Peritraumatic dissociation and posttraumatic stress symptoms: the moderating role of perceived threat.

Background: Although peritraumatic dissociation (PD) is viewed as a risk factor for posttraumatic stress disorder (PTSD), prospective studies taking into account other well-known risk factors for PTSD have been scarce, and the exploration of potential moderators within the relations between PD and PTSD has been lacking.Objective: Filling this gap, this prospective study explored the moderating role of perceived threat within the relations between PD and PTSD, above and beyond age, gender, education, and early trauma-related symptoms.Method: A convenience sample of 200 Israeli civilians filled out self-report questionnaires during the peritraumatic phase (T1) and one to two months after the posttraumatic phase (T2) of being exposed to rocket attacks.Results: The results showed that perceived threat and PD were associated with early trauma-related symptoms and PTSD symptoms. Moreover, perceived threat moderated the relationship between PD and all PTSD symptom clusters apart from avoidance.Conclusions: The present results suggest that the implications of PD are shaped by levels of perceived threat, so that detriments of PD are evident when the trauma is appraised as being highly threatening. Therefore, early interventions that aim to decrease PD may be beneficial in preventing PTSD symptoms of intrusion, hyper arousal, and negative alterations in mood and cognition, for individuals who perceive traumatic events as highly threatening.

Perceived threat was related to early trauma-related symptoms and PTSD symptoms.Peritraumatic dissociation was related to early trauma-related symptoms and PTSD symptoms.Perceived threat moderated the link between peritraumatic dissociation and PTSD symptoms.

Testing previously proposed models of the Tonic Immobility Scale in a peritraumatic sample of Israeli civilians: Support for a three-factor model.

OBJECTIVE: Tonic immobility (TI) is a peritraumatic response to extreme threats. It is associated with trauma psychopathology and poor treatment outcomes. Yet, previous psychometric evaluations have yielded inconsistent results regarding the number of latent factors of the Tonic Immobility Scale (TIS). Moreover, the TIS has never been validated in a Hebrew-speaking population. This study had two objectives: (a) to reassess previously proposed models of the TIS to determine whether it is best represented by a one-factor model of TI, a two-factor model of TI and fear, or a three-factor model of TI, fear, and detachment; and (b) to validate the TIS in a Hebrew translation. METHOD: A sample of Israeli adults was culled from an online survey following rocket attacks. Confirmatory factor analysis was applied to test the previously proposed models, and Pearson's correlations were used to test the association between each of the subscales representing the latent factors and psychological distress. RESULTS: The best representation of the data was provided by a three-factor model with latent constructs of TI, fear, and detachment. All three peritraumatic responses had significant correlations with peritraumatic distress. Moreover, the internal consistency of the TIS was good for the three subscales; this supports the reliability of the Hebrew version. CONCLUSION: This study supports using a three-factor model with latent constructs, and the scale appears to be psychometrically sound when translated into Hebrew. Future research should seek to replicate these findings in different trauma populations and should study the unique association of trauma symptomatology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Prospective Study of the Mediating Role of Tonic Immobility and Peritraumatic Dissociation on the 4 DSM-5 Symptom Clusters of Posttraumatic Stress Disorder.

Objective: Tonic immobility (TI) and peritraumatic dissociation (PD) are common peritraumatic reactions associated with psychopathology following trauma. The present study aimed to test whether TI and PD mediated the relationship between perceived threat during an episode of rocket shelling and subsequent posttraumatic stress symptoms.Methods: In a prospective study among 226 Israeli civilians, data were collected both during rocket shelling, between May 14, 2021, until ceasefire on May 21, 2021 (T1) and 1 to 2 months after ceasefire (T2). Measures included the Tonic Immobility Scale, Peritraumatic Dissociative Experiences Questionnaire, and PTSD Checklist for DSM-5. Four mediation models were applied for each posttraumatic stress symptom cluster.Results: Findings showed that a substantial proportion of participants had developed posttraumatic stress disorder (PTSD) symptoms at the time of follow-up (18.8%). Both TI and PD fully mediated the relationship between perceived threat and symptoms of intrusion, avoidance, and negative alterations in mood and cognition, but only PD mediated the relationship with alterations in arousal and reactivity.Conclusions: The present findings suggest that TI and PD may serve as mechanisms underlying the link between individuals' appraisals of threat during the peritraumatic phase and subsequent PTSD symptomatology. Future research should seek to replicate the present findings before any conclusions can be drawn. In particular, the association between PD and arousal and reactivity symptoms should be further explored, given that it might be multifaceted in nature.

Video Consultations and Safety App Targeting Pregnant Women Exposed to Intimate Partner Violence in Denmark and Spain: Nested Cohort Intervention Study (STOP Study).

BACKGROUND: Intimate partner violence (IPV) during pregnancy is a public health issue with wide-ranging consequences for both the mother and fetus, and interventions are needed. Therefore, the Stop Intimate Partner Violence in Pregnancy (STOP) cohort was established with the overall aim to identify pregnant women exposed to IPV through digital screening and offer women screening positive for IPV a digital supportive intervention. OBJECTIVE: The aim of this study was to (1) introduce the design and profile of the STOP cohort study, (2) assess the feasibility of implementing digital IPV screening among pregnant women, and (3) assess the feasibility of implementing a digital supportive intervention targeting pregnant women exposed to IPV. METHODS: Pregnant women attending antenatal care in the Region of Southern Denmark and in Andalucía, Spain were offered digital screening for IPV using validated scales (Abuse Assessment Screen and Women Abuse Screening Tool). Women who screened positive were eligible to receive a digital supportive intervention. The intervention consisted of 3-6 video consultations with an IPV counselor and a safety planning app. In Denmark, IPV counselors were antenatal care midwives trained by a psychologist specialized in IPV, whereas in Spain, the counselor was a psychologist. RESULTS: Data collection started in February 2021 and was completed in October 2022. Across Denmark and Spain, a total of 19,442 pregnant women were invited for IPV screening and 16,068 women (82.65%) completed the screening. More women in Spain screened positive for exposure to IPV (350/2055, 17.03%) than in Denmark (1195/14,013, 8.53%). Among the women who screened positive, only 31.39% (485/1545) were eligible to receive the intervention with only 104 (21.4%) of these women ultimately receiving it. CONCLUSIONS: Digital screening for IPV among pregnant women is feasible in an antenatal care context in Denmark and Spain; however, a digital supportive intervention during pregnancy appears to have limited feasibility as only a minor subgroup of women who screened positive for eligibility received the intervention. More research is needed on how to best support pregnant women exposed to IPV if universal IPV screening is to be implemented in antenatal care.

Can Women Shelters Help Reduce Symptoms of PTSD and C-PTSD? Trajectories of PTSD Symptom Development Following Partner- and Family-Related Violence.

BACKGROUND: To protect women from Intimate partner violence (IPV), women's shelters should not only provide emergency safety from IPV exposure, but also prolonged support that empowers women to build a life free from violence. The present study aims to investigate individual symptom development in association with residency at a women's shelter. METHOD: Data were collected at four different timepoints, that is, enrolment (T1, N = 150), 3-months residency (T2, = 110), 6-months residency (T3, N = 68) and after relocation (T4, N = 63). Women were included from four Danish women's shelters. The International Trauma Questionnaire (ITQ) was applied to test for post-traumatic stress disorder (PTSD) and Complex-PTSD (C-PTSD) at all timepoints. A paired sample t-test was used to test the mean symptom development, and a Latent Class Growth Analysis (LCGA) was applied to test for different classes of PTSD-trajectories. Logistic regression was applied to predict class membership from shelter-related variables and symptom severity, that is, length of residency, psychological counselling, revictimization and key symptoms of C-PTSD. RESULTS: The prevalence of PTSD (31%) and C-PTSD (37.9%) was high at enrolment. Although t-tests suggested a significant decline in symptoms at follow-up, the LCGA revealed different classes of symptom development. The two-class model was found to be the best representation of data with low-symptom- and high-symptom profiles, respectively. Overall, the largest decline in symptoms occurred within the first 3 months of residency. Revictimization was high and was further found to predict class membership. However, when included in a multiple regression only symptom severity predicted the high-symptoms profile class. DISCUSSION: Psychological treatment focussing on PTSD and C-PTSD is important for the women's future well-being and safety. Reports on revictimization was alarmingly high, which emphasises a continuing need to protect women from psychological violence within the shelters. These findings should be replicated in larger samples before we can draw any conclusion.

Validation of ICD-11 PTSD and DSO using the International Trauma Questionnaire in five clinical samples recruited in Denmark.

Background: The 11th version of the International Classification of Diseases (ICD-11) revised the diagnosis of Posttraumatic Stress Disorder (PTSD) and introduced Complex PTSD as a sibling disorder to PTSD. As the Danish Health Authorities will implement the ICD-11 in 2022, it is more relevant than ever to introduce a measure that enables the identification of ICD-11 PTSD and CPTSD. Objective: The primary aim of the present study was to test the construct validity of the ICD-11 conceptualization of PTSD and DSO in five clinical samples using translated versions of the International Trauma Questionnaire (ITQ). Method: Data from existing studies of adult survivors of sexual abuse (n = 385), women in shelters (n = 147), psychiatric outpatients endorsing an ICD-10 diagnosis of PTSD (n = 111), a heterogenous sample of psychiatric outpatients (n = 178) and refugees and torture survivors (n = 385) was used for the current study. Confirmatory factor analyses were conducted to test the internal structure of the ITQ, and regression models were conducted to test the convergent and discriminant validity of the factor solutions for each sample. Results: Findings supported the ICD-11 formulation of PTSD and disorders in self-organization (DSO) as a representation of the latent structure of the ITQ across five Danish clinical samples. Uniquely for women in shelters, however, the model displayed an unacceptable fit. A revised operationalization of re-experiencing proved a better fit when 'recurrent nightmares' was exchanged with symptoms of intense emotional reactions to reminders of the trauma for women in shelter as well as ICD-10 PTSD psychiatric outpatients. Conclusion: This study supports the use of a Danish translated version of the ITQ to assess symptoms of ICD-11 PTSD and DSO for the introduction of ICD-11 in 2022. Future research is needed to further explore the operationalization of re-experiencing across different trauma exposed populations.

Antecedentes: La décimo primera versión de la Clasificación Internacional de Enfermedades (CIE-11) revisó el diagnóstico de Trastorno de Estrés Postraumático (CIE-11) e introdujo el TEPT complejo como un diagnóstico hermano del TEPT. Como las autoridades de salud danesas implementarán la CIE-11 en el 2022, es más relevante que nunca introducir una medición que permita la identificación del TEPT y el TEPT complejo de acuerdo a la CIE-11.Objetivo: El principal objetivo del presente estudio fue probar la validez del constructo diagnóstico de la conceptualización del TEPT y de las Alteraciones en la Auto-Organización (DSO por sus siglas en inglés) en cinco muestras clínicas usando versiones traducidas del Cuestionario Internacional de Trauma (ITQ por sus siglas en inglés).Método: Se usaron para el presente estudio, datos de estudios ya existentes de sobrevivientes adultos de abuso sexual (n = 147), pacientes psiquiátricos ambulatorios con diagnóstico de TEPT de acuerdo a la CIE-10 (n = 111), una muestra heterogénea de pacientes psiquiátricos ambulatorios (n = 178) y refugiados y sobrevivientes de tortura (n = 385). Se usaron análisis factoriales confirmatorios para probar la estructura interna del ITQ, y se aplicaron modelos de regresión para probar la validez convergente y discriminante de las soluciones factoriales para cada muestra.Resultados: Los hallazgos apoyaron la formulación de ls CIE-11 del TEPT y de los desórdenes en la auto-organización (DSO) como una representación) de la estructura latente del ITQ en 5 muestras clínicas danesas. Sin embargo, en el caso de las mujeres de los centros de acogida, el modelo mostró un ajuste inaceptable. Una operacionalización revisada de la re-experimentación probó ser más ajustada cuando 'pesadillas recurrentes' fue reemplazada por los síntomas de reacciones emocionales intensas ante recordatorios del trauma para mujeres en los centros de acogida así como a los pacientes psiquiátricos ambulatorios con TEPT según la CIE-10.Conclusión: Este estudio apoya el uso de la versión traducida en danés del ITQ para evaluar síntomas de TEPT y DSO de acuerdo a la CIE-11 para la introducción de la CIE-11 en el 2022.Se requiere futura investigación para explorar la operacionalización de la re-experimentación en diferentes poblaciones expuestas al trauma.

The complex trauma of psychological violence: cross-sectional findings from a Cohort of four Danish Women Shelters.

Background: Psychological trauma has only recently been considered a traumatic event. Therefore, research on Posttraumatic Stress Disorder (PTSD) and Complex-PTSD following exposure to psychological violence, is less studied compared with physical and sexual violence. Objectives: This study aimed to establish the prevalence of PTSD and C-PTSD of among female victims of partner violence (IPV) and examine the unique association between different subtypes of IPV (i.e. physical, psychological and sexual IPV) and the traumatic response. Methods: The study includes a shelter-based sample of female victims of IPV (N = 147). Validated measures were used to estimate IPV exposure and mental health outcomes. Partial Correlation and Hierarchical Regression was used to examine the association between IPV and PTSD and C-PTSD, respectively. Results: The study found a high prevalence of both PTSD (56.5%) and C-PTSD (21.1%) in the sample. Overall, when controlling for the other types of violence, psychological violence correlated with PTSD, C-PTSD, negative affect and somatization. When controlling for psychological violence, neither physical nor sexual violence correlated with any of the mental health outcomes. Hierarchical regression models helped explain 23.5% and 29.7% of the variance in symptoms of PTSD and C-PTSD, respectively. Conclusion: A relatively large subgroup of the women had symptoms of C-PTSD, which demonstrate a potentially unmet need for trauma-informed treatment services in Danish Women Shelters. Psychological violence was found to be the strongest risk factor for all mental health outcomes and thus, it is important to acknowledge the severity of this IPV subtype.

Antecedentes: El trauma psicológico sólo recientemente ha sido considerado un evento traumático. Por lo tanto, la investigación sobre el Trastorno de Estrés Postraumático (TEPT) y el TEPT Complejo tras la exposición a la violencia psicológica, está menos estudiada en comparación con la violencia física y sexual.Objetivos: El objetivo de este estudio fue establecer la prevalencia del TEPT y el TEP-C entre las mujeres víctimas de la violencia de pareja (IVP, en siglas en inglés) y examinar la asociación distintiva entre los diferentes subtipos de IVP (es decir, IVP físico, psicológico y sexual) y la respuesta traumática.Métodos: El estudio incluye una muestra basada en refugios para mujeres víctimas de IVP (N = 147). Se utilizaron medidas validadas para estimar la exposición a la IVP y los resultados de salud mental. Se utilizó la correlación parcial y la regresión jerárquica para examinar la asociación entre la IVP y el TEPT y el TEPT-C, respectivamente.Resultados: El estudio encontró una alta prevalencia tanto de TEPT (56,5%) como de TEPC (21,1%) en la muestra. En general, al controlar los otros tipos de violencia, la violencia psicológica se correlacionó con el TEPT, el TEPT-C, el afecto negativo y la somatización. Al controlar la violencia psicológica, ni la violencia física ni la sexual se correlacionaron con ninguno de los resultados de salud mental. Los modelos de regresión jerárquica ayudaron a explicar el 23,5% y el 29,7% de la variación en los síntomas del TEPT y el TEPT-C, respectivamente.Conclusión: Un subgrupo relativamente grande de mujeres tenía síntomas de TEPTC, lo que demuestra una necesidad potencialmente no cubierta de servicios de tratamiento con información en traumas en los refugios de mujeres danesas. Se comprobó que la violencia psicológica era el factor de riesgo más fuerte para todos los resultados de salud mental y, por lo tanto, es importante reconocer la gravedad de este subtipo de IVP.

The psychological subtype of intimate partner violence and its effect on mental health: protocol for a systematic review and meta-analysis.

BACKGROUND/AIM: Psychological violence is estimated to be the most common form of intimate partner violence (IPV). Despite this, research on the independent effect of psychological violence on mental health is scarce. Moreover, the lack of a clear and consistent definition of psychological violence has made results difficult to compare. The present study therefore aims to consolidate knowledge on psychological violence by conducting a systematic review and random-effects meta-analysis on the association between psychological violence and mental health problems, when controlling for other types of violence (e.g. physical and sexual) and taking into account severity, frequency, and duration of psychological violence. METHOD: The present study is registered in the International Prospective Register for Systematic Reviews (PROSPERO; #CRD42018116026) and the study design follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Additional file 1). A dual search will be conducted in the electronic databases PsycINFO, PubMed, EMBASE, and Web of Science. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Metafor-package in the programming language R. The Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project will be used to assess the quality of the included studies (i.e. weak, moderate and strong). RESULTS AND DISCUSSION: The present review will help consolidate knowledge on psychological violence by evaluating whether frequency, severity or actual "type" of psychological violence produces the most harm. A thorough quality assessment will help overcome potential limitations regarding expected variations in terminology and assessment of psychological violence. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018116026 .

Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11.

With the publication of the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11) due for release in 2018, a number of studies have assessed the factorial validity of the proposed post-traumatic stress disorder (PTSD) and complex (CPTSD) diagnostic criteria and whether the disorders are correlated but distinct constructs. As the specific nature of CPTSD symptoms has yet to be firmly established, this study aimed to examine the dimension of affect dysregulation as two separate constructs representing hyper-activation and hypo-activation. Seven alternative models were estimated within a confirmatory factor analytic framework using the International Trauma Questionnaire (ITQ). Data were analysed from a young adult sample from northern Uganda (n = 314), of which 51% were female and aged 18-25 years. Forty per cent of the participants were former child soldiers (n = 124) while the remainder were civilians (n = 190). The prevalence of CPTSD was 20.8% and PTSD was 13.1%. The results indicated that all models that estimated affective dysregulation as distinct but correlated constructs (i.e. hyper-activation and hypo-activation) provided satisfactory model fit, with statistical superiority for a seven-factor first-order correlated model. Furthermore, individuals who met the criteria for CPTSD reported higher levels of war experiences, symptoms of anxiety and depression, and somatic problems than those with PTSD only and no diagnosis. There was also a much larger proportion of former child soldiers that met the criteria for a CPTSD diagnosis. In conclusion, these results partly support the factorial validity of the ICD-11 proposals for PTSD and CPTSD in a non-Western culture exposed to mass violence. These findings highlight that more research is required across different cultural backgrounds before firm conclusions can be made regarding the factor structure of CPTSD using the ITQ.

Planteamiento: Con la publicación de la 11ª edición de la Clasificación Internacional de Enfermedades que se publicará en 2018, varios estudios han evaluado la validez factorial de los criterios de diagnóstico propuestos del trastorno por estrés postraumático (TEPT) y trastorno por estrés postraumático complejo (TEPT-C) y si los trastornos están correlacionados pero son constructos distintos.Objetivo: Debido a que la naturaleza específica de los síntomas de TEPT-C aún no se ha establecido con firmeza, este estudio estableció como objetivo examinar la dimensión de la desregulación afectiva como dos constructos separados que representan la hiperactivación y la hipoactivación.Métodos: Se estimaron siete modelos alternativos dentro de un marco analítico factorial confirmatorio usando el Cuestionario Internacional de Trauma (ITQ, por sus siglas en inglés). Los datos se analizaron a partir de una muestra de adultos jóvenes del norte de Uganda (n = 314), de los cuales el 51% eran mujeres y tenían entre 18 y 25 años. El cuarenta por ciento de los participantes eran ex niños soldados (N = 124) mientras que el resto eran civiles (N = 190).Resultados: La prevalencia del TEPT-C fue del 20.8% y la del TEPT fue del 13.1%. Los resultados indicaron que todos los modelos que estimaron la desregulación afectiva como constructos distintos proporcionaron un ajuste satisfactorio del modelo con superioridad estadística para un modelo correlacionado de primer orden de siete factores. Además, las personas que cumplieron con los criterios del TEPT-C indicaron niveles más altos de experiencias de guerra, síntomas de ansiedad y depresión, y problemas somáticos que aquellos con solo TEPT y sin diagnóstico. También hubo una proporción mucho mayor de ex niños soldados que cumplieron con los criterios para un diagnóstico de TEPT-C.Conclusiones: Estos resultados respaldan parcialmente la validez factorial de las propuestas de la CIE-11 para el TEPT y el TEPT-C en una cultura no occidental expuesta a la violencia masiva. Estos hallazgos resaltan que se requiere más investigación en diferentes contextos culturales antes de poder llegar a conclusiones firmes con respecto a la estructura factorial de TEPT-C utilizando el ITQ.

PTSD, mental illness, and care among survivors of sexual violence in Northern Uganda: Findings from the WAYS study.

BACKGROUND: Previous studies have mainly considered war-affected youth as a homogenous group yet several subpopulations of war-affected youth, such as survivors of sexual violence, exist with unique mental health problems and treatment needs. This study aimed to assess posttraumatic stress disorder (PTSD), perceptions and meaning of mental illness, and access and barriers to mental health care among survivors of sexual violence. METHOD: Data were collected from survivors of sexual violence during war (N = 181) who are participants in the longitudinal War-Affected Youth Survey (WAYS) study in Northern Uganda. Chi-square tests of independence and binary logistic regression were used to compute participants' characteristics and assess relations between exposure to sexual violence and PTSD. RESULTS: Sixty-six (n = 119, 66%) reported sexual abuse: 35% (n = 63) of whom returned from captivity with at least 1 child, and 43% (n = 78) met the criteria for PTSD (Impact of Events Scale-Revised score [IES-R] ≥33). Those who reported sexual abuse scored significantly higher on PTSD (OR = 3.23; 95% CI [2.09, 6.93]), perceived more stigma, reported more barriers to seeking care, and viewed mental illness as futile and fatal compared with their peers without a history of sexual abuse. CONCLUSIONS: Survivors of sexual violence are at risk of PTSD and report major obstacles to treatment and care. More resources should be allocated for interventions to improve access to care for survivors of sexual violence. Psychoeducation to create awareness, demystify myths and public stigma about mental illness, and trauma-focused cognitive-behavioral therapies to reduce PTSD among survivors are recommended. (PsycINFO Database Record

Testing the validity of the proposed ICD-11 PTSD and complex PTSD criteria using a sample from Northern Uganda.

BACKGROUND: The International Classification of Diseases (ICD-11) is currently under development with proposed changes recommended for the posttraumatic stress disorder (PTSD) diagnosis and the inclusion of a separate complex PTSD (CPTSD) disorder. Empirical studies support the distinction between PTSD and CPTSD; however, less research has focused on non-western populations. OBJECTIVE: The aim of this study was to investigate whether distinct PTSD and CPTSD symptom classes emerged and to identify potential risk factors and the severity of impairment associated with resultant classes. METHODS: A latent class analysis (LCA) and related analyses were conducted on 314 young adults from Northern Uganda. Fifty-one percent were female and participants were aged between 18 and 25 years. Forty percent of the participants were former child soldiers (n=124) while the remaining participants were civilians (n=190). RESULTS: The LCA revealed three classes: a CPTSD class (40.2%), a PTSD class (43.8%), and a low symptom class (16%). Child soldier status was a significant predictor of both CPTSD and PTSD classes (OR=5.96 and 2.82, respectively). Classes differed significantly on measures of anxiety/depression, conduct problems, somatic complaints, and war experiences. CONCLUSIONS: To conclude, this study provides preliminary support for the proposed distinction between PTSD and CPTSD in a young adult sample from Northern Uganda. However, future studies are needed using larger samples to test alternative models before firm conclusions can be made.