Experiencing early life adversity (ELA) increases the risk of anxiety disorders, such as generalized anxiety disorder and post-traumatic stress disorder, with disproportionally higher risk in women compared to men. Neurodevelopmental and behavioral outcomes following ELA are multifaceted and are influenced heavily by the type of adversity experienced and sex of the individual. A major contributor to emotional dysfunction and anxiety disorders resulting from ELA are changes in fear and threat circuitry. Children who experienced ELA have been reported to show an accelerated development of the amygdala, a region involved in processing threat, and greater cerebrospinal levels of corticotrophin releasing hormone (Crh), an orchestrator of neuroendocrine and behavioral responses to stress. Work in rodents have linked Crh signaling within the lateral central amygdala (CeAL) with processing and responding to threat, core features disrupted in anxiety-related disorders. Further, sex biases in risk and symptom presentation have been proposed to be related to sexual dimorphic signaling of Crh across the brain that differentially influence a variety of Crh-dependent behaviors. However, it remains unclear what properties of ELA portend differential neurobiological risk, what is the basis of sex-differences for negative outcomes, and how specific mechanistic changes give rise to certain endophenotypes. In this work, I use genetic, cellular, and behavioral approaches to explore the impact of ELA and sex on perinatal development in mice and the functional consequences of altered Crh neuron activity in the CeAL on threat responding in adulthood. In Chapter 1, I review how factors such as sex and type of ELA influence amygdala development and Crh. In Chapter 2, I assess the impact of two forms of ELA, maternal separation (MS) and limited bedding and nesting (LBN) on perinatal development and anxiety-like behavior. Both forms of ELA shifted the timing of somatic maturation and basal CORT levels and led to increased anxiety-like behaviors, but the degree of the impact depended on the sex and type of adversity experienced. In Chapter 3, I demonstrate that a distinguishing feature between types of ELA was the predictability of maternal care. The type of ELA also contributed to sex-differences in Crh related gene expression in the perinatal amygdala. Increased expression was primarily observed in males following MS and in females following LBN. In Chapter 4, I investigate the functional consequences of ELA in the form of LBN on the activity of CeALCrh+ neurons in vivo and their causal role in threat reactivity indexed by the startle response. LBN rearing led to sustained activity of CeALCrh+ in female mice but diminished in male mice. Persistent activity of this population was necessary for and predicted the magnitude of startle responding. In Chapter 5, I discuss important considerations when integrating new advancements in the study of ELA and the use of sex as a biological variable. Collectively, this work deepens our understanding of the neurobiological mechanisms impacted by sex and ELA and holds promise for future strategies that may consider the sex and specific experiences of the individual to target specific endophenotypes and address the underlying root causes of anxiety disorders.

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School-age children are at high risk of experiencing traumatic and stressful events that can negatively impact their academic, emotional, and behavior performance (Brock et al., 2016). Any stressful situation (i.e., natural disaster) or adverse childhood experience (ACE) can potentially become a traumatic event for a child or adolescent. The current literature indicates that 60% of children experience at least one ACE, putting them at high risk for a variety of health and social problems (Manyema et al., 2018). Natural disasters adversely impact children's life as they have the potential to destroy physical structures and injure the child or family members. According to Inoue and colleagues (2018) natural disasters can additionally be considered as an ACE. The purpose of this study was to explore the relationship between PTSD symptoms of students who have experienced a natural disaster (e.g., hurricane exposure) and students’ internalizing and externalizing behaviors. Participants included 75 students from elementary, middle, and high school in a school district in the Southeastern United States. Linear regression showed that PTSD symptoms are significantly correlated with internalizing and externalizing behaviors. However, moderation and interaction effects showed that he type of hurricane exposure did not significantly moderate the relationship between PTSD symptoms and students' internalizing and externalizing behaviors. Implications from these results suggest that trauma-informed strategies are needed for students that are exposed to a traumatic event.

<p>Magnetic resonance spectroscopy (MRS) is a non-invasive diagnostic technique that provides unique information about the biochemical composition of the human body. By excluding the overwhelming signals from water and fat, clinically relevant biomarkers such as lactate, N-acetyl aspartate, choline, creatine, glutamate/glutamine (Glx), gamma-aminobutyric acid (GABA), glutathione, and myoinositol can be reliably quantified. MRS has diverse applications in investigating the metabolic window of a wide range of biochemical processes. </p> <p>Here, we have utilized MRS to better understand chemical changes associated with neurological disorders and treatment response. We have investigated neurometabolic imbalances in brain regions related to post-traumatic stress disorder (PTSD). MRS was applied to better understand the neurobiological processes of hyperbaric oxygen therapy in military veterans with clinically diagnosed traumatic brain injury and/or PTSD.</p>

Traumatic events are a common part of the human experience. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are common sequelae of trauma that are both associated with poor physical health and mortality. The objective of this dissertation is to identify common and unique risk factors for each disorder in order to identify at-risk groups for PTSD and/or depression following trauma. his dissertation is organized into five parts: 1) an introduction, 2) a simulation study exploring the use of test equating methods to standardize the Hospital Anxiety and Depression Scale (HADS) to the Beck Depression Inventory II (BDI) in order to create common depression scale across studies in a pooled analysis, 3) an individual participant data meta-analysis on risk factors for PTSD and depression following incident trauma, 4) a Mendelian Randomization analysis of childhood abuse victimization and neuroticism on PTSD and depression, 5) a discussion of the findings and avenues for future research. The simulation study found that an Equated BDI diagnosis had higher specificity (range: 0.86 to 0.91) compared to using the HADS diagnosis (range: 0.80 to 0.82) when the correlation between the BDI and HADS was greater than 0.7, but had lower sensitivity (Equated BDI range: 0.67 to 0.72; HADS range: 0.84 to 0.92). The Equated BDI diagnosis was found to improve statistical power when the prevalence of depression was 20% or higher with greater improvements when the proportion of studies assessing the depression with the HADS was less than 50%. In the individual participant data meta-analysis, common risk factors for acute and persistent MDD and PTSD were found including increased risk for female sex and reduced risk for those who experienced an accident versus an assault or other traumatic event as the index trauma. Acute MDD symptom severity was associated with persistent PTSD and remained significant after inclusion of acute PTSD symptom severity. In an analysis of PTSD symptom clusters, only reexperiencing symptoms were associated with persistent PTSD along with MDD symptom severity. In models of persistent MDD, acute PTSD symptom severity was associated with persistence, but neither overall symptom severity nor cluster symptom severities were associated with persistence after inclusion of acute MDD symptom severity. In the Mendelian Randomization analysis, childhood abuse victimization was found to be associated with PTSD symptom severity but was not associated with an increased odds of a MDD diagnosis, while neuroticism was associated with an increased odds of a diagnosis of MDD, but was not associated with an increase in PTSD symptom severity. Findings from the meta-analysis that leveraged the use of item-response theory imply that while PTSD and MDD share many risk factors for onset of symptoms following the experience of a traumatic event, persistence of symptoms depends most strongly on initial symptoms. However, PTSD and MDD were also found to have different relationships with childhood abuse victimization and neuroticism, indicating that some risk factors are unique to each disorder. Future studies can build upon these results, especially when pooling data from different studies, to further explicate the associations between PTSD, MDD, and their causes.

The issues surrounding asylum seekers in host countries like Sweden are severe concerns that need immediate attention, issues ranging from daily stressors constitute major problems to their mental health. There is therefore a need for both governmnet and non-government organizations to provide services that will upkeep the mental health status of these people. Notwithstanding, this study aimed to have a holistic view on the services provided by Soulidarity and Human Rights and Svenska Kyrkan organizations in Sweden. Through semi-structured interviews conducted with represntatives from these organizations based on the research questions that target the perception of their services, challenges, and recommendations. The empiricial data collected were analyzed using the theoretical framework of social support theory. The empricial result from this study shows that; asylum helped organizations provided a dimension of services ranging from individual, counseling, and leisure support services. Also, the services provided by these organizations were impactful to; build the self-confidence, abilities to perform tasks and build the self-esteem of these traumatic stress asylum seekers who came for help.  Furthermore, the workers in these organizations encountered challenges with working under complex migration and intergration policies that do not favor these asylum seekers, financial challenges, language difficulties, and internal problematic behaviors displaced from traumatic stresses asylum seekers. Finally, the workers in these organizations recommend that; changes in policies, financial improvement, and recruitment of more staff, strengthening sensitization, and empowerment of group rights are better ways of improving their services.

Bakgrund: Empatitrötthet påverkar många inom vården och kan ge stora konsekvenser för den som drabbas. Fenomenet kopplades till sjuksköterskor för första gången 1992 och är ett begrepp inom omvårdnad som syftar till att beskriva en form av utmattningssyndrom som kan drabba sjuksköterskor. Trauman är en oundviklig del av sjuksköterskans yrke, så väl som strävan efter ett empatiskt förhållningssätt. När dessa komponenter hamnar i obalans kan det påverka sjuksköterskans hela person, såväl kropp, ande som själ. Syfte: Att undersöka sjuksköterskors upplevelser av empatitrötthet. Metod: En systematisk kvalitativ litteraturstudie har utförts baserat på kvalitativa ansatser för att undersöka sjuksköterskors upplevelser av empatitrötthet. Resultat: Det finns många bidragande faktorer till utvecklandet av empatitrötthet. Specifika grupper av sjuksköterskor, nyutbildade och de som anser sig vara “frälsare”, löper störst risk att drabbas. Ett empatiskt förfarande är viktigt för att kunna ge en god vård. Konsekvenserna av empatitrötthet och avsaknaden av empati kan leda till negativ inverkan på sjuksköterskan, patienten och vården i sin helhet. Det finns vissa hanteringsstrategier att tillgå, främst diskuteras egenvård.  Konklusion: Litteraturstudien visar på bredden och komplexiteten av begreppet empatitrötthet. Resultatet visar på vikten av ökad kunskap kring fenomenet och hur det kan förebyggas samt lindras. / Background: Compassion fatigue affects many in healthcare and can have significant consequences for those who experience it. The phenomenon was first linked to nurses in 1992 and is a concept within nursing that aims to describe a form of burnout that can affect nurses. Trauma is an inevitable part of a nurse's profession, as well as the pursuit of an empathetic approach. When these components become imbalanced, it can affect the nurse's entire being, including their body, mind, and soul. Aim: To investigate nurses' experiences of compassion fatigue in closed care.  Method: A systematic qualitative literature review has been conducted based on qualitative approaches to examine nurses' experiences of compassion fatigue.  Result: There are many contributing factors to the development of compassion fatigue. Specific groups of nurses, such as newly graduated nurses and those who consider themselves "saviors," are at the highest risk of being affected. An empathic approach is important in providing good care. The consequences of compassion fatigue and the lack of empathy can have a negative impact on the nurse, the patient, and the healthcare system as a whole. There are some coping strategies available, primarily self-care.  Conclusion: The literature review demonstrates the breadth and complexity of the concept of compassion fatigue. The results emphasize the importance of increased knowledge about the phenomenon and how it can be prevented and eased.

This dissertation investigates the multiple grammars of trauma, survival, and witnessing through which personal suffering was articulated and acted upon in the aftermath of November 13, when a series of attacks on the Bataclan theater, cafés in Paris, and the Stade de France in Saint-Denis left 131 dead and thousands of survivors. Based on four years of participant observation research and original archival scholarship in France between 2018 and 2022, this research brings ethnology and history together to examine the aftereffects of colonialism not only “far afield” but also—within an epistemological frame that foregrounds relationality—at the diasporic “center.” “Postmetropolitan Trauma,” as I term it, thus offers a novel approach to the history of our present. Following the 2015 attacks in France, state insurers are processing individuals claims for PTSD compensation from the Guarantee Fund for Victims of Acts of Terrorism (FGTI). Meanwhile, an adjacent diagnostic practice is taking place at the National Institute of Health and Medical Research, where neuropsychologists are conducting biomedical research on PTSD in survivors. As testimonies are being processed by FGTI for financial compensation, on the one hand, and for a science of memory, on the other, a paradox arises: The ideal survivor for the neuropsychologist is she who overcomes her PTSD, and yet, for the purposes of trauma compensation, that is, from a forensic point of view, the survivor must remain symptomatic. In analyzing this paradox, I uncover reparation as a dynamic process of community making which is wider than its result, the final awarding or denial of compensation. While studies of the “War on Terror” have focused on the rise of the terrorist as the new Other, “Postmetropolitan Trauma” instead centers on the processes of subjectivation, identity construction, and community making that compensation produce in the wake of November-13. Who is considered a “survivor,” and as such an insider to trauma, and who is denied compensation as a “mere” witness? This novel approach reveals that the themes of violence and belonging are not restricted to the construction of perpetrators alone, but also shape the treatment of victims. In so doing, the dissertation proposes a new model for understanding the contradictory impulses of inclusion and exclusion, of violence and care, that shape the making of moral communities through historical trauma.

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