Adverse life events among bedouin and jewish women and the risk for postpartum depressive symptoms.

PURPOSE: Postpartum depression (PPD) affects 10-15% of postpartum women with increased risk among women with trauma history. The purpose of this study was to investigate the relationship between adverse life events and postpartum depressive symptoms among Bedouin and Jewish women. METHODS: A cross-sectional study was performed in a tertiary hospital in the southern district of Israel on women with singleton deliveries between November 2021 and March 2022. Eligible women completed two questionnaires to determine exposure to childhood trauma (CT) and other potentially traumatic events (PTE), including the Childhood Trauma Questionnaire (CTQ), and Lifetime Events Checklist questionnaire (LEC). To measure risk for PPD we used the Edinburgh Postnatal Depression Scale (EPDS). The associations between CT, PTE, and risk for PPD were analyzed and multivariable logistic regression models were constructed to control for potential confounders. RESULTS: A total of 201 women were included, 120 Bedouin (59.7%) and 81 Jewish (40.2%). In the entire study population, both CT and PTE were independently associated with risk for PPD (adjusted OR = 2.13, 95% CI 1.02-4.44, p = 0.043 and adjusted OR = 3.42, 95%, CI 1.46-8.00, p = 0.004, respectively). While among Bedouin women, PTE was independently associated with PPD risk (adjusted OR = 4.83, 95% CI 1.66-14.05, p = 0.004), no significant association was found among Jewish women. CONCLUSION: Both CT and PTE were associated with increased PPD risk in Bedouin and Jewish women. Only PTE, and not CT, was associated with PPD among Bedouin women. Understanding risk factors for PPD, and differences among minority groups, could promote prevention efforts for PPD.

Course and Prediction of Dissociation in Patients with Borderline Personality Disorder and Personality-Disordered Comparison Subjects: A 24-Year Follow-Up Study.

The first purpose of this study was to determine the course of dissociation among patients with borderline personality disorder (BPD) and personality-disordered comparison subjects (OPD) over 24 years of prospective follow-up. The second purpose was to determine clinically meaningful predictors of dissociation among patients with BPD. The Dissociative Experiences Scale (DES) was administered to 290 patients with BPD and 72 personality-disordered comparison subjects at baseline, and then once every two years over 24 years of prospective follow-up. Baseline predictors were assessed with the Revised Childhood Experiences Questionnaire (CEQ-R), the SCID-I, and the Shipley Institute of Living Scale. Time-varying predictors were assessed at baseline and every subsequent two years by means of the Abuse History Interview (AHI). Patients with BPD had higher baseline dissociation scores than personality-disordered comparison subjects. Whilst dissociation decreased significantly over time for both patient groups, the BPD group showed a steeper decline. Severity of childhood sexual abuse, adult history of rape, adult history of partner violence, and IQ were multivariate predictors of dissociation among patients with BPD. Taken together, the present findings suggest that a combination of interpersonal trauma exposure and cognitive abilities may contribute to the severity of dissociation in adult patients with BPD.

Childhood Trauma and Non-Suicidal Self-Injury Among Chinese Adolescents: The Chain-Mediated Role of Alexithymia and Rumination.

OBJECTIVE: To explore the associations between childhood trauma, alexithymia, rumination, and non-suicidal self-injury (NSSI) among adolescents and to provide theoretical and empirical evidence for effective prevention, identification, and intervention of NSSI in the future. METHODS: Questionnaires, including the Childhood Trauma Questionnaire, the twenty-item Toronto Alexithymia scale, the Ruminative Responses Scale, and the Adolescents Self-Harm Scale, were given to 1,270 Chinese teenagers. The mediating role was simulated utilizing Amos 24.0. RESULTS: The Pearson's product-difference correlation analyses indicated the two-by-two significant correlations between childhood trauma, alexithymia, rumination, and NSSI. The structural equation modeling suggests that alexithymia and rumination partially mediate between childhood trauma and NSSI in teenagers, respectively. Additionally, it reveals that alexithymia and rumination chain mediate between childhood trauma and NSSI. CONCLUSION: The study confirms the impact of childhood trauma on adolescents' NSSI and also highlights the mediating role of alexithymia and rumination between the two. This study enriches the findings of NSSI and provides a theoretical basis for preventing and intervening in dysfunctional behaviors among adolescents.

'The Relationship Between Childhood Traumas and Social Cognition Through Theory of Mind and Alexithymia in Bipolar Disorder'.

This study aimed to investigate the potential differences in childhood trauma (CT), theory of mind (ToM), a significant component of social cognition, and alexithymia in bipolar disorder (BD) patients and healthy controls. The study included 50 BD patients who met the study criteria and were under follow-up at our clinic along with 50 healthy controls. The two groups were matched for age, gender, and educational status. A sociodemographic questionnaire, Childhood Trauma Questionnaire (CTQ), Toronto Alexithymia Scale (TAS), Dokuz Eylul Theory of Mind Index (DEZIKO), Hamilton Depression Rating Scale (HDRS), and Young Mania Rating Scale (YMRS) were applied to all participants. The CTQ-Total, TAS total, and DEZIKO total scores were significantly higher in the BD group compared to the healthy group (p < .001). A significant positive correlation was identified between the TAS total score and CTQ physical neglect (r = 0.472, p = .001), CTQ emotional neglect (r = 0.449, p = .001) and CTQ total scores (r = 0.5, p < .001) in the BD group. A statistically significant negative correlation was identified between the DEZIKO faux pas score and the CTQ physical neglect score (r = -0.437, p = .002). BD patients had more adverse childhood experiences, lower ToM abilities despite being in remission, and more pronounced alexithymic personality features compared to healthy controls. We also identified a relationship between ToM, alexithymia, and adverse childhood experiences in BD.

Defining and distinguishing early life stress, trauma, adversity, toxic and chronic stress and allostatic load: a descriptive review.

AIMS: Various concepts are used to study the impact of stress on childhood development. These concepts are often used inconsistently or interchangeably. Our main objectives were to determine how selected stress concepts (chronic stress, toxic stress, allostatic load, early life stress, childhood adversity, childhood trauma and adverse childhood experiences; ACEs) are defined, operationalized and described, and to provide a theoretical context to aid the choice for a preferred concept in public health research. METHODS: For this descriptive review, we systematically searched for literature published before 4 August 2021, on PubMed, Embase and PsycInfo. Two independent reviewers included studies. Exclusion criteria were: no systematic review, not peer reviewed, not published in English, selected stress concepts were no predetermined variable or a substantial topic in the discussion, full text was unobtainable or study described non-human or non-childhood populations. Data extraction forms were used. Descriptives were gathered, publication fields were identified through Journal Citation Reports categories, and verbatim descriptions were ordered in text and Venn diagrams. RESULTS: Of 264 screened studies, 124 were included. ACEs, childhood adversity and childhood trauma were used most. ACEs were the main concept used most frequently (47.6%). A total of 11 of 14 public and environmental health journals used ACEs. All concepts refer to prolonged, repeated, interpersonal stress from 0 to 18 years, that can alter physiological systems. Four concepts were stressor oriented, two concepts focused on stress response and effect and one on the state of challenged homeostasis. CONCLUSIONS: ACEs seem most fitting for public health setting, due to their operationalizability, large set of core experiences and widespread use.

A Qualitative Study of School Nurses' Experience of Secondary Trauma.

This qualitative descriptive study explored school nurses' experiences of exposure to reports of trauma from those in their care. Online interviews of school nurses practicing in NJ, USA, were recorded and transcribed verbatim. The study found that school nurses were exposed to reports of others' trauma to varying degrees, with those serving in urban settings reporting more stories of exposure than those in suburban settings. Reports included numerous, layered traumas at the community and individual levels, including students' poverty-related adversity and psychological distress. Qualitative content analysis revealed four categories: Health Office as Safe Haven, Challenges Working Within the School Model, Things That We Hear: Reports of Trauma, and The Ripple Effect of Trauma. School-based challenges included a lack of collaboration, misunderstanding of the school nurse's role, and workload issues such as competing demands and limited time and resources. School nurses reported focusing on the individual's immediate needs and processing the experience afterward. They acknowledged they can only do so much, and shared stories of coping and resilience. Additional education, resources, and support in addressing student trauma can enhance the provision of school nursing services and support the well-being of school nurses, students, and staff. Further research is warranted with a larger and more diverse sample of school nurses, including attention to school nurse wellness and resilience strategies.

Regional brain activity and connectivity associated with childhood trauma in drug-naive patients with obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts and repetitive, compulsive behaviors, with childhood trauma recognized as a contributing factor to its pathophysiology. This study aimed to delineate brain functional aberrations in OCD patients and explore the association between these abnormalities and childhood trauma, to gain insights into the neural underpinnings of OCD. Forty-eight drug-naive OCD patients and forty-two healthy controls (HC) underwent resting-state functional magnetic resonance imaging and clinical assessments, including the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Childhood Trauma Questionnaire-Short Form (CTQ-SF). Compared to HCs, OCD patients exhibited significantly decreased amplitude of low-frequency fluctuations (ALFF) in the right cerebellum, decreased regional homogeneity (ReHo) in the right cerebellum and right superior occipital lobes (FWE-corrected p < 0.05), which negatively correlated with Y-BOCS scores (p < 0.05). Furthermore, cerebellar ALFF negatively correlated with the CTQ emotional abuse subscale (r = - 0.514, p < 0.01). Mediation analysis revealed that cerebellar ALFF mediated the relationship between CTQ-emotional abuse and Y-BOCS (good model fit: R2 = 0.231, MSE = 14.311, F = 5.721, p < 0.01; direct effect, c' = 0.153, indirect effect, a*b = 0.191). Findings indicated abnormal spontaneous and regional cerebellar activity in OCD, suggesting childhood trauma impacts OCD symptoms through cerebellar neural remodeling, highlighting its importance for clinical treatment selection.

Abnormal Serum BDNF and p-mTOR in MDD in Adolescents with Childhood Trauma.

Background: Adolescents with major depressive (MDD) episodes associated with childhood trauma have a poorer response to treatment and a higher risk of suicide. The underlying etiology is unclear. Brain-derived neurotrophic factor (BDNF) could improve depressive symptoms by down-regulating mammalian target of rapamycin (mTOR) signaling pathways, which was involved in adverse environmental stimuli during neurodevelopment. BDNF and mTOR have not been reported simultaneously in adolescents with major depressive episodes associated with childhood trauma. Methods: Childhood Trauma Questionnaire-Short Form (CTQ-SF), Children's Depression Inventory (CDI) and Children's Depression Rating Scale-Revised (CDRS-R) were used to evaluate the recruited adolescents with major depression episodes. Serum BDNF and p-mTOR levels were measured by ELISA in 31 adolescents with major depression episodes with childhood trauma and 18 matched healthy control. Results: The serum levels of BDNF were significantly lower (p<0.001); and the serum levels of p-mTOR were high (p=0.003) in the adolescents with the first episode of major depressive episode accompanied by childhood trauma. Of the 31 adolescents with major depressive episodes, 17 had suicide or self-injury. Compared with the healthy control group, the serum levels of BDNF in patients with suicide or self-injury were lower than those without suicide or self-injury(p<0.001); the serum levels of p-mTOR were higher than those without suicide or self-injury (p=0.01). While in patients without suicide or self-injury, only serum p-mTOR was significantly higher than that in healthy group (p=0.028). BDNF was negatively correlated with CDRS-R (r=-0.427, p=0.006), p-mTOR was positively correlated with CDI (r=0.364, p=0.048). According to Receiver Operating Characteristic Curve (ROC), the combination of serum BDNF and p-mTOR levels have better diagnostic value. Conclusion: Neurotrophic and signaling pathways, involving BDNF and p-mTOR, may play a role in adolescent MDD with a history of childhood trauma, especially patients with suicide and self-injury tendencies.

Childhood trauma and treatment resistance in first-episode psychosis: Investigating the role of premorbid adjustment and duration of untreated psychosis.

BACKGROUND: Early identification of treatment non-response in first-episode psychosis (FEP) is essential to outcome. Despite indications that exposure to childhood trauma (CT) can have adverse effects on illness severity, its impact on treatment non-response and the interplay with other pre-treatment characteristics is sparsely investigated. We use a lack of clinical recovery as an early indicator of treatment resistance to investigate the relationship between CT and treatment resistance status at one-year follow-up and the potential mediation of this effect by other pre-treatment characteristics. METHODS: This prospective one-year follow-up study involved 141 participants recruited in their first year of treatment for a schizophrenia-spectrum disorder. We investigated clinical status, childhood trauma (CT), premorbid adjustment (PA), and duration of untreated psychosis (DUP) at baseline and clinical status at one-year follow-up. Ordinal regression analyses were conducted to investigate how PA and DUP affected the relationship between CT and one-year outcome in FEP. RESULTS: 45 % of the FEP sample reported moderate to severe CT, with significantly higher levels of CT in the early treatment resistant group compared to participants with full or partial early recovery. Ordinal regression analysis showed that CT was a significant predictor of being in a more severe outcome group (OR = 4.59). There was a partial mediation effect of PA and a full mediation effect of DUP on the effect of CT on outcome group membership. DISCUSSION: Our findings indicate that reducing treatment delays may mitigate the adverse effects of CT on clinical outcomes and support the inclusion of broad trauma assessment in FEP services.

Is parental overcontrol a specific form of child maltreatment? Insights from a resting state EEG connectivity study.

INTRODUCTION: Recent studies suggest that parental overcontrol could be considered a specific form of childhood trauma (CT). Although previous research has shown that CT alters the functional and structural architecture of large-scale networks in the brain, the neural basis associated with parental overcontrol has not been sufficiently explored. Therefore, the main aim of the current study was to investigate the relationship between parental overcontrol and electroencephalography (EEG) triple network (TN) functional connectivity during the resting state (RS) condition in a non-clinical sample (N = 71; 39 females, mean age 23.94 ± 5.89 SD). METHODS: EEG was recorded during 5 min of RS with eyes closed. All participants were asked to self-report maternal and paternal overcontrol, CT and general psychopathology. All EEG analyses were performed using the exact low-resolution electromagnetic tomography software (eLORETA). RESULTS: Our results showed a significant positive correlation between maternal overcontrol and theta connectivity between the salience network and the central executive network. This connectivity pattern was independently associated with maternal overcontrol even when controlling for relevant confounding variables, including the severity of CT and the general level of psychopathology. This neurophysiological pattern may reflect a predisposition to detect and respond to potentially threatening stimuli in the environment, which is typically associated with excessive overcontrol. CONCLUSIONS: Our findings support the hypothesis that parental overcontrol should be considered a form of CT in all respects independent of the forms traditionally studied in the literature (i.e., emotional abuse, physical abuse, sexual abuse, and physical and emotional neglect).

Adverse Childhood events of individuals and its relationship with resilience.

OBJECTIVE: The aim of this study is to examine the relationship between childhood trauma and psychological resilience in the Turkish Cypriot community and to identify the predictors of psychological resilience. METHOD: The research was conducted with 354 individuals in a web-based online environment in Northern Cyprus. Data were collected using a "Personal Information Form", the "Adverse Childhood Events Scale", and the "Resilience Scale for Adults". Percentage, mean, standard deviation, and Pearson's correlation analysis were used in the data analysis. RESULTS: In the study, 16.67 % of the participants were exposed to war or conflict when they were young and 10.17 % had a mental illness. In addition, it was determined that there were statistically significant and negative correlations between the Adverse Childhood Events Scale scores and the scores they got from the Adult Resilience Scale and the sub-dimensions of the scale. Female gender and education level predicted the scores on the Resilience Scale for Adults positively, and the presence of mental disease and the scores on the Adverse Childhood Events Scale negatively predicted the scores on the Resilience Scale for Adults. CONCLUSION: In this study, gender, educational status, presence of mental illness, and the total score on the Adverse Childhood Events Scale were determined to be predictive variables affecting resilience. Considering the research findings, it is recommended that nurses plan studies for the protection of the mental health of children and adolescents and the groups exposed to trauma should be psychologically supported to raise individuals with high resilience.

Evaluation of the relationship between childhood traumas and emotion regulation skills in terms of adult obesity.

This study aims to reveal the relationship between childhood traumas and emotion regulation skills of obese and non-obese individuals. The research is a comparative-descriptive and correlational study. The obese group included 52 people with a BMI ≥ 30, and the non-obese group included 58 people with a BMI ≤ 25 kg/m2. Information Form, Childhood Trauma Questionnaire (CTQ), and Emotion Regulation Skills Questionnaire (ERSQ) were used in the study data. The rates of total childhood trauma and physical neglect were significantly higher in obese individuals (53.8 % vs. 32.8 %; 50 % vs. 22.4 %, respectively) than in non-obese individuals. Obese individuals were found to have lower emotion regulation skills. While a significant inverse relationship was found between childhood trauma and emotion regulation skills total and sub-dimension scores in obese individuals, no significant relationship was found in non-obese individuals. Psychiatric-mental health nurses can play an active role in the prevention and treatment of obesity by providing emotion regulation training to individuals in their roles as counselors and educators.

[Stress and depression-a neurobiological perspective]. / Stress und Depression ­ eine neurobiologische Perspektive.

Depression is a common and often very debilitating disease causing a high number of years lost to disability worldwide. Mortality rates are high due to suicide and depression-associated somatic disorders, which seem to have a bidirectional connection. Depression is considered to be stress associated. Adverse life events such as losses, interpersonal conflicts, financial issues, unemployment, and loneliness are often found in the patient history. Also childhood maltreatment is a known risk factor. Chronic stress can cause maladaptive changes in different neurobiological systems and may contribute to the development of depression. Relevant changes have been described in the stress-response and immune systems of persons with depression and those with childhood trauma or abuse. Psychotherapy and antidepressants are both effective, and current treatment guidelines recommend their combination in severe depressive episodes.

The mediating role of mentalization and integrative self-knowledge in the relationship between childhood trauma and fear of intimacy.

Introduction: Since intimacy is a fundamental human need within social relationships, and recognizing that a fear of intimacy correlates with various negative consequences, it becomes crucial to examine the origins and factors that contribute to addressing this issue. This research aimed to investigate the mediating roles of mentalization and integrative self-knowledge in the link between childhood trauma and the fear of intimacy. Methods: Conducted as correlational descriptive research, our study incorporates a total sample of 303 adult women and men participants aged 20 to 50 in Tehran using the convenience sampling method. They completed the Fear of Intimacy Scale (FIS), the Childhood Trauma Questionnaire (CTQ), the Mentalization Scale (MentS), and the Integrative Self-Knowledge Scale (ISK). To analyze the research data at the descriptive level, frequency, percentage, standard deviation, and Pearson's correlation coefficient were used, while path analysis tested our hypotheses in SPSS version 26 and AMOS version 24. Fit indices were used to check the model's fit, and the mediation test was performed using the bootstrapping method. The fit indices revealed an excellent fit of the model with the data (χ2 = 1.51, χ2/df = 1.51, p = 0.219; RMSEA = 0.05; SRMR = 0.02; CFI = 0.99; NFI = 0.99; TLI = 0.99). Results: Results indicate mentalization fully mediates the childhood trauma-fear of intimacy relationship (ß = 0.14, p < 0.01). However, the indirect relationship between childhood trauma and fear of intimacy through integrative self-knowledge was insignificant. The results also showed that the path coefficient from mentalization to fear of intimacy was negative and significant (ß = -0.41, p < 0.001), while the path coefficient from integrative self-knowledge to fear of intimacy was not significant (ß = -0.02, p > 0.05). Discussion: Based on the current findings indicating the complete mediation of mentalization and the insignificance of the mediation of integrative self-knowledge, we can deduce that enhancing the capacity for mentalization holds promise in effectively addressing intimacy-related issues. Overall, the study suggests mentalization effectively predicts the relationship between childhood trauma and fear of intimacy. This, in turn, may mitigate the detrimental effects of challenging childhood experiences on an individual's ability to engage in intimacy and cultivate emotional closeness.

The Role of Perceived Stress in the Relation between Childhood Maltreatment and Severity of Alcohol Use Disorder: A Mediation Analysis.

INTRODUCTION: Experiences of Childhood Maltreatment (CM) relate to relapse and lower treatment success in Alcohol Use Disorder (AUD), one of the most prevalent substance use disorders. However, the exact mechanisms of this relationship still remain unclear. This study examines perceived stress and "drinking to cope with negative affect" (coping) as possible mediators in this relationship. Moreover, it aims at uncovering the differential effects of the subtypes of CM. METHODS: N = 96 individuals (42% women; mean age 41 ± 13 years) including healthy controls and individuals with varying severity of AUD and CM completed the Alcohol-Dependence Scale, Childhood Trauma Questionnaire, Perceived Stress Scale and German Inventory of Drinking Situations. Mediation analyses including perceived stress as a mediator between CM (and subtypes) and severity of AUD, as well as a serial mediation of the relationship between CM and AUD severity by perceived stress and coping were conducted. RESULTS: Perceived stress significantly mediated the relation between CM and AUD severity and the serial mediation by perceived stress and coping turned out significant. Subtype-specific analyses did not yield significant results. CONCLUSION: This study reinforces perceived stress as a potential mechanism in the relation between CM and AUD severity. Moreover, coping further mediated the relationship between CM and AUD severity. Our results suggest including screening for CM (subtypes) in clinical routine in order to individually emphasize interventions focusing on stress regulation, as well as on developing healthy coping mechanisms, in patients with AUD. This might prevent heightened stress sensitivity, relapse and further maintenance of AUD.

A retrospective descriptive study of male perpetrators of intimate partner violence referred by judicial authorities: an example from Turkey.

PURPOSE: Our study examines the socio-demographic, forensic psychiatric, and childhood trauma exposure (CTE) data of Turkish intimate partner violence (IPV) perpetrators and draws comparisons with the violence data. METHODS: Data of male perpetrators referred to the domestic violence outpatient clinic by judicial authorities between November 2019 and June 2022 were retrospectively examined, with a focus on CTE data. RESULTS: The mean age of the male perpetrators examined in the study was 37.1 years. Among the overall sample, 16.2% (n = 17) had experienced violence at school in childhood, and 22.9% (n = 24) had experienced CTE. Regarding the frequency of domestic violence in their households, of the perpetrators admitted to the clinic for IPV, 40% (n = 42) reported rarely, 43.8% (n = 46) sometimes, and 16.2% (n = 17) often engaged in violent acts. There is a significant relationship between the frequency of IPV and the level of CTE (χ2: 13.052, SD: 2, p = 0.001, Cramer's V: 0.353). Similarly, individuals who witnessed domestic violence during childhood were found to commit partner violence more frequently (χ2: 8.157, SD: 2, p = 0.017, Cramer's V: 0.279). CONCLUSIONS: In this study, we found a strong relationship between CTE and IPV. To the best of our knowledge, our study is only example that investigates the relationship between CTE and IPV in a Turkish sample.

The role of sleep quality and anxiety symptoms in the association between childhood trauma and self-harm attempt: A chain-mediated analysis in the UK Biobank.

BACKGROUND: Childhood trauma is a risk factor for self-harm/suicidal behavior, but research on the potential association linking sleep quality and anxiety symptoms to childhood trauma and self-harm attempt is limited. The aim of this study was to describe the mediating role of sleep quality and anxiety symptoms between childhood trauma and self-harm attempt, and to provide a scientific basis for the prevention of self-harm behaviors. METHODS: This study ultimately included 11,063 study participants who participated in the baseline survey of this large prospective cohort study of the UK Biobank. We used structural equation modeling (SEM) to analyze the chain mediating role of sleep quality and anxiety symptoms in childhood trauma and self-harm attempt while controlling for covariates. RESULTS: A total of 19.58 % of study participants self-reported self-harm attempt. Sleep quality was negatively correlated with childhood trauma, anxiety symptoms, and self-harm attempt (p < 0.01). Childhood trauma, anxiety symptoms, and self-harm attempt were positively correlated (p < 0.01). In addition, after adjusting for confounders, anxiety symptoms were able to partially mediate the association between childhood trauma and self-harm attempt (effect value: 0.042, p < 0.01), and sleep quality and anxiety symptoms can chain mediate the association between childhood trauma and self-harm attempt (effect value:0.002, p < 0.01), with a total mediating effect of 65.67 % of the total effect. Subgroup analyses further showed that the mediating effects of sleep quality and anxiety symptoms on childhood trauma and self-harm attempt differed across age, gender, ethnicity, and smoking and drinking subgroups. CONCLUSIONS: This study found a complex relationship between childhood trauma, sleep quality, anxiety symptoms, and self-harm attempt, with sleep quality and anxiety symptoms mediating the relationship between childhood trauma and self-harm attempt. Multiple avenues of intervention, such as the provision of professional psychological interventions and timely monitoring, should be used to improve the sleep quality and mental health of individuals with traumatic childhood experiences and to prevent the occurrence of emotionally harmful behaviors such as self-harm/suicide.

Trauma-informed care.

In recent years, trauma informed care has become a heavily researched topic; however, it has yet to achieve a universal standard in the field of pediatric medicine. One of the primary tenants of trauma informed care is a clear understanding of the pervasiveness and complexities of childhood trauma, and its intersection with a child and caregiver's physical wellness. A major component of trauma informed care is addressing the way medical providers may be exposed to vicarious trauma, secondary traumatic stress, and compassion fatigue. By taking proactive steps to educate medical providers on the effects of trauma, they are better equipped to assess a family's needs and provide enhanced quality of care for their patients and themselves.

Childhood Trauma and its Relationship with Anxiety, Depression, and Suicidal Ideation among a Community Sample in Ilisan-Remo, Southwestern Nigeria: A Cross-Sectional Study.

BACKGROUND: Childhood exposure to maltreatment is an endemic health issue with tragic personal and socioeconomic repercussions. There is a dearth of information on the psychological outcomes of childhood trauma, specifically anxiety and depression, in adulthood in Nigeria. This study was conducted to determine the prevalence of childhood trauma and its relationship with anxiety, depression, and suicidal ideation among adults in a Nigerian community. METHODS: The study is a product of a secondary analysis of the relevant aspects of the data collected for the Ilisan-Remo Functional Bowel Disorder Project. It was a cross-sectional community-based study of adult aged 18-70 years in Nigeria. The relevant aspects of the research instrument included the demographic information; the Beck Anxiety and Depression Inventories for assessing anxiety and depression respectively, and the Early Trauma Inventory-Self Report Short-Form for accessing childhood trauma. Data were summarized and analyzed with appropriate instruments. Variables with p-values < 0.05 were considered significant. RESULTS: Adequate data for statistical analysis was available for 501 respondents. The mean age of the respondents was 32.69 ±12.8 years. Four hundred and forty (87.8%) respondents had at least one childhood trauma exposure. Physical punishment had the highest prevalence (77.2%), followed by general trauma (68.9%), emotional abuse (51.1%) and sexual abuse (34.9%). All the childhood traumas were either moderately or weakly correlated with the psychopathologies except physical trauma which was not correlated with suicidal ideation. Childhood trauma had a significant association with anxiety [AOR = 1.23 (95% CI, 1.13 - 1.35), p<0.001], depression [AOR = 1.19 (95% CI, 1.13 - 1.25), p <0.001] and suicidal ideation [AOR = 1.09 (95% CI, 1.02 - 1.16), p = 0.007]. CONCLUSION: The prevalence of childhood trauma was high in our study population and was associated with sychopathologies in adulthood. Stakeholders such as parents, government, teachers, and civil society organizations should make a concerted effort to deter it.

CONTEXTE: L'exposition des enfants aux mauvais traitements est un problème de santé endémique avec des répercussions personnelles et socio-économiques tragiques. Il existe une pénurie d'informations sur les conséquences psychologiques des traumatismes infantiles, notamment l'anxiété et la dépression à l'âge adulte au Nigeria. Cette étude a été menée pour déterminer la prévalence des traumatismes infantiles et leur relation avec l'anxiété, la dépression et les idées suicidaires chez les adultes d'une communauté nigériane. MÉTHODES: L'étude est issue d'une analyse secondaire des aspects pertinents des données collectées pour le projet Ilisan-Remo sur les troubles fonctionnels de l'intestin. Il s'agissait d'une étude transversale communautaire auprès d'adultes âgés de 18 à 70 ans au Nigeria. Les aspects pertinents de l'instrument de recherche comprenaient des informations démographiques ; les inventaires d'anxiété et de dépression de Beck pour évaluer respectivement l'anxiété et la dépression, et l'inventaire des traumatismes précoces - auto-rapport version courte pour évaluer les traumatismes infantiles. Les données ont été résumées et analysées avec des instruments appropriés. Les variables avec des valeurs de p < 0,05 ont été considérées comme significatives. RÉSULTATS: Des données adéquates pour l'analyse statistique étaient disponibles pour 501 répondants. L'âge moyen des répondants était de 32,69 ±12,8 ans. Quatre cent quarante (87,8 %) répondants avaient été exposés à au moins un traumatisme infantile. La punition physique avait la plus haute prévalence (77,2 %), suivie des traumatismes généraux (68,9 %), des abus émotionnels (51,1 %) et des abus sexuels (34,9 %). Tous les traumatismes infantiles étaient modérément ou faiblement corrélés avec les psychopathologies, sauf le traumatisme physique qui n'était pas corrélé avec les idées suicidaires. Les traumatismes infantiles avaient une association significative avec l'anxiété [OR ajusté = 1,23 (IC à 95 %, 1,13 ­ 1,35), p < 0,001], la dépression [OR ajusté = 1,19 (IC à 95 %, 1,13 ­ 1,25), p < 0,001] et les idées suicidaires [OR ajusté = 1,09 (IC à 95 %, 1,02 ­ 1,16), p = 0,007]. CONCLUSION: La prévalence des traumatismes infantiles était élevée dans notre population d'étude et était associée à des psychopathologies à l'âge adulte. Les parties prenantes telles que les parents, le gouvernement, les enseignants et les organisations de la société civile devraient faire des efforts concertés pour les prévenir. MOTS CLÉS: Traumatismes infantiles, Maltraitance des enfants, Anxiété, dépression, Nigeria.

Rethinking the concepts of the unconscious and analytic time.

The author proposes ways of rethinking the concepts of the unconscious and time in the analytic setting, including the very existence of the unconscious. Freud (1915) stated that the success psychoanalytic thinking has in making inferences about the patient's unconscious makes the existence of the unconscious "incontrovertible." The author submits that this success does not establish the existence of the unconscious; rather, the inferences we think we make about the unconscious are inferences about consciousness itself - the totality of our experiences of thinking, feeling, sensing, observing, and communicating with ourselves. The author then offers thoughts about a second analytic concept, the experience of time in the analytic setting. He conceives of there being two inseparable sorts of experiences of analytic time that stand in a dynamic relationship with one another: diachronic time (clock time) and synchronic time (dream time). In diachronic time, time is sequential; one thing leads to another. In synchronic time, all time is contained in the present. In analysis, childhood trauma is experienced for the first time (in synchronic time) in the co-created subjectivity of patient and analyst.