Worldwide there are several million war refugees, many of whom stay in the host countries for years. However, little is known about their long-term mental health. The current thesis examined the prevalence, course, and predictors of mental disorders and subjective quality of life (SQOL) in 854 war refugees from former Yugoslavia who had resettled in Germany, Italy and the United Kingdom 9.3 years previously. 215 interviewees with Posttraumatic Stress Disorder (PTSD) at baseline were reinterviewed one-year later. The participants were additionally assessed for use of social and health care interventions during the one-year follow-up period. Prevalence rates of mental disorders in the war refugees varied substantially across countries, with between 42.1% and 67.8% of refugees having a mental disorder. Warrelated factors explained most variance in rates of PTSD whereas post-migration factors explained most variance in mood, anxiety and substance use disorder rates. Risk factors for each disorder were consistent across host countries. At the end of the one-year follow-up period, a third of the sample no longer met the criteria for PTSD. Recovery was positively associated with employment and negatively associated with severity of war exposure, baseline PTSD symptom severity and use of mental health services. Despite the high rates of mental disorders, refugees felt reasonably satisfied with SQOL. Low SQOL was associated with poor post-migration living conditions and mental illness, but not with war trauma. In conclusion, mental disorders appeared to be highly prevalent in war refugees many years after resettlement. This increased risk may result from exposure not only to wartime trauma but also to post-migration socio-economic adversity. Policies promoting community integration and employment may be more effective than existing psychiatric and psychological interventions in improving mental health and quality of life in war refugees.

Background: People who experience physical trauma face a range of psychosocial outcomes. These may be overlooked by busy clinicians. While some risk factors are understood, our understanding of the psychological effects of violent injury remains limited. Furthermore, there has been little research on the effect of facial trauma. Although changes to appearance can be distressing, the effects of these have not been studied in traumatic injury patients. Aims: To establish the prevalence and persistence of psychological distress and appearance concerns following injury. To compare the psychological outcomes in i) violent and accidental injury and ii) facial and other injury, and iii) to identify explanatory risk factors for psychological distress. Methods: Participants were adults admitted to the Royal London Hospital with traumatic injuries. Two hundred and twenty five participants (225) completed questionnaires in hospital. Follow up was at three months (N = 100) and six months (N = 112). Standardised measures were used to assess symptoms of post-traumatic stress (PTSS) (Acute Stress Disorder Scale, PTSD Checklist), depression and anxiety (Hospital Anxiety and Depression Scale), and appearance concern (Derriford Appearance Scale). Explanatory measures were collected, including history of mental health. Data were analysed in logistic and linear regressions, using multilevel models. Results: PTSS and depressive symptoms affected 28% and 33% respectively at baseline. At six months, 27% and 31% respectively reported these symptoms. After adjusting for demographic factors, violent injury was associated with increased PTSS (OR 6.44, CI 1.75 to 23.75), depressive symptoms (OR 4.78, CI 1.41 to 16.18) and appearance concern (2.78, CI 0.09 to 5.47). A history of mental health problems increased distress. Conclusions: There were high levels of psychological distress in this sample. Violent injury was associated with a complex interaction of social and psychological factors. People vulnerable to distress may benefit from psychological support. Hospital admission provides a unique opportunity to engage them in interventions.

abstract: Traditionally when the topic of secondary traumatic stress (STS) is discussed, it is often in regard to medical professionals and first responders. People who have STS or compassion fatigue, as it has been renamed, have been defined as people who are dealing with traumatic stress and/or emotional burdens via their “patients.” This study, conducted at a major university in the southwest, measured educators’ perceptions of the extent of their compassion fatigue using the Professional Quality of Life Scale (ProQOL) before and after a voluntary online support training during last four weeks of the semester. Educators who were full time scored better than the educators who worked part time on the three components of the Compassion Fatigue Scale. Results from this study suggest that additional training surrounding compassion fatigue may be needed in the future. / Dissertation/Thesis / Doctoral Dissertation Educational Leadership and Policy Studies 2019

For some people, exposure to trauma results in the development of psychological maladjustment in the form of posttraumatic stress disorder. Veterans returning from combat zones tend to meet criteria for PTSD at rates significantly higher than what is observed in the general population. Mental health professionals, particularly those working with U.S. Department of Veterans Affairs, play an important role in the recovery of these Veterans. Research suggests that facilitating trauma therapy and/or being exposed second-hand to traumatic material can have negative consequences for the therapist. The current study focuses on the impact of trauma therapy on therapists who work with combat veterans through the VA. The study includes seven psychologists in the state of Iowa employed by VA. Findings support previous research by highlighting the impact therapy has on the clinician providing it. The impact of facilitating trauma therapy or working with traumatized populations is not wholly positive or negative, but often both. The current study suggests that what clinicians do in response to hearing trauma narratives that is of key importance.

Researchers have agreed that most rape victims vii experience stress-related symptoms similar to post-traumatic stress disorder. There have also been numerous studies that have tried to predict the severity of those stress-related symptoms, but the literature is inconclusive. Lack of perceived control is consistently mentioned in the rape research literature as being present in rape victims, but no study has empirically examined the relationship between perceived control and a rape victim's stress-related symptoms. The purpose of this study was to empirically examine the relationship between perceived control and stress-related symptoms in rape victims. This was accomplished by comparing a group of 33 subjects who reported being victims of rape with a group of 50 subjects who did not report being victims of rape. Mean stress-related symptom scores were correlated with perceived control scores; also, factors, including group membership and the time elapsed since a rape, were regressed onto the subjects' stress-related symptom scores. The correlations between stress-related symptoms and perceived control in the rape victim group were statistically significant, but the relationship was not present for the nonvictim group. Also, nonsignificant results were obtained for joint effects between perceived control and group membership, along with perceived control and time since a victim had been raped. The results suggest that low perceived control is a good predictor for elevated stress-related symptoms. Further research may clarify the relationship between perceived control and stress-related symptoms in rape victims.

Current theories of PTSD propose that impaired retrieval of trauma memories may impede processing of these memories and subsequent trauma recovery. This thesis investigated memory retrieval processes in trauma survivors with and without symptoms of posttraumatic stress, and in non-traumatised individuals exposed to a highly arousing event. Study 1 examined deliberate avoidance of unwanted memories in recent trauma survivors. The results indicated that attempts to forget were associated with poorer recall of forgotten information, but the size of this effect did not depend on the presence or absence of Acute Stress Disorder (ASD). Study 2 investigated automatic retrieval inhibition in trauma survivors with or without Posttraumatic Stress Disorder (PTSD). The results suggested that repeated retrieval of trauma-related information by individuals with PTSD can cause inhibition of related, but unpractised information. Studies 3 and 4 examined the relationship between the vantage point of trauma memories, avoidance and posttraumatic stress symptomatology. The findings indicated that recalling a traumatic event from an observer perspective is associated with post trauma avoidance. They also showed that an observer vantage point in the initial few weeks after trauma is associated with poorer long-term post trauma adjustment. Studies 5, 6 and 7 were analogue studies which analysed the impact of heightened arousal on memory retrieval in novice skydivers. The results suggested that elevated arousal can interfere with retrieval of information related to the arousal-inducing event. Study 7 also indicated that autobiographical memory for the event may be impaired. Finally, Study 8 examined the qualities of trauma memories that were accessed via different modes of retrieval. The results provided evidence that intrusive memories were experienced as more realistic and with more intense affect than memories for the same event that were deliberately retrieved. Together, the findings of this program of research extend current theories of PTSD by highlighting the mechanisms through which retrieval of trauma memories may be impaired. The results suggest that the quality of trauma memories is affected by avoidance processes, elevated arousal and level of conscious control the individual exerts over retrieval.

Comorbidity between substance use disorders and post traumatic stress disorder (PTSD) is common. Despite evidence to suggest that people with heroin dependence are at particular risk of PTSD, there is a dearth of research focussing on the interrelationship between these disorders. The present thesis aims to identify the prevalence of PTSD among people with heroin dependence, the correlates of this comorbidity, and its impact on treatment outcomes, the utilisation of treatment services, and treatment costs. Study 1 examines the epidemiology of PTSD and heroin dependence among 10,641 Australian adults who participated in the National Survey of Mental Health and Wellbeing. The prevalence of PTSD was highest among people with heroin or other opioid use disorders compared with any other drug class (33.2%). Comorbid PTSD was associated with poorer occupational functioning, and poorer physical and mental health. While general population studies provide crucial population estimates they do not allow for a detailed examination of the relationship between highly disabling but low prevalence disorders. The remaining studies were undertaken using a sample of 615 treatment seeking and non-treatment seeking dependent heroin users. Study 2 examines the prevalence and correlates of this comorbidity. PTSD was common (lifetime 41%; current 31%) and was associated with a more severe clinical profile. Studies 3 and 4 were based on follow-up data on this large cohort. Study 3 is the first study to examine the impact of PTSD on 2 year treatment outcomes for heroin dependence. Across the 2 year period, those with current PTSD at baseline performed more poorly in terms of their occupational functioning, physical and mental health. Study 4 found that this did not equate to the greater use of treatment services or an increased cost to the health care system among those with PTSD. It is concluded that PTSD and heroin dependence are highly comorbid conditions, and that this comorbidity is associated with poorer functioning and poorer treatment outcomes. Individuals entering treatment for heroin dependence should be assessed for PTSD so that they may receive appropriate treatment and referral. Further research is also needed to determine how best to treat this comorbidity.

This thesis explores the ways in which a number of individuals survived their experiences of severe and perpetrated trauma. I theorise the participant’s survival adaptations in terms of hope which I positioned as being an active relational process. A case study method was used to collect data from intersubjective-psychoanalytically informed therapy sessions, from three participants who each received 12, 60 minute therapy sessions. I utilised a hermeneutic ontology from the work of Gadamer, who contended that the development of understanding and meanings results from an active intersubjective process. This ontology and design enabled the research to capture and interpret aspects of the dynamic development of personal meanings about the experiences of surviving traumas. Central to my notions of hope is the concept of intersubjectivity which is based upon the work of Winnicott, Fairbairn, Ferenczi, Meares, Stern and Bromberg. Using their ideas about relatedness and identification I argue that survivors expressed hopeful intentions and actions through their conscious and unconscious adaptive strategies. I explore the peritraumatic hopeful adaptations the survivors made such as identifying with the aggressor, the splitting of self, and the overt valuing of relatedness. I further argue that hopeful intentions can be seen in such actions as the survivor remembering their trauma rather than re-enacting it, in their efforts in narrating their trauma histories despite their fears, shame and difficulties in finding a listener. The thesis concludes by exploring some of the ramifications for society of hope, trauma and witnessing: foremost being the need to recognise the vulnerable in our communities and the difficulties we face in meeting the challenges of knowing their stories. / Doctor of Philosophy (PhD)

Environmental factors such as stress and hormones acting during embryogenesis, as well as early life experiences such as parental care have been clearly demonstrated in animal models to shape the individual's phenotypic gene expression, brain development, and behavioural repertoires ( Meaney, 2005 ). However, human studies have not assessed both prenatal mental health and the quality of postnatal parental care with the same sample of mothers. The current study sought to fill this gap by investigating the impact of women's experiences of trauma and posttraumatic stress disorder ( PTSD ) before pregnancy on the mother's ante - and postnatal mental health problems, parenting, and children developmental outcomes. The study reported here is the second phase of a longitudinal study that commenced in 2002. In phase one community based middle class women in their third trimester of pregnancy were recruited and followed during the early postnatal period ( Linke, 2002 ; Lowe 2003 ). The current study assessed forty four mother - infant dyads at three time points during the second postnatal year. The dyads were divided into one of three groups ( control, trauma control and PTSD ) depending on the mother's trauma experience and whether she met the lifetime diagnosis for PTSD. The assessments included the measure of the mother and infant's basal cortisol, the mother's lifetime and ongoing mental health problems, the quality of the mother - infant relationship, and the development of the infant's general cognitive abilities, emerging language skills and emotional and behavioural self regulation. The current study found infant morning cortisol levels measured at 13 months of age were significantly predicted by maternal trauma experience and the subsequent PTSD symptoms of hyperarousal supporting the research of Yehuda and colleagues ( 2005 ) and implicating an epigenetic transmission of environmental experience from the mother to her offspring possibly via in utero programming of the HPA axis. Overall, maternal trauma was found to impact on both child language and self regulation development. Unexpectedly, the trauma control or resilient mothers were found to be least engaged with their infants, and their infants had the lowest language development. However, poorer language development was not mediated through dyadic emotional availability or maternal sensitivity. Maternal PTSD was found to be related to poorer child emotional and behavioural outcomes which were mediated through maternal mental health problems. Overall, the findings of the current study suggest that maternal trauma experience is associated with a biologically based mechanism occurring in both the mother and the infant which is protective for both the mother and the child's emotional health, but comes at a cost of slower infant language development. Furthermore, this mechanism appears to have broken down in the presence of maternal PTSD for both the mother and the infant with subsequent associations with greater maternal mental health problems, more problematic infant emotional and behavioural problems, and disorganised attachment. These findings have clinical implications, particularly for early intervention programs. The results need to be interpreted with caution due to the small sample size. However, the findings have broad implications in relation to resilience to trauma and the development of psychopathology and warrant repetition. / Thesis (Ph.D.)--School of Medicine, 2007.

Current theories of PTSD propose that impaired retrieval of trauma memories may impede processing of these memories and subsequent trauma recovery. This thesis investigated memory retrieval processes in trauma survivors with and without symptoms of posttraumatic stress, and in non-traumatised individuals exposed to a highly arousing event. Study 1 examined deliberate avoidance of unwanted memories in recent trauma survivors. The results indicated that attempts to forget were associated with poorer recall of forgotten information, but the size of this effect did not depend on the presence or absence of Acute Stress Disorder (ASD). Study 2 investigated automatic retrieval inhibition in trauma survivors with or without Posttraumatic Stress Disorder (PTSD). The results suggested that repeated retrieval of trauma-related information by individuals with PTSD can cause inhibition of related, but unpractised information. Studies 3 and 4 examined the relationship between the vantage point of trauma memories, avoidance and posttraumatic stress symptomatology. The findings indicated that recalling a traumatic event from an observer perspective is associated with post trauma avoidance. They also showed that an observer vantage point in the initial few weeks after trauma is associated with poorer long-term post trauma adjustment. Studies 5, 6 and 7 were analogue studies which analysed the impact of heightened arousal on memory retrieval in novice skydivers. The results suggested that elevated arousal can interfere with retrieval of information related to the arousal-inducing event. Study 7 also indicated that autobiographical memory for the event may be impaired. Finally, Study 8 examined the qualities of trauma memories that were accessed via different modes of retrieval. The results provided evidence that intrusive memories were experienced as more realistic and with more intense affect than memories for the same event that were deliberately retrieved. Together, the findings of this program of research extend current theories of PTSD by highlighting the mechanisms through which retrieval of trauma memories may be impaired. The results suggest that the quality of trauma memories is affected by avoidance processes, elevated arousal and level of conscious control the individual exerts over retrieval.