Journal of traumatic stress最新文献

Although there is considerable data to support the efficacy of several treatments for trauma-related disorders, the traumatic stress field continues to struggle with adequate implementation and uptake of such treatments in real-world settings, which greatly contributes to persistent health disparities in these disorders. Task-shifting, or the ability to train frontline providers in evidence-based treatments for psychological disorders following traumatic events in various local and global community settings, may be one avenue to improve the translatability, scalability, and sustainability of effective traumatic stress treatments. In this paper, we describe a range of implementation and training efforts to bring efficacious treatments for trauma-related disorders beyond the bedside and directly into the communities that could benefit the most. Our descriptions cover the training methodologies utilized and the fidelity measurement of efforts to train frontline providers in several distinct global settings, namely Chile, Portugal, Greece, the Caribbean, and Somaliland. In addition, we describe a large-scale, city-wide implementation and evaluation of providers’ fidelity to evidence-based traumatic stress treatment within a major U.S. city for further exemplification around how task-shifting can happen at a larger, systemic, top-down level. In our descriptions, we also critically examine the challenges our teams have encountered when doing such work and highlight successful strategies that could facilitate the reduction of inequities in traumatic stress treatment worldwide.

Many researchers have expressed concern regarding the reliability and validity of retrospective self-reports of sexual abuse. This study aimed to quantify the frequency of self-reported sexual abuse among vulnerable Mozambican women and evaluate the temporal stability of self-report across assessments. Participants (N = 173) were patients at the gynecology outpatient clinic of a public central hospital in Mozambique who were referred for recruitment by gynecologists and completed measures of sexual abuse, assessed using six items from the National Women's Study survey. Women reported a frequency of sexual abuse ranging from 9.2% (third assessment) to 10.4% (initial assessment). Concerning the temporal stability of self-reports, the percentage of agreement was above 90% for all sexual abuse items, and general sexual victimization achieved almost perfect kappa values, κs = .93–1.00. This work has implications for the promotion of sexual health and the prevention of violence.

Forcible displacement due to war and persecution has reached unprecedented heights across the globe. The mental health impact of trauma and displacement on refugee communities is profound. Although there are several evidence-based therapies that are efficacious in reducing symptoms of posttraumatic stress disorder and depression in refugees, many refugees do not have access to these, and, for those who do, a significant proportion do not respond. This article summarizes the closing panel at the 2024 International Society for Traumatic Stress Studies Annual Meeting, where four researchers and clinicians with expertise in refugee mental health reflected on core outstanding questions in the field and promising approaches to addressing these knowledge gaps. Common themes emerged from this discussion, including the importance of considering and addressing environmental stressors when providing psychological treatment for refugees, the critical role of the social and cultural context in refugee mental health, and the necessity of partnering with refugee communities to improve the quality and efficacy of research and clinical activities. This article concludes with suggestions for early-career researchers and clinicians who are working with refugee communities to facilitate trauma recovery and improve well-being.

The psychological impact of historical trauma can be passed on to future generations. The simultaneous presence of historical and individual trauma may increase psychological distress, especially in older adults. Older age potentially represents a phase of life with increased challenges, distress, life review, and reminiscence. Though both historical and individual trauma appear to contribute to psychological distress, a strong sense of coherence (SOC) may reduce psychological distress and posttraumatic stress in older age and in the context of historical trauma. We conducted a cross-sectional online survey among offspring of Holocaust survivors (OHS) from Germany, Israel, and the United States, focusing on the second generation and individuals aged 60–80 years who reported having survived individual trauma. Descriptive statistics, zero-order correlation analyses, and multiple regression were used to investigate factors influencing psychological distress, including gender, age, posttraumatic stress disorder (PTSD) symptoms, past victimization, family Holocaust knowledge, and SOC (balance, manageability, and reflection). The sample comprised 116 participants (70.1% female- identified, M_age = 67.85 years, SD = 4.45, range: 60–79 years). Multiple regression indicated that PTSD symptoms, B = 2.78, β = .58 (SE = .37), p < .001, and manageability, B = −0.54, β = −.20 (SE = .25), p = .034, were significantly associated with psychological distress. The final model accounted for 50.5% of the total variance in current psychological distress among older second-generation OHS. These findings highlight the importance of individual risk and protective factors in understanding distress among older people in the context of historical trauma.

The COVID-19 pandemic profoundly impacted mental health, with psychological distress varying across age and racial/ethnic groups. This study examined trajectories of five distress measures—symptoms of posttraumatic stress (PTS), anxiety, depression, anger, and somatization—over the first 2 years of the pandemic, adjusting for prepandemic mental health. Participants in a nationally representative, probability-based U.S. sample (N = 4,298, age range: 18–97 years) completed four online surveys from March 2020 to June 2022. Multilevel models revealed that symptom levels and changes over time varied by age group across outcomes. Across time, PTS and anxiety symptoms declined for most age groups at different rates, F(6, 85,660) = 6.21, p < .001. Younger adults initially reported higher PTS symptom levels at Wave 1, Bs = 0.10–0.14, p < .001, but levels converged across age groups by Wave 4. Rates of anxiety symptoms were similar across age groups at Wave 4 except for older adults, who reported significantly lower levels. Depressive symptoms and anger increased in the initial waves but declined by Wave 4, Bs = −0.25–0.02, p < .001. For all participants, somatization increased after Wave 1, B = −0.30, p < .001, and never returned to initial levels, B = −0.04, p < .001. Additionally, somatization was the only symptom with similar levels across age groups at each wave. Across race/ethnicity, Hispanic adults reported higher distress and less decline over time. Findings highlight distinct symptom trajectories across the pandemic, with generally lower distress levels among the oldest adults.

Disturbed sleep is a known risk factor for heightened mental health symptoms, and this association may be particularly problematic among emergency medical service (EMS) clinicians. Yet, associations between daily sleep quality and daily mental health symptoms are understudied among this vulnerable group. We used ecological momentary assessments to examine between- and within-person associations between perceived sleep quality and mental health symptoms in 79 EMS clinicians employed at a large agency in central New York. Participants completed eight daily assessments (558 total) on perceived sleep quality and symptoms of posttraumatic stress disorder (PTSD) and depression. Multilevel regression models examined between- and within-person effects of sleep quality, controlling for covariates. Between-person effects in each model accounted for 17.0% and 31.0% of the total variance, respectively; within-person effects explained 1.0% per model. Poorer between-person perceived sleep quality was associated with higher PTSD and depressive symptom severity; perceived sleep quality 1.0 standard deviation (SD) below the sample mean was related to 58.8% and 16.3% increases in PTSD and depressive symptoms, respectively. There was also a within-person effect for depressive symptoms: On days when a participant's perceived sleep quality was 1.0 SD below their average, depressive symptom severity increased by 3.0%. Poorer subjective sleep may be an important risk factor for mental health symptoms at the between-person level. EMS policies supporting healthy sleep may benefit clinicians who routinely experience poor sleep. Day-to-day subjective sleep quality may increase the risk for depressive symptoms. Interventions to improve sleep and manage depressive symptom fluctuations when sleep is poor might be helpful.

Written exposure therapy (WET) has emerged as a promising treatment for posttraumatic stress disorder (PTSD) with the potential to overcome common barriers to engagement. Several facets of WET lend themselves particularly well for adaptation to a group setting, yet few studies have examined WET in such formats. The objective of the present study was to present preliminary feasibility, acceptability, and clinical outcome data from a quality improvement project conducted in an outpatient psychiatry clinic that included patients who engaged in a virtual WET group. Participants were 28 adults from six WET group cohorts that occurred between January 2024 and March 2025. Overall attendance was strong (78.2%), with 67.9% of participants completing at least five of the six weekly sessions. Patient satisfaction ratings were high (80.0%), and 86.7% of participants indicated that they would recommend the group to other individuals struggling with trauma symptoms. Acceptability ratings were also largely supportive of the virtual (vs. in-person) and group (vs. individual) formats. There were large effect sizes for pre–post improvement in PTSD symptoms (PCL-5: M = 52.6 vs. 33.0), d = 1.39, and depressive symptoms (PHQ-9: M = 14.2 vs. 9.9), d = 0.86, among participants who completed the group. Our study provides preliminary data suggesting the feasibility and acceptability of a virtual WET group delivered in a naturalistic community setting, with strong attendance and high patient satisfaction. There is significant benefit to standardizing a group-based WET protocol and substantiating clinical benefits through a fully powered randomized controlled clinical trial.

Suicide is one of the leading causes of death among military personnel, and help-seeking is crucial to combating it. Research has not yet investigated the role that potentially morally injurious events (PMIEs), particularly betrayal, may play in moderating the effect of battlefield experiences on these variables. Data from 694 U.S. Army personnel, all of whom had at least one combat deployment, were analyzed to examine battlefield life-threatening experiences (LTEs), suicidal ideation, help-seeking behavior, PMIEs, depressive symptoms, anxiety symptoms, posttraumatic stress disorder (PTSD) symptoms, and aggression. Analyses revealed a significant interaction between LTEs and betrayal-type PMIEs predicting both a higher likelihood of suicidal thoughts and planning, relative risk ratio = 1.729, z = 2.13, p = .034, 95% confidence interval (CI) [1.043, 2.863], and help-seeking from fewer sources, incident rate ratio = 0.927, z = −2.26, p = .024, 95% CI = [0.868, 0.990]. These effects held even when controlling for depressive symptoms, anxiety symptoms, PTSD symptoms, and aggression. The findings suggest that betrayal-type PMIEs have a significant moderating effect on the impact of LTEs on suicidal ideation and help-seeking behavior, and this effect cannot be explained by the experience of the other four measured symptoms of psychological distress.

This commentary examines the application of Bonanno and Westphal's (2024) three axioms of resilience to military contexts. Drawing on international research, we evaluate evidence supporting the three propositions: resilience is the predominant outcome following trauma exposure, multiple factors contribute modestly to resilience, and resilience emerges from flexible self-regulation. We demonstrate how these axioms manifest in military populations, who face unique operational stressors with, at times, limited access to conventional coping resources. We propose methodological approaches for measuring resilience longitudinally across individual and organizational domains and discuss implications for military training that focuses on developing diverse coping strategies rather than bolstering single traits. The commentary emphasises the value of a data-driven approach wherein military personnel act as their own scientists, systematically evaluating whether a coping strategy is working and adapting accordingly. We highlight the critical interdependence between individual and organizational resilience in maintaining mental health among military personnel who face repeated trauma exposure.

Despite elevated rates of psychopathology, refugees underutilize mental health services. Mental health self-stigma is a prominent barrier to accessing psychological support; however, there is limited research on intervention approaches to reduce self-stigma among refugees. The present study aimed to provide further support for the Tell Your Story (TYS) intervention in reducing self-stigma and increasing help-seeking among Arabic-speaking male and female refugees. In this randomized controlled trial (RCT), 67 Arabic-speaking refugees with self-stigma and at least subthreshold posttraumatic stress symptoms (PTSS) were randomly allocated to the TYS group or waitlist control group. At baseline, postintervention, and 3-month follow-up, participants completed assessment measures indexing measures of self-stigma (related to symptoms and help-seeking) and help-seeking (intentions and behavior). Poisson regression analyses revealed that participants in the TYS group demonstrated more help-seeking behavior at 3-month follow-up than those in the waitlist control group, Hedges’ g = 0.67. However, linear mixed models showed that the waitlist control group demonstrated larger decreases in PTSD-related self-stigma across time, T2: g = 0.07, T3: g = 0.04, whereas no significant group differences were observed for self-stigma related to help-seeking. Although the findings were mixed and suggest a need for further investigation in a larger RCT with a sample of refugee men and women, the results provide support for the intervention's utility in expanding one's help-seeking network in a population with low treatment uptake.