Background: Recent Canadian Armed Forces operations involved multiple deployments and exposure to traumatic events that are associated with post-traumatic stress disorder, depression and substance abuse. Despite efforts to facilitate mental health care, some soldiers do not get the help they need. Objective: To understand soldiers’ experiences and explore barriers and facilitators they encountered accessing mental health care. Results: Qualitative descriptive interviews with 11 Canadian Armed Forces members revealed six major categories that provide insights into their experiences accessing mental health care. Participants’ revealed significant barriers to care including fear of damaging their career or being released, stigma beliefs and actions from peers and leaders, and physical and organizational barriers to care. Social support from family, military co-workers, and unit leaders facilitated care. Conclusions: Notwithstanding efforts to facilitate access to mental health care, some soldiers still perceive significant barriers to care.

Considerable research has demonstrated a link between thoughts of revenge, or vengeful rumination, and the development of posttraumatic stress disorder (PTSD) symptoms, particularly in situations involving interpersonal trauma. Personality factors have been related to both vengefulness and PTSD. No study to date has simultaneously examined the unique contributions of vengefulness and personality factors in the development of PTSD symptoms. Therefore, the present study addressed these questions in an inpatient sample by comparing contributions of the Big Five personality factors and vengeful rumination to the development of PTSD symptoms through correlation, hierarchical regression, and omnibus regression analyses. Results showed that Neuroticism predicted PTSD symptoms better than other personality factors, that Neuroticism and Agreeableness predicted vengeful rumination in opposite directions, and that personality factors and vengeful rumination each added unique variance in the prediction of PTSD symptoms. Future directions and implications are discussed.

The purpose of this study was to develop a manualized therapy group for wives or significant others of veterans with posttraumatic stress disorder and to evaluate its effectiveness in reducing wives' psychological symptoms. A second aim of the study was to determine if women's involvement in the wives group resulted in decreases in their husbands' PTSD symptoms. Women recruited for the study were administered pre-test measures during a screening session. They then participated in a 9-session manualized therapy group designed by the researcher that included psychoeducational, process, and support components. Examples of group topics included psychoeducation regarding PTSD, assertiveness and communication, intimacy, self-care, and stress management. After completing the group sessions, participants were asked to complete post-test measures. Other factors explored in this study included marital satisfaction, perceived social support, general satisfaction with the group, and demographic variables. Results indicated that wives who participated in the group treatment exhibited significant decreases in secondary stress symptoms and increases in marital satisfaction from pre-test to post-test. The majority of participants also reported high levels of satisfaction with the group process. Therefore, it appears that the group protocol presented in this study could be a useful tool in the treatment of wives of veterans with PTSD. The results of this study have potential implications regarding the clinical treatment of families of veterans with PTSD and the development of future programs within the VA system.

Abstract BACKGROUND: The PTSD Checklist-civilian (PCL-C) is one of the most commonly used self-report measures of PTSD symptoms, however, little is known about its validity when used in pregnancy. This study aims to evaluate the reliability and validity of the PCL-C as a screen for detecting PTSD symptoms among pregnant women. METHODS: A total of 3372 pregnant women who attended their first prenatal care visit in Lima, Peru participated in the study. We assessed the reliability of the PCL-C items using Cronbach's alpha. Criterion validity and performance characteristics of PCL-C were assessed against an independent, blinded Clinician-Administered PTSD Scale (CAPS) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. We tested construct validity using exploratory and confirmatory factor analytic approaches. RESULTS: The reliability of the PCL-C was excellent (Cronbach's alpha =0.90). ROC analysis showed that a cut-off score of 26 offered optimal discriminatory power, with a sensitivity of 0.86 (95% CI: 0.78-0.92) and a specificity of 0.63 (95% CI: 0.62-0.65). The area under the ROC curve was 0.75 (95% CI: 0.71-0.78). A three-factor solution was extracted using exploratory factor analysis and was further complemented with three other models using confirmatory factor analysis (CFA). In a CFA, a three-factor model based on DSM-IV symptom structure had reasonable fit statistics with comparative fit index of 0.86 and root mean square error of approximation of 0.09. CONCLUSION: The Spanish-language version of the PCL-C may be used as a screening tool for pregnant women. The PCL-C has good reliability, criterion validity and factorial validity. The optimal cut-off score obtained by maximizing the sensitivity and specificity should be considered cautiously; women who screened positive may require further investigation to confirm PTSD diagnosis. / Revisión por pares

Abstract Background There is limited research and guidelines regarding physiotherapy as a treatment approach      for post-traumatic stress (PTS). Refugee experience of physiotherapy interventions is hoped                      to contribute to awareness of the subject and to give insight into this developing field of the         profession. Purpose The purpose of the study was to investigate and describe refugees experience of post-             traumatic stress physiotherapy. The study was interested in both refugee experience of          treatment itself and of possible effects. Design and Method Qualitative explorative design. The study was based on five semi-structured interviews. A        qualitative, content analysis was used to process the data. Results          The analysis showed that the refugees faced many physical and psychological barriers to         treatment, especially relating to pain and somatisation, however they were able to                    experience increased bodily comfort during treatment itself. The relationship to         physiotherapist, the psychological impact of the treatment environment and other social      factors were also described as important to experience. Physiotherapy was described as positively affecting patient outcomes both in physical and mental health, despite certain uncontrollable/unmanageable symptoms making this difficult. The refugees were able to achieve generalisation of physiotherapy into their day-to-                     day life enabling them to self-manage to some extent and feel liberated from PTS symptoms. Conclusion The study agrees with the available literature on the effectiveness of treating refugee              patients suffering from post-traumatic stress with physiotherapy, not just to improve            physical health outcomes but even to give holistic improvements.  Keywords Post-traumatic stress, refugee, physiotherapy, experiences / Abstrakt Bakgrund Det finns begränsad forskning och riktlinjer gällande fysioterapeutisk behandling mot post-traumatisk stress (PTS). Flyktingars upplevelse av fysioterapeutisk behandling förväntas sprida kunskap och bidra till insikt i denna del av det fysioterapeutiska området som fortfarande är under utveckling. Syfte Syftet av studien var att utforska och beskriva flyktingars upplevelse av posttraumatisk stress-fysioterapi. Studiens intresse var av flyktingars upplevelse och effekt av den fysioterapeutiska behandlingen. Design och Metod Studien är av kvalitativ utforskande design baserat på användandet av 5 semi-strukturerade intervjuer. En kvalitativ innehållsanalys användes för att bearbeta informationen. Resultat Analysen visade att flyktingar möter många fysiska och psykiska hinder i behandlingen, mest gällande smärta och somatisering men att de kunde uppleva en viss grad av bekvämlighet under behandlingen ändå. Förhållandet till fysioterapeuten, den psykologiska effekten av behandlingsmiljön och andra sociala faktorer var också viktiga. Fysioterapi beskrevs ge positiv påverkan i resultatet av patienternas fysiska och mentala hälsa efter behandling trots utmaning från icke-hanterbara symptom. Flyktingarna kunde uppnå generalisering av deras fysioterapi till det dagliga livet som gjorde att de kunde hantera situationen själva till en viss grad och känna frihet från sina PTS symptom. Konklusion Studiens resultat går i samma linje som den tillgängliga litteraturen på effekten av att behandla flyktingar som lider av posttraumatisk stress med fysioterapi, inte bara för att öka den fysiska hälsan utan även för att ge mer vidgående holistiska förbättringar och livskvalitet. Nyckelord Post-traumatic stress, refugee, physiotherapy, experiences

The level of crime in South Africa as reflected by crime statistics affects a high number of adolescents. Trauma and stress associated with interpersonal violence can adversely affect the neurobiology of the individual, since social, emotional and cognitive influences interact in multifaceted ways with neurobiological systems to affect every-day adaptive functioning. This study was embarked upon to determine the difference in the expression of personality between adolescents exposed to community related interpersonal violence and those not exposed to such violence. The 183 research participants were selected from a group of 335 grade 12 learners from a single secondary school in a middle class community. The participants were placed into two sample groups by means of purposive sampling as follows: Sample 1 consisted of all the research participants that reported exposure to community related interpersonal violence during the past 5 years on the self-reporting questionnaire (n = 93). The research participants that did not report exposure to such violence formed Sample 2 (n = 90). Reflecting on the adolescent’s emotional, adaptive functioning and referring to high levels of anxiety and feelings of worthlessness, certain factors of the 16PF questionnaire were predicted to show a statistical significant difference after exposure to community related interpersonal violence after a period of 3 to 5 years. To assess the differences in personality profiles of adolescents exposed to community related interpersonal violence and those not exposed to violence, a MANOVA was used in analysing 16PF results. There were statistically significant differences between the two groups on Factor G (rule consciousness), Factor I (emotional sensitivity) and Factor Q4 (anxiety). This indicated that adolescents exposed to incidents of community related interpersonal violence are inclined to experience more tension, are emotional volatile, depressed and anxious. They tend to be more sensitive to environmental stressors and are likely to give up easily. The group exposed to interpersonal violence (Sample 1) experienced higher levels of PTSD as assessed with the PSD Questionnaire than the group that was not exposed to interpersonal violence (sample 2). The personality profiles of three groups (Sample 1 with high PTSD, Sample 1 with low PTSD and Sample 2) were compared by means of a MANOVA to test whether adolescents who experience high levels of PTSD express their personality different from others. The results identify differences in the expression of personality between adolescents of Sample 1 experiencing higher levels of PTSD and the adolescents who did not experience community related interpersonal violence (sample 2) on Factors G- (Selfindulgent and disregards obligations to people), I + ( Perception might be emotionally influenced) and Q4 + (Elevated levels of anxiety). The coping style (positive or negative coping) of adolescents exposed to community related interpersonal violence was assessed using the Kidcope. This was done to examine the possible influence of coping on the development of posttraumatic stress and differences in the expression of personality. There were no correlations between positive and negative coping and the level of PTSD symptoms and the 16PF. The research could therefore not identify coping as a medicating variable in the development of PTSD and differences in the expression of personality. However, research is required to evaluate coping closer to the time of the actual event. The results of this research are a clear indication that the experience of community-related violence has serious implications for the well-being and development of the personality of adolescents. Violence-exposed adolescents may experience symptoms characteristic of PTSD, including significant difficulty regulating one’s emotions and behaviour impacting on their social, cognitive, physiological and emotional functioning. The original target group for this study was the middle class income population and suburb with relatively good security. The sample was drawn from a typical middleclass environment and adolescents from communities with less protection may present different results if sampled for similar research. / Thesis (PhD)--University of Pretoria, 2014. / tm2015 / Psychology / PhD / Unrestricted

Understanding the neuronal basis of learning and memory is a fundamental problem in neuroscience. A leading theory, the origins of which date back to the beginning of the twentieth century, is that the neural basis for memory resides in engrams (also called memory traces), ensembles of cells that are activated during learning and reactivated during memory retrieval. Recent genetic tools have allowed researchers to visualize and manipulate memory traces in small brain regions; however, the ultimate goal is to analyze memory traces across the entire brain in order to better understand how memories are stored in neural networks and how multiple memories may coexist. In order to do so, methods and technologies need to be developed that allow labeling of engram cells throughout the brain, visualization of these cells, and automated quantification of cells in an anatomically precise manner. The first of these challenges has been addressed through the development over the past several years of different mouse models that permit the labeling of active cells throughout the brain at multiple time points. One of the most powerful models, the ArcCreERT2 mouse line, uses drug-induced genetic recombination to indelibly label cells throughout the brain in an activity-dependent manner. In this thesis, I present our work utilizing this model to solve the second and third challenges: imaging of brain-wide memory traces and automated quantification of labeled cells, as well as the application of these novel methods to understanding the engram network changes following fear extinction. Intact tissue clearing and imaging is a new and rapidly growing area of focus that holds great promise for enabling the brain-wide visualization of memory traces. We utilized the leading protocols for whole-brain clearing and applied them to the ArcCreERT2 mice. We found that CLARITY and passive clarity technique (PACT) greatly distorted the tissue, and immunolabeling-enabled three-dimensional imaging of solvent-cleared organs (iDISCO) quenched enhanced yellow fluorescent protein (eYFP) fluorescence and hindered immunolabeling. Alternative clearing solutions, such as tert-Butanol, circumvented these harmful effects, but still did not permit whole-brain immunolabeling. Clear unobstructed brain imaging cocktails and computational analysis (CUBIC) and CUBIC with Reagent 1A produced improved antibody penetration and preserved eYFP fluorescence, but also did not allow for whole-brain memory trace visualization. We developed CUBIC with Reagent-1A*, a modified CUBIC protocol that resulted in eYFP fluorescence preservation and immunolabeling of the immediate early gene (IEG) Arc in deep brain areas; however, optimized memory trace labeling still required tissue slicing into mm-thick tissue sections. Nonetheless, our data show that CUBIC with Reagent-1A* is the ideal method for reproducible clearing and immunolabeling for the visualization of memory traces in mm-thick tissue sections from ArcCreERT2 brains. Recent developments in brain-wide engram tagging strategies, primarily through the use of transgenic mouse models such as the ArcCreERT2 line, and whole brain imaging strategies, such as CLARITY, CUBIC, and iDISCO, have created the circumstances to, for the first time, be able to visualize throughout the brain neuronal activity that is directly linked to behavior. However, as noted above, quantifying and analyzing these brain-wide memory traces presents its own challenge, and widely applicable, readily accessible solutions to this problem have thus far been limited. Although a handful of freely available programs and suites do exist, such as CellProfiler and ClearMap, these are generally tailored to specific approaches, and in particular, no currently available solution exists for quantifying multi-labeled engram cells imaged in three dimensions along the coronal plane, a relatively common scenario that is sure to become even more prominent as greater adoption of the underlying technologies progresses. Using ImageJ and R, we developed an image analysis pipeline to solve precisely this problem. Our strategy allows for the segmentation of both the encoding and retrieval populations, including identification of the reactivated cells, and registration of segmented cells to an anatomical atlas in order to analyze cell activity in a region- and layer-specific manner. Post-traumatic stress disorder (PTSD) can develop following a traumatic event and results in heightened, inappropriate fear and anxiety. Approximately 8% of the US population suffers from PTSD, the main treatment for which is repeated exposure to triggering stimuli under controlled conditions. A better understanding of the neural circuits modified during this process would help advance therapeutic treatment for PTSD. We sought to determine the brain-wide neuronal activity changes underlying fear extinction, the best laboratory model of exposure therapy, by using the ArcCreERT2 x eYFP mice and our newly developed brain-wide segmentation and registration pipeline. ArcCreERT2 x eYFP mice were administered a 4-shock contextual fear conditioning (CFC) paradigm followed by either a 10-day extinction protocol or re-exposure to the aversive context without extinction. Following the final exposure session, mice were euthanized, and active cells were quantified throughout the brain using the pipeline. We found that fear learning leads to increased functional connectivity of amygdalar and hypothalamic regions, and extinction leads to a decentralization of the fear memory network and disengages the thalamus and striatal amygdala. Additionally, coordinated reactivation of the basomedial amygdala and secondary somatosensory cortex with frontal association regions are differentially modulated following extinction, and we identified the temporal association area and medial habenula as novel brain regions involved in modulating freezing behavior. In summary, in this thesis, we have developed a novel engram analysis pipeline and shown its potential for quantifying brain-wide memory traces. This is the first study to analyze brain-wide functional connectivity following fear learning and extinction of a recent fear memory, as well as the first study to analyze fear memory trace reactivation patterns across the brain and relate all three measures to behavioral output. This work both greatly enhances our understanding of the neural underpinnings of fear extinction and provides a toolset for readily exploring the neural underpinnings of other behaviors and types of associative memory.

We investigated the effects of the Gulf War on two groups of Kuwaiti children and youth. Those children experiencing war-related traumatic events and those who did not experience or witness a war-related traumatic event participated. Data were obtained from the mother of each child. Each mother completed a structured Interview which Included Child Traumatic Reaction Index, developed according to the DSM-IV (1994) criteria for Post Traumatic Stress Disorder (PTSD). The data indicated a significant interaction effect observed by mothers according to the child's gender, experience of war traumatic events, and PTSD. The results are discussed In terms of the diagnostic criteria for PTSD, the necessity of early Identification, and the difficulty associated with the diagnosing PTSD in children.

Recent studies of children and adolescents who have experienced a residential, industrial, or wild fire have suggested a causal link between fire disaster and PTSD related psychological distress. Not everyone, however, is equally affected by the stress of experiencing such an event, and the role of coping in this process may be an important mediating factor. Additionally, several studies have found that girls and African Americans report more distress following disasters than do boys and Caucasians. The current study sought to investigate the roles of exposure/loss, coping efficacy, and coping strategy in mediating psychological distress in adolescents after a disaster. The current study included a representative sample of 206 9th graders from a Central Florida High School affected by severe wildfires who were assessed via self-report measures 3- and 10- months after the fires, in a latent variable path analysis to assess the fit of a model including exposure/loss, coping efficacy, coping strategy, and PTSD, depression, and anxiety scores. Moreover, acculturation level and SES were included along with gender and ethnicity in testing for the moderating role of sociodemographics, as little research has delved into the important proximal factors affecting reported racial differences, as ethnicity is better conceptualized as a distal variable that works through a variety of proximal variables to affect outcomes. Results indicated that although the assessment of the global fit of the latent variable path model revealed it to be a poor fit to the data, component fit of the model pointed to a possible mediating role of coping efficacy between exposure/loss and psychological distress, as well as coping efficacy being associated negatively with avoidant coping strategies. Likewise, post hoc regression analyses indicated an important role for exposure/loss, coping efficacy, and coping strategy as they related to PTSD symptomatology in adolescents at both Time 1 and Time 2. Finally, although relationships between the proposed variables and PTSD did not interact with gender, acculturation, SES, or ethnicity, there was a significant interaction between acculturation and ethnicity signifying that for African American youth, high acculturation levels were predictive of less PTSD symptomatology. / Ph. D.

Background The postpartum period represents a major transition in the lives of many women, a time when women are at increased risk for the emergence of psychopathology including depression and PTSD. The current study aimed to better understand the unique contributions of clinically significant postpartum depression, PTSD, and comorbid PTSD/depression on mother–infant bonding and observed maternal parenting behaviors (i.e., behavioral sensitivity, negative affect, positive affect) at 6 months postpartum. Methods Mothers (n=164; oversampled for history of childhood maltreatment given parent study's focus on perinatal mental health in women with trauma histories) and infants participated in 6-month home visit during which dyads engaged in interactional tasks varying in level of difficulties. Mothers also reported on their childhood abuse histories, current depression/PTSD symptoms, and bonding with the infant using standardized and validated instruments. Results Mothers with clinically significant depression had the most parenting impairment (self-report and observed). Mothers with clinically significant PTSD alone (due to interpersonal trauma that occurred predominately in childhood) showed similar interactive behaviors to those who were healthy controls or trauma-exposed but resilient (i.e., no postpartum psychopathology). Childhood maltreatment in the absence of postpartum psychopathology did not infer parenting risk. Limitations Findings are limited by (1) small cell sizes per clinical group, limiting power, (2) sample size and sample demographics prohibited examination of third variables that might also impact parenting (e.g., income, education), (3) self-report of symptoms rather than use of psychiatric interviews. Conclusions Findings show that in the context of child abuse history and/or current PTSD, clinically significant maternal depression was the most salient factor during infancy that was associated with parenting impairment at this level of analysis.