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Complex posttraumatic stress disorder and dissociation in trauma-exposed Chinese adolescents: a latent class analysis. 受过创伤的中国青少年的复杂创伤后应激障碍和解离:潜类分析。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-05-29 DOI: 10.1080/20008066.2024.2351292
Li Wang, Haibo Fu, Hengjia Guo, Ping Liu, Yajie Bi, Shu Luo, Yuwei Han, Yuxuan Wang, Chengqi Cao

Background: Preliminary evidence provides support for the proposition that there is a dissociative subtype of Complex posttraumatic stress disorder (CPTSD). Research on this proposition would extend our knowledge on the association between CPTSD and dissociation, guide contemporary thinking regarding placement of dissociation in the nosology of CPTSD, and inform clinically useful assessment and intervention.Objectives: The present study aimed to investigate the co-occurring patterns of CPTSD and dissociative symptoms in a large sample of trauma exposed adolescents from China, and specify clinical features covariates of such patterns including childhood trauma, comorbidities with major depressive disorder (MDD) and generalized anxiety disorder (GAD), and functional impairment.Methods: Participants included 57,984 high school students exposed to the coronavirus disease 2019 (COVID-19) pandemic. CPTSD and dissociative symptoms, childhood traumatic experience, and functional impairment were measured with the Global Psychotrauma Screen for Teenagers (GPS-T). Major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Latent class analysis (LCA) was employed to test the co-occurring patterns of CPTSD and dissociative symptoms. Analysis of covariance (ANCOVA) and chi-square tests were respectively used to examine between-class differences in continuous and categorical clinical covariates.Results: A 5-class model emerged as the best-fitting model, including resilience, predominantly PTSD symptoms, predominantly disturbances in self-organization (DSO)symptoms, predominantly CPTSD symptoms, and CPTSD dissociative subtype classes. The CPTSD dissociative subtype class showed the lowest level of functioning and the highest rates of MDD, GAD and childhood trauma.Conclusions: Our findings provide initial empirical evidence supporting the existence of a dissociative subtype of CPTSD, and inform for further research and clinical practice on traumatized individuals.

背景:初步证据表明,复杂创伤后应激障碍(CPTSD)存在解离亚型。对这一命题的研究将扩展我们对 CPTSD 与解离之间关联的认识,指导当代关于将解离置于 CPTSD 分类学中的思考,并为临床有用的评估和干预提供信息:本研究旨在调查中国受创伤青少年中CPTSD和解离症状的共存模式,并明确这种模式的临床特征协变量,包括童年创伤、合并重性抑郁障碍(MDD)和广泛性焦虑障碍(GAD)以及功能障碍:研究对象包括57984名受到2019年冠状病毒病(COVID-19)大流行影响的高中生。通过全球青少年精神创伤筛查(GPS-T)测量了 CPTSD 和分离症状、童年创伤经历和功能障碍。重度抑郁症(MDD)和广泛性焦虑症(GAD)症状分别通过患者健康问卷-9(PHQ-9)和广泛性焦虑症-7(GAD-7)进行测量。采用潜类分析(LCA)来检验 CPTSD 和分离症状的共存模式。方差分析(ANCOVA)和卡方检验分别用于检验连续和分类临床协变量的类间差异:结果:一个五类模型成为最佳拟合模型,包括复原力、以创伤后应激障碍症状为主、以自我组织紊乱(DSO)症状为主、以 CPTSD 症状为主和 CPTSD 解离亚型类。CPTSD 解离亚型类别的功能水平最低,而 MDD、GAD 和童年创伤的发病率最高:我们的研究结果为支持 CPTSD 解离亚型的存在提供了初步的实证证据,并为针对创伤个体的进一步研究和临床实践提供了参考。
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引用次数: 0
Self-stigma mediates the relationships between childhood maltreatment and symptom levels of PTSD, depression, and anxiety. 自我烙印是童年虐待与创伤后应激障碍、抑郁和焦虑症状水平之间关系的中介。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-07-10 DOI: 10.1080/20008066.2024.2370174
Shilat Haim-Nachum, Amit Lazarov, Reut Zabag, Andrés Martin, Maja Bergman, Yuval Neria, Doron Amsalem

Background: Childhood maltreatment is a risk factor for developing multiple forms of psychopathology, including depression, posttraumatic stress disorder (PTSD), and anxiety. Yet, the mechanisms linking childhood maltreatment and these psychopathologies remain less clear.Objective: Here we examined whether self-stigma, the internalization of negative stereotypes about one's experiences, mediates the relationship between childhood maltreatment and symptom severity of depression, PTSD, and anxiety.Methods: Childhood trauma survivors (N = 685, Mage = 36.8) were assessed for childhood maltreatment, self-stigma, and symptoms of depression, PTSD, and anxiety. We used mediation analyses with childhood maltreatment as the independent variable. We then repeated these mediation models separately for childhood abuse and neglect, as well as the different subtypes of childhood maltreatment.Results: Self-stigma significantly mediated the relationship between childhood maltreatment and depression, PTSD, and anxiety symptoms. For sexual abuse - but not physical or emotional abuse - a significant mediation effect of self-stigma emerged on all symptom types. For childhood neglect, self-stigma significantly mediated the relationship between both emotional and physical neglect and all symptom types.Conclusion: Our cross-sectional study suggests that different types of childhood maltreatment experiences may relate to distinct mental health problems, potentially linked to increased self-stigma. Self-stigma may serve as an important treatment target for survivors of childhood abuse and neglect.

背景:童年虐待是导致多种心理病态的风险因素,包括抑郁症、创伤后应激障碍(PTSD)和焦虑症。然而,童年虐待与这些精神病理学之间的关联机制仍不太清楚。目的:在此,我们研究了自我污名(对个人经历的负面刻板印象的内化)是否会介导童年虐待与抑郁症、创伤后应激障碍和焦虑症症状严重程度之间的关系:对童年创伤幸存者(N = 685,Mage = 36.8)进行了童年虐待、自我污名以及抑郁、创伤后应激障碍和焦虑症状的评估。我们使用了以童年虐待为自变量的中介分析。然后,我们针对儿童虐待和忽视以及儿童虐待的不同亚型分别重复了这些中介模型:结果:自我污名对童年虐待与抑郁、创伤后应激障碍和焦虑症状之间的关系有明显的中介作用。对于性虐待(而非身体或情感虐待),自我污名对所有症状类型都有显著的调节作用。在儿童被忽视方面,自我污名对情感和身体忽视与所有症状类型之间的关系都有显著的中介作用:我们的横断面研究表明,不同类型的童年虐待经历可能会导致不同的心理健康问题,这可能与自我污名的增加有关。对于童年遭受虐待和忽视的幸存者来说,自我污名可能是一个重要的治疗目标。
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引用次数: 0
How do young men narrate the redemption story of a sexual assault perpetrator? 年轻人如何讲述性侵犯罪犯的救赎故事?
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-08-14 DOI: 10.1080/20008066.2024.2386829
Brianna C Delker, Paige Michel, Camille A Fogel, Aubrie L Patterson, Greyson Mize, Thea Huber, Kate C McLean

Background: Little is known about how young men who have committed sexual assault might acknowledge wrongdoing and eventually change and make amends. There are practical barriers to seeking the real redemption stories of perpetrators.Objective: To explore hypothetical pathways to young men's accountability-taking and amends (i.e. redemption) after perpetration of sexual assault.Method: In a pre-registered, qualitative story completion study, we presented heterosexual, cisgender college men (N = 54) with a date-based sexual assault story written by a fictional male perpetrator. Participants were prompted to complete the story so that the protagonist, who initially denies wrongdoing, eventually changes and becomes a violence prevention advocate.Results: A thematic analysis of the redemption stories revealed that this study's speculative task was a challenging one. Half of the stories did not provide an explanation for how the perpetrator was able to acknowledge wrongdoing. Overall, individualistic themes (e.g. he introspected) were more common than relational, community, or societal facilitators of redemption.Conclusions: Without infrastructure for accountability-taking and repair, or narrative exemplars to draw from in public life, it is difficult to envision redemption from violence. Rare gender-based, structurally attuned analyses of sexual violence in the stories point the way towards a more transformative vision of redemption.

背景:人们对实施性侵犯的年轻男性如何承认错误行为并最终改变和补偿知之甚少。寻找施暴者真实的救赎故事存在实际障碍:探索年轻男性在实施性侵犯后承担责任和做出补偿(即救赎)的假设途径:在一项预先登记的定性故事完成研究中,我们向异性恋、同性别的男性大学生(54 人)展示了一个由虚构的男性施暴者撰写的基于约会的性侵犯故事。参与者在提示下完成故事,从而使最初否认错误行为的主人公最终改变并成为一名暴力预防倡导者:对救赎故事的主题分析表明,本研究的推测任务具有挑战性。有一半的故事没有解释施暴者是如何承认错误的。总体而言,个人主义主题(如他进行了反省)比关系、社区或社会的救赎促进因素更为常见:没有问责和修复的基础设施,也没有公共生活中可借鉴的叙事典范,就很难设想从暴力中获得救赎。对故事中的性暴力进行罕见的性别分析和结构性分析,为实现更具变革性的救赎愿景指明了方向。
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引用次数: 0
The Norwegian traumatic grief inventory-self report plus (TGI-SR+): a psychometric evaluation in traumatically bereaved people. 挪威创伤性悲伤清单--自我报告强化版(TGI-SR+):对创伤性丧亲人群的心理测量评估。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-08-20 DOI: 10.1080/20008066.2024.2391248
Lonneke I M Lenferink, Iren Johnsen, Pål Kristensen, Nataskja-Elena Kersting Lie, Josefin Sveen

Background: Prolonged grief disorder (PGD) has been added to the ICD-11 and DSM-5-TR. The Traumatic Grief Inventory-Self Report Plus (TGI-SR+) assesses self-rated PGD intensity as defined in ICD-11 and DSM-5-TR. The TGI-SR + is available in multiple languages, but has not been validated yet in Norwegian.Objective: The aim of this study was to evaluate the psychometric properties of the Norwegian TGI-SR + .Method: Bereaved adults (N = 307) whose child or sibling died ≥6 months ago due to a sudden or violent loss completed the TGI-SR + and measures for posttraumatic stress, depression, and precursor PGD symptoms. We examined the factor structure and internal consistency of the ICD-11 and DSM-5-TR PGD items. Convergent validity and known-groups validity was evaluated. Probable PGD cases, pair-wise agreement between diagnostic scoring rules for both PGD criteria-sets, and cut-off scores were calculated.Results: The 1-factor model for ICD-11 and DSM-5-TR PGD showed the best fit and demonstrated good internal consistency. Convergent validity was supported by strong associations between summed ICD-11 and DSM-5-TR PGD scores and summed posttraumatic stress, depression, and precursor prolonged grief scores. Known-groups validity was supported by PGD intensity being related to educational level and time since loss. The perfect pair-wise agreement was reached using the ICD-11 and DSM-5-TR PGD diagnostic scoring rules. The optimal cut-off score for detecting probable PGD cases, when summing all TGI-SR + items, was ≥73.Conclusions: The Norwegian TGI-SR + seems a valid and reliable instrument to assess ICD-11 and DSM-5-TR PGD intensity after losing a child or sibling under traumatic circumstances.

背景:长期悲伤障碍(PGD)已被列入 ICD-11 和 DSM-5-TR。创伤性悲伤量表--自我报告增强版(TGI-SR+)可评估ICD-11和DSM-5-TR中定义的自我评定的PGD强度。TGI-SR+ 有多种语言版本,但尚未在挪威语中得到验证:本研究旨在评估挪威语 TGI-SR + 的心理测量特性:其子女或兄弟姐妹在≥6个月前因突然或暴力丧生的失去亲人的成年人(N = 307)填写了TGI-SR +和创伤后应激反应、抑郁和PGD前兆症状测量表。我们研究了 ICD-11 和 DSM-5-TR PGD 项目的因子结构和内部一致性。我们还评估了收敛有效性和已知群体有效性。计算了可能的 PGD 病例、两套 PGD 标准的诊断评分规则之间的配对一致性以及临界分数:结果:ICD-11 和 DSM-5-TR PGD 的单因素模型显示出最佳拟合度和良好的内部一致性。ICD-11 和 DSM-5-TR PGD 的总分与创伤后应激反应、抑郁和前兆性长期悲伤的总分之间存在很强的关联,这支持了聚合效度。PGD强度与教育水平和丧亲时间相关,这也支持了已知群体有效性。通过使用 ICD-11 和 DSM-5-TR PGD 诊断评分规则,达到了完美的双向一致性。将所有TGI-SR +项目相加,检测可能的PGD病例的最佳临界分数为≥73.结论:挪威TGI-SR +似乎是评估在创伤情况下失去子女或兄弟姐妹后ICD-11和DSM-5-TR PGD强度的有效而可靠的工具。
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引用次数: 0
Adult refugees' perspectives on the impact of trauma and post-migration hardships on learning. 成年难民对创伤和移民后艰辛对学习的影响的看法。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-10-01 DOI: 10.1080/20008066.2024.2403249
Janita Flem Tomren, Marianne Opaas

Background: Research shows that adult refugees' well-being and future in the reception country heavily depend on successfully learning the host language. However, we know little about how adult learners from refugee backgrounds experience the impact of trauma and adversity on their learning.Objective: The current study aims to investigate the perspectives of adult refugee learners on whether and how trauma and other adversity affect their learning.Methods: We conducted in-depth interviews with 22 adult refugees (10 women) attending the Norwegian Introduction Programme (NIP). The participants came from six Middle Eastern, Central Asian, and African countries. Two questionnaires were included, one about past stressful life events (SLESQ-Revised), and one about mental health symptoms and current psychological distress following potentially traumatic experiences (PCL-5).Results: Participants held varying beliefs about trauma's impact on learning: that it had a constant impact, that it was situational, or that it had no impact. Other aspects they brought up as having an essential effect on learning and school attendance include psychological burdens from past and present school experiences, and post-migration hardships such as loneliness, depression, ongoing violence, and negative social control. Post-migration trauma and hardships exacerbated the burden of previous trauma and were frequently associated with a greater negative influence on learning.Conclusion: This study adds new insights from adult refugee learners themselves into how post-migration hardships as well as trauma can impact their learning, and the importance of recognising their struggles. A safe space is required for refugees to open up about their difficulties in life and with learning. This knowledge can be used to enhance teaching practices, foster better teacher-student relationships, and inform policy-making decisions, ultimately benefiting both individuals and society.

背景:研究表明,成年难民在接收国的福祉和未来在很大程度上取决于能否成功学习东道国语言。然而,我们对来自难民背景的成年学习者如何体验创伤和逆境对其学习的影响知之甚少:本研究旨在调查成年难民学习者对创伤和其他逆境是否以及如何影响其学习的看法:我们对参加挪威入门课程(NIP)的22名成年难民(10名女性)进行了深入访谈。参与者来自六个中东、中亚和非洲国家。调查问卷包括两份,一份是关于过去的生活压力事件(SLESQ-修订版),另一份是关于潜在创伤经历后的心理健康症状和当前的心理困扰(PCL-5):结果:关于创伤对学习的影响,参与者持有不同的看法:认为创伤会持续影响学习,认为创伤是情境性的,或者认为创伤不会影响学习。他们认为对学习和出勤率有重要影响的其他方面包括过去和现在的学校经历所造成的心理负担,以及移民后的困难,如孤独、抑郁、持续的暴力和消极的社会控制。移民后的创伤和苦难加重了之前的创伤负担,往往对学习产生更大的负面影响:这项研究从成年难民学习者自身的角度,对移民后的困难和创伤如何影响他们的学习,以及认识到他们的挣扎的重要性,提出了新的见解。难民们需要一个安全的空间来敞开心扉,讲述他们在生活和学习中遇到的困难。这些知识可用于加强教学实践,促进更好的师生关系,并为决策提供信息,最终使个人和社会受益。
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引用次数: 0
A systematic review and meta-analysis on the efficacy of dialectical behavior therapy variants for the treatment of post-traumatic stress disorder. 关于辩证行为疗法变体治疗创伤后应激障碍疗效的系统回顾和荟萃分析。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-10-01 DOI: 10.1080/20008066.2024.2406662
Karin Prillinger, Andreas Goreis, Sarah Macura, Carola Hajek Gross, Annika Lozar, Selina Fanninger, Anna Mayer, Claudia Oppenauer, Paul L Plener, Oswald D Kothgassner

Background: While there are well-established treatments for post-traumatic stress disorder (PTSD), these interventions appear to be less effective for individuals with comorbid borderline personality disorder (BPD) symptoms. Dialectical Behavior Therapy (DBT) for PTSD and DBT Prolonged Exposure (PE) are both effective interventions for treating these patients, but a comprehensive analysis evaluating the efficacy of these two interventions is lacking.Objective: To determine the effect sizes of PTSD-specific DBT treatments.Methods: We conducted a systematic review and pre-registered meta-analysis of the DBT literature for treating PTSD (osf.io/62rfq). Eligible trials and treatment evaluations published before September 2023 were searched in SCOPUS, PubMed, and the Cochrane Library databases. Thirteen articles were identified, and data were extracted for primary (PTSD symptoms) and secondary outcomes (BPD, depression, dissociation, non-suicidal self-injury [NSSI]). Treatment effects were calculated for randomised controlled trials, controlled clinical trials, and pre-post evaluations.Results: Overall, the studies involved 663 participants. Compared with control groups, PTSD-specific DBT treatments showed moderate effects in reducing PTSD symptom severity g = -0.69 (95% CI -1.03 to -0.34, p < .001) and depression g = -0.62 (95% CI -1.13 to -0.12, p = .016). Moreover, the pre-post changes showed an overall effect size for dissociative symptoms of g = -0.72 (95% CI -1.05 to -0.40, p < .001), for BPD-associated symptoms of g = -0.82 (95% CI -1.06 to -0.59, p < .001), and for NSSI frequency (g = -0.70, 95% CI -1.12 to -0.28, p = .001).Conclusions: Based on the results of our meta-analysis, DBT-PTSD and DBT PE were effective in reducing PTSD symptom severity and comorbid depressive symptoms. Further research on stage-based treatments should focus on systematically assessing NSSI, BPD symptoms, and suicidality.

背景:虽然创伤后应激障碍(PTSD)有成熟的治疗方法,但这些干预措施对合并有边缘型人格障碍(BPD)症状的患者似乎效果较差。针对创伤后应激障碍的辩证行为疗法(DBT)和DBT延长暴露疗法(PE)都是治疗这些患者的有效干预措施,但目前还缺乏对这两种干预措施疗效的全面分析评估:目的:确定 PTSD 特异性 DBT 治疗的效应大小:我们对治疗创伤后应激障碍的 DBT 文献(osf.io/62rfq)进行了系统回顾和预先注册的荟萃分析。我们在 SCOPUS、PubMed 和 Cochrane Library 数据库中检索了 2023 年 9 月之前发表的符合条件的试验和治疗评估。确定了 13 篇文章,并提取了主要结果(创伤后应激障碍症状)和次要结果(BPD、抑郁、解离、非自杀性自伤 [NSSI])的数据。计算了随机对照试验、临床对照试验和前后评价的治疗效果:这些研究共涉及 663 名参与者。与对照组相比,创伤后应激障碍特异性 DBT 治疗在降低创伤后应激障碍症状严重程度方面显示出中等效果 g = -0.69 (95% CI -1.03 to -0.34, p g = -0.62 (95% CI -1.13 to -0.12, p = .016)。此外,前后变化对分离症状的总体影响大小为 g = -0.72 (95% CI -1.05 to -0.40, p g = -0.82 (95% CI -1.06 to -0.59, p g = -0.70, 95% CI -1.12 to -0.28, p = .001):根据我们的荟萃分析结果,DBT-PTSD 和 DBT PE 能有效降低创伤后应激障碍症状的严重程度和合并抑郁症状。对基于阶段的治疗方法的进一步研究应侧重于系统评估 NSSI、BPD 症状和自杀倾向。
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引用次数: 0
Effects of childhood adversities on alexithymia features vary between sexes. Results of a prospective population study. 童年逆境对自闭症特征的影响因性别而异。一项前瞻性人口研究的结果。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-10-11 DOI: 10.1080/20008066.2024.2407256
Raimo K R Salokangas, Tiina From, Henri R W Salokangas, Lara Lehtoranta, Jaana Suvisaari, Seppo Koskinen, Jarmo Hietala, Matti Joukamaa, Max Karukivi

Introduction: Adverse childhood experiences (ACEs) associate with various mental disorders, including personality features. Our understanding of how ACEs influence alexithymia features in the general population is limited. In a prospective population setting, we studied whether ACEs associate with alexithymia, and the role of sex and emotional symptoms in this association.Methods: In a Finnish population-based prospective study, 3,142 individuals aged between 30 and 64 years completed eleven ACE questions and the Toronto Alexithymia Scale in 2000 and 2011, and the Hopkins Symptoms Checklist in 2011. The effect of ACEs on alexithymia and its subdomains - difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT) in 2000 and 2011 - was analysed using repeated measures ANOVA.Results: The number of ACEs and their main component, childhood social disadvantage, associated positively with total alexithymia scores and its subdomains DIF and DDF, and negatively with EOT. After controlling for the effect of depression and anxiety, the strength of these associations was reduced, but the effect of social disadvantage on DIF and EOT remained significant in females. Childhood family conflicts associated positively with DIF in males and negatively with EOT in females. Additionally, maternal mental problems associated positively with DIF and DDF in females.Discussion: In the general population, ACEs, particularly social disadvantage, are associated with adult alexithymia features. Alexithymia features, detectable from youth, may predispose individuals to emotional disturbances caused by childhood adversities. The effect of family conflicts and maternal mental problems on alexithymia features varies between sexes.

导言童年不良经历(ACE)与包括人格特征在内的各种精神障碍有关。我们对童年逆境经历如何影响普通人群的情感障碍特征的了解还很有限。在一项前瞻性人群调查中,我们研究了ACE是否与亚历山大症有关,以及性别和情绪症状在这种关联中的作用:在一项基于芬兰人口的前瞻性研究中,3142 名年龄在 30 至 64 岁之间的人分别在 2000 年和 2011 年填写了 11 个 ACE 问题和多伦多亚历山大症量表,并在 2011 年填写了霍普金斯症状核对表。采用重复测量方差分析法分析了2000年和2011年ACE对情感障碍及其子域--识别感受困难(DIF)、描述感受困难(DDF)和外向思维(EOT)--的影响:结果表明:ACE的数量及其主要组成部分--童年社会不利条件与情感缺失总分及其子域DIF和DDF呈正相关,而与EOT呈负相关。在控制了抑郁和焦虑的影响后,这些关联的强度有所降低,但在女性中,社会不利条件对 DIF 和 EOT 的影响仍然显著。童年时期的家庭冲突与男性的 DIF 呈正相关,而与女性的 EOT 呈负相关。此外,母亲的精神问题与女性的 DIF 和 DDF 呈正相关:讨论:在一般人群中,ACE,尤其是社会不利条件,与成年后的情感障碍特征有关。从青少年时期就能发现的亚历山大症特征,可能使个体容易因童年逆境而产生情绪障碍。家庭冲突和母亲精神问题对情感障碍特征的影响因性别而异。
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引用次数: 0
On the concordance between CAPS-5 and PCL-5 scores. 关于 CAPS-5 和 PCL-5 评分之间的一致性。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-11-14 DOI: 10.1080/20008066.2024.2407728
Daniel J Lee, Frank W Weathers, Michelle J Bovin, Brian P Marx

Background: As reported in this journal, Resick and colleagues (2023) investigated discrepancies between scores from two widely used PTSD measures: the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers et al., 2013) and the PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013), a clinician-rated structured interview and a self-rated questionnaire, respectively. Using data from four clinical trials of active-duty military personnel and veterans, the authors replicated the common finding that PCL-5 scores are higher than CAPS-5 scores. They then examined item response distributions, finding that ratings on the PCL-5 were more evenly distributed across all five options whereas specific CAPS-5 scores were used relatively infrequently. Concluding that this finding indicates a problem that should be addressed, they offered suggestions for revising anchors and items to improve correspondence between the two measures.Objective: The results are informative and the nature and size of the sample are well-suited to this important research question. However, we have a number of concerns and comments about this paper.Conclusion: In our view, the authors mischaracterized the CAPS-5 and PCL-5 in several important ways, resulting in some erroneous conclusions about their findings and the expected nature of the relationship between the CAPS-5 and PCL-5. Given that these issues are vital to the field of traumatic stress, we felt compelled to address them and provide an alternative perspective.

背景:正如本刊所报道的,Resick及其同事(2023年)调查了两种广泛使用的创伤后应激障碍测量方法得分之间的差异:DSM-5临床医师管理创伤后应激障碍量表(CAPS-5;Weathers等人,2013年)和DSM-5创伤后应激障碍核对表(PCL-5;Weathers等人,2013年),这两种方法分别是临床医师评分的结构化访谈和自我评分的问卷。作者利用四项针对现役军人和退伍军人的临床试验数据,重复了 PCL-5 评分高于 CAPS-5 评分这一共同发现。然后,他们对项目反应分布进行了研究,发现 PCL-5 的评分在所有五个选项中的分布更为均匀,而 CAPS-5 的具体分数则相对较少使用。他们得出结论认为,这一发现表明存在一个需要解决的问题,并提出了修改锚点和项目的建议,以改善两种测量方法之间的对应关系:结果很有参考价值,样本的性质和规模也非常适合这一重要的研究问题。然而,我们对这篇论文有一些担忧和意见:我们认为,作者在几个重要方面错误地描述了 CAPS-5 和 PCL-5,导致他们对研究结果以及 CAPS-5 和 PCL-5 之间关系的预期性质得出了一些错误的结论。鉴于这些问题对创伤应激领域至关重要,我们认为有必要解决这些问题,并提供另一种视角。
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引用次数: 0
Effect of trauma on asylum seekers and refugees receiving a WHO psychological intervention: a mediation model. 创伤对接受世界卫生组织心理干预的寻求庇护者和难民的影响:中介模型。
IF 5 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-06-03 DOI: 10.1080/20008066.2024.2355828
Riccardo Serra, Marianna Purgato, Federico Tedeschi, Ceren Acartürk, Eirini Karyotaki, Ersin Uygun, Giulia Turrini, Hildegard Winkler, Irene Pinucci, Johannes Wancata, Lauren Walker, Mariana Popa, Marit Sijbrandij, Maritta Välimäki, Markus Kösters, Michela Nosè, Minna Anttila, Rachel Churchill, Ross G White, Tella Lantta, Thomas Klein, Thomas Wochele-Thoma, Lorenzo Tarsitani, Corrado Barbui

Background: Scalable psychological interventions such as the WHO's Self-Help Plus (SH+) have been developed for clinical and non-clinical populations in need of psychological support. SH+ has been successfully implemented to prevent common mental disorders among asylum seekers and refugees who are growing in number due to increasing levels of forced migration. These populations are often exposed to multiple, severe sources of traumatisation, and evidence of the effect of such events on treatment is insufficient, especially for non-clinical populations.Objective: We aim to study the effect of potentially traumatic experiences (PTEs) and the mediating role of symptoms of posttraumatic stress disorder (PTSD) on the improvement following SH+.Method: Participants allocated to SH+ who received at least three sessions (N = 345) were extracted from two large, randomised, European prevention trials involving asylum seekers and refugees. Measures of distress, depression, functional impairment, and post-traumatic stress symptoms were administered at baseline and 6 months post-intervention, together with measures of well-being and quality of life. Adjusted models were constructed to examine the effect of PTEs on post-intervention improvement. The possible mediating role of PTSD symptoms in this relationship was then tested.Results: Increasing numbers of PTEs decreased the beneficial effect of SH+ for all measures. This relationship was mediated by symptoms of PTSD when analysing measures of well-being and quality of life. However, this did not apply for measures of mental health problems.Conclusions: Exposure to PTEs may largely reduce benefits from SH+. PTSD symptomatology plays a specific, mediating role on psychological well-being and quality of life of participants who experienced PTE. Healthcare professionals and researchers should consider the role of PTEs and PTSD symptoms in the treatment of migrants and refugees and explore possible feasible add-on solutions for cases exposed to multiple PTEs.

背景:针对需要心理支持的临床和非临床人群开发了可推广的心理干预措施,如世界卫生组织的自助加(SH+)。SH+ 已成功用于预防寻求庇护者和难民中常见的精神障碍,由于被迫移民的人数不断增加,这些人的数量也在不断增加。这些人群通常会遭受多重、严重的心理创伤,而有关此类事件对治疗影响的证据并不充分,尤其是对非临床人群而言:我们旨在研究潜在创伤经历(PTEs)的影响,以及创伤后应激障碍(PTSD)症状对 SH+ 后病情改善的中介作用:方法:从两项涉及寻求庇护者和难民的大型欧洲随机预防试验中抽取了至少接受过三次 SH+ 治疗的参与者(N = 345)。在基线和干预后 6 个月,对苦恼、抑郁、功能障碍和创伤后应激症状进行了测量,同时还对幸福感和生活质量进行了测量。建立了调整模型,以检验创伤后应激症状对干预后改善的影响。然后检验了创伤后应激障碍症状在这种关系中可能起到的中介作用:结果:PTEs 数量的增加降低了 SH+ 对所有测量指标的有益影响。在分析幸福感和生活质量时,创伤后应激障碍症状对这种关系起到了中介作用。然而,这并不适用于精神健康问题的测量:结论:暴露于 PTEs 可能会在很大程度上减少 SH+ 的益处。创伤后应激障碍症状对经历过 PTE 的参与者的心理健康和生活质量起着特殊的调节作用。医疗保健专业人员和研究人员应考虑 PTEs 和创伤后应激障碍症状在移民和难民治疗中的作用,并为暴露于多种 PTEs 的病例探索可行的附加解决方案。
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引用次数: 0
Evocation of positive memories as complement to trauma-focused cognitive-behavioural therapy for intimate partner violence against women. 唤起积极记忆作为针对亲密伴侣暴力侵害妇女行为的创伤认知行为疗法的补充。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-11-12 DOI: 10.1080/20008066.2024.2419699
María Crespo, M José Hernández-Lloreda, Carlos Hornillos, Alejandro Miguel-Alvaro, Silvia Sánchez-Ferrer, Ana A Antón

Background: Focusing on positive memories as a complement to trauma-focused interventions for intimate partner violence against women (IPVAW) could contribute to enhancing the recovery from trauma with the development of a more integrated and emotionally modulated autobiographical narrative.Objective: To test the effectiveness of a trauma-focused cognitive behavioural therapy (CBT) tailored for IPVAW that incorporates the evocation of positive memories.Methods: Female survivors of IPVAW entered a randomized controlled trial comparing trauma-focused CBT for IPVAW (CBT; n = 35) to a version that incorporates the evocation of positive memories (CBT-M+; n = 44) and to a waitlist (WL; n = 12) control group. Pre and post measures were obtained for: posttraumatic stress, meaning of trauma, affect, emotional regulation, associated symptoms, self-concept and overall functioning.Results: A total of 43.04% of women who entered treatment dropped out, without significant treatment differences. Pre-post changes were not significant for the WL; both treatments resulted in significant improvements, with good effect sizes, for posttraumatic stress (g = 0.78 and g = 1.00 for CBT and CBT-M+, respectively), meaning of trauma, affect, associated symptoms, self-concept and overall functioning, but not in emotional regulation. There were no significant differences between CBT and CBT-M+ in the direct comparisons; however, the effect sizes showed better effects of CBT for centrality of the IPVAW, whereas they favoured CBT-M+ for PTSD, depression, self-esteem and impairment measures. No clinically significant change was reached for the WL, while both treatments significantly reduced the percentage of women with PTSD and self-esteem problems; additionally, the percentage of women with depression and impairment problems in the CBT-M+ group was significantly decreased.Conclusions: Although there were few differences between both treatments, CBT-M+ seemed to have a greater effect, pointing to the potential of the inclusion of the evocation of positive memories that should be further researched.

背景:将积极记忆作为针对亲密伴侣暴力侵害妇女行为(IPVAW)的创伤干预措施的补充,有助于通过发展更完整、情绪更稳定的自传体叙事来促进创伤康复:目的:测试针对亲密伴侣暴力侵害妇女行为(IPVAW)的创伤认知行为疗法(CBT)的有效性,该疗法结合了唤起积极记忆的方法:遭受暴力侵害的女性幸存者参加了一项随机对照试验,该试验比较了针对遭受暴力侵害的创伤认知行为疗法(CBT;n = 35)和包含唤起积极记忆的版本(CBT-M+;n = 44),以及候补名单对照组(WL;n = 12)。对创伤后压力、创伤的意义、情感、情绪调节、相关症状、自我概念和整体功能进行了前后测量:共有 43.04% 的妇女退出了治疗,但治疗效果差异不大。WL 治疗前后的变化不显著;两种治疗方法都能显著改善创伤后应激反应(CBT 和 CBT-M+ 的 g = 0.78 和 g = 1.00)、创伤的意义、情感、相关症状、自我概念和整体功能,但在情绪调节方面效果不显著。在直接比较中,CBT 和 CBT-M+ 之间没有明显差异;但是,效应大小显示,CBT 在 IPVAW 中心性方面的效果更好,而在创伤后应激障碍、抑郁、自尊和损伤测量方面,CBT-M+ 的效果更好。在 WL 方面,两种治疗方法都没有达到临床意义上的显著变化,但在创伤后应激障碍和自尊问题上,两种治疗方法都显著降低了妇女的比例;此外,在 CBT-M+ 组中,抑郁和损伤问题的妇女比例也显著降低:结论:虽然两种治疗方法之间的差异不大,但 CBT-M+ 似乎有更大的效果,这表明唤起积极记忆的方法具有潜力,值得进一步研究。
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引用次数: 0
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European Journal of Psychotraumatology
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