Childhood trauma exposure is associated with a range of adverse outcomes, including post-traumatic stress disorder (PTSD). Parents are often children’s main source of support following a trauma. However, little is known about the experiences of parents in supporting their child post-trauma and research into the relationship between parenting and childhood PTSD has yielded mixed findings. The five papers in this thesis aimed to investigate the role of parental responses in child adjustment following child trauma exposure. Paper 1 presents a meta-analytic review of the association between parenting and child PTSD symptoms. A small, yet highly significant relationship between parenting and child PTSD was identified, but given the limited number of studies available and the potential influence of methodological factors, only tentative conclusions are made. Nonetheless, the finding that parenting is associated with child PTSD informed the following four papers in this thesis. Paper 2 qualitatively examined parents’ experiences of supporting their children following single-incident trauma and presentation at an Emergency Department. As no child in Paper 2 accessed psychological treatment post-trauma, Paper 3 presents an investigation of parents’ views of providing care for children with clinically significant levels of post-traumatic distress. The trauma-specific aspects of parental support identified in Papers 2 and 3 highlight the need for a validated measure of post-trauma parental responses. Paper 4 describes the development and preliminary evaluation of a measure of parental appraisals and behaviours following trauma exposure. Finally, the majority of studies that examined parenting behaviours in Paper 1 were conducted in a Western, low-risk context; therefore, the aim of Paper 5 was to examine the views of parents of trauma exposed children in the peri-urban settlement of Khayelitsha, South Africa. Overall, the results indicate that parental responses are associated with child PTSD symptoms and highlight the strategies used by parents to promote child recovery.

Various traumatic events such as automobile accidents, structure fires, or terrorist attacks result in traumatic and thermal injury. Fire is a destructive force that can alter or destroy evidence, and thermal alterations have negative effects on forensic and anthropological recovery and analysis. Blunt force trauma is particularly difficult to analyze because of the multiple ways in which this trauma appears on a body and the variety of objects that can impact and fracture a bone or the variety of ways a body can impact a blunt surface. As fire is a common way to cover up a crime and blunt force trauma is used as a means to kill or injure an individual, it is necessary to understand the differences between these two types of fractures that can present together on bone. The present study was performed to determine the amount of survivability of traumatic fracture patterns in remains that have been exposed to a burning event. The sample used for this investigation was composed of twenty limbs (forty long bones) from five full-grown, domestic, female sheep (Ovis aries) obtained from a farm in Connecticut. Thirty specimens were traumatized with the head of an Estwing ball peen hammer and ten were left as controls. After specimens were subjected to blunt force trauma, each was radiographed using Computed Tomography. They were then placed in a small structure, 8' x 8', that was constructed to simulate the conditions of a house fire. Each post-burn bone was analyzed based on a number of characteristics. A trauma score of "1" no trauma, "2" ambiguous, and "3" traumatic fractures were given based on these observations. CT scans were examined after bone samples had been analyzed. Again, each specimen's CT scan was given a trauma score ("1" no trauma, "2" ambiguous, and "3" traumatic fractures). Results from the bone analysis on the 30 traumatized and burned specimens revealed that 15 did not have trauma, 2 were ambiguous (i.e., they may have trauma but traumatic characteristics were not distinct), and 13 presented with distinguishable traumatic injury. Comminuted was the most prominent type of fracture, and the next most common fracture was oblique. The majority of traumatic injury was found on the middle portion of the bone. CT examination showed that 12 specimens had suffered traumatic injury. The two analyses were compared and showed an agreement of 83.3% between the trauma scores. Results show that differentiation of traumatic and thermally induced fractures is possible using various fracture characteristics as well as taphonomic indicators to determine the sequence of events.

Intimate partner violence (IPV) is a public health concern in the United States that puts women at increased risk for negative health and vocational outcomes. Severity and duration of negative outcomes, however, vary widely among trauma survivors, with some women developing more severe, negative outcomes and others developing less severe or fewer negative outcomes, or none at all. The study of cognitive appraisals for trauma, or an individual's assessment of her/his beliefs, feelings, and behaviors after a traumatic event, shows promise for illuminating what, and how, post-trauma outcomes develop for trauma survivors. Few studies have examined cognitive appraisals of trauma in relation to IPV, and none to date have examined them in relation to physical health and vocational outcomes. The purpose of this dissertation study was to use a correlational, descriptive, non-experimental, survey research design to examine whether trauma appraisals mediate the relationships among a broad range of IPV experiences and mental health, physical health, and vocational outcomes for adult women IPV survivors. Participants were a community sample of 158 women who had experienced IPV in adulthood. Participants were recruited from multiple community organizations and completed surveys online or in-person or over-the-phone with the principal investigator. Stepwise linear regressions were used to analyze the mediation models, and linear regressions were performed to examine how specific trauma appraisals predicted physical health and vocational outcomes. Dissertation study findings showed that trauma appraisals significantly and fully mediated the relationship between IPV experiences and mental health outcomes for women, with appraisals of fear, alienation, and anger significantly predicting mental health outcomes. When childhood betrayal trauma was controlled for within this model, however, trauma appraisals only partially mediated the relationship between IPV and trauma-related mental health. A mediation model was not used for physical health and vocational outcomes, but findings revealed that appraisals of self-blame and anger significantly predicted physical health outcomes, and appraisals of anger and shame significantly predicted vocational self-efficacy outcomes. These findings highlight the importance that trauma appraisals play in the development of a broad range of outcomes for IPV survivors. Implications for future research and practice are discussed.

Objectives: A systematic literature review was conducted to investigate whether aging impacts on emotion regulation and whether there are relationships between aging, emotion regulation and psychosocial outcomes. An empirical study used a cross-sectional quantitative design to examine the nature of trauma exposure in a clinical group of older people. A novel model was developed to investigate the relationship between trauma exposure and psychosocial outcomes and to examine whether emotion dysregulation and resilience had a role in this relationship. Method: The search strategy used in the review identified 15 relevant papers which met the inclusion criteria which were assessed for quality and relevant findings extracted. The empirical study recruited 47 participants from psychological therapy services who completed six self-report measures of trauma exposure, resilience, emotion dysregulation, PTSD symptoms, quality of life, anxiety and depression. A bootstrapped corrected procedure was used to test the indirect effects of resilience and emotion regulation. Results: Results of the review indicated that older people used positive reappraisal more than younger people. Examining the relationship between age, emotion regulation and psychosocial outcomes was difficult because of differences in the nature of relationships investigated, the definition and measurement of variables and additional variables examined. Results of the empirical study indicated trauma exposure to be reported by all participants and to be directly related to PTSD symptoms. Further analysis indicated that emotion dysregulation partially mediated this relationship. Trauma exposure was not directly related to anxiety, depression and quality of life but was indirectly related through emotion dysregulation. Resilience was not found to be associated with trauma exposure. Conclusions: The review highlighted the complexity of the relationship between age, emotion regulation and psychosocial outcomes. Results of the empirical study improved understanding about the nature of trauma exposure in a clinical group of older people. It also supports the importance of emotion dysregulation as an intervening variable in the relationship between trauma exposure and psychosocial outcomes. Clinical practice issues and areas for future research were identified.

Polysialic acid (PSA) is a linear homopolymer formed of chains of 2,8-linked sialic acid. Found predominantly attached to the neural cell adhesion molecule, PSA acts to reduce cell-cell adhesion during development. It is also found in some areas of the adult central nervous system (CNS) associated with persistent neuroplasticity. Preliminary data from our laboratory indicated an inverse relationship between PSA expression and the formation of perineuronal nets (PNNs), specialised extracellular matrix structures with a role in limiting plasticity in the adult CNS. The primary aims of this thesis were to investigate this relationship in more detail, using in vitro models of PNN formation and in vivo. Also, to evaluate whether lentiviral vector-mediated PSA expression can enhance locomotor recovery and neuroplasticity in a rodent model of spinal cord injury. PNNs were heterogeneously distributed throughout the grey matter of the rat cervical spinal cord, and increased in numbers down the dorsoventral axis. Induced expression of PSA in the spinal cord of either naïve or injured rats did not alter the number or density of PNNs. Similarly, enzymatic removal of PSA from the surface of cultured embryonic neurons did not affect the formation of the PNNs. In a rodent model of cervical spinal cord injury, induced PSA expression resulted in an improvement in hindlimb, but not forelimb, locomotor function compared to animals injected with control virus. Interestingly, this was not associated with an increased density of serotonin or synaptophysin-labelled boutons in the areas of induced PSA expression. Taken together, the data presented in this thesis suggests that while induced PSA expression may contribute to improved locomotor function in a model of cervical spinal cord injury, this is not due to a reduction in the density or number of PNNs in the spinal cord.

Traumatic brain injury (TBI) is a devastating disease causing disability and death, and currently there are no effective treatments available. Therefore, there is an utmost need to improve our understanding of the pathophysiology of TBI and to identify potential therapies that can provide neuroprotection after injury. The aims of this thesis were to develop an in vivo and in vitro model of TBI, in which to assess the potential neuroprotective effects of an omega-3 polyunsaturated fatty acid (PUFAs), docosahexaenoic acid (DHA). Method The controlled cortical impact (CCI) in vivo model of TBI was optimized and performed in mice. Both a behavioural (Morris water maze (MWM) for cognitive deficits) and histological endpoints (astrogliosis, lesion size and activated microglia) were used to assess severity and neuroprotective effects of DHA. An in vitro model of mechanical TBI was also set up and optimized. This model employed 3D astrocyte cultures obtained from GFP positive rat pups. The CCI impactor from the in vivo studies was used to damage the cultures, and at 24 hours, 5 days and 10 days the astrogliosis and cell number was measured. Results The optimization of the in vivo studies demonstrated that at impaction depth of 2.2 mm produced an injury that was significantly different to the sham injury, in MWM performance and increased astrogliosis. Interestingly, there was an increase in the amount of astrogliosis on the contralateral side of the brain. A second study performed using the 2.2 mm injury parameters was performed, where an injection of DHA was administered via the tail vein 30 min after injury. The DHA-treated group did not demonstrate any neuroprotection compared to the injury-only group. However, there was an increase in the amount of astrogliosis in the contralateral hippocampus of the DHA-treat group. In the fat-1 studies it was shown that older male mice performed worse in the MWM, that the fat-1 gene did not confer neuroprotection but did lead to increased astrogliosis. The in vitro study revealed that astrocytes in the lesioned gels demonstrated an increase in astrogliosis, there was also an increase in the number of cell in the cultures following the lesion. Conclusion In conclusion, the in vivo model of CCI replicated components of the human TBI including a behavioural deficit and pathophysiological changes. Omega-3 PUFAs failed to demonstrate functional neuroprotection in this model, but histologically, promoted an increase in reactive astrogliosis. The development of a novel in vitro model of focal injury in a 3D culture system, that elicits reactive astrogliosis, could be used to support further studies of the astrocytic responses to mechanical injury.

The boundaries of victimhood have received increasing attention in criminology, particularly considering the recent proliferation in 'trauma talk' or 'trauma creep'. Noting the connections between victims and trauma, there is now increasing recognition of the impact of victimisation, not only on individuals, but upon families, communities and cultures with its effects extending across time, place and person. Following David Garland's assertion of the 'return of the victim' 15 years ago, the interests of victims have moved to centre stage of the criminal justice system with the experiences of some taken to be representative of others. While this has encouraged an appreciation of the extent of suffering in victimisation, it is easy to understand how we might 'lose sight of the individual victim'. This research presents a qualitative study of the phenomenon of bereaved family activism. Findings presented in this thesis are based upon 15 in-depth interviews and participant observations with Mothers Against Violence: a Manchester-based charity that emerged in response to an intense period of gun violence and ensuing community outcry in the 1990s. The aim of this thesis was to explore how victims have confronted and mobilised their experiences of lethal violence to promote acknowledgment and prompt recognition. By refocusing on the individual and foregrounding the victim, this thesis asked how those involved understand, make sense of and give value to their experience in light of their role in Mothers Against Violence. Data collected was analysed through thematic analysis, remembering the embedded nature of such stories in cultural, historical and biographical contexts, communities and the research exchange. Findings are presented as a way of following the stories of individuals to the moment of collective action. The primary contributions of this thesis can be summarised under the following headings; firstly, applications of 'trauma' in victimology; secondly, understanding victim movements such as Mothers Against Violence as spaces for emotional, social and practical learning; thirdly, conceptualising victimisation as one moment in a series of 'turning points'; and fourthly, the role of stories in prompting recognition, encouraging identification and assembling communities.

Aim The aims of this project were to (i) evaluate whether the trauma care system established in Hong Kong has improved the survival rate among trauma patients; (ii) evaluate the effectiveness of trauma teams and their coordinators, primary trauma diversion, and performance improvement programmes, and assess the influence of gender and age on patient outcomes; and (iii) compare clinical outcomes before and after the establishment of a trauma system in Hong Kong and measure them against those achieved in an established regional trauma system in Australia. / Background Injury is a major public health problem that creates an enormous social burden. Although Hong Kong has tried to build up a trauma care system according to the criteria employed by the American College of Surgeons Committee on Trauma, there are a number of differences between the two. The effectiveness of the key components of trauma care processes and their clinical outcomes are unclear, and the final outcome in terms of survival rate is unknown. / Conclusion Proficient trauma teams, primary trauma diversion, and clinical guidelines are key components of the trauma system that contribute to improved outcomes. / Methods Retrospective analysis of data collected prospectively from the trauma registries in Hong Kong and Australia. The Trauma and Injury Severity Score (TRISS), the W score, the Z score, the M score, and Ws statistics are employed to evaluate the mortality rate. / Results The W score for Hong Kong improved significantly from - 4.79 in 1997 to 0.51 in 2009 after the trauma system was established (P<0.05). The improving trend observed in the Ws score (- 4.86 +/- SE 1.24 Vs 1.06 +/- SE 0.74) over the same period indicates that the survival rate increased from 1997 to 2009 (P < 0.01). The time taken to deliver the patient from the scene to definitive care was reduced by 97 minutes (P < 0.001) using a primary trauma diversion strategy. Proficient trauma teams are associated with reduced mortality in patients with a moderately poor probability of survival (p = 0.007) and trauma nurse coordinators play an essential role in conducting trauma audits and maintaining trauma registries. The introduction of guidelines and staff education could result in significant improvements to the trauma care process. Advancing age is associated with an increased mortality rate, whereas gender is not. Injury prevention programmes in Hong Kong are inadequate. / Yeung, Hiu Hung. / Advisers: Timothy H. Rainer; Wai Sang Poon. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 282-328). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Given past findings that have linked trauma and lack of personal control to greater suicidal risk in adults, the present study examined how trauma presence and personal control are uniquely involved in predicting suicidal risk in a sample of 469 college students. Regression analyses indicated that both trauma presence and personal control were significant predictors of suicidal risk, as was their interaction. The present findings suggest a need to consider both trauma presence and low personal control in assessing for suicidal risk in college students.

No description available.