A Virtual Reality Simulation to Examine the Relationship Between Post-Traumatic Stress Symptoms and Decision-Making in First Responders.

First responders (FRs) are continuously exposed to critical incidents, considered traumatic events (TEs). This cumulative exposure increases the risk for post-traumatic stress disorder (PTSD). However, there is no evidence about the relationship between PTSD symptoms and emergency decision-making (EDM). The objective of this study was to examine the EDM of FRs during a virtual reality through the simulation of two emergency scenarios to collect data on the reaction time and the number of incorrect decisions. We also assessed PTSD symptoms, TE, and sociodemographics. The sample included 368 Portuguese FRs, were 295 (80.20%) males and 73 (19.80%) females, with a mean age of 33.96 (SD = 9.38). Considering the probable PTSD diagnosis according to the DSM-5, 85 (23.10%) of the FRs met the criteria. These individuals who meet the criteria exhibited higher EDM scores (M = 19.60, SD = 5.99) compared to those without probable PTSD (M = 17.87, SD = .5.66) (F(1, 360) = 5.32, p = .02, partial η2 = .015). We found that TEs had a direct effect on EDM, ß = -.16, Z = -3.74, p < .001), and the pathway of trauma-PTSD symptoms-decision-making an indirect effect, ß = .02, Z = 3.10, p = .002). Individuals exposed to more TEs demonstrated faster and more accurate decision-making in the context of EDM. However, when these individuals developed PTSD symptoms, their decision-making became slower and less accurate. The inclusion of a trauma-informed approach for FRs to prevent individual and job-related consequences is discussed.

HIV Diagnosis in the Context of Stable Relationships: A Qualitative Study With Women Living in Portugal.

ABSTRACT: The purpose of this phenomenological study is to explore the acceptance of HIV diagnosis of women in stable relationships. Based on eight semistructured interviews with cisgender Portuguese women, thematic analysis identified four interrelated themes that illustrated the emotional and psychosocial dynamics involved in this journey. Following an HIV diagnosis, participants grappled with complex emotions, societal perceptions, and the internalization of stigma. Marital relationships underwent profound changes, with trust breakdown and emotional distancing. Coping mechanisms ranged from seeking support to living in secrecy, which impacted psychological well-being. Acceptance of HIV diagnosis is influenced by self-stigmatization, societal perceptions of HIV, and gender dynamics. The findings contribute to the development of tailored interventions, emphasizing the interconnected nature of physical and psychological well-being in the diagnosis acceptance process.

Assessment of the Health Status of Women in Prison: A Comparison between Drug Users versus Non-users.

This study aims to analyze the history of substances use, clinical diagnoses, contacts with healthcare, and health complaints. Also, it aims to compare the health status of substance users versus non-users. Health records of 93 detained women from a prison in northern Portugal, with a mean age of 38.02 years old, were reviewed and coded using both International Classification of Primary Care-2 and International Classification of Diseases-10th. Data revealed high percentages of detainees with a history of substance use and pre-existing clinical diagnosis. During the first month of imprisonment, on average, participants had complained to a health professional 14.63 times. Substance users were younger and presented more mental health problems and health complaints. Health policies and professional practices in prison must include immediate assessment of a woman's health concerns and foster the development of efficient protocols to address those problems, especially substance use disorder treatment.

Posttraumatic stress disorder symptoms and dissociation as serial mediators of the relationship between cumulative victimization and adjustment problems among poly-victimized at-risk youth.

INTRODUCTION: Poly-victimization (PV) has a greater adverse impact on adolescents' lives than any single victimization type, even when repeatedly experienced. Adolescents who experience PV tend to present with an array of adjustment problems, and research has begun to identify mechanisms linking PV to adjustment problems. Both posttraumatic stress disorder (PTSD) and dissociation are linked to PV and adjustment problems; however, it is unclear how these variables play a role in the pathways from PV to adjustment problems. This study assessed PTSD and dissociation as serial mediators in the PV-adjustment problems link. METHOD: Two hundred eighteen Portuguese youth identified as poly-victims (56% girls) and aged between 12 and 17 years old (M = 15.63; SD = 1.26) were recruited from three at-risk contexts' cohorts. Participants completed self-report measures of trauma exposure, posttraumatic symptoms, dissociative symptoms, and emotional and social adjustment problems. RESULTS: The study results suggest that, among poly-victim adolescents, PTSD and dissociation may be mediators of the relationship between the cumulative extent of victimization and adjustment problems. CONCLUSION: The current study's findings highlight the importance of careful assessment of both PTSD and dissociative symptoms and indicate that targeted interventions are essential when working with poly-victimized youth with the highest scores of cumulative victimization. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The mediating role of posttraumatic stress symptoms on somatization in adolescents: A two-wave longitudinal study.

OBJECTIVE: Trauma as well as adverse childhood experiences (ACEs) have been associated with increased rates of later somatization symptoms. Some evidence has proposed that posttraumatic stress symptoms (PTSS) can mediate this relationship. However, most data come from adult samples. This two-wave longitudinal study aimed to investigate the relationship between cumulative adversity (total amount of adverse and traumatic experiences), PTSS and somatization symptoms in adolescents. METHOD: The sample included 150 adolescents, mean age of 16 years old (M = 15.99, SD = 1.25) with 67 (44.7%) males and 83 (55.3%) females. All were exposed to at least one traumatic event or one childhood adversity. The interval time between the two assessments was about 1 year. RESULTS: The results showed that the PTSS Cluster E, alterations in arousal and reactivity, partially mediated the relationship between cumulative adversity and somatization symptoms (B = .09, BSE = .03, CI [.01, .15]). However, the effect size of the mediation was medium, while the direct effect was large (B = .34, BSE = .08, CI [.18, .50]). CONCLUSIONS: While arousal and reactivity symptoms seem to play a key role in adolescents suffering from somatization symptoms, cumulative adversity have their own direct and strong contribution. Clinicians should consider assessing PTSS and cumulative adversity when caring for adolescents suffering with somatic symptoms to better deliver intervention plans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The impact of modes of administration on self-reports of offending: evidence from a methodological experiment with university students.

Objectives: Current knowledge about the causes of offending behavior is heavily reliant on self-reports of offending (SRO). However, methodological research on the impact of modes of administration on SRO is very scarce. Further, the existing evidence conflicts with the general knowledge about responding to sensitive questions. In this study, we aimed to test whether SRO are affected by modes of administration. Methods: We carried out a methodological experiment, with a 2 (interviewer-administered vs. self-administered surveys) × 2 (paper-and-pencil vs. computer- assisted surveys) factorial design. A total of 181 undergraduate students were randomly assigned to one of these conditions and completed the International Self-Report Delinquency 3 (ISRD3) questionnaire. Results: Findings showed an increased odds of reporting offending behavior in self-administered surveys, compared to face-to-face interviews. Paper-and-pencil and computer-assisted modes resulted in comparable estimates of offending. Conclusions: This experiment provides evidence that SRO provide more accurate estimates of offending behavior using self-administered surveys.

Adverse Lifelong Experiences in Portuguese People Living With HIV: A Retrospective Study.

ABSTRACT: This study aimed to analyze the adverse life experiences encountered by people living with HIV in Portugal, analyze differences between men and women, and identify which experiences were related to HIV transmission modes-sexual activity or injection drug use. We used a sample of 328 participants with a mean age of 45.64, mostly men (79.6%), with a known diagnosis of HIV for 10.34 years. Women and persons who inject drugs reported significantly more adverse outcomes throughout life. Physical abuse during childhood was significantly associated with the sexual transmission mode, whereas having a parent sent to prison during childhood, physical violence, experiencing a life-threatening injury/illness (other than HIV) during adulthood, and injuring someone during adulthood were associated with injection drug use. Practical implications are discussed at the prevention and intervention levels.

The psychometric properties of the adolescent dissociative experiences scale (A-DES) in a sample of Portuguese at-risk adolescents.

Dissociation is a process that often occurs as a sequela of psychological trauma, and it is interrelated with psychological and behavioral problems. In the at-risk adolescent population, dissociation is often underdiagnosed and undertreated. Having reliable measures to assess this phenomenon can help in identifying adolescents at-risk and improve treatment outcomes. This study assessed the psychometric properties of the Adolescent Dissociative Experiences Scale (A-DES) with a sample of 402 Portuguese adolescents recruited from three at-risk populations. Participants completed self-report measures of trauma exposure, posttraumatic symptoms, psychological and behavioral problems, and the A-DES. A subset of the sample also completed test-retest measures. Confirmatory factor analyses revealed a best-fitting 3-factor model. Analyses revealed good internal consistencies and good agreement test-retest reliability for the scale overall and the factor-based sub-scales. Construct and predictive validity was supported with results showing that A-DES discriminates between youth reporting high versus low levels of cumulative trauma exposure and youth who meet or do not meet criteria for a probable PTSD diagnosis. Study findings replicate prior research supporting a 3-factor model of dissociation and the usefulness of A-DES to identify adolescents with dissociative symptoms. Clinical and research implications are discussed.

Measuring Self-Serving Cognitive Distortions with Special Reference to Juvenile Delinquency: A Validation of the "How I Think" Questionnaire in a Sample of Portuguese Adolescents.

The present study aims to test the psychometric properties of the Portuguese version of the "How I Think" (HIT) questionnaire. The HIT questionnaire is a self-report measure of self-serving cognitive distortions. Our sample was comprised of 442 Portuguese-speaking adolescents and young adults (254 males and 188 females), aged between 12 and 20 years. Of the total 442 participants, 351 were recruited from a Portuguese school and 91 from four Portuguese detention centers for juvenile delinquents. Data analysis provided evidence supporting the original six-factor model solution, composed of a four-category typology of self-serving cognitive distortions (i.e., Selfcentered, Blaming Others, Minimizing/Mislabeling, and Assuming the Worst), an Anomalous responding, and one Positive filler factor. Further, results showed satisfactory internal consistency, convergent validity, and discriminant validity. In conclusion, this article provides Portuguese researchers and practitioners with a valid measure of self-serving cognitive distortions.

The Impact of Psychopathology Associated With Childhood Trauma on Quality of Life in Portuguese Adolescents: A Two-Wave Longitudinal Study.

Introduction: The aim of this study was to explore the mediating effect of psychopathology between childhood adversity and trauma and quality of life (QOL) in adolescents. The second aim of the study was testing the moderation by social support of this mediation effect. Methods: Self-reports of childhood adversity and trauma, QOL, social support, and psychopathology were collected from 150 Portuguese adolescents' who had been exposed to at least one traumatic event or one childhood adversity (M age = 16.89, SD = 1.32). The surveys were administered at two time points with an approximate time interval of 1 year. Results: Indirect effects were observed for depression (B = -0.33, CI [-0.62, -0.11]), somatization (B = -0.52, CI [-0.82, -0.23]), and post-traumatic stress symptoms (PTSS) (B = -0.23, CI [-0.45, -0.01]), but not for anxiety (B = 0.20, CI [-0.08, 0.50]). A moderated mediation was found between social support and depression (B = -0.10, CI [-16, -0.04]), and PTSS (B = 0.03, CI [-0.1, -0.05]), but not for somatization (B = -0.02, CI [-0.8, 0.05]). Conclusions: We found that depression and somatization were strong mediators of the relationship between adversity/trauma and QOL, whereas PTSS was moderately mediated this relationship. Anxiety did not mediate this relationship. The moderated-mediation effect of social support was only found for depression and PTSS. The improvement of QOL in adolescents exposed to childhood adversity and trauma should include the assessment of psychopathology symptoms and social support, with the aim of identifying risk and protective factors.

Post-Traumatic Stress Disorder and Identity Transformation After Experiences of Psychological Abuse: A Mixed-Methods Approach.

Psychological abuse (PA) is being associated with the development of post-traumatic stress disorder (PTSD). However, few studies have focused exclusively in this type of abuse. This study aimed to examine the relationship between PA and PTSD symptoms according to gender and understand the impact of severe PA in identity transformation, in a Portuguese university sample. Using a mixed-methods approach, 158 students answered an e-survey containing closed and open-ended questions. Results indicated a positive correlation between PA and PTSD symptoms. Women were significantly different from men concerning PA, contrarily to PTSD symptoms that did not present significant gender differences. The qualitative analysis revealed two different forms of adjustment, in both genders: positive-indicating personal growth-and negative changes-impacting relationships and emotional states. The more negative changes were described, the more PTSD symptoms were presented, regardless gender. Raising awareness can help young recognize themselves as victims and prevent the development of detrimental mental health status.

Alternative Models of DSM-5 Posttraumatic Stress Disorder in Portuguese Adolescents Exposed to Trauma and Childhood Adversity.

The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated, with evidence supporting the recently proposed seven-factor hybrid model. However, few studies examining PTSD symptom structure have assessed the implications of these proposed models on diagnostic criteria and PTSD prevalence. In the present study, we examined seven alternative DSM-5 PTSD models within a confirmatory factor analysis (CFA), using the Child PTSD Symptom Scale-Self-Report for DSM-5 (CPSS-5). Additionally, we generated prevalence rates for each of the seven models by using a symptom-based diagnostic algorithm and assessed whether substance abuse, depression, anxiety symptoms, and daily functioning were differentially associated with PTSD depending on the model used to derive the diagnosis. Participants were 317 adolescents aged 13-17 years (M = 15.93, SD = 1.23) who had experienced a DSM-5 Criterion A trauma and/or childhood adversity. The CFA results showed good fit indices for all models, with the seven-factor hybrid model presenting the best fit. The rates of PTSD diagnosis varied according to each model. The four-factor DSM-5 model presented the highest rate (30.6%), and the seven-factor hybrid model presented the lowest rate (17.4%). Similar to the CFA analysis, the inclusion criteria for the diagnosis based on the hybrid model also presented the strongest associations with daily functional impairment, odds ratio (OR) = 1.48, 95% CI [1.25, 1.75]; and adverse childhood experiences, OR = 1.46, 95% CI [1.16, 1.82]. Research and clinical implications of these results are discussed, and suggestions for future investigation are presented.

Early adversity and adult delinquency: the mediational role of mental health in youth offenders.

This research explores the mediational role of mental health in the relationship between early adverse experiences and current self-reported delinquency in young adults with past juvenile justice involvement. Seventy-five young adults with official records of juvenile delinquency in 2010/2011 filled out our protocol in 2014/2015 including the Adverse Childhood Experiences (ACE) questionnaire, the Brief Symptom Inventory, and the D-CRIM questionnaire (evaluating delinquency). The global level of adverse experiences during childhood and adolescence was related to mental health problems and self-reported delinquency in young adulthood, while psychopathological symptoms were also related to current self-reported delinquency. The mental health indicator partially mediated the link between early adversity and current self-reported offending in individuals with past juvenile justice involvement. Our results are in line with previous psychological and neurobiological approaches and highlight the importance of mental health services in youth offender rehabilitation. Future directions for research are provided.

Early adversity and adult delinquency: the mediational role of mental health in youth offenders / Adversidade precoce e delinquência na idade adulta: o papel mediador da saúde mental em jovens ofensores

Abstract This research explores the mediational role of mental health in the relationship between early adverse experiences and current self-reported delinquency in young adults with past juvenile justice involvement. Seventy-five young adults with official records of juvenile delinquency in 2010/2011 filled out our protocol in 2014/2015 including the Adverse Childhood Experiences (ACE) questionnaire, the Brief Symptom Inventory, and the D-CRIM questionnaire (evaluating delinquency). The global level of adverse experiences during childhood and adolescence was related to mental health problems and self-reported delinquency in young adulthood, while psychopathological symptoms were also related to current self-reported delinquency. The mental health indicator partially mediated the link between early adversity and current self-reported offending in individuals with past juvenile justice involvement. Our results are in line with previous psychological and neurobiological approaches and highlight the importance of mental health services in youth offender rehabilitation. Future directions for research are provided.

Resumo Esta pesquisa explora o papel mediador da saúde mental na relação entre experiências adversas precoces e delinquência autorreportada em jovens adultos com historia de envolvimento no sistema de justiça juvenil. Setenta e cinco jovens adultos com registros de delinquência juvenil em 2010/2011 preencheram o protocolo em 2014/2015, incluindo o Questionário de Experiências Adversas na Infância, o Inventário de Sintomas Psicopatológicos e o D-CRIM (que avalia a delinquência). O nível global de experiências adversas na infância e adolescência associou-se tanto a problemas de saúde mental como à delinquência autorreportada em jovens adultos, os sintomas psicopatológicos estiveram também associados à delinquência juvenil no presente. O indicador de saúde mental parcialmente mediou a relação entre adversidade precoce e o nível atual de delinquência em indivíduos com história de envolvimento no sistema de justiça juvenil. Os nossos resultados estão em linha com abordagens psicológicas e neurológicas prévias e salientam a importância dos serviços de saúde mental na reabilitação de jovens ofensores. Direções futuras são apresentadas.

A Step Toward a Better Understanding of the Relationship Between Victimization and Emotional Distress: Indirect Effect of Adult Attachment and Interaction With Household Dysfunction.

A history of victimization has been linked to the latter development of emotional distress. However, not all victims develop emotional distress in response to victimization, emphasizing the need to identify mediators that can guide intervention, as well as moderators to more targeted preventive actions. Within a developmental psychology framework, we aimed to test two models: (a) the role of adult attachment as a mediator in the relationship between victimization and emotional distress, and (b) the role of household dysfunctions as moderators in the relationship between victimization and emotional distress, in psychiatric patients. Participants were 120 adult psychiatric patients, between ages 20 and 79 years (M = -47.22, SD = 13.102) that responded to questions assessing household dysfunction in the family of origin, victimization, and adult attachment. Results revealed that adult attachment was a significant mediator in the association between victimization and emotional distress. Parental mental disorder and total household adversity were significant moderators for that same association. These results provide important clues for intervention. The focus on promoting secure adult relationships may contribute not only to the psychosocial adjustment of psychiatric patients but also to a healthier family functioning. Reducing the household dysfunction may provide a protective environment for the development of children, promoting a positive psychosocial adjustment, also preventing the intergenerational transmission of violence, insecure attachment, and emotional distress.

What is told when the story is retold? Consistency of victimization reports in psychiatric patients.

The use of retrospective self-reports is a major methodological concern when ascertaining the occurrence of victimization experiences, with additional concerns when assessing psychiatric patients. The test for consistency can overcome some of these concerns, increasing the confidence in the information reported. Our aim was twofold: (1) to know the consistency of victimization reports; and (2) to test the role of changes on emotional distress in predicting report discrepancies, in a sample of 34 adult psychiatric patients. Participants were assessed twice, with a year interval. Sexual abuse was the experience that presented the higher level of consistency for childhood victimization, while assault with a weapon had the higher consistency level for adolescent and adult victimization. We found that increases on emotional distress predicted report discrepancies, and more specifically, increases in the report of victimization. Our results displayed acceptable consistency levels, suggesting some stability in the reporting of victimization over time. Considering that inconsistencies tended either to increases and decreases in the reporting of victimization, it would be important to consider the impact of such experiences when intervening with psychiatric patients.

Screening Tool for Psychological Intimate Partner Violence: Portuguese Validation of the Psychological Maltreatment of Women Inventory.

BACKGROUND/OBJECTIVE: The Psychological Maltreatment of Women Inventory-Short Form (PMWI-SF) is a well-established and brief instrument for assessing psychological intimate partner violence (IPV). In the absence of a specific tool to assess psychological IPV in Portuguese women, this study sought to confirm the factor structure of the Portuguese PMWI-SF and analyze its psychometric properties. METHOD: Five hundred and six women filled out the e-survey including the assessment of IPV (Revised Conflict Tactics Scales, Psychological Abuse Survey, and PMWI-SF) and psychopathology through the Brief Symptom Inventory. Sociodemographic characteristics, construct validity, and internal consistency were analyzed, and a cutoff for the PMWI-SF was established. RESULTS: Confirmatory factor analysis for the 2-factor structure (emotional/verbal abuse and domination/isolation) showed an excellent fit for the last 6 months and across the life span. Factors possessed good internal consistency (α ≥ .70) and test-retest reliability (r ≥ .90). Pearson's correlation analysis revealed the PMWI factors were positively correlated with proximal variables. PMWI-SF scores demonstrated excellent differentiation between women with and without psychological IPV (area under the curve [AUC] = .948; confidence interval or CI [.93, .97]). The PMWI-SF cutoff score that provided the optimal balance was 32 (sensitivity = 83.8%; specificity = 91.7%). CONCLUSIONS: The PMWI-SF is a valid and reliable instrument for assessing the experience of psychological IPV in Portuguese women.

Needs and Achievements of the Juvenile Justice System: Insights From Two Empirical Studies With Portuguese Young Adults.

Over the last decade, studies have evaluated the effectiveness of interventions for juvenile offenders; nonetheless, those studies were more focused on recidivism than on the mechanisms associated with criminal perpetration. The current study explores the role of juvenile justice involvement and detention measures in a set of psychological, social, and criminal behavior characteristics in early adulthood. Seventy-five young adults with official records of juvenile delinquency in 2010-2011 and 240 young adults from the community filled out our protocol in 2014-2015. Young adults with juvenile justice involvement showed worse psychological, social, and criminal outcomes than those from community. Detention appears to be related to the number of deviant friends, delinquency, and school achievement in early adulthood. Our findings are in line with the labeling and deviant peer contagion theories and establish the main areas of interventions that affect the identified needs. A set of policy implications is provided.

Different settings, different approaches: a qualitative comparison of Portuguese dietitians' beliefs, attitudes and practices about obesity in public and private settings.

OBJECTIVE: With obesity being a major public health epidemic, dietitians are charged with the difficult task to assist clients in modifying their behaviours. Since there are inconsistent data about dietitians' beliefs, attitudes and practices concerning obesity and little is known concerning differences in public and private practice, we conducted the present study to address those gaps. DESIGN: Semi-structured interviews analysed according to thematic analysis procedures. SETTING: Public primary-care and private settings. SUBJECTS: Seventeen Portuguese registered dietitians working in public primary-care (n 10) and private settings (n 7). RESULTS: Regardless of work context, 'persistence of efforts' emerged as the main characteristic of dietitians' action. Besides holding negative attitudes towards obese patients, their practices are not negatively influenced. They perceive themselves as active agents in promoting lifestyle changes, offering as many management strategies as possible to empower patients, feeling positive about the accomplishment of a successful weight loss, believing in their own efficacy and competency in helping patients. However, differences in reimbursement, work environment, perceived barriers, patient characteristics and availability of resources seem to contribute to differences in persistence according to the setting in which dietitians are working, evidenced by an increase of efforts and engagement in private practice and a decrease in public primary-care practice. CONCLUSIONS: Portuguese dietitians present a positive mindset and actions about obesity treatment outcomes; however, education in behaviour change strategies should be improved. The public health system requires reorganization to enhance effective obesity management delivery. Motivation driving dietitians' work in private settings should be addressed.

Relationship Between HIV and Depressive Symptomatology in Patients From Northern Portugal: Analysis of Individual, Health, and Social Predictors.

Depression is the most prevalent mental disorder in people living with HIV. Our study involved 371 participants in outpatient treatment for HIV in hospitals in northern Portugal. Participants were referred to the study by the attending physician/nurse, and data were collected through an individual interview at a single evaluation moment. Participants were mostly male (70%), with an average age of 46.63 years (SD = 11.77), and a known diagnosis of HIV for an average of 10.13 years (SD = 6.42). Severe depressive symptoms were identified in 18% of participants. We identified several significant predictors of depressive symptoms: being female, being in a situation of social exclusion, having adverse experiences throughout life, infection by sexual contact in a stable marital relationship, daily concerns regarding health, negative family relationships, and dissatisfaction with social support. Findings suggest the need to include regular mental health assessments and referral for specialized psychological support services.