Advancing the understanding and treatment of post-traumatic stress disorder with computational modelling.

The existing theories of post-traumatic stress disorder (PTSD) have inspired large volumes of research and have contributed substantially to our current knowledge base. However, most of the theories are of a qualitative and verbal nature, and may be difficult to evaluate and compare with each other. In this paper, we propose that one way forward is to use computational modelling to formulate more precise theories of PTSD that can be evaluated by (1) assessing whether the model can explain fundamental phenomena related to PTSD, and (2) comparing simulated outcomes with real data. Computational modelling can force us to describe processes more precisely and achieve stronger theories that are viable for testing. Establishing the theoretical groundwork before undertaking empirical studies can help us to avoid doing research with low probability of valid results, and counteract the replicability crisis in psychology. In conclusion, computational modelling is a promising avenue for advancing the understanding and treatment of PTSD.

Computational modelling can help us to specify the psychological processes involved in PTSD, which may increase our understanding of how best to help people to recover after traumatic events.With computational models of PTSD, we can simulate the consequences of the theoretical principles and make sure to design research studies that are theoretically well grounded.To validate the computational models, high-quality empirical data are still needed.

The efficacy of psychological interventions for adult post-traumatic stress disorder following exposure to single versus multiple traumatic events: a meta-analysis of randomised controlled trials.

BACKGROUND: Previous meta-analyses of psychological interventions for adult post-traumatic stress disorder (PTSD) did not investigate whether efficacy is diminished in individuals with PTSD related to multiple (vs single) traumatic events. We aimed to assess whether treatment efficacy would be lower in randomised controlled trials involving multiple-event-related PTSD versus single-event-related PTSD. METHODS: For this meta-analysis, we searched PsycINFO, MEDLINE, Web of Science, and PTSDpubs from database inception to April 18, 2023. Randomised controlled trials involving adult clinical samples (≥70% meeting full PTSD criteria) with adequate size (≥10 participants per arm) were included. We extracted data on trial characteristics, demographics, and outcome data. Random-effects meta-analyses were run to summarise standardised mean differences (Hedges' g). Trials involving 100% of participants with single-event-related PTSD versus at least 50% of participants with multiple-event-related PTSD (ie, associated with ≥two traumatic events) were categorised. Quality of evidence was assessed using the Cochrane criteria. The review protocol was registered in PROSPERO (CRD42023407754). FINDINGS: Overall, 137 (85%) of 161 randomised controlled trials were included in the quantitative synthesis, comprising 10 684 participants with baseline data and 9477 with post-treatment data. Of those randomly assigned, 5772 (54%) of 10 692 participants identified as female, 4917 (46%) as male, and three (<1%) as transgender or other. 34 (25%) of 137 trials exclusively involved women, 15 (11%) trials exclusively involved men, and the remainder were mixed samples. Mean age across the trials was 40·2 years (SD 9·0) ranging from 18·0 years to 65·4 years. 23 (17%) of 137 trials involved participants from low-income and middle-income countries (23 [17%] of 137). Data on ethnicity were not extracted. At treatment endpoint, psychological interventions were highly effective for PTSD when compared with passive control conditions in both samples with single-event-related PTSD (Hedges' g 1·04 [95% CI 0·77-1·31]; n=11; I2=43%) and multiple-event-related PTSD (Hedges' g 1·13 [0·90-1·35]; n=55, I2=87%), with no efficacy difference between these categories (p=0·48). Heterogeneity between studies was substantial but outlier-corrected analysis yielded similar results. Moderate-sized effects were found compared with active control conditions with no significant difference between single-trauma and multiple-trauma trials. Results were robust in various sensitivity analyses (eg, 90% cutoff for multiple-trauma trials) and analyses of follow-up data. The quality of evidence was moderate to high. INTERPRETATION: Contrary to our hypothesis, we found strong evidence that psychological interventions are highly effective treatments for PTSD in patients with a history of multiple traumatic events. Results are encouraging for clinical practice and could counteract common misconceptions regarding treatment and treatment barriers. FUNDING: None.

The bidirectional associations between caregiver and child symptoms in the parent-led treatment stepping together for children after trauma.

BACKGROUND: An innovative approach to child trauma treatment in which caregivers are allocated treatment tasks has shown promising results, but less is known about the bidirectional associations between caregiver and child symptoms during treatment. METHODS: Eighty-two child-caregiver dyads who participated in the parent-led therapist-assisted Stepping Together for Children after Trauma (ST-CT) were included (child age: 7-12 years, mean = 9.9 years). Caregivers' emotional reactions and anxiety/depression and children's posttraumatic stress (PTS) and depression were assessed pretreatment, mid-treatment, and posttreatment. We investigated the possible directional associations between caregivers' emotional reactions and anxiety/depression and children's PTS and depression using random intercept cross-lagged panel models. RESULTS: Symptoms improved in both caregivers and children. Lower levels of caregiver emotional reactions at pretreatment predicted improved child PTS at mid-treatment; lower levels of caregiver emotional reactions at mid-treatment predicted improved child depression at posttreatment; and lower levels of child PTS at mid-treatment predicted improved caregiver emotional reactions at posttreatment. CONCLUSIONS: These findings suggest that caregivers and children can impact each other's responses to a parent-led child trauma-focused treatment. Notably, children with caregivers who were less affected by their own emotional reactions exhibited greater improvement in both PTS and depression. Supporting the caregivers may benefit both children and caregivers. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT04073862; https://clinicaltrials.gov/ct2/show/NCT04073862.

The differential impact of the DSM-5 post-traumatic stress symptoms on functional impairment in traumatized children and adolescents.

BACKGROUND: This study aims to provide a better understanding of the individual impact of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) post-traumatic stress symptoms (PTSS) on functional impairment in trauma-exposed children and adolescents. Identifying PTSS that have the most impact on functional impairment can broaden our understanding of post-trauma reactions and guide the selection of treatment components and techniques required to help patients to restore functioning following trauma exposure. METHOD: Utilizing relative importance analyses, unique shared variance of each DSM-5 PTSS with functional impairment were estimated in clinical samples of 3400 Norwegian (Mage = 14.18, SDage = 2.49, rangeage = 7-17) and 747 US (Mage = 10.76, SDage = 3.10, rangeage = 7-17) children and adolescents from naturalistic settings. RESULTS: Negative beliefs, detachment from others, inability to experience positive emotions, and diminished interest in activities within the symptom cluster negative alterations in cognitions and mood, and the hyperarousal symptom concentration problems accounted for the largest proportions of unique variance explained in functional impairment in both samples. Further, the hyperarousal symptom irritability showed a unique high association with functional impairment in the US sample. CONCLUSION: As negative beliefs, emotional numbing symptoms, concentration problems and irritability may be especially related to functional impairment in traumatized children and adolescents, monitoring and targeting these symptoms throughout therapy might be of particular importance to restore functioning as early as possible and to facilitate overall recovery.

Efficacy of psychological interventions for post-traumatic stress disorder in children and adolescents exposed to single versus multiple traumas: meta-analysis of randomised controlled trials.

BACKGROUND: Previous meta-analyses of psychotherapies for children and adolescents with post-traumatic stress disorder (PTSD) did not investigate whether treatment efficacy is diminished when patients report multiple (versus single) traumas. AIMS: To examine whether efficacy of psychological interventions for paediatric PTSD is diminished when patients report multiple (versus single) traumas. METHOD: We systematically searched PsycInfo, MEDLINE, Web of Science and PTSDpubs on 21 April 2022 and included randomised controlled trials (RCTs) meeting the following criteria: (a) random allocation; (b) all participants presented with partial or full PTSD; (c) PTSD is the primary treatment focus; (d) sample mean age <19 years; (e) sample size n ≥ 20. Trauma frequency was analysed as a dichotomous (single versus ≥2 traumas) and continuous (mean number of exposures) potential moderator of efficacy. RESULTS: Of the 57 eligible RCTs (n = 4295), 51 RCTs were included in quantitative analyses. Relative to passive control conditions, interventions were found effective for single-trauma-related PTSD (Hedges' g = 1.09; 95% CI 0.70-1.48; k = 8 trials) and multiple-trauma-related PTSD (g = 1.11; 95% CI 0.74-1.47; k = 12). Psychotherapies were also more effective than active control conditions in reducing multiple-trauma-related PTSD. Comparison with active control conditions regarding single-event PTSD was not possible owing to scarcity (k = 1) of available trials. Efficacy did not differ with trauma exposure frequency irrespective of its operationalisation and subgroup analyses (e.g. trauma-focused cognitive-behavioural therapy only). CONCLUSIONS: The current evidence base suggests that psychological interventions for paediatric PTSD can effectively treat PTSD in populations reporting single and multiple traumas. Future trials for PTSD following single-event trauma need to involve active control conditions.

Complex PTSD and treatment outcomes in TF-CBT for youth: a naturalistic study.

Background: Complex posttraumatic stress disorder (CPTSD) has recently been added to the ICD-11 diagnostic system for classification of diseases. The new disorder adds three symptom clusters to posttraumatic stress disorder (PTSD) related to disturbances in self-organization (affect dysregulation, negative self-concept, and disturbances in relationships). Little is known whether recommended evidence-based treatments for PTSD in youth are helpful for youth with CPTSD. Objectives: This study examined whether Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is useful in reducing PTSD and CPTSD in traumatized youth. Methods: Youth (n = 73, 89.0% girls, M age = 15.4 SD = 1.8) referred to one of 23 Norwegian child and adolescent mental health clinics that fulfilled the criteria for PTSD or CPTSD according to ICD-11 and received TF-CBT were included in the study. Assessments were conducted pre-treatment, and every fifth session. Linear mixed effects models were run to investigate whether youth with CPTSD and PTSD responded differently to TF-CBT. Results: Among the 73 youth, 61.6% (n = 45) fulfilled criteria for CPTSD and 38.4% (n = 28) fulfilled criteria for PTSD. There were no differences in sex, age, birth country, trauma type, number of trauma types or treatment length across groups. Youth with CPTSD had a steeper decline in PTSD and CPTSD compared to youth with PTSD. The groups reported similar levels of PTSD and CPTSD post-treatment. The percentage of youth who dropped out of treatment was not different across groups. Further, the groups did not differ significantly in number of received treatment sessions. Conclusions: This is the first study to examine whether TF-CBT is helpful for youth who have CPTSD using a validated instrument for measuring CPTSD. The results suggest that TF-CBT may be useful for treating CPTSD in youth. These are promising findings that should be replicated in studies with larger sample sizes.

Antecedentes: El trastorno de estrés postraumático complejo (TEPT-C) ha sido agregado recientemente al sistema de diagnóstico para la clasificación de enfermedades CIE-11. El nuevo trastorno agrega tres grupos de síntomas al trastorno de estrés postraumático (TEPT), relacionados con alteraciones en la autoorganización (desregulación afectiva, autoconcepto negativo y alteraciones en las relaciones). Poco se sabe acerca de si los tratamientos basados en evidencia recomendados para el TEPT en jóvenes son útiles para los jóvenes con TEPT-C.Objetivos: Este estudio examinó si la Terapia Cognitiva Conductual Centrada en el Trauma (TF-CBT en sus siglas en inglés) es útil para reducir el TEPT y el TEPT-C en jóvenes traumatizados.Método: Se incluyó en el estudio a jóvenes derivados a una de las 23 clínicas noruegas de salud mental para niños y adolescentes, que cumplían con los criterios para TEPT o TEPT-C según el CIE-11 y recibieron TF-CBT (n = 73, 89% niñas, M edad = 15,4, DE = 1,8). Se realizaron evaluaciones antes del tratamiento y cada cinco sesiones. Se ejecutaron modelos de efectos mixtos lineales para investigar si los jóvenes con TEPT-C y TEPT respondían de manera diferente a la TF-CBT.Resultados: Entre los 73 jóvenes, el 61,6% (n = 45) cumplió con los criterios de TEPT-C y el 38,4% (n = 28) cumplió con los criterios de TEPT. No hubo diferencias en sexo, edad, país de nacimiento, tipo de trauma, número de tipos de trauma o duración del tratamiento entre los grupos. Los jóvenes con TEPT-C tuvieron una disminución más pronunciada en TEPT y TEPT-C en comparación con los jóvenes con TEPT. Los grupos reportaron niveles similares de TEPT y TEPT-C después del tratamiento. El porcentaje de jóvenes que abandonaron el tratamiento no difirió entre los grupos. Además, los grupos no difirieron significativamente en el número de sesiones de tratamiento recibidas.Conclusiones: Éste es el primer estudio que examina si la TF-CBT es útil para los jóvenes que tienen TEPT-C mediante un instrumento validado para medir el TEPT. Los resultados sugieren que la TF-CBT puede ser útil para tratar el TEPT-C en jóvenes. Estos son hallazgos prometedores que deberían replicarse en estudios con tamaños muestrales más grandes.

Understanding the relationships between trauma type and individual posttraumatic stress symptoms: a cross-sectional study of a clinical sample of children and adolescents.

BACKGROUND: Characteristics of traumatic events may be associated with the level and specific manifestation of posttraumatic stress symptoms (PTSS). This study examined the differences and similarities between overall levels, profiles and networks of PTSS after sexual trauma, domestic violence, community violence, non-interpersonal trauma, sudden loss or serious illness of a loved one, and severe bullying or threats. METHODS: PTSS were measured in a clinical sample of 4,921 children and adolescents (6-18 years old, M = 14.0, SD = 2.7, 63.7% female) referred to Child and Adolescent Mental Health Services. We compared 95% confidence intervals (CI) for each symptom with 95% CI for overall PTSS within each trauma type (self-reported worst trauma). We also computed cross-sectional networks and searched for differences in networks according to trauma type and overall symptom level. RESULTS: The overall frequencies of PTSS were highest following sexual trauma; somewhat lower for domestic violence and severe bullying or threats and lowest after community violence, non-interpersonal trauma and sudden loss or serious illness. Psychological cue reactivity, avoidance and difficulties with sleeping and concentrating were generally among the most frequent symptoms. Sexual trauma, domestic violence and severe bullying or threats were associated with higher frequencies of negative beliefs and persistent negative emotional states. Few differences in symptom networks across trauma type emerged. CONCLUSION: Different types of trauma exposure may be associated with different profiles of symptom frequencies. Knowledge about this may be useful for clinicians and for the movement towards evidence-based personalized psychological treatment.

No buffer effect of perceived social support for people exposed to violence during the COVID-19 pandemic: a cross-sectional community study.

Background: The COVID-19 pandemic has represented a burden to communities worldwide. Research indicates that this burden is not equally distributed in the community, and vulnerable groups, such as violence-exposed individuals may pay a particularly high prize. Perceived social support is known to buffer against negative effects of trauma and adversity, but it is not clear whether this is the case during times of social restrictions and lockdowns. In this study, we tested if perceived social support could buffer the link between pandemic worry and psychological distress in a community sample and in the subgroup exposed to violence during the pandemic. Methods: A stratified, presumed representative sample of the Norwegian population (N = 1,041, response rate = 39.9%) responded to a cross-sectional web survey in May 2020. Fifty-nine participants (5.7%) had been exposed to physical, sexual, and/or psychological violence during the last month. Results: Current violence, pandemic worry, and perceived social support were independently associated with psychological distress. In the total sample, perceived social support moderated the relationship between pandemic worry and psychological distress. However, this was not found in individuals who were exposed to current violence. Conclusions: Even though high levels of perceived social support can protect against psychological distress in the face of pandemic worry in the community, it seems that this resource is not as useful for individuals exposed to current violence. Outreach health and care services are warranted to support the needs of this particular vulnerable group.

Antecedentes: La pandemia de COVID-19 ha representado una carga para las comunidades alrededor del mundo. La investigación indica que esta carga no se distribuye equitativamente en la comunidad, y los grupos vulnerables, como los individuos expuestos a violencia pueden pagar un precio particularmente alto. Se sabe que el apoyo social percibido actúa como modulador en contra los efectos negativos del trauma y la adversidad, pero no está claro si este es el caso durante periodos de restricciones sociales y confinamientos. En este estudio, evaluamos si el apoyo social percibido podría modular la asociación entre la preocupación pandémica y el sufrimiento psicológico en una muestra de la comunidad y en el subgrupo expuesto a violencia durante la pandemia.Métodos: Una muestra estratificada, que se presume representativa de la población noruega (N = 1,041, tasa de respuesta = 39,9%) respondió una encuesta web transversal en mayo de 2020. Cincuenta y nueve participantes (5.7%) habían estado expuestos a violencia física, sexual, y/o psicológica durante el último mes.Resultados: La violencia actual, la preocupación pandémica y el apoyo social percibido se asociaron de forma independiente al sufrimiento psicológico. En la muestra total, el apoyo social percibido moderó la relación entre la preocupación pandémica y el sufrimiento psicológico. Sin embargo, esto no fue encontrado en individuos que estaban expuestos a violencia actual.Conclusiones: Incluso aunque altos niveles de apoyo social percibido pueden proteger contra el sufrimiento psicológico de cara a la preocupación pandémica en la comunidad, parece que este recurso no es tan útil para individuos expuestos a violencia actual.Extender el alcance de los servicios de salud y cuidado se justifica para apoyar las necesidades de este grupo vulnerable en particular.

Trusting Others During a Pandemic: Investigating Potential Changes in Generalized Trust and Its Relationship With Pandemic-Related Experiences and Worry.

Generalized trust, the belief that most other people can be trusted, has positive consequences for health and wellbeing. An increased sense of community is often seen in times of crisis or disaster, but it is unclear whether this is the case in the COVID-19 pandemic. The objectives of the current study were to assess whether generalized trust increased in an early pandemic phase compared to pre-pandemic levels, and whether trust was lower in individuals who felt particularly threatened or burdened in the pandemic. We compared levels of generalized trust in a population-representative Norwegian sample (n = 1,041) with pre-pandemic levels from the European Social Survey (ESS). Age- and gender-adjusted expected scores were compared to observed scores, using weighted data. Secondly, we tested whether indicators of pandemic-related strain, perceived health risks, or pandemic-related worry were associated with a lower level of generalized trust. This cross-sectional study was conducted in an early opening-up phase (May, 2020). The observed levels of generalized trust in an early pandemic phase did not differ significantly from expected levels based on pre-pandemic measures. Higher trust was found among individuals who reported personal experience with the COVID-19 disease (tested positive, admitted to hospital, or lost someone to the disease). Pandemic-related worry and a high perceived health threat were both associated with a lower level of generalized trust. These results indicate that personal experiences with the COVID-19 pandemic could influence trust in others, although this link may be context-dependent. Generalized trust is considered to be an important asset in society, and promote health and well-being. As the pandemic evolves, there is a risk that we may lose, or a chance that we could gain, trust, with potential consequences for our health.

Changes in Violence and Clinical Distress Among Men in Individual Psychotherapy for Violence Against Their Female Partner: An Explorative Study.

Most interventions for men who have acted violently toward their partner have been conducted as group interventions within a criminal justice context. Therefore, few studies have examined individual psychotherapy and how such interventions may reduce partner violence. In this study, we aimed to describe changes in violence, and changes in clinical distress in men undergoing individual psychotherapy targeting their use of partner violence, at a clinic organized within a psychosocial health care context. This is a naturalistic prospective study of men voluntarily receiving individual psychotherapy for their use of violence against their female partner. Participants were 84 male clients, and data on their use of physical violence, physical controlling violence, property violence and psychological violence were collected pretreatment, posttreatment and at follow-up 1.5 years after treatment from both the men, and their partners (n = 58). The percentage of use of all types of violence during a typical month the last year decreased from pretreatment to follow-up, according to both the men, and their partners. Over the course of treatment, use of all types of self-reported violence during the last month was reduced, however, this was only partially confirmed by their partners. Number of sessions was associated with a lower risk of having used physical and physically controlling violence 1.5 years after treatment. Alcohol abuse or dependency, or qualifying for one or more psychiatric diagnoses, were not associated with levels or change in use of violence. On average, the men's clinical distress declined over the course of psychotherapy. The findings suggest that individual psychotherapy may be a promising and worthwhile intervention for intimate partner violence. Studies with more elaborate designs are needed to identify the core mechanisms of psychotherapy for violence, and to corroborate these results with higher levels of evidence.

Worry and mental health in the Covid-19 pandemic: vulnerability factors in the general Norwegian population.

BACKGROUND: There is an urgent need for knowledge about the mental health consequences of the ongoing pandemic. The aim of this study was to identify vulnerability factors for psychological distress and reduced life satisfaction in the general population. Furthermore, we aimed to assess the role of COVID-related worries for psychological distress and life satisfaction. METHODS: A presumed representative sample for the Norwegian population (n = 1041, response rate = 39.9%) responded to a web-survey in May 2020. The participants were asked about potential vulnerability factors including increased risk for severe illness from COVID-19 (underlying illness, older age), socioeconomic disadvantage (living alone, unemployment, economic problems), and pre-existing mental health vulnerability (recent exposure to violence, previous mental health challenges). Additional measures included COVID-related worry, psychological distress, and life satisfaction. RESULTS: More than one out of four reported current psychological distress over the threshold for clinically significant symptoms. Socioeconomic disadvantages, including living alone and pre-existing economic challenges, and pre-existing mental health vulnerabilities, including recent exposure to violence and previous mental health problems, were associated with a higher level of psychological distress and a lower level of life satisfaction. A higher level of COVID-related worry was significantly associated with a higher level of psychological distress, and a lower level of life satisfaction, even when adjusting for all the vulnerability factors. CONCLUSION: This study identified several vulnerability factors for mental health problems in the pandemic. Individuals recently exposed to violence and individuals with pre-existing mental health problems are at particular risk. Worrying about the consequences of the pandemic contributes negatively to current mental health. However, worry cannot explain the excess distress in vulnerable groups. Future research should focus on how COVID-related strains contribute to mental health problems for vulnerable groups.

Trauma in the third decade: Ruminative coping, social relationships and posttraumatic stress symptoms.

BACKGROUND: Previous research suggest that rumination and poor social relationships contribute to the maintenance of posttraumatic stress symptoms (PTSS) after traumatic events. Less is known about how these factors work together. The aim of this study was to assess the association between ruminative coping style and long-term PTSS, and to determine whether perceived social support and loneliness can attenuate or potentiate this association, respectively. METHODS: This study used cross-sectional data from survivors and bereaved (n = 185) collected 26 years after the 1990 fire on the Scandinavian Star ferry. RESULTS: Ruminative coping style, perceived social support, and loneliness were all uniquely associated with PTSS. Social support, but not loneliness, moderated the association between ruminative coping style and PTSS. LIMITATIONS: The 26-year interval between the traumatic event and the data collection mean that we cannot infer how a ruminative coping style, perceived social support, and loneliness could affect PTSS in the early aftermath of disaster. CONCLUSIONS: The results suggest that perceived social support and loneliness play different roles in long-term maintenance of PTSS. Whereas loneliness seem to have a direct association with PTSS, high social support may also protect against the negative effects of a ruminative coping style on PTSS. Social relationships may play a crucial role in recovery from trauma, particularly in individuals with a ruminative coping style.

The network approach to posttraumatic stress disorder: a systematic review.

Background: The empirical literature of network analysis studies of posttraumatic stress symptoms (PTSS) has grown rapidly over the last years. Objective: We aimed to assess the characteristics of these studies, and if possible, the most and least central symptoms and the strongest edges in the networks of PTSS. Method: The present systematic review, conducted in PsycInfo, Medline, and Web of Science, synthesizes findings from 20 cross-sectional PTSS network studies that were accepted for publication between January 2010 and November 2018 (PROSPERO ID: CRD42018112825). Results: Results indicated that the network studies investigated a broad range of samples and that most studies used similar analytic approaches including stability analysis. Only strength centrality was generally adequately stable. Amnesia was consistently reported to have lowest strength, while there was substantial heterogeneity regarding which nodes had highest strength centrality. The strongest edge weights were typically within each DSM-IV/DSM-5 PTSD symptom cluster. Conclusions: Hypothesis-driven studies are needed to determine whether the heterogeneity in networks resulted from differences in samples or whether they are the product of underlying methodological reasons.

Antecedentes: La literatura empírica los estudios de análisis en redes de síntomas de estrés postraumático (SEPT) ha crecido rápidamente en los últimos años.Objetivos: Nuestro objetivo fue el evaluar las características de estos estudios y, de ser posible, evaluar cuáles eran aquellos síntomas más cardinales y cuáles no, y cuáles eran los enlaces más fuertes en las redes de los SEPT.Métodos: La presente revisión sistemática, realizada en PsycInfo, Medline, y Web of Science, sintetiza los hallazgos de 20 estudios transversales en redes sobre SEPT que se basaron sobre información transversal, y que fueron aceptados para publicación entre enero de 2010 y noviembre de 2018 (PROSPERO ID: CRD42018112825).Resultados: Los resultados indicaron que los estudios en redes investigaron un amplio rango de muestras, y que la mayoría de estudios emplearon enfoques analíticos similares, incluyendo el análisis de estabilidad. Solo la centralidad de la fuerza fue generalmente adecuadamente estable. Se informó consistentemente que la amnesia tenía la fuerza más baja, mientras que había una heterogeneidad sustancial con respecto a qué nodos tenían la centralidad de la fuerza más alta. Los pesos de los enlaces de red más fuertes se encontraban, por lo general, dentro de cada racimo de síntomas para trastorno de estrés postraumático contemplados en el DSM IV/DSM 5.Conclusiones: Se necesitan estudios derivados de hipótesis para determinar si la heterogeneidad de las redes resultó de las diferencias en las muestras, o si resultaron del producto de cuestiones metodológicas subyacentes.

Am I an island? A network analysis exploring aspects of social landscapes after childhood violence.

OBJECTIVE: Exposure to violence during childhood can have severe long-term consequences for social relationships. In the current study, we sought to disentangle some of the phenomena involved by utilizing a network approach to study the perceptions of aspects of social landscapes in young adulthood of victims of childhood violence. METHOD: We used network analysis to describe the connections between perceived positive social support, barriers to social support, violence-related shame, childhood family cohesion, and perceived negative responses from others for 443 individuals exposed to childhood violence. RESULTS: Respondents' enjoyment of spending time with family in childhood was strongly connected to many other aspects of their social landscapes. The highest values for expected influence were found for worrying about what others thought and experiencing support from others. Finding that other people withdrew from them after the violence had occurred had both high strength centrality and a high value of expected influence and was associated with shame and barriers to social support. CONCLUSIONS: The results suggest that these elements can play important roles in the social landscapes of victims of childhood violence. Further research specifying the directionality between these elements is necessary. It may be helpful for clinicians working with victims of childhood violence to explore their perceptions of their social landscapes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Correction to: Long-term mental health in unaccompanied refugee minors: pre- and post-flight predictors.

In the original publication, the Table 1 was published.

Long-term mental health in unaccompanied refugee minors: pre- and post-flight predictors.

Unaccompanied refugee minors are a particularly vulnerable group. The aim of this study is to increase our knowledge about possible pathways to well-being and integration for unaccompanied refugee minors as they strive to establish new lives in a host county. The present study followed a group of youth who fled to Norway without their caregivers at three time points; 6 months (n = 95; M age = 13.8, 80% boys), 2 years (n = 78; M age = 16.5, 83% boys), and 5 years (n = 47; M age 20.0, 83% boys) after arrival. Linear mixed effects models were used to assess whether age, gender, and trauma exposure prior to arrival were associated with levels and changes in symptoms of posttraumatic stress (PTS), depression, anxiety, and externalizing symptoms over time. Regression analyses were conducted to examine whether daily hassles, perceived social support, and new trauma experiences predict PTS, internalization, externalization, and somatization. The mean levels of depression had decreased significantly at 5 years, but mean levels of anxiety, PTS, and externalizing symptoms did not. Females and severely trauma exposed had higher levels of symptoms. Higher age was associated with less change in symptoms of depression and posttraumatic stress over time. Five years after arrival, many still experienced clinical levels of mental health problems, and level of daily hassles was an important predictor. Support may be needed not only at arrival to handle mental health problems in general and posttraumatic stress in particular, but also after resettlement. Help to manage daily hassles may be especially important to ensure well-being and integration.

Long-term mental health and social support in victims of disaster: comparison with a general population sample.

BACKGROUND: Trauma and traumatic bereavement have well-known consequences for mental health, but little is known about long-term adjustment, particularly with respect to health-protective factors.AimsTo assess the levels of anxiety/depression and perceived social support among the survivors and the bereaved 26 years after the Scandinavian Star ferry disaster compared with expected levels from the general population. METHOD: Anxiety/depression and social support were assessed in face-to-face interviews with the survivors and the bereaved (N = 165, response rate 58%). Expected scores were calculated for each participant based on the means and proportions for each age and gender combination from a general population sample. We computed the ratio between expected and observed scores, standardised mean differences with 95% confidence intervals and standardised effect sizes. RESULTS: We found an elevated level of anxiety/depression symptoms in the victims (Mdiff = 0.28, 95% CI 0.18, 0.38; effect size 0.43, 95% CI 0.31, 0.55) and a significant excess of individuals with a clinically significant level of symptoms. The observed level of perceived social support was significantly lower than that expected (Mdiff = -0.57, 95% CI -0.70, -0.44; effect size -0.73, 95% CI -0.89, -0.57). This was the case for both survivors and those who were bereaved and for both men and women. CONCLUSIONS: This study reveals that disaster survivors and the bereaved reported elevated levels of anxiety and depression symptoms 26 years after the event. They also reported a markedly reduced level of social support. Traumas and post-traumatic responses may thus cause lasting harm to interpersonal relationships.Declaration of interestNone.

Loneliness as a mediator of the relationship between shame and health problems in young people exposed to childhood violence.

RATIONALE: Shame related to childhood violence can be detrimental to mental and physical health. Shame may erode social bonds. OBJECTIVE: In this study we tested whether loneliness is an important pathway between violence-related shame and health problems. METHOD: Individuals who reported exposure to childhood violence in a telephone interview survey in 2013 (wave one) were re-contacted 12-18 months later (wave two), as part of a more general survey of the Norwegian adult population. In total, 505 adolescent and young adult participants (mean age = 21 years) responded to questions about violence exposure, violence-related shame, loneliness, anxiety/depression symptoms, and somatic health complaints. We used counterfactually based causal mediation analysis within the structural equation modelling framework to test whether loneliness mediated a potential association between shame and health. RESULTS: Shame had a profound effect on anxiety/depression symptoms and we identified both direct and indirect effects. Loneliness mediated about one third of the relationship between shame and anxiety/depression symptoms. The relationship between shame and somatic health complaints was weaker in total, but this more modest effect largely occurred indirectly through loneliness. CONCLUSIONS: Our results add to the literature by highlighting the role of loneliness in the relationship between shame and health. Shame may have the potential to break down social connectedness, with a detrimental effect on health. Clinicians may find it helpful to pay close attention to the way shame regulates social interaction. Preventing social isolation and loneliness may promote good health in violence victims.

Imagining What Could Have Happened: Types and Vividness of Counterfactual Thoughts and the Relationship With Post-traumatic Stress Reactions.

A growing body of research suggests that counterfactual thinking after traumatic events is associated with post-traumatic stress reactions. In this study we explored frequency of upward and downward counterfactuals in trauma-exposed individuals, and how trauma-related counterfactuals were represented in terms of vividness. We examined the relationships between vividness and frequency of counterfactual thoughts and post-traumatic stress reactions in two groups who had experienced different types of traumatic exposure, namely survivors and bereaved from the fire on the ferry Scandinavian Star in 1990. Even after 26 years, both survivors and bereaved reported that they currently entertained thoughts about what could have happened during the fire on Scandinavian Star. Survivors reported more downward counterfactuals than the bereaved, whereas the bereaved reported more upward counterfactuals than the survivors did. Vividness of counterfactual thoughts, as well as reported frequency of upward and downward counterfactuals, were associated with post-traumatic stress reactions. Our results suggest that both upward and downward counterfactuals can be harmful, and that vivid counterfactuals about a traumatic event might play a similar role in post-traumatic stress as trauma memories. Therefore, traumatized individuals who entertain counterfactual thoughts may benefit from interventions that target these thoughts specifically.