Journal of traumatic stress最新文献

Adverse childhood experiences (ACEs) are linked to numerous negative physical and mental health outcomes. The current study addressed theoretical, conceptual, and measurement problems by evaluating a novel extension to the seminal ACEs questionnaire (ACEs-Q). Two U.K.-based adult samples (N_{Study 1} = 859, N_{Study 2} = 297) were used to examine the structure of the ACEs-Q via principal component analysis (PCA) and, within a structural equation modeling (SEM) framework, reflective and composite-formative models, as well as to develop and validate a supplementary measure-the ACEs-Related Impairment Questionnaire (ACEs-RIQ)-designed to assess the impairment associated with ACEs. In Study 1, PCA supported a two-factor ACEs-Q structure encompassing Childhood Maltreatment (CM) and Household Challenges (HC) factors. Both SEM approaches showed similar associations with internalizing outcomes, primarily driven by CM, composite-formative: β_Depression = .50, β_Anxiety = .43, β_Stress = .42; reflective: β_Depression = .51, β_Anxiety = .43, β_Stress = .42. Although the findings indicate compatibility of the ACEs construct with both modeling approaches, the composite-formative model, where dichotomous items function as contributing indicators that form rather than reflect the construct, is more closely aligned with the current conceptualization of ACEs. In Study 2, the ACEs-RIQ demonstrated high internal consistency, Cronbach's α = .92, and predictive validity comparable to the ACEs-Q, tested through SEM. The ACEs-RIQ was found to be a valid, reliable instrument that extends the ACEs-Q by capturing impairment due to adversity rather than exposure alone.

Childhood abuse and neglect worsen physical and mental health through adulthood. This study examined how childhood adversity affected physical and psychological symptoms associated with breast cancer treatment and survivorship at three points within the cancer trajectory. Breast cancer survivors (N = 209) were recruited following diagnosis and completed three visits at pretreatment, 6 months posttreatment, and 18 months posttreatment. All survivors completed the Childhood Trauma Questionnaire to assess abuse and neglect exposure prior to 18 years of age. At each visit, participants completed self-report measures of depressive symptoms, anxiety symptoms, pain, fatigue, and sleep quality. When controlling for disease-related variables, sexual abuse significantly interacted with study visit to predict pain, p = .002. No other significant interactions emerged. Analyses of main effects revealed that breast cancer survivors who experienced higher rates of each abuse or neglect type experienced poorer sleep quality, Bs = 0.20-0.39, p < .001-p = .002; higher fatigue, Bs = 0.81-1.4, ps < .001-p = .020; more depressive symptoms, Bs = 0.55-0.56, ps $\le$  .001; and higher anxiety symptoms, Bs = 0.35-0.54, p < .001-p =  .002. Only physical neglect was significantly associated with pain, B = 0.12, p = .041. Results suggest that breast cancer survivors who experienced abuse and neglect earlier in life are at increased risk of adverse physical and psychological symptoms throughout survivorship. Providers should consider screening for early life trauma to understand unique risks associated with navigating breast cancer treatment and survivorship.

Despite the number of empirically supported treatments for posttraumatic stress disorder (PTSD) available in U.S. Department of Veterans Affairs (VA) specialty mental health settings, many veterans decline referrals to this setting or do not follow through with recommended care. Thus, the expansion of PTSD services into primary care settings is crucial for increasing access to evidence-based treatments among veterans. To this end, the current pilot project examined the acceptability, feasibility, and preliminary effectiveness of written exposure therapy (WET) delivered to veterans with clinically significant trauma-related symptoms presenting to VA primary care. Veterans (N = 36) were assessed pretreatment, posttreatment, and 1-month follow-up. Mean satisfaction ratings assessed via the Client Satisfaction Questionnaire-8 suggest that the treatment was acceptable (M = 28.00, SD = 3.91). Recruitment and retention rates suggest that the treatment was feasible to deliver, with 88.0% of respondents who expressed interest initiating treatment and 66.0% of those who initiated treatment completing treatment. Further, the results revealed large reductions in PTSD symptom severity from pre- to posttreatment, d = 0.94, and pretreatment to 1-month follow-up, d = 0.89, as assessed using the PTSD Checklist for DSM-5. These findings provide initial support for WET when delivered to veterans presenting with trauma-related symptoms in a primary care setting.

Bisexual and other multigender-attracted (e.g., pansexual, queer) people (bi+) report disproportionately high posttraumatic stress symptoms (PTSS) linked to a high frequency of discrimination and general trauma exposure. Bi+ people of color (POC) may be particularly vulnerable to PTSS given exposure to intersectional discrimination (e.g., LGBTQ+ racism, racial/ethnic heterosexism). Identity conflict (i.e., perceived incongruence between one's sexual and racial/ethnic identities) may link intersectional discrimination to PTSS. Using cross-sectional survey data from 295 bi+ POC (M_age = 27.6 years), we estimated three structural equation models to test associations between intersectional discrimination and PTSS severity (Model 1), provisional posttraumatic stress disorder (PTSD) diagnosis (Model 2), and PTSD symptom domains (intrusions, avoidance, negative alterations in cognitions and mood [NACM], arousal/reactivity; Model 3). Each model adjusted for exposure to potentially traumatic events (PTEs) and estimated indirect effects via identity conflict. Accounting for PTEs, intersectional discrimination was associated with higher PTSS severity, β = .21, p = .003, and all PTSD symptom domains, βs = .15-.21, ps = .005-.025, but not provisional PTSD diagnosis, β = .15, p = .071. Discrimination direct effects were nonsignificant (accounting for identity conflict); however, indirect effects via identity conflict were significant for PTSS severity, β = .11, p < .013 (Model 1), and avoidance, β = .13, p = .007, and NACM symptoms, β = .12, p = .005 (Model 3). Other indirect effects were nonsignificant. Findings highlight intersectional minority stressors as risk factors for PTSS among bi+ POC, above and beyond trauma exposure, which may inform trauma-focused treatments.

Faith or spirituality may foster resilience among forcibly displaced individuals facing postmigration stress, including the loss of social networks, cultural adjustment, and uncertainty. Although prayer and community gatherings promote resilience, their role in building individual and community resilience under postmigration stress is less known. Forcibly displaced adults (N = 272) completed measures of positive religious coping, fate and destiny-related beliefs, and religious and spiritual struggles. Outcomes were individual and community resilience, with postmigration living difficulties examined as a moderator. Positive religious coping was associated with higher individual resilience, β = .15, p = .018, whereas higher religious struggles were associated with lower resilience, β = -.22, p = .001. Postmigration stress moderated the association between spiritual struggles and individual resilience, with the negative association between spiritual struggles and resilience weakening as postmigration stress increased. Both higher positive religious coping, β = .35, p < .001, and higher fate and destiny-related beliefs, β = .37, p < .001, were associated with higher community resilience. Higher postmigration stress was modestly associated with higher community resilience, β = .14, p = .015, but did not moderate observed associations. Taken together, spirituality serves as an important social and psychological resource for forcibly displaced individuals, fostering both individual and community resilience. Under higher postmigration stress, individuals adapt by relying on available coping mechanisms, mitigating the impact of religious struggles on resilience. Programs that promote culturally meaningful religious coping and shared spiritual practices may offer community-driven pathways to resilience for populations navigating forced displacement.

In the present study, the novel family genetic risk score (FGRS) method, a reliable quantification of latent genetic risk, was applied to posttraumatic stress disorder (PTSD) to examine associations between genetic liability and clinical features of PTSD among 3,097,180 individuals in the Swedish national registries. FGRS was calculated based on lifetime PTSD status for first- through fifth-degree relatives and examined both in PTSD cases with any lifetime registration (PTSD total) and in cases with more than one registration (recurrent PTSD) in relation to sex, age at onset (AAO), recurrence, mode of ascertainment (inpatient [IP], outpatient specialty care [SC], primary care [PC]), and comorbidities. Sex differences were not found for recurrent PTSD, but for PTSD total, female registrants had a lower FGRS value compared to male registrants, M = -.017, 95% CI of difference [-.029-.005]. Higher FGRS was found at earlier AAO for PTSD total and recurrent PTSD, ps < .001, and scores were higher among individuals with comorbidities, ps < .001. Higher FGRS was related to the number of PTSD recurrences among both total PTSD and recurrent PTSD, ps < .001 (linear effect). For both PTSD types, FGRS scores were as follows: PC < SC < IP, ps < .001. The findings indicate that genetic risk for PTSD is associated with several clinical features of the disorder, which should be included in future studies of genetic risk for PTSD. Continued investigation of these clinical features in epidemiological and molecular genetic studies of PTSD is warranted to further validate the findings.

There is growing interest in novel approaches to treating posttraumatic stress disorder (PTSD), including the use of psychedelic substances combined with psychotherapy, often referred to as psychedelic-assisted therapy, to better meet the needs of patients who do not prefer or respond to traditional evidence-based treatments. Among these treatments, 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy (MDMA-AT) has shown promising outcomes in recent randomized controlled trials, with high response and remission rates. However, the U.S. Food and Drug Administration declined to approve MDMA-AT for marketable use in August 2024 due to concerns about insufficient evidence. This paper reviews the current state of the scientific literature on MDMA-AT for PTSD, including putative mechanisms of action; key strengths and limitations of methodologies used to date; gaps in the evidence; and clinical, ethical, and regulatory considerations. Key limitations to be addressed in future studies include challenges with blinding, a lack of active comparator conditions, a lack of head-to-head comparisons of different models, inadequate safety monitoring, and limited sample generalizability. We describe emerging research that integrates MDMA with established trauma-focused therapies, such as prolonged exposure therapy and cognitive processing therapy, to leverage MDMA's effects on known cognitive behavioral mechanisms of action and support future implementation. Future research directions for advancing knowledge and consideration for the dissemination of MDMA-AT are discussed.

This qualitative study examined the dialectical association between psychosocial trauma and political conscientization in the lives of activists advocating for persons with marginalized sexual orientations and gender identities (2SLGBTQIA+) in São José dos Campos, Brazil. Drawing on participatory research and grounded in liberation psychology and intersectionality, the study involved collaboration with 10 activists through participation in advocacy activities, semistructured interviews, and collective reflection. Our reflexive thematic analysis indicated four main themes: (a) addressing psychosocial harm and trauma in the realm of sexual orientation and gender identity, highlighting how activists navigate the effects of historical violence and activist work and employ strategies of self- and collective care; (b) decoding and confronting intersecting power structures, capturing how activists interpret and resist institutional and everyday oppression; (c) reclaiming and preserving collective memory, describing activists' efforts to resignify and document 2SLGBTQIA+ histories through art, research, and the transformation of cultural traditions; and (d) cultivating citizenship and political consciousness, reflecting the pursuit of rights and recognition by pressuring state institutions and creating autonomous spaces for community support. These interwoven themes illustrate how activism is lived as a dialectical process, both a site of conflict exposure and a space for resignifying suffering, fostering critical awareness, and enacting collective agency. The analysis highlights that responses to psychosocial trauma and resistance are deeply interconnected and continually negotiated through conscientization and collective engagement. Findings indicate that social movements, health professionals, and researchers should support intersectional, community-led initiatives centering psychosocial care, critical reflection, and the dialectical reinterpretation of collective memory.

The International Trauma Questionnaire (ITQ) assesses posttraumatic stress disorder (PTSD) and the disturbances in self-organization (DSO) aspect of complex PTSD (CPTSD) per the ICD-11. This study examined the ITQ's factor structure among violence- or abuse-exposed women in Northern Ireland, a region with a history of conflict (i.e., "the Troubles"), to validate its use in this unique sociopolitical context. The sample consisted of the 542 women who participated in the Violence Against Women and Girls Survey in Northern Ireland. All participants completed the ITQ and reported lifetime experiences of various forms of violence and abuse. Construct validity was assessed by testing four models of ITQ's factor structure using confirmatory factor analysis (CFA). Regression analyses were performed on the factors from the two best-fitting CFA models to predict PTSD and DSO scores using age and types of violence as predictors. The two-factor second-order model and the correlated six-factor first-order model both showed good fit. Factor loadings indicated that all ITQ items adequately measured their intended constructs, λs = .697-.973. Regression analyses on both models revealed that physical violence, sexual violence, and digital abuse significantly predicted both PTSD and DSO scores, with stalking predictive of PTSD only, two-factor second-order model: βs = .118-.244, correlated model: βs = .101-.287. Findings suggest that the ITQ is a reliable and valid tool for assessing PTSD and DSO in women living in Northern Ireland. Associations with violence types showed partial differences and overlap, highlighting value in examining PTSD and CPTSD regarding specific trauma types.

Trauma exposure is associated with a range of adverse mental health and sociodemographic factors. However, gender-specific patterns related to distinct trauma types and social variables remain underexplored. Using cross-sectional data from a nationally representative sample of 1,766 Icelandic adults randomly selected from the national population registry (n = 930 women, n = 836 men, M_age = 49.6 years), we examined posttraumatic stress symptom (PTSS) severity across trauma types and sociodemographic factors, focusing on gender differences. Trauma exposure was assessed using the Life Events Checklist for DSM-5 (LEC-5) and categorized into noninterpersonal trauma, interpersonal trauma, and sexual violence (SV). PTSS severity was measured using the PTSD Checklist for DSM-5 (PCL-5), and sociodemographic indicators included relationship status, educational attainment, employment, disability, and perceived financial stability. Hierarchical ordinary least squares regression analyses showed that exposure to SV or interpersonal trauma, financial instability, disability, and being unpartnered were independently associated with higher PTSS severity. The final model explained 19% of the variance in PTSS scores with standardized effects |β| ≈ .08-.23. Gender differences observed in the initial model were substantially reduced after accounting for trauma type and sociodemographic factors, consistent with the interpretation that observed gender disparities in PTSS may reflect contextual rather than inherent differences. These findings highlight the importance of integrating trauma type, gender, and social context to understand vulnerability to PTSS and inform gender-sensitive, trauma-informed prevention and intervention strategies.