European Journal of Psychotraumatology最新文献

Background: Populations affected by war, genocide, political violence, and forced displacement endure severe psychosocial disruption. Resilience is increasingly recognized as key to recovery, yet its definitions, measurement, and mechanisms of transmission in collective trauma contexts remain inconsistently addressed.Objective: This review aimed to synthesize how resilience is conceptualized, measured, and transmitted in the context of collective trauma, and to quantitatively assess the association between trauma exposure and resilience.Methods: Following PRISMA 2020 guidelines and registered in PROSPERO (CRD420250651118), we searched seven databases (e.g. Scopus, Embase, PubMed, PsycINFO) and screened 16,447 records. Eligible studies examined both man-made collective trauma exposure and resilience as an outcome or process. After full-text review, 53 studies were included: 16 qualitative studies and 9 reviews underwent thematic synthesis and 28 were included in a three-level random-effects meta-analysis of 43 effect sizes. Moderator analyses explored demographic and conceptual influences on the association.Results: Three integrative models of resilience were identified: (1) intrapersonal resource models (e.g. coping, emotional regulation), (2) multisystemic and relational process models (e.g. family, community support), and (3) sociocultural continuity and identity models (e.g. collective memory, tradition). These were derived from seven definitions categories, seven domains of protective and risk factors, and five measurement categories. The meta-analysis showed a significant negative association between trauma exposure and resilience (r = -0.109, 95%CI [-0.163, -0.055], p < .0001; I² = 82.3%), robust after outlier adjustment (r = -0.121). Stronger associations were observed in predominantly male samples (r = -0.176) and in intrapersonal or national resilience frameworks (r = -0.136), compared to relational models (r = -0.038), and across age in a quadratic pattern (QM[2] = 11.21, p = .0037). Trauma type, timing, and measurement method were not significant moderators.Conclusion: Resilience following collective trauma is best conceptualized as a multidimensional, context-sensitive process involving psychological, social, and cultural dimensions. Findings support an integrative framework and call for culturally grounded and system-oriented interventions.

Background: People seeking refuge and asylum must often endure diverse adversities before, during, and after migration, making them more susceptible to develop psychological problems. The effect of post-migration stressors on responsiveness to psychological treatment is unclear.Objectives: To: (1) evaluate the scope of the literature on the relation between post-migration stressors (e.g. struggles related to legal status in the context of resettlement) and outcomes of interventions targeting PTSD and comorbid conditions, in adult refugees and asylum seekers; (2) identify conceptual and methodological limitations of the literature; and (3) present limitations and recommendations for future research.Methods: This review follows the guidelines of PRISMA-ScR for Scoping Reviews, and the Population, Concept, and Context (PCC) framework for identifying concepts pertaining to the review question and the search strategy.Results: From 1,151 studies found through PsycINFO, PubMed, Web of Science Select, and review of sources, we assessed the 14 studies that fulfilled our criteria and found various post-migration barriers and facilitators of treatment success. Obtaining a more secure immigration status, reported in four studies, was the most emphasized factor associated with clinical improvement. Although the quality of the studies was overall high, there were frequent study limitations including small sample sizes and inconsistent post-stressor measures.Conclusion: Recommendations for future research include more robust methodologies, including mixed and longitudinal designs, and consistently using valid tools to assess post-migration stressors. The studies provide evidence for the effectiveness of psychological treatment in reducing symptoms of distress, despite being implemented in the context of post-migration stress. Post-migration stressors, although they may hamper treatment results, are not an indication to withhold treatment but a sign that additional services may be needed, but uniform and consistent evaluation of post-migration stressors should be implemented.

Background: The Russian invasion of Ukraine has resulted in forced displacement, with over six million Ukrainian refugees across Europe, of whom 81,770 are residing in Norway. This displacement and, in many cases, preceding war experiences, has led to increased vulnerability to trauma and mental health challenges. There is to date little knowledge about the extent to which structured mental health interventions can mitigate symptoms in Ukrainian refugees. Narrative Exposure Therapy (NET), a short-term trauma-focused intervention, has demonstrated efficacy in reducing post-traumatic stress disorder (PTSD), depression and dissociation symptoms among individuals exposed to organized violence and war.Aim: The protocol aims to assess the clinical effects of NET on PTSD, dissociation, and depression symptoms among Ukrainian refugees in Norway and to facilitate training and supervised praxis for Ukrainian health professionals in using NET.Methods: This study employs a pretest-posttest randomized controlled experimental design (RCT). Ukrainian health workers in Norway will receive a total of 450 hours of NET training through an online course. As a part of the training, they will, under supervision, administrate NET to Ukrainian refugees. Participants will be screened and assessed at three time points: baseline, immediately after treatment, and at a 6-month follow-up. Validated instruments in Ukrainian and Russian will be used to assess trauma experiences, symptoms, and comorbidities. Exclusion criteria: active psychotic spectrum disorders, neurodevelopmental disorders and concurrent trauma therapy. The study also contains an embedded qualitative sub study that will involve phronetic iterative thematic analysis of anonymized therapy narratives collected during NET sessions, aiming to understand how participants construct meaning from traumatic events, how narrative coherence evolves throughout therapy, and how identity reconstruction occurs post-trauma.Trial registration: ClinicalTrials.gov identifier: NCT07062042..

Background: The negative effects of prenatal stress on children's development and the buffering effects of maternal behaviour are well documented. However, specific maternal responses to trauma, particularly among families experiencing cumulative stressors during pregnancy and early childhood, remain less understood.Objective: This study investigated the interplay between prenatal stress in the context of the coronavirus disease 2019 (COVID-19) pandemic and consequent maternal trauma responses and children's difficulties in the context of war-related trauma.Methods: We recruited 318 pregnant women in Israel during the first wave of the COVID-19 pandemic (Time 1). Prenatal depression, anxiety, and COVID-related stress symptoms were assessed. When children were approximately 3.5 years old (SD = 0.02), the mothers were asked to report on parental responses related to the ongoing war and their child's emotional and behavioural difficulties (Time 2). Structural equation modelling was used to examine how maternal trauma responses mediate the association between prenatal stress-related mental health symptoms and children's difficulties during war.Results: Maternal prenatal depressive, anxious, and COVID-19-related stress symptoms predicted maladaptive maternal trauma responses during the war, which in turn were associated with increased emotional and behavioural problems in their children. Among the specific maternal trauma-related responses examined, cognitive avoidance and overprotectiveness were the only behavioural responses during the war significantly associated with children's difficulties.Conclusions: Our study highlights the impact of pandemic-related prenatal stress on maternal responses and children's difficulties during war, emphasizing the importance of identifying at-risk families as well as developing targeted interventions that mitigate negative parenting responses, particularly avoidance and overprotection.

Background: Among individuals with psychotic experiences, those with a history of developmental trauma face greater symptom severity and worse clinical outcomes compared to those without. Dissociation constitutes a prominent, characteristic of this group's clinical presentation, whose nuances and associated characteristics remain however understudied in psychosis research. We aimed to address this gap by conducting a qualitative study to investigate the phenomenology, context, and impact of dissociative experiences in individuals with subclinical psychosis and a history of developmental trauma.Methods: 25 UK-based participants with a history of developmental trauma and meeting criteria for subclinical psychosis, based on the CAPE-15, were recruited via social media. Participants attended semi-structured interviews online, which were transcribed verbatim and analysed with thematic analysis by two researchers.Results: Thematic analysis yielded the following themes: (1) Phenomenology of Dissociation; (2) Context of Dissociation; (3) Impact of Dissociation; (4) Dissociation and Psychotic-like Phenomena. Participants described experiences of detachment and compartmentalisation, which when experienced were confusing and often distressing. Dissociation was linked to affective experiences, their history of developmental trauma and psychotic-like experiences.Conclusion: This study elucidates the complex and varied nature of dissociative experiences in individuals with subclinical psychosis with a history of developmental trauma. These findings highlight the need for further research to understand the manifestation of dissociation in this population and the links with distress and other aspects of psychopathology. Importantly, it is essential to use this understanding to inform the development of interventions and improve clinical recognition and management.

Objective: The aim of this study is to investigate the psychometrics of the Dutch version of the Child and Adolescent Trauma Screener (CATS-2). By this, an international recognized instrument to screen symptoms of post-traumatic stress (PTSS) in children and adolescents according to the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5) becomes available for Dutch youth.Procedure and Method: Based on the validated CATS-2 we established the Dutch version, named the KJTS. A total of 587 children and adolescent, age 7-21, and 658 caregivers referred to mental health care services in Amsterdam was included in the study to examine psychometric properties. The construct was tested by confirmatory factor analysis (CFA). Furthermore reliability, convergent-divergent patterns and diagnostic test accuracy were examined.Results: The underlying DSM-5 factor structure with four symptom clusters (re-experiencing, avoidance, negative alterations in mood and cognitions, hyperarousal) was supported by CFA showing a good fit for the selfreport (CFI = .95, TLI = .94), and an acceptable fit for the caregiver report (CFI = .90, TLI = .89). The KJTS showed excellent reliability (alpha = .92) on both selfreport and caregiver report. The convergent-discriminant validity pattern showed medium to strong correlations with measures of internalization problems, such as anxiety and affective problems (r = .44-.72) and low to medium correlations with externalizing symptoms (r = .21-.36). The ROC-curve analysis has proven a good accuracy (AUC = .81; n = 106).Discussion and conclusion: This study demonstrates the psychometric accuracy of the KJTS in a Dutch clinical population. The KJTS reflects adequately the dimensionality of PTSD as described in the DSM-5, with a good fit for selfreports, an acceptable fit for caregiver reports, excellent reliability and sufficient validity. Limitations are described. The outcomes support the use of the KJTS in research and clinical practice for screening and monitoring of PTSS.

Background: Sleep disturbances are highly prevalent in traumatized refugees and often persist despite treatment, and adapted scalable interventions are needed. The group intervention 'Sleep Training adapted for Refugees' (STARS) is a culturally- and context-sensitive approach based on evidence-based treatments for sleep disturbances (e.g. CBT-I, IRT). This study evaluated the feasibility, acceptability, and effectiveness of STARS.Method: A randomized-controlled trial (STARS vs. waitlist) with 47 young male Afghan refugees was conducted in a routine clinical setting (DRKS-ID: DRKS00024419) with pre-, post- and 3-month follow-up assessments. The primary outcome was insomnia severity (Insomnia Severity Index); secondary outcomes included PTSD, anxiety and depression symptoms, nightmares, coping with nightmares, fear of sleep, selected sleep diary measures, and quality of life. The data were analysed using mixed models.Results: Adherence to STARS was high (dropout = 17.4%, average attended sessions = 77%) as was client satisfaction (M_CSQ-4 = 12.74, SD_CSQ-4 = 2.08). A medium to large significant effect of time was observed for insomnia severity (d = 0.96) and most secondary measures (except nightmares and fear of sleep). However, there was no significant interaction with condition at post-treatment for the primary outcome (d = 0.29) and most secondary outcomes; the only exceptions were increased coping with nightmares, decreased daytime sleep, and time in bed.Conclusions: STARS appears feasible for treating sleep disturbances in traumatized refugees in a routine clinical setting, showing moderate to large within-group effects. However, it was not superior to the waitlist, likely due to unexpected improvements in the waitlist group. Adjustments to STARS may enhance its efficacy. Further research is needed to determine how STARS can be a scalable add-on treatment for sleep disturbances in traumatized refugees and asylum seekers.Trial registration: German Clinical Trials Register identifier: DRKS00024419..

Background: Depression is a prevalent mental disorder with high morbidity and mortality globally. Methylmalonic acid (MMA) is involved in the pathogenesis of numerous diseases. However, it is unclear whether there is an association between MMA and the prevalence of depression.Methods: This study enrolled 7866 US adults from the 2011-2014 survey of the National Health and Nutrition Examination Survey (NHANES). Individuals were categorized into depression group and non-depression group based on Patient's Health Questionnaire-9 (PHQ-9) score. The association between MMA concentrations and prevalence of depression was analysed by multivariate logistic and linear regression, restricted cubic spline regression, and subgroup analysis. Mediation analysis was used to explore the role of inflammation in the relationship between MMA and depression.Results: MMA concentrations were higher in participants with depression than those without depression. There was a positive and linear relationship of MMA concentrations with PHQ-9 score and depression risk, respectively. Moreover, the association was stable in most subgroups. Furthermore, inflammatory factors were positively correlated to MMA concentrations and prevalence of depression. In addition, white blood cell, neutrophil and alkaline phosphatase (ALP) mediated the relationship between MMA and depression.Conclusion: Our findings revealed that there was a linear and positive correlation between MMA and the prevalence of depression in US adults, which might be mediated by inflammation.

ABSTRACTObjective: The 11th version of the International Classification of Diseases (ICD-11) introduces Posttraumatic Stress Disorder (PTSD) and complex PTSD (CPTSD) as two distinct trauma-related disorders. The International Trauma Questionnaire (ITQ) is the most widely used measure of assessment and has been adapted for use in children and adolescents (ITQ-CA), but a corresponding caregiver version is still missing. We aimed to close this gap by adapting the ITQ-CA and provide an initial validation of the ITQ - Caregiver Version (ITQ-CG). A corresponding measure of assessment from caregiver-perspective is integral for the use in child psychology, psychiatry and research.Method: Altogether, 326 children and adolescents who attended the department of child and adolescent psychiatry were rated by their caregivers using a set of standardized measures. Excluding patients due to missing data or no trauma exposure, a final sample of 223 patients was analysed. Factorial structure of the ITQ-CG and multiple forms of validity were examined using confirmatory factor, latent class and correlation analysis.Results: Confirmatory factor analysis supported the two-factor higher-order model of ICD-11 CPTSD as the factorial structure of the ITQ-CG. Convergent-divergent validity of main- and subscales of the ITQ-CG was evidenced by respective correlations with criterion variables. Latent class analysis supported the discriminant validity of the ITQ-CG, identifying a CPTSD-, PTSD-, DSO- and low symptoms-class. The CPTSD-class was associated with highest rates of comorbid psychopathology and functional impairment. Concurrent validity was evidenced by satisfactory concordance between caregiver- and child-reports.Conclusion: This study provides the construction and initial validation of the ITQ-CG to assess ICD-11 PTSD and CPTSD in children and adolescents from caregiver-perspective. We found compelling evidence for the ITQ-CGs validity, identifying it as an easy-to-use screening instrument to assess ICD-11 PTSD and CPTSD from caregiver-perspective. The ITQ-CG is freely available for clinicians and researchers.