = 1.547, p < .001), and higher anhedonia at 6-months (β = 2.050, p < .001). Neural activity to reward outcome occurred in the bilateral ventral striatum (VS), anterior cingulate cortex, and right ventrolateral prefrontal cortex. Right VS activity moderated prospective relationships between lifetime trauma exposure and depression at 6 months (β = -3.275, p = .037), where greater trauma was associated with lower depression 6 months later for those with higher right VS activity.Conclusion: Reward neural network activity was associated with improvements in depression in individuals with more lifetime trauma exposure. Targeting reward network function or using psychosocial strategies to enhance positive affect may be an important strategy to address depression, particularly among adolescents exposed to trauma.

Background: Refugees resettled in high-income countries are at high risk of post-traumatic stress disorder (PTSD) and often face multiple post-migration stressors that can influence symptom severity. While individual and cumulative effects of these stressors have been examined, little is known about how they interact and change during treatment.Objective: To investigate changes in the structure and interconnections of post-migration stressors among refugees with PTSD before and after mental health treatment.Method: Participants were refugees with PTSD receiving multidisciplinary treatment at a specialised mental health clinic in Denmark, as part of a randomised controlled trial. The Post-Migration Living Difficulties Checklist (17-item Danish version) (PMLD) was completed pre- and post-treatment. Partial correlation networks were estimated for each time point, with network comparison test assessing changes in global network connectivity. Predictability of individual stressors and paired-sample t-tests for item-level change were also conducted.Results: Global network connectivity increased significantly from pre- to post-treatment (p = .004), suggesting stronger interrelations among stressors over time. Overall PMLD score did not change from pre- to post-treatment, but on item-level, financial and housing-related stress decreased (p = .006; p = .028), while concerns about returning to the country of origin in an emergency increased (p = .028).Discussion: Post-migration stressors became more interconnected during treatment, underscoring the need to address them not as isolated issues but as interdependent, mutually reinforcing challenges shaped by cultural and structural contexts. Clinically, effective support for trauma-affected refugees requires multi-level interventions that integrate legal, social, and economic determinants alongside mental health care.

Background and Objectives: Omega-3 fatty acids have positive effects on mental health. This study aimed to explore the association between plasma omega-3 fatty acid levels and the risk of post-traumatic stress disorder (PTSD).Methods: This study explored the association between plasma omega-3 fatty acid levels and risk of developing PTSD. In total, 82,391 adults from the UK Biobank were included in this study. PTSD screening was performed using a PCL-6 score greater than 13, based on responses to the online mental health questionnaire. Multivariate logistic regression analyses were performed to evaluate the association between omega-3 fatty acid levels and the risk of PTSD. Additionally, a two-sample bidirectional Mendelian randomisation (MR) analysis was used to investigate potential causal relationships.Results: A significant association was found between high omega-3 fatty acid levels and a lower risk of PTSD. For each 1 unit increase in omega-3 fatty acids, the adjusted odds ratio (OR) was 0.75 (p = 9.05E-05); for each 1% increase in total fatty acids, the adjusted OR was 0.95 (p = 4.30E-07). Among the population that has experienced catastrophic traumatic exposure, the results remained consistent. MR analysis indicated that high omega-3 levels and omega-3/total fatty acid ratios were causally linked to a reduced risk of PTSD (per 1 unit increase, OR = 0.99; p = .029; per 1% increase, OR = 0.98; p = .037). Conversely, PTSD was causally associated with lower omega-3 levels (beta = -0.203, p = 2.12E-05) and a lower omega-3/total fatty acids ratio (beta = -0.266, p = 1.52E-07). Subgroup analyses revealed that females might benefit more significantly (OR = 0.64, p = 3.59E-07; p-interaction = .010).Conclusions: This study suggests a negative association between PTSD and omega-3 fatty acids, indicating that omega-3 supplementation may be an effective preventive and therapeutic strategy for PTSD.

Background: Individuals with migration history from Türkiye form one of the largest migrant communities in Germany, comprising around 1.5 million first generation migrants and 1.4 million second generation individuals born in Germany. Research indicates that both migration-related and contextual factors (e.g. discrimination and stigma) are linked to elevated psychological distress in this group. While these experiences can be understood within the framework of minority stress, little is known about how migration-related losses and grief intersect with such stress processes in this population.Method: This qualitative study employed two semi-structured focus group discussions (N = 18), conducted separately for first and second generation individuals with a migration history from Türkiye. With participants' consent, focus group interviews were audio-recorded, transcribed, and analysed using thematic analysis in MAXQDA. The minority stress model was extended to include migration-specific stressors.Results: Migration-related loss and grief are central experiences among individuals of Turkish origin in Germany, deeply shaping their sense of belonging and identity, with discrimination and structural inequalities further exacerbating their impact on mental health. The results extend the minority stress model by integrating migration-specific stressors, particularly loss and grief, illustrating their interaction with minority stress processes. Moreover, grief transforms across generations, as the second generation internalizes parental grief while also facing new stressors, particularly discrimination, emphasizing the need for an intergenerational perspective.Conclusion: This study highlights the complex interplay of migration-related stress, grief, and identity among individuals with Turkish migration history in Germany. By extending the minority stress model, it underscores the impact of interpersonal racism and societal rejection while emphasizing intergenerational differences. The findings provide a foundation for future research and interventions, underscoring both individual and communal resilience within the Turkish community and informing tailored mental health support for diverse migrant populations.

Background: Victims of interpersonal violence have an increased risk to (a) develop post-traumatic stress disorder (PTSD), and (b) experience future interpersonal violence, a phenomenon called revictimization. Incidentally, PTSD is also a risk factor for revictimization, resulting in a vicious cycle for victims. To date, no interventions exist that effectively reduce the risk of revictimization in people suffering from PTSD. Furthermore, while the responsibility for preventing violence always resides with the perpetrator, we mostly see victims in clinical practice. We have chosen for a multi-dimensional approach to prevention by focusing on developing an intervention for potential victims.Objective: Our aim was to identify the skills that experts by experience would like to acquire in a novel intervention aimed at decreasing vulnerability for revictimization after trauma treatment. Secondly, this approach allowed the identification of risk factors for revictimization from a patient perspective.Methods: We conducted a qualitative study consisting of two focus groups with a total of N = 16 participants, with M_age = 49.0 (SD = 14.2) of which N = 8 were female. Participants were patients at a trauma expertise centre and had been victims of interpersonal violence in the past. The transcribed audio tapes were analyzed using iterative and reflexive thematic analysis.Results: We identified four main themes: 'emotion-focused skills', 'internal dialogue', 'communication skills', and 'managing social environment'. The results indicate that experts by experience would like to acquire skills that span emotional, cognitive, and behavioural dimensions to decrease their vulnerability for revictimization.Conclusions: Novel interventions aimed at decreasing vulnerability for revictimization after trauma treatment should incorporate the skills that experts by experience would like to acquire, such as awareness of emotions & bodily signals, coaching oneself, and managing the social environment, among others. Our results partially align with the evidence-based model of revictimization.

Background: Psychological First Aid (PFA) is a widely used approach to provide psychosocial support to individuals in the aftermath of a stressful event. PFA training requires a costly, structured approach, including repetitive simulation-based training with actors. The rapid emergence of large language models (LLMs) could provide easy access to PFA simulation training, enabling trainees to practice conversations repeatedly and flexibly, learn from mistakes, and build emotional resilience. In addition, this would allow for training in geographically isolated regions where PFA training may be most needed.Objective: To explore the potential of LLMs for PFA simulation training.Methods: Using a digital autoethnography approach, we conducted three role plays with ChatGPT-3.5-turbo, an LLM-based chatbot, in scenarios addressing challenges typical of PFA training. In each role-play, the chatbot simulated an individual in the aftermath of a stressful situation, and a researcher took on the roles of both a trainer configuring a simulation session and a learner serving as a PFA provider. The chatbot's ability to respond, adapt, and facilitate the training process was evaluated using reflexive thematic analysis.Results: Our study showed that ChatGPT effectively portrayed realistic characters, collaborated effectively with the trainer, and provided feedback to the learner. However, we also noted challenges concerning overly stereotyped characterizations, identity confusion, and following the trainer's instructions.Conclusions: While utilizing LLMs for PFA simulation training demonstrates significant promise, achieving their full educational potential requires careful refinement, thorough empirical validation, and ongoing ethical oversight.

Background: Foster carers provide care for children who have been removed from their primary caregivers due to serious adverse experiences. While considerable research focuses on trauma among foster children, little is known about the traumatic experiences and resulting (secondary) traumatic stress in foster carers themselves.Objective: To review existing literature on traumatic experiences and traumatic stress among foster carers. Methods: We conducted a scoping review following the methodological framework developed by the Joanna Briggs Institute [Peters, M. D. J., Marnie, C., Tricco, A. C., Pollock, D., Munn, Z., Alexander, L., McInerney, P., Godfrey, C. M., & Khalil, H. (2020). Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis, 18(10), 2119-2126. https://doi.org/10.11124/JBIES-20-00167] and reported it in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and checklist. We searched for literature in MEDLINE, Embase and PsycINFO.Results: We included nine studies (2005-2024) involving over 2,200 foster carers. Results indicate that (1) many foster carers have personally experienced adverse childhood experiences; (2) carers report indirect trauma exposure through their children's narratives and direct exposure, such as threats or violence; (3) a notable portion experience high levels of secondary traumatic stress; and (4) higher levels of trauma exposure are related to higher levels of secondary traumatic stress.Conclusions: The findings highlight the need for mental health screening, ongoing training, and systemic support for foster carers. Acknowledging carers as both caregivers and trauma-affected individuals is essential to trauma-informed care, as it contributes to the wellbeing of both foster children and foster carers, and helps ensure stable foster placements. Given the limited number of studies, future research should further explore the specific trauma foster carers encounter in their caregiving role, the nature and severity of their secondary traumatic stress symptoms, and how these factors influence their caregiving capacity and the stability of foster placements.

Background: Physical activity is increasingly incorporated in trauma-focused treatments as an augmentation strategy to improve treatment outcome. In a novel VR exposure treatment known as 3MDR (Multi-modal Motion-assisted Memory Desensitization and Reconsolidation), patients engage in low-intensity physical activity by walking on a treadmill throughout the therapy session, approaching trauma-related pictures that progressively enlarge until fully displayed in a VR environment. Physical activity is considered a key augmentation strategy in this treatment, with the proposed mechanism that walking toward a trauma-related picture facilitates the reduction of trauma-related avoidance, thereby improving treatment outcome. However, neither the specific effect of walking during this treatment nor the proposed working mechanism have been scientifically examined yet.Objective: In this paper we describe the rationale and study design of a randomised controlled trial (RCT) to examine the specific effect of walking toward trauma-related stimuli during VR exposure on treatment outcome. In addition, we will test whether walking toward trauma-related pictures facilitates a greater reduction in trauma-related avoidance.Method: Patients with PTSD (N = 158) are randomised to two treatment conditions: walking (VR exposure while walking) or stationary (VR exposure without walking), while keeping all other treatment aspects constant. Participants in both conditions receive two preparatory treatment sessions, 6 or 12 VR exposure sessions, and one closure session. The primary outcome is clinician-rated PTSD symptom severity. Secondary outcomes are both clinician-rated- and self-reported trauma-related avoidance symptom severity, as well as self-reported PTSD symptom severity. Assessments take place pre- and after 6 and 12 VR exposure sessions (posttreatment), and at 3-, 6-, 12- and 18- months follow-up.Conclusion: This RCT aims to examine whether incorporating walking during trauma-focused treatment in a VR exposure environment augments the treatment of patients with PTSD.

Background: Posttraumatic stress disorder (PTSD) is highly prevalent among people with HIV (PWH) and is associated with poor psychological functioning and reduced adherence to antiretroviral therapy (ART), threatening treatment outcomes. Although the Community Resiliency Model (CRM) and mindfulness-based stress reduction (MBSR) have separately demonstrated efficacy for PTSD, no intervention integrating these approaches has been specifically developed for PWH.Objective: This study aimed to evaluate the efficacy and mechanisms of an Integrated Mindfulness-Based Programme (IMBP), combining CRM and MBSR, in reducing PTSD symptoms and enhancing ART adherence among PWH.Methods: Eighty-two PWH with PTSD were assigned to either the IMBP intervention group or the control group. PTSD symptoms and ART adherence were assessed at baseline, post-intervention, and 3-month follow-up. Mindfulness, rumination, and resilience were evaluated as potential mediators. Data were analyzed using generalized estimating equations (GEE) and mediation modelling.Results: Compared with the control group, participants receiving IMBP demonstrated significantly greater reductions in PTSD symptoms and improvements in ART adherence, both immediately post-intervention and at 3-month follow-up (all p < .01). Mediation analysis revealed that increased mindfulness, enhanced resilience, and decreased rumination partially mediated the effect of the intervention on PTSD symptoms.Conclusion: The IMBP intervention was effective in reducing PTSD symptoms as well as improving ART adherence in PWH. The mediating roles of mindfulness, resilience, and rumination suggest plausible mechanisms through which the intervention operates. These findings support the clinical utility of IMBP as a low-resource intervention for addressing the dual challenges of trauma and treatment adherence in vulnerable HIV-positive populations.

Introduction: A host of cross-sectional studies have identified problematic substance use and post-traumatic stress symptoms as risk factors for repeated interpersonal violence (revictimization) in college samples. However, it remains unclear which factors are associated with revictimization for patients who meet diagnostic criteria for both substance use disorder (SUD) and post-traumatic stress disorder (PTSD). The identification of factors associated with revictimization is an important step towards preventing violence against people with psychiatric disorders and can inform treatment.Method: Data were based on the Treatment of PTSD and Addiction (TOPA) study, a randomized controlled trial including N = 209 patients that received inpatient and outpatient treatment for SUD and PTSD. We selected participants who had experienced interpersonal victimization at baseline (N = 203) and assessed revictimization across the 9-month follow-up period. Revictimization included: physical violence, violence with a gun, sexual violence, and 'other unwanted sexual experience'. The risk factors we investigated were severity of PTSD, severity of alcohol and drug use disorder, interpersonal difficulties, sex, and age. We analysed the data using logistic regression analyses with multiple imputation for missing data.Results: Physical violence was the most common type of revictimization during the study period (26.0%), closely followed by 'other unwanted sexual experience' (20.0%). The severity of PTSD and age were univariate predictors for revictimization; however, only age was robustly related to revictimization while accounting for other study variables. We conducted sensitivity analyses with complete cases and observed data.Discussion: Approximately two in five individuals experienced revictimization across the 9-month follow-up period, underscoring it as a clinically relevant issue. Since age emerged as the only risk factor for revictimization in our sample, future research should focus on identifying modifiable factors associated with age, e.g. impulsivity and novelty seeking. These factors may be addressed in interventions aimed at reducing the risk of revictimization.