Health outcomes following a traumatic event are an important aspect of recovery from any type of trauma. Further, distress and psychopathology, specifically Posttraumatic Stress Disorder (PTSD), have been shown to have a significant impact on physical health recovery post-trauma. The current study utilized a sample of 56 (48 women, 8 men) residential fire survivors to examine the potential mediating effect of PTSD and PTSD symptom subclusters. Participants were interviewed four months after a residential fire and were assessed on levels of exposure to the fire (Fire Questionnaire & Resource Loss Scale), PTSD symptomology (Anxiety Disorder Interview Schedule), and somatic health complaints (Brief Symptom Inventory). Consistent with previous findings, PTSD was found to mediate the relationship between exposure to a traumatic event and reporting of health symptoms. Further, the increased arousal subcluster was found to mediate the aforementioned relationship; the avoidance symptom subcluster was found to partially mediate the same relationship. Implications of results of the current project are discussed with regard to the impact of trauma on survivorsâ health, along with recommendations for further research. / Master of Science

Bakgrund: Psykisk ohälsa är ett folkhälsoproblem världen över och i Sverige har det framkommitatt patienter med psykisk ohälsa har sämre förutsättningar för att få ett adekvat omhändertagande vid somatisk sjukdom,och att allmänsjuksköterskor gör skillnad i omvårdnaden av patienter med psykisk ohälsa. Tidigare forskning har visat att allmänsjuksköterskor har haft en ytlig förståelse för psykisk ohälsa och haft svårigheteratt bedöma vad som är somatiskt och vad som är psykiskt. Syfte: Syftet med studien var att beskriva vilka faktorer som allmänsjuksköterskor upplever påverkar deras bemötande av patienter med psykisk ohälsa som söker somatisk sjukvård. Metod: En allmän litteraturstudie. Resultat: Faktorer som påverkade allmänsjuksköterskors bemötande av patienter med psykisk ohälsa identifierades i fyra teman: Rädslor, tid, psykisk ohälsa i somatisk kontext samt kompetens. Slutsats: Det krävs mer utbildning för allmänsjuksköterskor i områden som berör bemötandet och omvårdnad gentemot patienter med psykisk ohälsa, och det krävs mer utbildning för att reducera sjuksköterskors rädslor genom att öka förståelsen för patienternas beteende. Klinisk betydelse: Genom att bli medveten om kunskapsbristen så kan det leda till ett mer reflekterande förhållningssätt över hur man bemöter och uppfattar patienter med psykisk ohälsa vilket kan möjliggöra att utöka vidare kunskap. / Background: Mental health is a public health problem worldwide and in Sweden there is awareness that health care contributes to poorer care of patients with mental illness, which for instance is verified by general nurses who have made difference in the care of patients with mental illness. Overall, previous research has shown that nurses have had a superficial understanding of mental illness which has led to difficulties to estimate what is somatic and what is mental. Patients with mental disorders are a vulnerable group which been exposed by stigmatization and studies have shown that it reflects the nurse and patient relationship in the performance of the nursing care. Aim:The aim of this study was to describe the factors that general nurses experience affects their treatment of patients with mental illness who are searching for somatic health care. Method: A literature review. Results: Factors affecting general nurse’s treatment of patients with mental illness identified four themes: Fears, time, mental illness in a somatic context, and competence. Conclusion: It requires more training for general nurses in areas related to treatment and care towards patients with mental illness, and more training is required to increase nurse ́s understanding of patients behavior to reduce nurse’s fears. Clinical significance: By becoming aware of the lack of knowledge it can lead to a more reflective approach over how to respond and perceive patients with mental illness, which could enable to strengthen further knowledge.

Existing research demonstrates that sexual trauma victims experience increased risk of adverse health outcomes including cardiovascular disorders, increased risk of chronic pain, and somatic health complaints. Similarly, sexual trauma is correlated with increased risk of adverse psychological effects including PTSD, depression, and anxiety. Perceived stigmatization as a result of sexual trauma has been hypothesized to be a mechanism through which sexual trauma affects health. Sexual trauma stigma (STS) has been found to mediate the relationship between sexual trauma and psychological distress. The experience of stigmatization has also been linked to somatization and is associated with increased anxiety. Similarly, among a sample of participants with a trauma history, adversity and resultant discrimination predicted somatic health complaints with post-traumatic stress symptoms (PTSS) partially mediating this relationship. However, the experience of STS specifically and its effect on somatic health complaints and anxiety has not yet been examined. As anxiety is associated with somatic symptoms, and is often comorbid with PTSS, it may be a mechanism through which STS effects somatic health complaints. Therefore, the current study seeks to examine the relationship between STS and somatic health complaints as well as the potential mediating effect of anxiety. It was hypothesized that STS would predict somatic health complaints, and that anxiety would mediate this relationship. An international sample of 528 women with a sexual trauma history was recruited via social media (Reddit) and mediation results were found using the “psych” package for RMarkdown (Version 5.2.2) with bootstrapping (5000 samples). Overall, the model was significant R2 = .19, (F(2,1230) = 148.53, p < .01). Regression analyses revealed that sexual trauma stigma was a significant predictor of both anxiety (b = .21, SE = .01, p < .01) and somatic health symptoms (b = .13, SE =.01, p < .01), and that anxiety also predicted somatic symptoms (b = .39, SE = .03, p < .01). Anxiety was found to significantly mediate the relationship between sexual trauma and somatic health symptoms, b = .08, SE = .01, 95% CI [0.06, 0 .11]. Current findings confirm the relationship between sexual trauma stigma and somatic health complaints and identify anxiety as an important mediator of this relationship. Providers should be aware that experiences of sexual victimization are related to feelings of stigmatization and may increase anxiety, impacting somatic health complaints. These findings indicate future clinical implications for trauma informed care within medical settings to better serve women who may experience stigma related to sexual trauma and highlights anxiety as a key target for interventions to reduce somatic symptoms.

Bakgrund  Att leva med en psykiatrisk diagnos omgärdas med både stigmatisering och myter, det leder dessutom till ökad samsjuklighet, ökat somatiskt vårdbehov och förkortad livstid. Sjukvården ska behandla alla människor på samma villkor och syftet med denna studie var att belysa erfarenheter av somatisk sjukvård för patienter som har en psykisk sjukdom.  Metod  En litteraturöversikt baserad på tio kvalitativa artiklar.  Resultat  Personer med psykiatriska diagnoser har erfarenheter från den somatiska sjukvården som att den inte är tillgänglig för alla och att det kan vara svårt att få rätt hjälp. Engagemanget från vårdgivaren upplevs som bristande och diagnostisk överskuggning sker vid flertalet besök. Personernas erfarenheter präglas av att fysisk och psykisk hälsa påverkar varandra, när personerna inte har fått korrekt somatisk vård har deras psykiska hälsa försämrats. Resultatet delades in i fem kategorier; Vårdens tillgänglighet och engagemang, Diagnostisk överskuggning, Fysisk och psykisk hälsa påverkar varandra, Stigmatisering och Disempowerment.  Slutsats  Denna studie visar på att personer med psykiatriska diagnoser har negativa erfarenheter från somatisk sjukvård vilket också lett till att de inte vill uppsöka sjukvård samma utsträckning. Det finns behov av ytterligare forskning inom området och en förändring i attityder gällande personer med psykiatriska diagnoser från vårdpersonalen. / Background  To live with a psyciatric diagnosis involves living with stigmatisation and myths, it also leads to increased comorbidity, increased somatic need for care and shortened life. The healthcare is supposed to treat all people at the same terms and the purpose of this study was to highlight experiences of somatic healthcare for patients who have a mental illness.  Method  A litterature study with ten qualitative studies.  Results  People with mental illnesses have experiences from somatic healthcare such that it is not available to everyone and that it can be difficult to get the right help, the commitment from the care provider is perceived as lacking and diagnostic overshadowing occurs during many visits. Peoples experiences are characterized by physical and mental health affecting each other, when the person have not received proper somatic care, their mental health has deteriorated. The result was divided into five categories; Care availability and commitment, Diagnostic overshadowing, Physical and mental health affect each other, Stigmatization and Disempowerment  Conclusion  This study shows that people with mental illnesses have negative experiences from somatic health care, which has also led to them not wanting to seek care to the same extent. There is a need for more research in the area and a change in attitude regarding people with mental illnesses from the healthcare professionals.

Posttraumatic Stress Disorder (PTSD) has been demonstrated as the primary pathway through which morbidity and mortality is achieved post-trauma. However, less is known about protective factors to PTSD, depression, and self-reported health outcomes of adults following a traumatic event. Through examination of residential fire survivors, the current project evaluated the predictive validity of protective factors of PTSD as they relate to PTSD, depression, and somatic health outcomes. Additionally, the project collapsed the three outcomes variables into a unified health construct and evaluated protective factors ability to predict health. It was hypothesized the peritraumatic emotionality, social support, and resource loss would predict PTSD, depression, and somatic health. Additionally, it was predicted that peritraumatic emotionality, social support, and resource loss would predict a unified construct of health. Participants were assessed via self-report and semi-structured interviews approximately four months post-fire. Results of the current project demonstrated strong associations amongst peritraumatic emotionality and resource loss for many of the outcome variables. However, social support was not found to be a predictor of any of the outcomes variables. When evaluating the unified health construct, resource loss was found to significant predict a resilient group of trauma survivors four months post-fire. The present study suggests lower peritraumatic emotionality and lower sustained resource loss are significant protective factors for resiliency from trauma. / Ph. D.