Public and scholarly interest in the intergenerational effects of maternal adverse childhood experiences (ACEs) on children’s internalizing or externalizing behaviors continues to grow. ACEs are defined as traumatic events that occur prior to the age of eighteen, such as emotional, physical, or sexual abuse, neglect, and household dysfunction. The existing research has helped explicate the potential intergenerational consequences of these events on a child’s behavior, which provides useful information on who is the most at-risk. A systematic review was conducted to determine these effects. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases CIANHL, PubMed, PsycINFO, PsycARTICLES, Sociological Abstracts, and Web of Science were used to search for articles measuring maternal ACEs and child internalizing or externalizing behaviors. Other inclusion criteria were that the journal articles presented results from empirical studies, and the articles were published between 1995 and January 2022. The initial search yielded 1601 possible articles. Two independent reviewers reviewed all abstracts to determine whether the study met inclusion criteria; 22 articles were retained for data extraction. Across studies, children were assessed across a range of ages from 6 weeks to 16-17 years old. Participants were primarily recruited from medical clinics, followed by schools, although there was diversity of recruitment site, with some studies recruiting from Head Start programs, domestic violence shelters, WIC clinics, CPS reports, and an online platform. The majority of studies included used retrospective reporting of the original 10-item ACEs questionnaire to assess maternal ACEs, and the Child Behaviors Checklist was commonly used to assess child internalizing and externalizing behaviors. The outcomes most commonly predicted by maternal ACEs included child externalizing behaviors, depression, behavioral and social-emotional problems, anxiety, and negative temperament characteristics. Other outcomes less commonly assessed, but found to be associated with maternal ACEs, were lower academic performance, developmental delays, attention problems, trauma symptoms, and likelihood of psychiatrics diagnosis overall. Inconsistent results were found for internalizing behaviors, as some studies found these to be significantly associated with maternal ACEs, while this relationship was not significant in other studies. Mediators and moderators explored in the studies were also extracted and will be presented as well. Results of this systematic review highlight what is currently known in this field, and identify opportunities for future research. For example, examining internalizing behaviors as a unitary construct may be less helpful than examining specific internalizing behaviors individually, given the conflicting findings in this area.

Fostering a Trauma Informed Mindset in the Criminal Justice System Lauren Ledford, Mary Jo Oliver M.S., Meredith Jordan, Chloe Salyer, Adam Walker, Andrea D. Clements Ph.D. The presence of early childhood adversity and trauma is disproportionately high in individuals involved with the criminal justice system compared to the non-criminally involved population. Childhood adversity and trauma is consistently linked to many adverse lifelong outcomes such as increased mortality, increased risk of mental illness, and increased risk of substance use disorder. In order to respond to this increased risk, empathy and community-wide interventions have emerged as effective means of responding and resisting re-traumatization. Community and empathy-based training of law enforcement officials may assist in understanding trauma and combatting its effects as they are often some of the first people to come in contact with individuals experiencing the effects of childhood adversity and trauma. This study sought to evaluate the effectiveness of Trauma-Informed Care (TIC) training for police officers in their ability to have knowledge of, believe to be relevant, understand, feel confident implementing, and apply TIC principles. We hypothesized knowledge, relevance, understanding, implementation confidence, and application of TIC would all increase from pre-assessment to post-assessment. As part of an initiative to increase TIC awareness and implementation, 64 police officers participated in a one-day training that began with a pre-survey and ended with a post-survey. Both surveys contained measures concerning TIC knowledge, relevance, understanding, implementation confidence, and application. The post survey also included an additional measure regarding training quality satisfaction. The sample consisted primarily of White (N = 44), middle-aged males (M = 42.27, SD = 8.588). There was a significant difference between TIC knowledge t(56) = -4.593, p<.001, d = 1.096, TIC relevance t(56) = -2.488, p = .016, d = .912, TIC understanding t(56) = -8.611, p <.001, d = 2.932, and implementation confidence t(56)= -5.942, p <.001, d = 1.326 from the pre to post assessment. However, there was not a significant difference between TIC application t(56) = -1.826, p = .073, d = .585 from pre to post assessment. The consistently significant increase in TIC scores indicate that a TIC training is an effective means of improving officer perception of trauma and willingness to implement TIC practices.

Background: Unhelmeted motorcyclists injured in states with lax or poorly enforced helmet safety laws are frequently seen in rural trauma centers. A trauma surgeon started a comprehensive injury prevention and research fund with outreach to a three-state trauma center catchment area promoting injury prevention at area high schools and local communities. We hypothesized that unhelmeted riders would have more severe head injuries and fatalities than helmeted riders. Methods: A trauma registry review of 708 injured motorcycle riders over an 11-year period examined demographics, helmet use, and clinical outcomes of helmeted and unhelmeted riders. A full-time injury prevention coordinator collaborating with law enforcement provided electronic and mechanical simulations with discussions regarding helmet use, alcohol avoidance, and responsible motorcycle riding for area high school students. This program coincided with the second half of our 11-year study. Multiple regression analysis evaluated predictors for head injury and death. Results: Unhelmeted motorcyclists suffered worse head injuries, (OR 8.8, CI 1.6-2.4, P <.001), more severe overall injury (OR 10, CI 12.7-18.6, P <.001), and higher mortality (OR 2.7, CI.02-.15, P <.001). Local motorcycle-related trauma center admissions and deaths have stabilized in recent years while statewide motorcycle crashes have increased (P <.05). Discussion: Unhelmeted motorcyclists suffer worse head injuries and mortality rates. Physician-led outreach efforts for injury prevention may be effective. Trauma surgeons have ongoing opportunities to promote responsible motorcycle riding for schools and local communities.

This study sought to examine pathways of coping and healing for women experiencing homelessness and poverty in the Boston area. Data was collected through participant observations of shelter dynamics, semi-structured interviews with shelter clients (referred to as “guests”), card-sorting activities in which participants were asked to rank self-generated cards for support groups, coping mechanisms, and internal selves across a range of situations, and a free association task, which involved having participants submit whatever self-generated cards of the above groups they associated with the terms “health,” “safety,” “shame,” and “pride,” respectively. Results were subsequently organized into three analytical chapters representative of the three levels of physiological response to threat. The first level of analysis looks at social engagement in the form of receiving and giving care. The second level examines expressions of rage and how these contribute into cycles of isolation, violence, and suffering. The third level further explores these dynamics within the realm of grief and erasure. The final chapter of this thesis then discusses the implications of these areas, as well as some suggestions for how to improve or potentially intervene in the perpetuation of these cycles, with a focus on how to emphasize healing while decreasing the need for coping.

Bakgrund:   Jobbet som sjuksköterska innebär att man kan tvingas hamna i situationer som upplevs som obehagliga och traumatiska. En traumatisk upplevelse definieras som en händelse som på något sätt är svårhanterlig eller sitter kvar hos en person en längre tid. Personer som utsätts för trauma kan utveckla PTSD, ett tillstånd som kan ge både fysiska och psykiska problem. Syfte: Att beskriva hur sjuksköterskor hanterar upplevda traumatiska händelser. Metod: En kvalitativ litteraturstudie har utförts. Med hjälp av databasen Cinahl har 10 vetenskapliga artiklar granskats och utgör resultatet i studien. Analysmetoden som användes är inspirerad av metasyntes och presenteras i Fribergs bok från 2017.   Resultat:  Fyra huvudområden identifierades; professionalitet, socialt stöd, kollegialt stöd och personliga hanteringsstrategier. Professionalitet visar att det skapas en distans gentemot traumatiska händelser och genom socialt och kollegialt stöd kan sjuksköterskor hantera psykologiska motgångar efter ett trauma. Ett flertal personliga hanteringsstrategier förekommer.  Slutsats:  Genom olika strategier för att hantera trauma bidrar sjuksköterskan till att orka med sitt arbetsliv men även tiden utanför arbetet. Det ger en hållbarhet i arbetet och ser till att sjuksköterskan kan ge god och säker vård åt sina patienter.

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In youth hockey the act of bodychecking is used to separate the opponent from possession of the puck by contacting the body. In one form or another bodychecking has been an integral part of hockey, especially competitive hockey. Bodychecking is associated with a high risk for concussion symptoms with a number of studies reporting a significant decrease in concussion symptom presentation when bodychecking is removed from the game (Black et al., 2016). To decrease the incidence of concussion symptom presentation and maintain body checking in the game, some leagues have introduced modified body contact rules. This study compared the brain trauma profiles, characterized by frequency and magnitude, of players playing with modified body contact rules to a standard bodychecking hockey league. U15 AAA adhered to standard bodychecking, while M15 minor only allowed shoulder-to-shoulder contact while keeping sticks on the ice and travelling in the same direction along the boards. 16 U15 AAA and 16 M15 minor hockey games were analyzed documenting head impacts, and head impact conditions that were reconstructed to examine the differences by comparing frequency and magnitudes of head impact events. There were 76 and 101 impacts in AAA and M15 minor, respectively. Most common events in AAA were head-to-glass, shoulder, and other; and in M15 minor were head-to-shoulder, head, and other. Magnitudes were grouped into very low, low, medium, high, and very high. The only magnitude levels that were significantly different when comparing total head impacts were more very low magnitude head impacts in M15 minor. Most common frequencies of magnitude levels for events in AAA were low glass, and in M15 minor were very low head, and low shoulder events. Changing the body contact rules increased the frequency of very low magnitude events and did not change the frequency of individual events between the medium and very high magnitude events. The low magnitude displayed a shift from head-to-glass to shoulder-to-head events when body contact rules were modified. These findings suggest that modifying body contact rules can result in differences in the frequencies and magnitudes of head impacts in U15 ice hockey. Changing body contact rules resulted in changes of most common events, though the frequency of magnitudes of brain trauma did not decrease with modified contact. It is important to understand the risks associated with the frequencies of events and magnitudes in both divisions.

Major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) are chronic, debilitating illnesses. Impairments in cognitive processes such as social cognition, episodic simulation, and neuropsychological performance have been documented separately in both disorders. Despite our increasing knowledge of these impairments, the potential underlying transdiagnostic mechanisms remain relatively unexplored. This thesis examines correlates of these processes in persons with a primary diagnosis of MDD with a history of trauma exposure, and in persons with PTSD. The first study examined the association between the social cognitive domain of empathy and parental bonding in women with PTSD associated with childhood abuse. Participants with PTSD reported altered levels of cognitive and affective empathy, compared to controls. Paternal care during childhood was the only predictor of cognitive empathy (i.e., perspective taking). The second study investigated the specificity of episodic simulation of future positive, negative, and neutral events in relation to parental bonding and neuropsychological functioning among participants with MDD. Optimal parental bonding and higher scores on measures of neuropsychological functioning were associated with increased specificity of episodic simulation. In the third study, we examined the relation between dissociative symptoms and neuropsychological functioning in participants with MDD. Patients with MDD report significantly higher levels of dissociation as compared to controls, and more severe dissociation was related to poorer neuropsychological performance among this patient group. Lastly, using independent component analysis of resting-state fMRI data, the fourth study examined the association between intrinsic connectivity networks and neuropsychological performance among participants with MDD. Connectivity within the default mode, salience, and central executive networks was associated with neuropsychological and clinical (i.e., depression, dissociation, PTSD) variables. Overall, this thesis demonstrates that variables such as parental attachment, dissociation, and intrinsic connectivity networks may underlie some of the alterations in cognitive processes seen in MDD and trauma-related disorders. / Dissertation / Doctor of Philosophy (PhD) / Major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) negatively affect quality of life and day-to-day functioning. These populations show difficulties in domains related to cognitive processing, such as empathy, imagining future events, and neuropsychological functioning (e.g., memory and attention). This thesis focuses on examining variables that may be related to these difficulties. In particular, we study developmental variables, such as parental bonding, clinical symptoms, such as dissociation, and neuroimaging data. Our findings suggest that these variables are all related to impairments in different areas of cognitive processing. By understanding what may be contributing to these cognitive difficulties, we may be able to design treatment strategies that target the underlying causes of these difficulties.

<p> Trauma is a devastating consequence that affects the human identity resulting in the shattering of basic trust in oneself, others, and God. Often people suffering the effects of trauma turn to the Christian community for answers and assistance. Through understanding how trauma affects a person the Christian community is better equipped to walk along side those who are in the recovery process. Compassion creates a safe place for an individual to reveal the depths of emotional pain. The attribute of resilience enables the traumatized individual to continue moving through the recovery process. Six narratives were examined using constructive narrative theology as the methodology. From weaving these narratives together it became apparent that the Christian community can best aid a traumatized person by listening to their story, entering into their lament, drawing out their metaphorical and symbolic language, lifting them up in prayer, and leaving them in God's hands.</p> / Thesis / Master of Arts (MA)

Past research demonstrates that participants who label themselves as ‘victims' experience worse trauma-related outcomes than those who label themselves as ‘survivors.' Self-labeling in trauma research is typically measured using a dichotomous measure where participants choose either victim or survivor, but this construct may be better conceived as more continuous. The current study assessed self-labeling as a possible continuous construct and explored its predictive validity. To capture self-labeling as a continuous construct, we created and utilized a new scale, the Trauma Self-Labeling Measure. Two hundred eleven participants completed a battery of questionnaires to measure self-labeling and four trauma-related outcomes: posttraumatic stress symptoms (PTSS), depression, anxiety, and resilience. When tested on the continuous trauma self-labeling measure, an overwhelming number of participants chose in-between victim and survivor (78.9%) which suggests self-labeling is better assessed using a continuous measure than dichotomous. However, correlation analyses revealed that the continuous self-labeling measure was not significantly correlated to the four trauma-related outcomes, whereas the dichotomous self-labeling, continuous victim, and continuous survivor measures were. When conducting post-hoc analyses, we found an unexpected positive correlation between the continuous victim and survivor self-labeling measures. This unexpected positive correlation suggests that self-labeling is not a singular construct, as previously assumed, but rather is composed of separate victim and survivor constructs. In conclusion, the current study provides the first empirical evidence to support the idea that self-labeling is more continuous than dichotomous and composed of two separate constructs of victim and survivor.