Résumé : Les conséquences individuelles et populationnelles associées au syndrome de stress post-traumatique (SSPT) sont de plus en plus connues dans la littérature. Toutefois, peu d’études ont documenté cette problématique dans une population générale de personnes âgées ayant vécu différents types d’évènements traumatiques. Les objectifs de ce mémoire sont de documenter l’association entre le syndrome de stress post-traumatique, la qualité de vie et les coûts du système de santé dans une population de personnes âgées de 65 ans et plus qui consultent en médecine générale. Ce projet de mémoire consiste à l’analyse secondaire des données provenant de l’Étude sur la Santé des Aînés (ESA)-Services qui a été conduite entre 2011-2013 et qui inclut une population de personnes âgées de 65 ans et plus qui consultent en médecine générale au Québec. Les données de l’étude ESA-Services ont été appariées aux données individuelles provenant des bases de données administratives de la Régie d’Assurance Maladie du Québec (RAMQ). Le SSPT a été mesuré à partir de l’échelle du SSPT. La qualité de vie auto-rapportée a été mesurée à partir de trois instruments : l’EQ-5D-3L, l’Échelle Visuelle Analogue et l’Échelle de Satisfaction de Vie. L’évaluation des coûts a été effectuée selon la perspective du système de santé. L’utilisation des services de santé a été mesurée à partir des données individuelles provenant des bases de données administratives. Des régressions linéaires multivariées ont été utilisées pour vérifier l’association entre le SSPT et la qualité de vie. Des modèles généralisés avec distribution gamma ont été utilisés pour évaluer l’association entre le SSPT et les coûts reliés à l’utilisation des services de santé. Une augmentation des symptômes du SSPT était associée avec une plus faible qualité de vie liée à la santé (EQ-5D-3L) et à une plus faible satisfaction de la vie (Échelle de Satisfaction de Vie). Nos résultats ont aussi montré que la présence du SSPT était associée avec des coûts totaux du système de santé plus élevés. Nous suggérons la conduite d’études supplémentaires afin de mieux comprendre l’association entre le SSPT et ses conséquences sur le bien être des individus et sur le système de santé. / Abstract : Individual and societal consequences associated with post-traumatic stress syndrome (PTSS) have been documented in the literature. However, few studies have documented these issues in a population of older adults who have experienced different types of traumatic events. The objectives of this thesis are to document the quality of life and healthcare costs associated with PTSS in a population of older adults aged 65 years and over. Secondary data analyses were carried out on data from the ESA (Étude sur la Santé des Aîné(e)s)-Services study conducted between 2011-2013 and included a general population of older adults aged 65 years and over who consulted in the general medicine sector in Quebec. Data from the ESA-Services study was linked with individual information from the RAMQ (Régie d’Assurance Maladie du Québec) administrative database. PTSS was measured using the PTSS scale. Self-reported quality of life was measured using three instruments: EQ-5D-3L, Visual Analog Scale and Satisfaction With your Life Scale. Costs associated with health service use were estimated from the healthcare system perspective. Healthcare use was measured using data available in the RAMQ administrative database. Multivariate linear regressions were used to study the association between the PTSS and quality of life. Generalized models with gamma distribution were used to evaluate the healthcare costs associated with PTSS. An increase in PTSS symptoms was found to be associated with a lower health-related quality of life (EQ-5D-3L) and a lower life satisfaction (Satisfaction With Life Scale). Our results also showed that the presence of PTSS was associated with higher total healthcare costs. We suggest that further studies be conducted to better understand the association between PTSS and its consequences on individual well-being and on the healthcare system.

The biological energy concepts used by Freud to account for unconscious mental processes in psychoanalysis are discredited by modem biological findings. As a result, different psychoanalytic schools developed new foundational theories in order to verify unconscious mentation. The present study argues that these theories are unsuccessful for two main reasons. Firstly, replacing Freud's drive energy theory with other equally hypothetical foundational constructs does not solve the problem of finding proof for the existence of unconscious mentation. Secondly, the clinical psychoanalytic definition of unconscious mentation as imaginary, internally generated processes, autonomous from the external world is misguided. External sensory data may play a formative role in producing unconscious mentation. In particular, neurobiological findings on sensory data encoding and storage in human infants may throw light on the nature of unconscious processes. The present study therefore compares ideas derived from Lacanian psychoanalysis with neuropsychological memory and infant research findings to ascertain whether unconscious mentation is linked to the memory encoding of sensory data in infants. This analysis is in tum contrasted with a more contemporary psychoanalytic synthesis of findings on infant memory and unconscious mentation (Lichtenberg, 1989, Lichtenberg, Lachmann, and Fosshage, 1992). The latter theory identifies connections between unconscious mentation and the encoding of sensory memories in infancy, but does not connect the episodic and procedural memory constructs used in this account to specific neurolo·gical mechanisms in the brain. The present study's original contributions therefore involve firstly connecting the development of aversive episodic and procedural memories to neurological mechanisms in the brain during the period between birth and 28 months of age. Secondly, this memory model suggests that the storage of aversive memories in infancy has lasting unconscious motivational significance for subjects. Presymbolic memories may unconsciously manipulate conscious attention and memory retrieval in verbal subjects, inviting comparison with the psychoanalytic concept of dynamic unconscious mentation. Thirdly, the presymbolic memory model contributes towards a novel understanding of false memories of childhood sex abuse, and the dissociation of real traumatic memories that occur in many cases of Post Traumatic Stress Disorder. / Psychology / D.Litt. et Phil. (Psychology)

Thesis (MA (Psychology))--University of Stellenbosch, 2008. / Few studies have assessed the prevalence of Post-Traumatic Stress Disorder (PTSD) associated with the receipt of an HIV-positive diagnosis and no published studies in South Africa have used a structured clinical interview to assess the above-mentioned. The present cross-sectional study assessed the prevalence of HIV-related PTSD among a sample of recently diagnosed patients attending public health clinics in the Boland region of the Western Cape. The PTSD module of the Composite International Diagnostic Interview (CIDI), together with a battery of self-report instruments assessing symptoms of traumatisation, depression and anxiety were administered to 85 patients who had been diagnosed with HIV in the year preceding data collection. In addition, HIVrelated PTSD and symptomatology were assessed using an adapted version of the PTSD module of the CIDI. The self-report instruments administered were (a) a demographic questionnaire, (b) the Posttraumatic Stress Diagnostic Scale (PDS) which assessed current PTSD symptom severity, and (c) the 25-item Hopkins Symptom Checklist (HSCL-25) which assessed psychological distress, and symptoms and intensity of anxiety and depression. The primary aim of the present study was to determine the prevalence of HIV-related PTSD among a sample of recently diagnosed HIV-positive individuals attending HIV clinics in the Boland region. The second aim was to determine the lifetime prevalence of PTSD among the sample. The third aim was to determine the percentage of the sample that endorsed the DSM-IV’s PTSD A2 criterion and the subsequent HIV-related PTSD symptomatology among those who did and did not meet full criteria for HIV-related PTSD. The fourth aim was to determine the level of psychological distress reported by the sample. The prevalence of lifetime PTSD was 29.4% (95% confidence interval [CI], 20.7% - 39.8%). Sixty-nine of the eighty-five participants (81.2%) endorsed the DSM-IV’s PTSD A2 criterion. Of the total sample, 34 participants (40%) (95% CI, 30.2% - 50.6%) met the full criteria for HIV related PTSD. The majority of participants reported mild PTSD symptom severity (45.8%). Over half the sample (51.4%) experienced clinically significant distress. Of those participants diagnosed with HIV-related PTSD, 82.4% were clinically distressed, and 76.5% and 58.8% experienced high levels of depression and anxiety, respectively. The present study’s findings suggest that receiving an HIV-positive diagnosis and/or being HIVpositive may be considered a traumatic stressor that frequently results in HIV-related PTSD. Findings of the present study indicate the need for adequate support and care for HIV-positive individuals. Given the various barriers to efficient mental health interventions and services in South Africa, there are significant challenges that need to be addressed in order to ensure that the mental health and welfare of HIV-positive individuals are both adequately assessed and appropriately maintained.

Thesis (MEd(Psych)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: This study explores the use of Eye Movement Desensitisation (hereafter referred to as EMDR), a form of psychotherapy on a female adolescent sexual assault survivor. Adolescence as a developmental stage is characterised by specific issues, such as the search for own identity. Sexual trauma may increase the inner conflict, because of the adolescent's ability to deal with the trauma at a higher cognitive level than in earlier childhood. Without support including psychotherapy, the adolescent sexual assault survivor may be at risk of developing mental health problems including Post-traumatic Stress Syndrome (hereafter referred to as PTSD). This research is a qualitative case study, involving only one adolescent participant. Mary (pseudonym) a sexual assault survivor, was selected from referrals the Unit for Educational Psychology at the University of Stellenbosch received from the Child Protection Unit of the South African Police Services. She was referred because she displayed symptoms of depression and PTSD, which affected her relations with her parents, siblings and peers. She also struggled to cope emotionally with the academic demands of school. The ecosystemic approach was chosen as the preferred framework within which to locate this study. In assessment and intervention this framework lends itself to focussing on relationships and systems rather than merely the individual with a problem. The study explores the use of EMDR to alleviate symptoms of depression and PTSD in Mary. She attended thirteen sessions of which the first three were used to assess her level of functioning. Data were collected by means of self-report questionnaires including the Beck's Depression Inventory and the Dissociative Experiences Scale, interviews and therapy sessions during which EMDR was used. The data were analysed using codes, categories and themes, interpreted and the study concluded with a discussion of the findings. The findings suggest that EMDR effectively alleviated Mary's symptoms of depression and PTSD. However, since the study was limited to a single participant, a larger sample is recommended to determine whether EMDR might be a feasible treatment tool for female adolescent sexual assault survivors. / AFRIKAANSE OPSOMMING: Hierdie studie ondersoek die gebruik van Oogbeweging Desensitifisering Herprosessering (hierna verwys as OBDH), 'n tipe psigoterapie, om 'n vroulike adolessente slagoffer van seksuele misbruik te ondersteun. Adolessensie as 'n ontwikkelingsfase word deur spesifieke kwessies gekenmerk, onder andere die soeke na 'n eie identiteit. Seksuele trauma mag die innerlike konflik verhoog, weens die adolessent se vermoeë om dit op 'n hoër vlak van ontwikkeling as die jonger kind te hanteer. Sonder ondersteuning, insluitend psigoterapie, mag die adolessent die risiko loop om geestesversteurings soos Posttraumatiese stresversteuring (hierna verwys as PTSV) te ontwikkel. Hierdie navorsing was 'n kwalitatiewe gevallestudie en slegs een adolessente deelnemer was daarby betrokke. Mary (skuilnaam) 'n seksuele geweld oorwinnaar, is gekies vanuit verwysings wat die Eenheid vir Opvoedkundige Sielkunde van die Universiteit van Stellenbosch van die Kinderbeskermings-eenheid van die Suid-Afrikaanse Polisie Dienste ontvang het. Sy is verwys aangesien sy blykbaar simptome van depressie en PTSV geopenbaar het, wat haar verhoudings met haar ouers, sibbe en portuurgroep beïnvloed het. Sy het ook emosioneel gesukkel om die akademiese eise van die skool te hanteer. Die ekosistemiese benadering is gekies as die raamwerk vir hierdie studie. In assessering en intervensie lê dié benadering groter klem op verhoudings en sisteme, as op 'n individu met 'n probleem. Die doel van hierdie studie was om vas te stelof die gebruik van OBDH verligting van simptome van depressie en PTSV in Mary teweeg sou bring. Sy het dertien sessies bygewoon en die eerste drie is gebruik om haar vlak van funksionering te bepaal. Data is ingesamel deur middel van die Beck's Depression Inventory en die Dissociative Experiences Scale vraelyste, onderhoude en terapie sessies waarin OBDH ook gebruik was. Die data is ontleed deur middel van kodes, kategorieë en temas, geïnterpreteer en die studie eindig met 'n bespreking van die bevindinge. Die bevindinge het aangedui dat OBDH effektief Mary se simptome van depressie en PTSV verlig. Omdat die studie egter beperk was tot 'n enkele deelnemer, word 'n groter getal deelnemers aanbeveel om te bepaal of OBDH moontlik geskik is om vroulike adolesente oorwinnaars van seksueel geweld te ondersteun.

Research psychologists often complain that practitioners disregard research evidence whilst practitioners sometimes accuse researchers of failing to produce evidence with sufficient ecological validity. The tension that thus arises is highlighted, using the specific illustrative examples of two treatment methods for post-traumatic disorder (PTSD): Eye-Movement Desensitisation and Reprocessing (EMDR) and exposure based interventions. Contextual reasons for the success or failure of particular treatment models that are often only tangentially related to the theoretical underpinnings of the models are discussed. Suggestions regarding what might be learnt from these debates are put forward and implications for future research are discussed.

Background: The literature suggests a consensus that individuals can become traumatised through listening to another’s trauma. Much of this research, however, has focused on individuals who have had direct, face-to-face contact with the primary victims of trauma. It therefore appears that there is a paucity of research looking at contact which is less direct, such as telephone contact. Aims: The current research aimed to explore the levels of secondary traumatic stress and posttraumatic stress disorder in a sample of Samaritan telephone volunteers, with a view to understanding some of the correlates of trauma. It also aimed to explore the personal construct systems of a sub-sample of Samaritan telephone volunteers, and explore any relationships between personal construct systems and trauma. Method: A cross-sectional design was employed. Questionnaires were used to assess levels of secondary traumatic stress and posttraumatic stress in Samaritan telephone volunteers spread across the United Kingdom. Repertory grid technique was used with a sub-sample of Samaritan telephone volunteers to elicit bipolar constructs comparing themselves and others. Results: 299 Samaritan telephone volunteers completed or partially completed the questionnaires, and of these 50 volunteers completed the repertory grids. Levels of secondary trauma (as determined by the Modified Secondary Trauma Scale) correlated with discrepancy in construing of the current and ideal self, levels of posttraumatic stress and exposure to potentially traumatic events. The Samaritans were not found to be suffering with secondary trauma. Degree of elaboration of self-construing reduced after the named traumatic event, and there was a significant difference in degree of elaboration for ‘self after traumatic event’ on the emergent poles of constructs. Conclusions: This research appears to be the first dedicated to assessing secondary trauma in telephone crisis line volunteers, lending some support to Sewell and Cromwell’s (1990) personal construct model of posttraumatic stress. The findings of this study challenge crisis lines to think about secondary trauma, and to implement some teaching and training around this area. Additionally, it reinforces that further research in the area is needed, and highlights the relative merits of employing a repertory grid methodology alongside questionnaires in understanding trauma.

Background: Guidelines for the treatment of Post-Traumatic Stress Disorder recommend 8-12 session of trauma-focused CBT or EMDR, however there is an extensive body of literature criticising the PTSD paradigm and usefulness of recommended therapies in treating PTSD in the 'real world', particularly with the complex presentations of refugees . Alternative models for 'complex' PTSD have been proposed, as have transtheoretical phased stages for treatment. To date there has been no research into refugees' experience of trauma-therapy. Leaving a significant gap in understanding of how trauma therapy works. Aims: With this gap in the research in mind, and in line with the current focus on service user involvement in research, this study aims to investigate refugees' experiences of trauma-therapy. Methodology: Semi-structured interviews were conducted with six refugees who were coming towards the end of trauma-therapy with a specialist trauma service. The transcripts of the interviews were then analysed using Interpretative Phenomenological Analysis (IPA). Results: Six master themes emerged from analysis: 'Therapy as a light in a dark place', 'Rebuilding a shattered sense of self', 'A changing relationship with the world and others', 'Escaping the past to pursue a future', 'A journey from sceptic to convert' and 'From an unknown mystery to a known mystery'. These master themes along with the subordinate themes are expanded into a narrative account of participants' experiences. Implications & Conclusion: Amongst numerous implications for clinical practice the need for support to engage in therapy, thorough explanation of therapy and pre-empting of possible conflicts and difficulties arising were identified. Allowing time to build a therapeutic relationship, the usefulness of the PTSD construct for individuals and the importance of the 'non-specific' factors of therapy in addition to the teaching of techniques to manage symptoms were also found to be of importance. This study has made an important contribution to knowledge about refugees' experiences of therapy for trauma.

Bakgrund: Sjuksköterskan har stor del i den nära patientvården och förväntas vara en god lyssnare genom sitt personcentrerade vårdgivande. Händelser som är traumatiska drabbar förutom den direkt berörda patienten även sjuksköterskan genom sekundär exponering. Syfte: Syftet med studien var att belysa förekomst av STS hos sjuksköterskor samt beskriva hur det påverkar vårdkvalitet och personcentrerad vård. Metod: Litteraturstudie med en översikt av relevanta artiklar i databaserna PubMed och CINAHL. Resultatet baseras på 14 artiklar som uppfyllde inklusionsoch kvalitetskrav. Resultat: Sjuksköterskan påverkas av STS på flera plan, både professionellt och personligt. Vårdkvaliteten blir lidande om STS påvisas. Den personcentrerade vården utgör grunden i sjuksköterskans yrkesutövande men om medvetenhet saknas för STS finns risken att sjuksköterskan påverkas så till den grad att hen väljer att sjukskriva sig och/eller byta arbetsplats. Slutsats: STS är ett relativt okänt begrepp och det kan vara svårt att se tecken på begynnande symtom. Sjuksköterskan kan utsättas för STS oberoende arbetsplats. Detta kan sänka effekten i yrkesutövandet genom personliga symtom som; irritabilitet, trötthet, minskad empati, depression, återupplevelser av tidigare upplevda traumatiska händelser med flera. Arbetsplatsens ledarskap inverkar på identifieringen av sjuksköterskans utveckling/hanterande av STS. / Background: The nurse has a large responsibility in the near patient care and is expected to be a good listener within the person-centered care. Events that are traumatic affects both the directly affected patient but also the nurse through their secondary exposure. Aim: The purpose of this study is to highlight the incidence of STS in nurses as well as to describe how it affects the quality of care and person-centered care. Method: Literature review of relevant articles in databases PubMed and CINAHL. The results of this literature study are based on 14 articles that met the inclusion and quality criteria. Results: The nurse is affected by STS on several levels, both professionally and personally. The quality of the fundamental person-centered care will be affected if STS is noted and the risk is imminent that the nurse affects to such an extent that they may choose to call in sick and/or change their jobs. Conclusion: STS is a relatively unknown concept. The nurse may face STS independent of workplace and the results can be showed in a lower quality of care and personal symptoms such as; irritability, fatigue, decreased empathy, depression, re- experiences of previously experienced traumatic events, and others. Leadership influence on identification of nurse’s STS development and handling.

Bakgrund: Den globala sjuksköterskebristen och omsättningen av sjuksköterskor är idag ett stort problem som bland annat leder till ökade kostnader och svårigheter att behålla en hög kvalitet på vården. En av anledningarna till att sjuksköterskor sjukskriver sig är den emotionella påfrestning som yrket medför. Compassion fatigue är ett begrepp som belyser de negativa effekter som kan komma av en långvarig exponering för andras lidande. Förutom sjukskrivningar kan compassion fatigue leda till högre benägenhet att begå kliniska misstag, försämrad vård och social isolering. Syfte: Syftet med denna litteraturstudie var att belysa compassion fatigue inom sjuksköterskeyrket genom att utforska de resurser och strategier som sjuksköterskor använder sig av för att motverka compassion fatigue. Metod: En litteraturöversikt baserad på 13 vetenskapliga artiklar. Resultat: Resultatet delades upp i två domäner: resurser och strategier. Att få stöd var den mest förkommande resursen, att ventilera genom samtal var den vanligaste strategin och denna resurs respektive strategi förekom i 12 av de 13 artiklarna. Övriga resurser som framkom var: att ges möjlighet till reflektion och att ha tid och plats för vila. Övriga strategier som framkom var att utöva religion och andlighet, att motionera, att ägna sig åt fritidsaktiviteter, att undvika svåra situationer, att förändra sin inställning samt att sätta gränser och hitta balans. Konklusion: Utifrån denna studie kan slutsatsen dras att sjuksköterskor verksamma inom olika verksamheter och i olika länder anser att socialt stöd samt att ventilera genom samtal på ett informellt sätt är betydelsefulla resurser och strategier för att motverka compassion fatigue. Vidare finns det en otydlighet kring begreppet. För fortsatt forskning är det viktigt att tydligt definiera och särskilja compassion fatigue från liknande begrepp. / Background: Shortage and turnover of nurses is currently a major problem, leading to increased costs and difficulties maintaining high quality care. Emotional stress caused by the nature of the profession is one reason for sick leave amongst nurses. Compassion fatigue as a concept sheds light upon the negative effects caused by long-term exposure to the suffering of others. Compassion fatigue is linked to an increased tendency for clinical mistakes, reduced quality of care and social isolation. Aim: The purpose of this review of literature was to shed light on compassion fatigue within the nursing profession while exploring the strategies and resources that nurses use to deal with this. Method: A literature review based on 13 articles. Findings: The findings of this study were divided into two domains: resources and strategies. The resource and strategy most frequently mentioned by nurses, was to get support and to ventilate their emotions. Both occurred in 12 of the 13 articles. Other resources that emerged were: to be given the opportunity to reflect and to have a time and place for rest. Other strategies that emerged were: to practice religion and spirituality, to exercise, engaging in hobbies, to avoid difficult situations, to change their attitude, to set limits and to find a work-life balance. Conclusion: Based on this study it can be concluded that nurses in several different settings and countries consider social support and to ventilate their feelings in an informal way valuable resources and strategies in managing compassion fatigue. The definition of compassion fatigue suffers from a great ambiguity and needs to be further defined and separated from similar terms.

Individuals who have experienced a traumatic event and develop Post-Traumatic Stress Disorder (PTSD) frequently show deficits in both primarily “cool” and “hot” cognitive executive functions (e.g., traditional & emotional Stroop tasks, respectively) that can be impacted by high affective salience. Given the dimensional nature of psychopathology, questions remain about individuals within the general population who have experienced trauma but do not meet full criteria for PTSD and yet may manifest problems in these areas, especially areas of hot and cool executive functioning (EF). Thus, the current project was designed to assess hot and cool EF in a relatively large sample of individuals from the general population who have experienced trauma and currently demonstrate sub-clinical levels of post-traumatic symptoms. The Stroop task, Emotional Stroop task, and a novel modified Implicit Association Test were utilized to assess EF across a spectrum of individuals with varying traumatic histories and level of post-traumatic symptoms. Results suggest that a greater frequency of trauma experiences was moderately associated with worse performance on both hot and cool executive functioning measures. Specifically, females within the sample evidenced a close relationship between traumatic experiences, post-trauma symptoms, and executive functioning. Clinical and theoretical implications are discussed.