BACKGROUND AND AIMS: Globally, chronic low back pain (CLBP) affects 70-80% of adults at some point in their lives and current treatments are widely unsuccessful in relieving pain. Understanding the underlying neurophysiological (e.g., descending pain inhibition) and biobehavioral (e.g., stress) processes contributing to chronic pain in patients with CLBP is needed for the development of novel treatments. Previous studies have shown that acute stress can impact pain sensitivity and that childhood trauma may predispose a person to CLBP, but the mechanisms underlying this impact are unknown. Conditioned Pain Modulation (CPM) is a psychophysical paradigm used in research to assess descending pain modulatory pathways, which are thought to be impaired in patients with CLBP as well as in those with childhood trauma. The overlap of conditions has not been explored. The current study explored the impact of childhood trauma on the CPM response within a sample of patients with CLBP being treated at a tertiary pain clinic. CLBP patients exposed to an acute stress paradigm were expected to shower higher pain sensitivity, with acute stress significantly interacting with a history of childhood trauma as a factor leading to the higher pain sensitivity. METHODS: 46 Participants with CLBP (n=46, mean age=49 years, 55.3% female) recruited from a pain treatment service completed a Quantitative Sensory Testing (QST) and CPM before and after an acute psychological stressor. Participants were randomized to a control (n=25) or an acute-stress (n=21) condition. The acute-stress condition included the Stroop Color Word Task (SCWT) and a mental arithmetic task prior to completing the QST protocol a second time. The control participants did not undergo any additional stressors and completed the QST protocol a second time after a 20-minute break. Participants’ CPM response was measured by the average change in pressure pain threshold (PPT) from baseline to the conditioning stimulus (non-dominant hand in ice-water bath). A “Good CPM response” was defined as a CPM effect above 100, indicating that the pain threshold increased when exposed to the conditioning stimulus. To examine the impact of childhood trauma on pain sensitivity, participants completed a Childhood Traumatic Events Scale (CTES) to assess the presence and severity of six types of trauma (death, parental upheaval, sexual, violence, illness or injury, other upheaval) during childhood. The CTES was scored as a continuous variable by calculating the sum the trauma severity for all six trauma types. RESULTS: A large majority of the sample (94% of participants) showed an increase in pain threshold during hand immersion in ice water, which was contrary to our hypothesis based on prior research done on other chronic pain conditions and CLBP. Participants exposed to an acute stressor had an impaired CPM effect compared to those that were not exposed to an acute stressor, however there was no difference between groups (p=0.277). A history of childhood traumatic events did not correlate significantly with an impaired baseline CPM or a change in CPM effect when exposed to an acute stressor. CONCLUSION: The current study used novel QST modalities, including CPM, to analyze the interaction between acute and chronic stress on pain sensitivity. Ultimately, this study found that exposure to an acute stressor had a negative effect on CPM, indicating that when under experimental stress participants were more sensitive to pain compared to when they were not under stress, although the findings were not statistically significant. These findings should be further investigated to expand the understanding of the neurophysiological mechanisms underlying CLBP and to potentially provide novel treatment modalities for patients with CLBP.

Ambulanssjuksköterskor exponeras regelbundet för traumatiska händelser i sitt arbete, vilket utgör en risk för psykisk ohälsa i olika former. Trots kännedom om riskerna och vikten av stöd består brister i det befintliga stödsystemet. Bristerna påverkar inte bara sjuksköterskornas välbefinnande och arbetsprestation, utan även patientsäkerheten. Syftet med examensarbetet var att beskriva ambulanssjuksköterskors upplevelser av stöd efter traumatiska händelser för att öka kunskapen om stödets betydelse efter traumatiska händelser. Examensarbetet har genomförts som en kvalitativ semistrukturerad intervjustudie med induktiv ansats. Datainsamlingen och analysprocessen genererade tre kategorier; Organisatoriska brister, organisatoriska tillgångar och betydande faktorer utanför organisationens stödstrukturer följt av åtta subkategorier som genererade en struktur. Resultatet påvisar organisatoriska brister, brister i befintliga handlingsplaner och brist på tid till bearbetning. Samtidigt framkom organisatoriska tillgångar, såsom värdet av stödjande samtal och en stödjande chef. Betydande faktorer utanför organisationen stödstrukturer beskrevs i form av kollegialt stöd och egenansvar. Informanterna betonade vikten av proaktivt och långsiktigt stöd. Examensarbetet understryker vikten av ett strukturerat och anpassat stödsystem för ambulanssjuksköterskor efter traumatiska händelser. Förbättringar krävs för att säkerställa deras psykiska hälsa och förmågan att leverera högkvalitativ vård. / Ambulance nurses are regularly exposed to traumatic events in their work which poses a risk for various forms of mental illness. Despite awareness of the risks and the importance of support, weaknesses in the existing support system persist. These weaknesses affect not only the well-being and work performance of the nurses but also patient safety. The purpose of this thesis was to describe ambulance nurses’ experiences of support following traumatic events to increase the knowledge about the significance of support after such events. The thesis was conducted as a qualitative semi-structured interview study with an inductive approach. Data collection and analysis generated three categories: organizational deficiencies, organizational assets and meaningful factors outside the organizational support structures, followed by eight subcategories that formed a structure. The results show organizational deficiencies, a lack of structured action plan and lack of time for processing. Meanwhile, organizational assets such as the value of supportive counselling and supportive manager. Meaningful factors outside the organizational support structures were described in the form of collegial support and personal responsibility. The interviewed ambulance nurses emphasized the importance of proactive and long-term support. The thesis highlights the importance of a structured and tailored support system for ambulance nurses after traumatic events. Improvements are required to ensure their mental health and ability to deliver high quality care.

Previous research indicates that those with a history of abuse have an increased risk to experience subsequent traumatic events. This study utilized a convenience sample of undergraduate students to examine the reaction of those with a history of abuse to subsequent traumatic experiences. In addition, the study assessed the level of posttraumatic growth an individual experiences following childhood abuse. The level of posttraumatic growth was examined to determine if the growth allowed for participants to better handle successive traumas. Those with a history of abuse experienced higher levels of symptomology following a successive traumatic event. Results did not support the hypothesis that among those with a history of abuse, lower levels of posttraumatic growth would predict higher levels of symptoms following a later trauma. Implications and limitations of the study, as well as directions for future research are discussed.

The negative impact of war on child mental health has been repeatedly documented. Still, the majority of children exposed to ethnic and political violence show no signs of clinical disorder. In Western countries of exile, these findings have prompted a variety of attempts to evaluate refugee children, in the hope of identifying and offering support to those children “at risk”. This study critically examines one such attempt. The aims are fourfold: 1. to describe the range and pattern of child trauma-stress exposure and mental health reactions as captured on clinician semi-structured interview; 2. to critically compare clinician assessment with independent parent, child and teacher reports; 3. to identify factors of potential risk or protective import for child mental health; 4. to draw clinical implications: from whom and by what means can children at risk be reasonably identified? The target of our study was the entire population of Bosnian-Serbian-Croatian speaking child refugee families assigned to Umeå and surrounding municipalities during 1994-95. Fifty families, containing 90 children aged one month to 20 years, were included in the study. Assessment occurred in two phases. First, a semi-structured interview was conducted that inquired broadly as to the child’s family background, trauma-stress exposure, emotional-behavioral problems, patterns of family functioning, and future hopes. Second, standardized self-report questionnaires were administered, separately to parent and child, to provide alternative appraisal of the child’s war exposure, mental health symptoms, coping strategies, and social network. Teacher evaluation of child cognitive-social functioning as well as emotional-behavioral problems was also obtained. Clinician semi-structured interview revealed the child’s pre-war period as preponderantly good, and provided richly detailed narratives of child exposure during war and resettlement that clustered into a limited number of type-stories. Independent parent assessment captured the same broad strokes of child war exposure; but both approaches – fixed questionnaire and semi-structured interview – showed specific areas of blindness. Teenage self-report offered a disparate but equally rich account of war exposure, while that of primary school child was significantly less detailed. Nearly half of the study children (48%) were identified on clinician interview with one or more mental health problem “demanding further attention”. Depressiveness was the single most prevalent symptom (31%), followed by posttraumatic reactions (23%) and anxiety-regressiveness (15%). Independent symptom appraisal by parent and primary school child was largely concordant with that of clinician, while teenagers made similar assessment as to who was in distress, but defined the nature of that distress differently. Teacher report stood apart, identifying fewer inward emotional problems and asserting the cognitive-social competence of the vast majority of study children. Trauma-stress exposure during both war and resettlement presented as an unequivocal risk to mental health, but accounted for only part of outcome variance. Additional factors of strong import related broadly to “living in the present”. Parent impairment of daily routines, child dissatisfaction with school and an ongoing quarrelsome relationship presented as risk factors. Protection was associated with parent maintenance of a warm family climate and of concrete physical-emotional caring, child social ties to physically present others, including teacher; and above all, a family sense of hope for the future. Results support the general robustness of our semi-structured approach. Exploring the child’s present well-being in narrative relation to past and future, our assessment captured and gave meaning to the complexity of child exposure and behavior. At the same time, independent parent and child appraisals provided an additional richness to the retelling and evaluation of child experience. Particularly the apartness of teacher report underscores the need to incorporate an outside-world vantage point in the process of risk assessment.

Background: A recent epidemiological analysis on premenstrual dysphoric disorder (PMDD) in the community revealed increased rates of DSM-IV posttraumatic stress disorder (PTSD) among women suffering from PMDD. Aims: To explore whether this association is artifactual or might have important pathogenic implications. Methods: Data come from a prospective, longitudinal community survey of an original sample of N¼1488 women aged 14–24, who were followed-up over a period of 40 to 52 months. Diagnostic assessments are based on the Composite International Diagnostic Interview (CIDI) using the 12-month PMDD diagnostic module. Data were analyzed using logistic regressions (odds ratios) and a case-by-case review. Results: The age adjusted odds ratio between PTSD and threshold PMDD was 11.7 (3.0–46.2) at baseline. 10 women with full PTSD and at least subthreshold PMDD were identified at follow-up. Most reported an experience of abuse in childhood before the onset of PMDD. Some had experienced a life-threatening experience caused by physical attacks, or had witnessed traumatic events experienced by others. 3 women reported more than one traumatic event. Conclusions: A case-by-case review and logistic regression analyses suggest that women with traumatic events and PTSD have an increased risk for secondary PMDD. These observations call for more in-depth analyses in future research.

Policininkai, kaip specifinė profesinė grupė, tarnyboje susiduria su trauminiais įvykiais, darbe patirtą stresą dažniausiai įveikia neigiamomis strategijomis. Šio tyrimo tikslas – nustatyti policininkų patirtų traumų padarinių ir veiksnių, susijusių su traumine patirtimi, ypatumus. Tyrimo uždaviniai buvo įvertinti subjektyvų pareigūnų trauminį patyrimą, potrauminio streso simptomatikos intensyvumą, nevilties išgyvenimo intensyvumą, patiriamą potrauminį augimą, gaunamą socialinę paramą. Tyrime dalyvavo 81 policijos pareigūnas, per pastaruosius 3 metus tarnyboje patyręs trauminį įvykį. Tyrime taikytos šios metodikos: Įvykio poveikio skalė – revizuota (IES-R) (Weiss, 2004; liet. k. Kazlauskas ir kt., 2006), Subjektyvaus trauminio patyrimo skalė (STP) (Kazlauskas, Gailienė, Šimėnaitė, 2007), Potrauminio augimo skalė (PTA) (Tedeschi, Calhoun, 1996; liet. k. Gailienė, Kazlauskas, 2005), Becko nevilties skalė (BHS) (Beck, Steer, 1988) ir parengtas specialus Policininko sukrečiančio įvykio ir potrauminio patyrimo klausimynas (sudarė darbo autorė). Tyrimas atskleidė, kad apie 60 proc. policijos pareigūnų profesinėje veikloje patiria trauminius įvykius. Dažniausiai traumines situacijas policininkai patiria tada, kai yra sunkiai sužalota arba nužudyta auka. Nepaisant trauminės patirties, neigiamų policininkų traumos psichologinių padarinių nenustatyta: silpna neviltis, maži potrauminio streso sutrikimo požymių rodikliai. Taip pat žemas potrauminio augimo lygis. Rezultatai rodo, kad... [toliau žr. visą tekstą] / Policemen, as a specific professional group, often encounter traumatic events at service and usually handle the stress experienced at work with the help of negative strategies. The purpose of this research is to determine the peculiarities of consequences of traumas and factors related to traumatic experience. The goals of the research were to assess the subjective experience of officers, symptomatics of post-traumatic stress disorder, intensiveness of the feeling of hopelessness, post-traumatic growth and social assistance received. 81 police officer who has experienced a traumatic event at service during the 3 recent years, participated in the research. The methods applied in the research are as follows: The Impact of Event Scale – revised (IES-R) (Weiss, 2004; Lith.: Kazlauskas et al., 2006), The Subjective Traumatic Experience Scale (STE) (Kazlauskas, Gailienė, Šimėnaitė, 2007), The Post-traumatic Growth Inventory (PTGI) (Tedeschi, Calhoun, 1996; Lith. Gailienė, Kazlauskas, 2005), Beck’s Hopelessness Scale (BHS) (Beck, Steer, 1998) and specially compiled questionnaires for policemen on a shocking event and post-traumatic experience (created by the author of this study). The research has revealed that about 60 percent of police officers experience traumatic events in their professional activities. Most frequently experienced traumatic situations by policemen are those, where there is a heavily injured, or killed victim. Regardless of traumatic experience, negative... [to full text]

Les travailleurs qui œuvrent en protection de la jeunesse sont régulièrement exposés à des événements traumatiques (ÉT) au travail. De ces événements découlent de nombreuses conséquences individuelles (hypervigilance, dépression, trouble de stress post-traumatique, etc.) et organisationnelles (absentéisme, arrêts de travail, démissions, etc.), celles-ci pouvant perdurer dans le temps, voire s’amplifier, sans intervention adéquate. Les meilleures pratiques à favoriser dans la phase aiguë (0-30 jours) suivant un ÉT demeurent nébuleuses et ne nous permettent actuellement pas d’offrir un soutien optimal aux travailleurs qui expérimentent des réactions post-traumatiques plus ou moins sévères dans les jours/semaines suivant l’ÉT. Or, le soutien social est reconnu pour être un facteur déterminant dans le rétablissement des individus exposés à un ÉT, le soutien des collègues étant particulièrement important en contexte de travail. Toutefois, nous ignorons comment le soutien des collègues se manifeste après un ÉT et comment celui-ci est perçu par les travailleurs victimes. Objectif. Explorer les différentes actions de soutien posées par les collègues en protection de la jeunesse et les distinguer selon qu’elles étaient perçues comme du soutien positif ou négatif par les travailleurs victimes d’ÉT. Méthode. Une méthode qualitative de type exploratoire a permis de procéder à une analyse thématique (inter-cas) et à des études de cas typiques (intra-cas). Des entrevues semi-structurées de 30 travailleurs victimes d’ÉT au cours des 30 derniers jours ont été analysées. Résultats. Les actions de soutien rapportées par les participants pouvaient être assimilées aux catégories de House (1981) - soutien émotionnel, instrumental, informationnel et d’évaluation. Le type de soutien le plus fréquemment rapporté était le soutien émotionnel et la majorité des participants ont rapporté avoir reçu du soutien positif de la part de leurs collègues. Les différentes actions positives et négatives sont détaillées. Conclusion. Le soutien positif concorde avec les principes essentiels d’intervention post-traumatique tandis que le soutien négatif renvoie principalement à un manque de ressources organisationnelles et à une culture de normalisation de la violence. / Child protection workers are regularly exposed to traumatic events at work. From these events arise numerous individual consequences (hypervigilance, depression, post-traumatic stress disorder, etc.) and organizational consequences (absenteeism, sick leave, turnover, etc.), which can last over time or even amplify without adequate intervention. The best practices to promote in the acute phase (0-30 days) following a traumatic event remain unclear and do not currently allow us to offer optimal support to workers who experience more or less severe post-traumatic reactions in the days/weeks following a trauma. Social support is recognized to be a determining factor in the recovery of individuals exposed to traumatic events, support from colleagues being particularly important for events occurring in the workplace. However, we do not know how the support of colleagues manifests itself after a traumatic event neither how it is perceived by exposed employees. Objective. Explore the support offered by colleagues after trauma and distinguish support actions according to whether they were perceived as positive or negative by employees. Method. An exploratory qualitative method was used to conduct a thematic analysis (inter-case) and typical case studies (intra-case). Semi-structured interviews of 30 employees exposed to a traumatic event in the past 0-30 days were analyzed. Results. Support actions reported by participants could fit the typology of House (1981), namely emotional, instrumental, informational and evaluation support. The most frequently reported type of support was emotional support, and the majority of participants reported receiving positive support from colleagues. Positive and negative actions are detailed. Conclusion. Positive support offered by colleagues is consistent with the essential principles of early post-traumatic intervention, while negative support refers mainly to a lack of organizational resources and a culture where violence is trivialized. The study suggests that organizations should invest in an approach based on emotional support rather than trivialization.

Background: A recent epidemiological analysis on premenstrual dysphoric disorder (PMDD) in the community revealed increased rates of DSM-IV posttraumatic stress disorder (PTSD) among women suffering from PMDD. Aims: To explore whether this association is artifactual or might have important pathogenic implications. Methods: Data come from a prospective, longitudinal community survey of an original sample of N¼1488 women aged 14–24, who were followed-up over a period of 40 to 52 months. Diagnostic assessments are based on the Composite International Diagnostic Interview (CIDI) using the 12-month PMDD diagnostic module. Data were analyzed using logistic regressions (odds ratios) and a case-by-case review. Results: The age adjusted odds ratio between PTSD and threshold PMDD was 11.7 (3.0–46.2) at baseline. 10 women with full PTSD and at least subthreshold PMDD were identified at follow-up. Most reported an experience of abuse in childhood before the onset of PMDD. Some had experienced a life-threatening experience caused by physical attacks, or had witnessed traumatic events experienced by others. 3 women reported more than one traumatic event. Conclusions: A case-by-case review and logistic regression analyses suggest that women with traumatic events and PTSD have an increased risk for secondary PMDD. These observations call for more in-depth analyses in future research.

Mémoire de maîtrise présenté en vue de l’obtention de la maîtrise en psychoéducation, option recherche et stage (M. Sc.) / La littérature montre que les personnes autistes sont plus à risque de vivre des événements potentiellement traumatiques. Toutefois, les études sur le trauma chez les personnes autistes portent majoritairement sur des aspects cliniques, tels que la symptomatologie et les outils d’évaluation. On en connait peu sur les sources de traumas auxquelles elles sont confrontées, les mettant ainsi à risque d’y être exposées à répétition. Nous en savons encore moins sur la perception des personnes autistes elles-mêmes sur ce qu’elles considèrent comme traumatique. Certains événements pouvant être considérés traumatiques ne font pas partie des sources reconnues par le DSM-5-TR pour l’obtention du diagnostic de trouble de stress post-traumatique (TSPT). Ces événements sont nommés « low magnitude » et réfèrent à des événements de moindre sévérité, tels une rupture ou de la victimisation. Une récente étude qualitative s’est intéressée à la perception de personnes autistes sur les événements considérés traumatiques à l’enfance (Kerns et al. 2022). Les entrevues de cette étude ont fait émerger 16 sources, dont les expériences sensorielles et les transitions. Dans la même optique, la présente étude vise (1) à explorer les sources de traumas exprimées par des personnes s’identifiant comme étant autistes; (2) à déterminer la proportion des catégories soulevées entrant dans la définition du DSM-5-TR pour le TSPT ; puis (3) à déterminer dans quelle proportion la catégorisation des sources traumatiques de Kerns et al. (2022) est reproduite dans la présente étude. Les données du mémoire proviennent de deux forums permettant aux personnes autistes et leur famille de converser sur divers sujets. Une analyse thématique à l’aide du logiciel QDA Miner a permis l’émergence des sources de traumas, puis un codage manuel a permis le calcul de la proportion des sources définies par le DSM-5-TR et la proportion des sources reproduites par Kerns et al. (2022). Les messages extraits ont été composés par des personnes s’identifiant autistes et abordant le trauma. Les résultats suggèrent la présence de 64 sources traumatiques, soit 18 définies par le DSM-5-TR et 46 non définies par le DSM-5-TR pour le diagnostic de TSPT. Les sources recensées sont donc, pour 71,9% d’entre elles, absentes de la définition d’une situation traumatique par le DSM-5-TR. L’ensemble des sources rapportées sont présentes dans la catégorisation de Kerns et al. (2022) et huit s’y ajoutent. Cette étude vise à mettre l’accent sur le point de vue des personnes autistes concernant les éléments traumatiques qu’elles peuvent vivre, dans le but de faciliter la prévention et l’intervention. / Research shows that people with autism are at a greater risk of experiencing potentially traumatic events. Studies on trauma in autistic people focus mainly on clinical aspects, such as symptomatology and assessment tools. However, little is known about the sources of the trauma they face, putting them at risk of repeated exposure. Even less is known about autistic people's perceptions of what they consider traumatic. Some events that may be considered traumatic are not among the sources recognized by the DSM-5-TR for the diagnosis of post-traumatic stress disorder (PTSD). These events are termed “low magnitude” and refer to events of lesser severity, such as a break-up or victimization. A recent qualitative study focused on how people with autism perceive events considered traumatic in childhood (Kerns et al. 2022). Interviews in this study revealed 16 sources, including sensory experiences and transitions. Similarly, the present study aims to: (1) explore the sources of trauma expressed by people identifying themselves as autistic; (2) determine the proportion of categories raised falling within the DSM-5-TR’s definition of PTSD; and (3) determine the proportion of Kerns et al.'s (2022) categorization of traumatic sources replicated in the present study. The data in this report originates from two forums, where autistic people and their families can discuss a variety of subjects. A thematic analysis using QDA Miner software enabled the emergence of trauma sources, followed by manual coding to calculate the proportion of sources defined by the DSM-5-TR and the proportion of sources reproduced by Kerns et al. (2022). The extracted messages were composed by people identifying themselves as autistic and addressing trauma. The results suggest the presence of 64 traumatic sources, 18 defined by the DSM-5-TR and 46 not defined by the DSM-5-TR for the diagnosis of PTSD. Thus, 71.9% of the sources identified were not included in the DSM-5-TR’s definition of a traumatic situation. All but eight of the sources reported in the current study are present in the categorization of Kerns et al. (2022). The aim of this study is to focus autistic people’s point of view regarding traumatic experiences they may encounter, with an aim to facilitate prevention and intervention.

South Asians are the third fastest growing racial/ethnic minority group in the United States with distinct cultural characteristics. The coronavirus disease 2019 (COVID-19) pandemic has disproportionately impacted racial and ethnic minorities in the U.S, including South Asians, across several life domains: work, home life/education, social activities, economic, emotional and physical health, infection, quarantine, and positive changes. The COVID-19 pandemic may have critically impacted South Asians with traumatic event experiences and posttraumatic stress disorder (PTSD) symptom severity across several life domains. Limited work suggests high rates of interpersonal traumas and substantial PTSD symptom severity in the South Asian community. Uniquely, the current study examined which life domains impacted by the COVID-19 pandemic associated with a greater count of traumatic event types, interpersonal vs. non-interpersonal traumas, and PTSD symptom severity. Results revealed that negative experiences in social activities, as well as distress in economic, emotional, and physical health domains, were significantly associated with the count of traumatic event types. Negative social activity experiences, and distress in the economic and emotional health domains, were also significantly associated with PTSD symptom severity. Quarantine and physical health domains significantly associated with the count of interpersonal traumas, while COVID-19-related experiences (in social, quarantine, and infection domains) significantly associated with the count of non-interpersonal traumas. Findings inform clinically relevant pandemic research in a vulnerable population and provide trauma and PTSD prevalence estimates in the South Asian community.