What will others think of me? The longitudinal association between trauma-related shame and guilt and psychopathology after a terror attack.

BACKGROUND: Trauma-related shame and guilt have been identified as important factors for mental health following interpersonal trauma. For survivors of terror and disasters, however, the role of shame and guilt remains largely unknown. AIMS: To explore the long-term occurrence of trauma-related shame and guilt among survivors of a terror attack, and the potential importance of these emotions for mental health. METHOD: A total of 347 survivors (48.7% female, mean age at the time of the attack: 19.25 years, s.d. = 4.40) of the 2011 massacre on Utøya island, Norway, participated in face-to-face, semi-structured interviews. Trauma-related shame and guilt were measured with items from the Shame and Guilt After Trauma Scale at 2.5 and 8.5 years post-terror attack. Post-traumatic reactions and anxiety/depression at 8.5 years post-terror attack were measured with the University of California at Los Angeles PTSD Reaction Index and the Hopkins Symptom Checklist-25, respectively. Associations between trauma-related shame/guilt and post-trauma psychopathology were analysed by multiple linear regressions. RESULTS: Trauma-related shame and guilt were prevalent among survivors at both 2.5 and 8.5 years post-terror attack. In unadjusted analyses, shame and guilt, at both time points, were significantly associated with post-traumatic stress reactions and anxiety/depression. Shame remained significantly associated with mental health when adjusted for guilt. Both earlier and current shame were uniquely related to mental health. CONCLUSIONS: Trauma-related shame and guilt may be prevalent in survivors of mass trauma several years after the event. Shame, in particular, may play an important role for long-term mental health. Clinicians may find it helpful to explicitly address shame in treatment of mass trauma survivors.

Warning signals? An explorative study of distant recollections of the moments before a disaster.

Background: How do we remember what happened shortly before a traumatic experience? There has been little focus on the temporal context of trauma memories, but a few studies suggest that aspects of what happened in the moments prior to a traumatic experience may be selectively enhanced and prioritized in memory.Objective: The main aim of this study was to investigate the occurrence, nature, and content of voluntary memories about what happened shortly before a disaster. The participants were individuals who had survived a fire on the passenger ferry Scandinavian Star 26 years earlier.Methods: Data collection took the form of face-to-face interviews. The analysis was carried out in two steps. First, all the narratives from participants who were aged 7 years or older at the time of the fire (N = 86) were coded in terms of the presence of detailed descriptions of what happened before the fire. Next, the narratives that included detailed descriptions of the moments before (N = 28) were included in a thematic analysis, focusing on coding the mode and the content.Results: More than one-third of the participants reported detailed accounts of what happened in the hours, minutes, or seconds before the fire. These memories included detailed descriptions of sensory impressions, dialogues, actions, and thoughts. Two themes stood out in the thematic analysis: (1) unusual observations and danger cues; and (2) counterfactual thoughts.Conclusion: The finding that specific details from the moments before a traumatic event may be vividly recalled indicates that peripheral details of traumatic events can be prioritized in memory. Such details may be interpreted as warning signals. Future research should examine whether such memories might stimulate long-standing thoughts of the world as being dangerous, and hence carry the threat forward in time.

A qualitative study exploring the occurrence, nature, and content of memories about what happened shortly before a disaster.For some trauma survivors, experiences or observations shortly before a traumatic event can be vividly recalled in detail, after more than two decades.Such detailed memories of what happened before a traumatic experience may be interpreted as warning signals; furthermore, they may stimulate long-standing thoughts of the world as dangerous, thus carrying the threat forward in time.

Healthcare utilization after mass trauma: a register-based study of consultations with primary care and mental health services in survivors of terrorism.

BACKGROUND: Knowledge on healthcare utilization after mass trauma is needed to strengthen the public health preparedness to such incidents. Using register-based data, this study had a unique opportunity to investigate how young survivors' use of primary care physicians (PCP) and mental health services (MHS) changed after a terrorist attack. METHODS: We examined register-based data on PCP and MHS consultations among 255 survivors (52% male) of the 2011 Utøya youth camp attack in Norway 3 years before and after the attack, and their reason for encounter with the PCP according to the International Classification for Primary Care (ICPC- 2). RESULTS: The PCP and MHS consultation rates (CR) were higher in female than male survivors both acutely and at long-term. The mean yearly CRs increased from 2.25 to 4.41 for PCP and 1.77 to 13.59 for MHS the year before and after the attack in female survivors, and from 1.45 to 3.65 for PCP and 1.02 to 11.77 for MHS in male survivors. The third year post-attack CRs for PCP were 3.55 and 2.00; and CRs for MHS were 5.24 and 2.30 in female and male survivors, respectively. Among female survivors, 76% consulted PCP and 12% MHS the year preceding the attack; post-attack 93% consulted PCP and 73% MHS the first year; decreasing to 87 and 40% the third year. Among male survivors, 61% consulted PCP and 7% MHS the year preceding the attack; post-attack 86% consulted PCP and 61% MHS the first year, and 67 and 31% the third year. As for PCP consultations, there was a particular increase in psychological reasons for encounter following the attack. CONCLUSIONS: This study indicates that it is important to anticipate an increased healthcare utilization several years following mass trauma, particularly of MHS. Both PCP and MHS practitioners played important roles in providing healthcare for psychological problems in young survivors of terrorism in a country with universal and largely publicly financed healthcare and a gatekeeping system. The healthcare utilization could be different in countries with other health systems or psychosocial care responses to mass trauma.

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.

Adolescents amid the COVID-19 pandemic: a prospective study of psychological functioning.

BACKGROUND: The spread of coronavirus disease (COVID-19) and the accompanying countermeasures can significantly impact the wellbeing of adolescents. There is a lack of longitudinal studies that can shed light on potential social, emotional, and behavioral development in adolescents. We aimed to identify potential changes in adolescent psychosocial functioning from pre-pandemic to peri-pandemic assessment, and secondly, to identify specific patterns of change. METHODS: This longitudinal study was based on a Lithuanian community sample of 331 adolescents aged 12-16 at T1 (M = 13.87, SD = 1.59). T1 data collected before the pandemic (March-June, 2019) was compared with T2 data collected during the COVID-19 outbreak (October 2020). Psychosocial functioning was assessed by The Strengths and Difficulties Questionnaire (SDQ). Multivariate latent change modeling and latent class change approaches were used to identify patterns of change. RESULTS: We found a small but significant increase in hyperactivity/inattention, emotional symptoms, but also prosocial behavior from before to during the pandemic, even adjusting for resilience, lifetime abuse experience, and socio-demographic situation. Three change profiles were identified in the latent change analysis: (1) a majority (70.7%) experienced a significant increase in psychosocial problems; (2) a smaller sub-group (19.6%) with increased peer problems only; (3) a small group (9.7%) showing no negative change and an increase in prosocial behavior. CONCLUSIONS: The study found a significant negative impact of the COVID-19 pandemic on mental health in the majority of adolescents, as well as indications of positive social development in a small group. These findings highlight the importance of identifying and supporting adolescents in the time of the pandemic more effectively. Accumulating knowledge about human responses to the coronavirus, particularly in young people, is pivotal to societal preparedness for future pandemics.

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.

PTSD and complex PTSD in adolescence: discriminating factors in a population-based cross-sectional study.

Background: Chronic and repeated trauma are well-established risk factors for complex posttraumatic stress disorder (CPTSD) in adult samples. Less is known about how trauma history and other factors contribute to the development of CPTSD in adolescence. Objective: The aim of this study was to assess the potential contribution of trauma history and social factors to CPTSD in adolescents. Method: In a cross-sectional community study of 1299 adolescents aged 12-16 years, PTSD (n = 97) and CPTSD (n = 108) was assessed with the Child and Adolescent version of the International Trauma Questionnaire (ITQ-CA). Trauma exposure, family functioning, school problems, and social support as potential discriminating factors between the PTSD and CPTSD groups were investigated. Results: Cumulative trauma exposure did not discriminate between PTSD and CPTSD in this sample. CPTSD was associated with family problems (such as financial difficulties and conflicts in the home), school problems (bullying and learning difficulties), and lack of social support. Conclusions: Our study indicates that factors other than cumulative trauma are important for the development of CPTSD in adolescence. Interventions targeting adolescent's social environment both at home and at school may be beneficial.

Antecedentes: Los traumatismos crónicos y repetidos son factores de riesgo bien establecidos para el trastorno de estrés postraumático complejo (CPTSD) en muestras de adultos. Se sabe menos acerca de cómo la historia del trauma y otros factores contribuyen al desarrollo de TEPT-C en la adolescencia.Objetivo: El objetivo de este estudio fue evaluar la potencial contribución de la historia de trauma y los factores sociales al TEPT-C en adolescentes.Método: En un estudio comunitario transversal de 1299 adolescentes de 12 a 16 años, se evaluó el PTSD (n = 97) y CPTSD (n = 108) con la versión para Niños y Adolescentes del Cuestionario Internacional de Trauma (ITQ-CA por sus siglas en ingles). Se investigaron la exposición al trauma, el funcionamiento familiar, los problemas escolares y el apoyo social como posibles factores de discriminación entre los grupos de TEPT y TEPT-C.Resultados: La exposición acumulada al trauma no discriminó entre TEPT y TEPT-C en esta muestra. El TEPT-C se asoció con problemas familiares (como dificultades financieras y conflictos en el hogar), problemas escolares (acoso escolar {bullying} y dificultades de aprendizaje) y apoyo social.Conclusiones: Nuestro estudio indica que otros factores además del trauma acumulativo son importantes para el desarrollo de TEPT-C en la adolescencia. Las intervenciones dirigidas al entorno social de los adolescentes tanto en el hogar como en la escuela pueden resultar beneficiosas.

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.

Patterns of abuse and effects on psychosocial functioning in Lithuanian adolescents: A latent class analysis approach.

BACKGROUND: There is considerable evidence that child abuse and neglect has a significant impact on social relationships and mental health across the lifespan. OBJECTIVE: We aimed to estimate the prevalence of child abuse in Lithuanian adolescents, to identify patterns of abuse experiences using a latent class analysis approach, and to assess psychosocial functioning associated with these patterns of abuse. PARTICIPANTS AND SETTING: The study was based on a sample of 1299 adolescents from the Lithuanian general population aged 12-16 (M = 14.24, SD = 1.26) years. METHODS: Lifetime abuse exposure measures included neglect, emotional abuse, physical abuse, online sexual violence, sexual abuse from adult, and sexual abuse from peers. Psychosocial functioning was measured with the Strength and Difficulties Questionnaire (SDQ). Patterns of abuse were identified by a two-step latent class analysis (LCA). RESULTS: Around two-thirds of adolescents (71 %) reported at least one type of abuse over their lifetime. The results of the LCA indicated that for each type of abuse two different groups of adolescents can be distinguished in terms of the severity of abuse, and four classes 'less-severe', 'peer sexual', 'adult sexual', and 'severe abuse' were identified. Psychosocial functioning varied significantly between the four classes with higher psychosocial functioning problems associated with high severity and sexual abuse. CONCLUSIONS: The study revealed a high child abuse prevalence in Lithuania. The results show that the psychosocial functioning of adolescents is associated with severity and types of abuse experiences.

Early Pain and Other Somatic Symptoms Predict Posttraumatic Stress Reactions in Survivors of Terrorist Attacks: The Longitudinal Utøya Cohort Study.

Survivors of traumatic events commonly suffer from long-term pain and related somatic symptomatology. To test the predominant hypothesis that survivors' pain comprises sequela of persistent posttraumatic stress symptoms (PTSS), we assessed the sequential order of symptom development among young survivors of a terrorist attack. All 490 survivors of the 2011 Utøya (Norway) attacks were invited to the longitudinal Utøya cohort study; 355 (72.4%) participated. The mean survivor age was 19.3 years (SD = 4.6) and 169 were female (47.6%). Somatic symptoms, including headache, other pain and fatigue, and PTSS, were measured 4-5 months (T1), 14-16 months (T2), and 32-33 months (T3) after the attack. Longitudinal associations between somatic symptoms and PTSS were assessed in cross-lagged structural equation model (SEM) analyses, which were adjusted for known confounders. Higher pain levels and other somatic symptoms at T1 consistently predicted PTSS at T2 in SEM analyses, r = .473, p < .001. Beyond this early-to-intermediate posttraumatic phase, somatic symptoms did not significantly predict PTSS: T2-T3, r = .024, p = .831; T1-T3, r = -.074, p = .586. PTSS did not significantly predict later somatic symptomatology at T1-T2, r = .093, p = .455; T2-T3, r = .272, p = .234; or T1-T3, r = -.279, p = .077. The findings indicate that survivors' early pain and related somatic symptoms strongly and consistently predict later psychopathology. After severe psychological trauma, early interventions may need to address individuals' pain to hinder chronification.

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).

Child abuse and physical health: A population-based study on physical health complaints among adolescents and young adults.

Aims: To investigate whether adolescents and young adults with a history of child abuse had more physical health complaints compared to their unexposed peers. We also aimed to estimate associations between different child abuse types with physical health complaints and associations between the number of child abuse types and physical health complaints. Methods: This population-based telephone survey over two waves included 506 adolescents and young adults exposed to child abuse and 504 non-abused peers aged 16-33 years. We applied linear regression analyses to investigate associations between child abuse types and physical health complaints, unadjusted and mutually adjusted for co-occurring abuse, and to investigate how the number of child abuse types associated with physical health complaints. Results: Participants exposed to child abuse reported significantly more physical health complaints. The child abuse types strongly co-occurred. When adjusting for co-occurring child abuse, only sexual and emotional abuse were significantly associated with physical health complaints. Physical health complaints increased with the higher number of child abuse types experienced. Conclusions: Our findings suggest that exposure to abuse, particularly sexual and emotional, during childhood predicts physical health complaints in adolescence and early adulthood. In a public health perspective, early identification of child abuse may be beneficial in preventing physical health complaints later in life.

The Social Context of Violence: A Study of Repeated Victimization in Adolescents and Young Adults.

Multiple factors may influence the risk of exposure to childhood violence and repeated victimization, although most research has focused on individual rather than contextual factors. Moreover, it is unclear whether family background factors associated with exposure to childhood violence also are associated with revictimization in young adulthood. This article investigates individual and contextual factors associated with childhood abuse and revictimization. Data from a community telephone survey, collected at two different time points (N = 1,011, 16-33 years of age), were used. Logistic regression analysis was applied to analyze family background factors in childhood violence-exposed cases and non-exposed controls. Similar analyses were conducted for the relationship of individual and contextual variables in the revictimized and the non-revictimized groups. The adjusted analyses showed that social problems (≥2 or more social problems: odds ratio [OR] = 2.89, 95% confidence interval [CI] = [1.41, 5.94]) and frequent binge drinking (OR = 1.21, 95% CI = [1.05, 1.40]) were significantly associated with repeated victimization whereas social support decreased the odds (OR = 0.74, 95% CI = [0.55, 0.99]). Family problems and low family cohesion growing up (although measured at Wave 2) were significantly associated with childhood exposure to violence, but not with revictimization. Our findings emphasizes that it is useful to separate factors associated with childhood abuse from factors related to revictimization to identify current ecological aspects that can be addressed to prevent further abuse.

The mediating role of posttraumatic stress reactions in the relationship between child abuse and physical health complaints in adolescence and young adulthood.

Background: Child abuse is associated with physical health problems in adolescence and adulthood, but the mechanisms involved are unclear. A possible mediating effect of posttraumatic stress reactions (PTSR) linking child abuse with later physical health complaints has not been fully investigated. Objective: The current study investigated whether PTSR could be a potential mediator in the relationship between child abuse and physical health complaints in adolescents and young adults. If so, we also investigated whether this was the case for different child abuse types alone or in combination. Method: The study sample comprised 506 adolescents and young adult victims of child abuse and 504 unexposed matched controls aged 16-33 from a community sample. We measured child abuse retrospectively and current PTSR at wave 1 (2013), and current physical health complaints at wave 2 (2014/15). We tested a model of PTSR as a possible mediator between child abuse and physical health complaints and conducted causal mediation analysis to estimate direct and indirect pathways. Each child abuse type was studied in isolation and in combination with other abuse types. Results: PTSR had a notable, significant mediating effect on the relationship between child abuse and physical health complaints in our overall model (average causal mediation effect; ACME = 0.14, p < 0.001), accounting for 85% of the total effect. The mediated pathway was also significant in analyses of the different child abuse types. The mediating effect of PTSR was most prominent in individuals reporting exposure to more than one child abuse type. Conclusions: The current study indicates that PTSR may be an important mediator in the relationship between child abuse and physical health complaints. Health professionals should be aware of the important role that PTSR may have in maintaining or exacerbating physical health problems in child abuse victims. However, a reverse model could not be tested in this study and the results need confirmation in future prospective studies.

Antecedentes: El maltrato infantil se encuentra asociado con problemas de salud física en la adolescencia y en la adultez, pero los mecanismos involucrados no son claros. Un posible efecto mediador de las reacciones de estrés traumático (PTSR en su sigla en inglés) relacionando el maltrato infantil con quejas de salud física posteriores no ha sido investigado suficientemente.Objetivo: El presente estudio investigó si la PTSR podría ser un mediador potencial en la relación entre el maltrato infantil y las quejas de salud física en adolescentes y adultos jóvenes. También investigamos si esto era el caso para diferentes tipos de maltrato infantil de forma individual o en combinación.Método: La muestra del estudio consistió en 506 adolescentes y adultos jóvenes víctimas de maltrato infantil y 504 controles sin exposición al maltrato con edades de 16 a 33 años provenientes de una muestra comunitaria. Medimos el maltrato infantil retrospectivamente, el actual PTSR en la ola 1 (2013), y las quejas actuales de salud física en la ola 2 (2014/2015). Pusimos a prueba un modelo de la PTSR como un posible mediador entre el maltrato infantil y las quejas de salud física y llevamos a cabo un análisis de mediación causal para estimar los efectos directos e indirectos. Cada tipo de maltrato fue estudiado de forma separada y en combinación con otros tipos de abuso.Resultados: La PTSR tuvo un efecto mediador significativo en la relación entre el maltrato infantil y las quejas de salud física en nuestro modelo general (efecto mediador causal promedio; ACME en sus siglas en inglés = 0.14, p <0.001), correspondiendo al 85% del efecto total. La mediación fue también significativa en los análisis de los diferentes tipos de maltrato infantil. El efecto mediador de la PRSR fue más prominente en aquellos individuos que reportaron la exposición a más de un tipo de maltrato infantil.Conclusiones: PTSR podría ser un mediador importante en la relación entre el maltrato infantil y las quejas de salud física. Los profesionales de la salud deberían estar conscientes del rol que la PTSR puede tener en la mantención y la exacerbación de los problemas de salud física en las víctimas de maltrato infantil. Sin embargo, un modelo reverso no pudo ser probado y los resultados necesitan confirmación en futuros estudios prospectivos.

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.

A decennial review of psychotraumatology: what did we learn and where are we going?

On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma. This editorial is part of a special issue/collection celebrating the 10 years anniversary of the journal where we will acknowledge some of our most impactful articles of the past decade (also discussed below and marked with * in the reference list). In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline. These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience. We address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help us to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions 1. Where did we stand in 2010? 2. What did we learn in the past 10 years? 3. What are our knowledge gaps? We conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.

El 6 de diciembre de 2019 comenzamos el décimo año de la European Journal of Psychotraumatogy (EJPT), una revista de acceso abierto completa sobre psicotrauma. Esta editorial es parte de un número especial que celebra el décimo aniversario de la revista y reconoce algunos de nuestros artículos más impactantes de la última década. En esta editorial, los editores presentan una revisión decenal del campo que aborda una gama de temas que son fundamentales tanto para la revista como para la psicotraumatología como disciplina. Estos incluyen desarrollos neurobiológicos (genómica, neuroimagen e investigación neuroendocrina), formas de exposición a traumas e impacto a lo largo de la vida, traumas masivos e intervenciones tempranas, traumas relacionados con el trabajo, traumas en poblaciones de refugiados y las posibles consecuencias de traumas como el trastorno de estrés postraumático (TEPT) o TEPT complejo, pero también resiliencia. Abordamos las innovaciones en tratamientos psicológicos, medicamentos (mejorados) y asistidos por tecnología, mediadores y moderadores como el apoyo social y, finalmente, cómo los nuevos métodos de investigación nos ayudan a obtener información sobre las estructuras de los síntomas o predecir mejor el desarrollo de los síntomas o el éxito del tratamiento. Nuestro objetivo fue responder tres preguntas 1. ¿Dónde nos encontrábamos en 2010? 2. ¿Qué aprendimos en los últimos 10 años? y 3. ¿Cuáles son nuestras brechas de conocimiento? Concluimos con una serie de recomendaciones sobre las principales prioridades para la dirección futura del campo de la psicotraumatología y, en consecuencia, la revista.

Shame predicts revictimization in victims of childhood violence: A prospective study of a general Norwegian population sample.

OBJECTIVE: Victims of childhood violence often experience new victimization in adult life. However, risk factors for such revictimization are poorly understood. In this longitudinal study, we investigated whether violence-related shame and guilt were associated with revictimization. METHOD: Young adults (age = 17-35) exposed to childhood violence (n = 505) were selected from a (Country) population study of 6,589 persons (Wave 1), and reinterviewed by telephone 12-18 months later (Wave 2). Wave 1 measures included shame, guilt, social support, posttraumatic stress, and binge drinking frequency, as well as childhood violence. Logistic regression was used to estimate associations between Wave 1 risk factors and Wave 2 revictimization (physical or sexual violence, or controlling partner behavior). RESULTS: In total, 31.5% (n = 159) had been revictimized during the period between Wave 1 and 2. Of these, 12.9% (n = 65) had experienced sexual assault, 22% (n = 111) had experienced physical assault and 7.1% (n = 36) had experienced controlling behavior from partner. Both shame and guilt were associated with revictimization, and withstood adjustment for other potentially important risk factors. In mutually adjusted models, guilt was no longer significant, leaving shame and binge drinking frequency as the only factors uniquely associated with revictimization. CONCLUSIONS: Violence-prevention aimed at victims of childhood violence should be a goal for practitioners and policymakers. This could be achieved by targeting shame, both on both on the individual level (clinical settings) and the societal level (changing the stigma of violence). (PsycINFO Database Record (c) 2018 APA, all rights reserved).