Bakgrund: Ambulanspersonal är en yrkesgrupp som i sitt yrkesutövanden riskerar att utsättas för traumatiska händelser som kan vara mycket påfrestande och stressfulla. Trots erfarenhet och träning blir vissa trauman stundtals övermäktiga och kan ge reaktioner som posttraumatiskt stressyndrom. Risken att utveckla PTSD ökar med antalet upplevda trauman och prevalensen i yrkesgruppen är hög. Syfte: Syftet var att beskriva vilka traumatiska händelser ambulanspersonalen upplevde som mest stressfulla. Syftet var även att beskriva ambulanspersonalens upplevelser och hantering av posttraumatiskt stressyndrom i relation till traumatiska händelser i sitt yrkesutövande. Syftet var dessutom att granska artiklarnas kvalitet utifrån den metodologiska aspekten undersökningsgrupp. Metod: Beskrivande litteraturstudie innefattande elva vetenskapliga artiklar av både kvalitativ och kvantitativ ansats sökta i medicinsk och omvårdnadsorienterade databas. Huvudresultat: Traumatiska händelser som upplevdes mest stressfulla innefattade händelser som involverade akut sjuka och allvarligt skadade barn, vilka väckte en emotionell respons och där ambulanspersonalen identifierade sig med nödställda. Upplevelser av PTSD kännetecknades av överspändhet, sämre prestation, mental avstängning och återupplevande av minnesbilder. Hantering av PTSD utmärktes av copingstrategier som känslomässig distans, fokusering, stöd, återhämtning, kontroll och förberedelse. Slutsats: Ambulanspersonal upplever i sitt yrkesutövande traumatiska händelser som kan vara mycket stressfulla och som kan leda till posttraumatiskt stressyndrom. Upplevelserna kan ge psykiska och fysiska symtom som påverkar hälsa och funktionsförmåga. Ambulanspersonalen behöver utbildning i copingstrategier för att hantera kritiska incidenter på ett gynnsamt sätt, speciellt händelser som involverar barn. Strategier behövs för att stärka känslan av kontroll och förmågan till fokusering, där förberedelse, socialt stöd och återhämtningstid är betydelsefullt.

The purpose of the study is to investigate social workers experiences of compassion fatigue as well as their thoughts about health and risk factors in the area. The method used is a qualitative interview study in which eight social workers, investigating child welfare matters, were individually interviewed. The study shows that most of the social workers describe their own experiences of burnout but not of secondary traumatic stress. The most important support for not suffer from compassion fatigue is to be supported and the possibility to ventilate with colleagues and managers. However, the social workers consider that the risk of burnout is primarily due to a heavy workload in terms of the number of cases and high staff turnover. Finally, the study indicates that social workers do not have experience of secondary traumatic stress because they are using tools that prevent this. However, the risk of experiencing burnout is high since they have not found strategies for managing workplace stress. / Syftet med studien är att undersöka socialarbetares upplevelser av sympatistress samt deras tankar om frisk- och riskfaktorer inom området. Metoden som använts är en kvalitativ intervjuundersökning där åtta socialarbetare, som utreder barnavårdsärenden, enskilt har intervjuats. Studien visar att de flesta av socialarbetarna beskriver att de har egna upplevelser eller erfarenheter av utbrändhet men inte av sekundär traumatisk stress. Det viktigaste stödet för att inte drabbas av sympatistress, uppger socialarbetarna, vara stöd från och möjligheten att ventilera med kollegor och chefer. Dock anser de att risken för att bli utbränd främst beror på hög arbetsbelastning, i form av mängden ärenden samt hög personalomsättning. Slutligen pekar studien på att socialarbetarna inte har upplevelser av sekundär traumatisk stress då de använder sig av verktyg som förhindrar detta. Dock är risken för att drabbas av utbrändhet hög då de ännu inte funnit strategier för att hantera påfrestningar som är kopplade till arbetsplatsen.

Thesis (MA) -- University of Stellenbosch, 2000. / ENGLISH ABSTRACT: Judgement of risk for negative events in certain situations was investigated in a group of emergency medical service (EMS) personnel with a diagnosis of posttraumatic stress disorder (PTSD; n = 27) and a group without PTSD (n = 74). Participants completed the PTSD Symptom Scale: Self-Report version (Faa, Riggs, Dancu, & Rothbaum, 1993), an EMS work experiences questionnaire, the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979), and an event probability questionnaire designed to assess judgement of risk. Participants with PTSD overestimated amount of risk involved in comparison to participants without PTSD, thereby demonstrating a judgement bias for risk related events. The present study found that the judgement bias in PTSD participants extended to include not just external harm related events but also general negative events (without potential threatening/harmful consequences), negative social events, and negative workrelated events. Of the posttraumatic symptomatology assessed, avoidance symptomatology was found to be the best predictor of judgement bias. The results of the present study are discussed in terms of the cognitive clinical psychology theories of PTSD, which predict the manifestation of judgement bias in PTSD, and cognitive experimental psychology explanations of the effect of negative emotional states on judgement processes. / AFRIKAANSE OPSOMMING: Oordeeloor risiko vir negatiewe gebeurtenisse in sekere situasies is ondersoek by "n groep mediese nooddienspersoneel met "n diagnose van posttraumatiese stresversteuring (PTSV; n = 27) en "n groep sonder PTSV (n = 74). Deelnemers het die PTSD Symptom Scale: Self-Report version (Foa, Riggs, Dancu, & Rothbaum, 1993), "n mediese nooddiens werkservaringe-vraelys, die Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979), en "n gebeurtenis-waarskynlikheidsvraelys wat opgestel is om oordeeloor risiko te meet, voltooi. Deelnemers met PTSV het die mate van risiko betrokke oorskat in vergelyking met deelnemers sonder PTSVen sodoende "n beoordelingsydigheid vir risiko-verbandhoudende situasies gedemonstreer. In die huidige studie is gevind dat beoordelingsydigheid by PTSV deelnemers nie beperk was tot eksterne skade-verbandhoudende gebeurtenisse nie, maar dat dit ook veralgemeen het na algemene negatiewe gebeurtenisse (sonder potensieel skadelike gevolge), negatiewe sosiale gebeurtenisse, en negatiewe werksverwante gebeurtenisse. Daar is gevind dat, wat PTSV-simptomatologie betref, vermyding die beste voorspeller van beoordelingsydigheid was. Die resultate van die huidige studie word bespreek in terme van kognitiewe klinies-sielkundige teorieë van PTSV, wat die aanwesigheid van beoordelingsydigheid voorspel, en kognitiewe eksperimentele-sielkunde verklarings van die effek van negatiewe emosionele toestande op beoordelingsprosesse.

Thesis (MA)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: This study investigated the incidence of depression, post-traumatic stress symptomatology, anger and guilt in a shelter sample of 40 battered women. In addition, the presence of dysfunctional, evaluative beliefs, as viewed from a Rational-emotive perspective, was investigated, as well as the relationship between dysfunctional beliefs and symptoms of psychopathology. Participants completed the Beck Depression Inventory, Post-traumatic Stress Diagnostic Scale, Anger Diagnostic Scale, Trauma Related Guilt Inventory and Survey of Personal Beliefs. It was found that 63% of the participants showed moderate to severe levels of depression, while 59% manifested high post-traumatic stress symptomatology. Between 38% and 50% experienced problems with anger whilst 48.5% showed moderate guilt. In general, these symptoms did not correlate with the age of participants or with the duration or frequency of abuse, except for anger which was related to a history of childhood sexual and/or physical abuse. The results of the Survey of Personal Beliefs indicated that the group displayed Otherand Self-directed Demands, Awfulizing, Low Frustration-tolerance and Negative Selfworth. Only Low Frustration-tolerance (underestimation of coping skills) correlated significantly with levels of depression, anger and guilt. / AFRIKAANSE OPSOMMING: Hierdie studie het die insidensie van depressie, post-traumatiese stressimptome, woede en skuldgevoelens in 'n groep van 40 vroulike slagoffers van gesinsgeweld, wat die huweliksverhouding verlaat het en in 'n skuiling vir mishandelde vroue opgeneem is, ondersoek. Die disfunksionele, evaluerende kognisies, soos deur die Rasioneel-emotiewe gedragsterapie gepostuleer, asook die korrelasie tussen hierdie kognisies en die simptome van psigopatologie, is ook ondersoek. Deelnemers het die Beck Depression Inventory, Post-traumatic Stress Diagnostic Scale, Anger Diagnostic Scale, Trauma-Related Guilt Inventory en Survey of Personal Beliefs voltooi. Die resultate het aangedui dat 63% van die deelnemers matige tot ernstige vlakke van depressie getoon het, terwyl hoë post-traumatiese stressimptomatologie by 59% voorgekom het. Tussen 38% en 50% het probleme met woede getoon, terwyl matige skuldgevoelens by 48.5% voorgekom het. Oor die algemeen het hierdie simptome nie verband getoon met die ouderdom van deelnemers of met die duur of frekwensie van die mishandeling nie, behalwe die vlak van woede wat 'n verband getoon het met 'n geskiedenis van kindermolestering. Tellings op die Survey of Personal Beliefs het aangedui dat die groep die disfunksionele, evaluerende kognisies van Self- en Ander-gerigte Eise, Katastrofering, Lae Frustrasie - toleransie en Negatiewe Selfwaarde getoon het. Slegs Lae Frustrasie-toleransie (onderskatting van hanteringsvaardighede) het beduidend met vlak van depressie, woede en skuldgevoelens gekorreleer.

The purpose of this project is to examine how the factors of gender, placement status, type of treatment, the number of different types of trauma experienced, and a child’s age at the start of treatment may influence end of treatment symptom severity scores for children ages 2-12 years who received trauma-informed evidence-based treatment for trauma. Method: Caregivers and children receiving outpatient services (N=134) completed the Child Behavioral Checklist, Trauma Symptom Checklist for Young Children, and the Trauma Symptom Checklist for Children-Alternate Version at baseline and end of treatment. Hypotheses were tested with a series of ANCOVA analyses, Independent t-Tests, and a Paired Samples t-Test. Results: While statistically significant improvements were found between baseline and termination outcome scores regardless of treatment type, TF-CBT was found to more successfully reduce externalizing and total problem scores at termination compared to PCIT. Despite the relatively young age of this sample, significant differences in externalizing and total problem scores on the CBCL were found for older children at the end of treatment. No significant differences were found between pre-and post-test internalizing and externalizing scale scores for either TF-CBT or PCIT. Additionally, examination of caregiver and child daily functioning scale scores indicated improved ratings of daily functioning from baseline to the end of treatment. Implications: Behavior problems stemming from traumatic exposure may resolve differently from behaviors that result from environmental factors apart from trauma. Trauma recovery is dependent upon successful matching of client characteristics and need to treatment type. Practitioners are encouraged to be mindful of the specialized needs of older children who are seeking treatment. Research that focuses on clarifying the factors that differentiate symptom resolution can inform treatment selection decisions. Social work educators are encouraged to design curriculum that is trauma-informed with an emphasis on helping students learn how to think critically about a child’s needs and to integrate this knowledge into treatment decisions. The development of policies that incentivize agencies to provide evidence-based care can increase the availability of research-supported care for trauma exposed youth.

Research investigating the role of two evolutionary constructs – perceptions of defeat and entrapment – in various psychological problems and processes has burgeoned over recent years. This meta-analysis quantitatively summarised the findings from 38 studies (11,343 participants) which examined relationships between perceptions of defeat and entrapment and four psychological problems commonly encountered in NHS clinical services: depression, suicidality, anxiety problems and Post-Traumatic Stress Disorder (PTSD). All correlations between defeat and entrapment and the four psychological problems were large by Cohen’s (1988) criterion. Correlations between defeat and entrapment and depression were larger than those for the other psychological problem groups, and significantly larger than those for anxiety problems and PTSD. The magnitude of the observed correlations introduces the possibility that defeat and entrapment, and perhaps other evolutionary constructs, may be integral components or driving forces behind all psychological problems. A robust approach to sensitivity analysis provided confidence that the population effect size estimates are robust and were not severely inflated by unpublished studies not included in the meta-analysis. As there was no significant between-study heterogeneity, moderator analyses were undertaken on an exploratory basis. Findings are generally consistent with theoretical predictions from the Involuntary Defeat Strategy, the theoretical model underpinning the literature. Overall, perceptions of defeat and entrapment appear to be strong risk factors for the four psychological problems examined, perhaps representing transdiagnostic processes that are common across various psychological problems. The potential role of defeat and entrapment in mental health assessment, formulation, intervention and evaluation, is considered in detail and limitations of this meta-analysis and of the literature on which it is based are discussed, highlighting areas of research where future work is needed.

Some sections of the appendices are not available in the electronic copy of this thesis due to their format. The full version is available for consultation at the University of Leicester Library.

Background and aims: The provenance of post-concussion symptoms (PCS) and post-traumatic stress (PTSD) after mild traumatic brain injury (mTBI) is controversial. This thesis investigated factors influencing these two conditions separately, as well as the interplay between PCS and PTSD, in individuals with mTBI and a control sample without mTBI (orthopaedic injuries). Method: Consecutive adult attendees of an Emergency Department with mTBI or orthopaedic injury were prospectively recruited and completed the Rivermead Post-concussion Questionnaire (RPQ) and Trauma Screening Questionnaire (TSQ) for PTSD at two weeks (T1) and three months (T2) post-injury. The sample at T1 consisted of 34 with complicated mTBI, 76 with uncomplicated mTBI and 47 with orthopaedic injury, and 18 with complicated mTBI, 43 with uncomplicated mTBI and 33 orthopaedic controls at T2. Results: Although there were no differences in overall PCS symptomology between groups, a subset of PCS symptoms (headaches, dizziness and nausea) was found to be specific to mTBI at both time points. These symptoms are proposed to have a neurological basis, as opposed to a psychological basis. PTSD interacted with PCS, particularly in mTBI, such that PTSD was associated with greater “neurogenic” and “psychogenic” symptomology in this group, but only a moderate increase in psychogenic symptoms for controls. A model of the influence of PTSD on PCS is presented. PTSD was influenced by poor memory quality for the traumatic event and attribution of blame to others, but not by mTBI. Discussion and conclusions: Though mTBI may set the scene for at least neurogenic symptoms of PCS to occur, psychological mechanisms, particularly PTSD, have a significant role in the persistence of PCS. Our findings suggest the need for a clear story and sense of meaning for a traumatic event for good recovery from PTSD. Taken together, the results suggest that psychological interventions, particularly aimed at PTSD, may be most effective after mTBI.

This study began testing the Sewell and Williams (in press) model that differing trauma types yield differing presentations in social versus event processing domains. Other hypotheses explored trauma type with levels of guilt, and shame-proneness with anxiety. Volunteers were 44 male combat veterans being treated for PTSD. Data analyses determined whether trauma type related to guilt and perceived social support and whether shame-proneness related to levels of anxiety. High shame persons may process anxiety and social support differently than low shame persons. Results can assist professionals understand how a person's functioning is affected by certain types of trauma. Future research should focus on increasing social support for persons who have experienced trauma.

Bakgrund Posttraumatiskt stressyndrom bör betraktas som en folkhälsosjukdom där diagnostisering och behandling behöver uppmärksammas. Ungdomar som överlevt livshotande händelser tenderar att återuppleva dessa traumatiska händelser och undviker att handskas med känslorna som uppkommer, vilket kan leda till psykiska besvär. Syfte Att undersöka riskfaktorer som finns för att utveckla posttraumatiskt stressyndrom bland ungdomar samt undersöka vilka datainsamlingsmetoder de inkluderade artiklarna valt. Metod Deskriptiv design användes i litteraturstudien som inkluderar 13 stycken vetenskapliga artiklar från databaserna PsycInfo och PubMed. Likheter och skillnader i artiklarnas resultat identifierades och använda datainsamlingsmetoder sammanställdes. Huvudresultat Att vara utsatt för våld och traumatiska händelser såsom fysisk skada eller se någon lida/dö, vara tjej, äldre ungdom, utsatt för daglig stress, splittrad familj och sämre socialt stöd var riskfaktorer för att utveckla posttraumatiskt stressyndrom. Tio av tretton artiklar hade kvantitativ ansats och använde frågeformulär för att få svar på vilka riskfaktorer det fanns. En artikel hade kvantitativ ansats men använde inte frågeformulär och två hade endast kvalitativ ansats i form av intervju som datainsamlingsmetod. Slutsats Denna litteraturstudie identifierade olika riskfaktorer som ligger till grund för utveckling av PTSD bland ungdomar. De vanligaste som återkom i nästan alla studier var att utsättas för våld, vara med om traumatiska händelser, vara tjej, sämre socialt stöd inom familj och skola, förlora en anhörig och vardagliga stressorer. Att som sjuksköterska och övrig vårdpersonal inneha denna kunskap kan bidra till att tidigare kunna identifiera ungdomar med PTSD samt anpassa omvårdnaden till denna grupp på bästa sätt. / Background Posttraumatic stress disorder should be considered as a public health disease where diagnosing and treatment require attention. Adolescents who have survived life-threatening events tend to relive these traumatic events and avoid to deal with the emotions that occur, which can lead to mental disorders. Aim Identify which risk factors there is to develop posttraumatic stress disorder among adolescents and examine which data collection methods the included articles have chosen. Method Descriptive design has been used in this literature study including 13 articles collected from the databases PsycInfo and PubMed and has been categorized by similarities and differences. The articles data collection methods has been presented from the methodological aspect. Main results To be exposed to violence and traumatic events as physical injury or see someone suffer/die, be a girl, older adolescent, exposed to daily stress, broken family and have less social support were some risk factors for developing posttraumatic stress disorder. Ten of thirteen articles had a quantitative approach and used questionnaire to get responses for which risk factors there was. One article had a quantitative approach but did not use a questionnaire and two articles had qualitative approach and used interview as data collection method. Conclusion In this literature study different risk factors were identified underlying to develop PTSD among adolescents. The most common risk factors in almost all of the studies were to be exposed to violence, experience traumatic events, be a girl, have less social support from family and school, lose a family member and daily stress. As a nurse it is important to keep this in mind so the care for the adolescents are as good as possible and that coping is used in the right way.