Objective: A sizable body of literature has now examined posttraumatic stress (PTS) symptoms in youth in the aftermath of disaster. Meta-analysis is the preferred tool with which to inform funding decisions, service delivery, and public policy. Method: The present meta-analysis quantitatively synthesized this literature (k=96 studies; Total N = 74,154), summarizing the magnitude of overall associations between disasters and youth PTS, and identifying child, disaster, and study method factors associated with variations in the magnitude of these associations. Results: Despite variability across studies, disasters had a significant effect on youth PTS symptoms, falling in the small-to-medium range of magnitude. Aspects related to pre-existing child characteristics, the disaster and the child’s disaster exposure, and study methodology are significantly associated with variations in the magnitude of disaster effects on youth PTS symptoms. Specifically, female gender, higher death toll, closer proximity, personal loss, and perceived threat and distress at the time of the event were each associated with increased post-disaster PTS in youth. Regarding methodological factors, studies conducted within the first year postdisaster, studies that used established PTS measures, and studies that relied on childreport data identified a significant effect on youth PTS, whereas studies conducted after the first year, studies relying on non-established measures, and studies relying on parentreport data did not. Conclusion: In the aftermath of disasters, governmental funding agencies and private foundations provide substantial resources for child services following disasters. The present meta-analytic findings can help to inform optimal allocation of these resources and targeted intervention efforts, as well as the development and refinement of new interventions for youth suffering in the aftermath of disasters. / Psychology

Indiana University-Purdue University Indianapolis (IUPUI) / US military personnel often experience ongoing distress after being exposed to traumatic events, and many develop posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Both general theories of stress and coping and cognitive theories of PTSD suggest that traumatic events give rise to distress by negatively influencing important beliefs and goals related to the self, other people, and the world. According to these theories, more positive belief- and goal-systems are associated with less severe symptoms of distress. Two constructs that tap into these systems are general self-efficacy and subjective meaning in life. The overall goal of the current study was to examine the ways general self-efficacy and subjective meaning in life relate to posttraumatic stress and depressive symptoms and symptom clusters in US military personnel, both cross-sectionally and longitudinally. Data from a VA-funded intervention study (n = 191) were examined. Results demonstrated that meaning in life is consistently associated with posttraumatic stress and depressive symptoms and symptom clusters cross-sectionally, whereas general self-efficacy is only associated with some aspects of depressive symptoms. Longitudinal analyses further revealed that meaning in life is associated with the Cluster D symptoms of PTSD and the cognitive-affective symptoms of depression. Interpretations, possible explanations, implications, and future directions are provided. Continued research in this area may identify important targets for treatment that enhance ongoing efforts to facilitate recovery from trauma.

African Americans have reported higher levels of Posttraumatic Stress Disorder (PTSD) symptoms than their Caucasian counterparts in some studies. Variables hypothesized to contribute to differential levels of PTSD symptoms between African Americans and Caucasians that have not been adequately explored in these studies include ethnicity, resource loss, religious coping, and social support. The purpose of this study was to test portions of a model that characterizes the relationship between traumatic events and PTSD symptoms in African Americans and Caucasians. It was hypothesized that ethnicity, perceived ethnic identity, socioeconomic status (SES), resource loss, religious coping, family support, and professional support would be significant predictors of PTSD symptoms. Data from 59 African American children and adolescents, aged 4 to 20, and 54 of their Caucasian counterparts from the Residential Fire Project were used to examine the role of ethnicity, SES, resource loss, religious coping, family support, and professional support in the development of PTSD symptoms. Data from 86 African Americans and 417 Caucasians, aged 15 to 21 from the National Comorbidity Survey (NCS), were used to examine the role of ethnicity, perceived ethnic identity, SES, religious coping, family support, mental healthcare, and non-mental healthcare in the development of PTSD symptoms. Participants in the Fire Project were interviewed individually, and completed self-report questionnaires. Results indicated that only resource loss factors contributed significantly to the prediction of variance in PTSD symptoms. Participants in the NCS were also interviewed individually. Results indicated that mental healthcare, family support, SES, ethnicity, and religious coping contributed significantly to the prediction of variance in PTSD symptoms in this sample. Findings are discussed within a psychosocial model. / Master of Science

For healthcare agencies and other professionals to most efficiently provide aid following large scale community tragedies, agencies and professionals must understand the determinants that lead individuals to require and seek various forms of help. This study examined Andersen's Behavioral Model of Healthcare Use and its utility in predicting service use in a population of students at Virginia Tech following the shootings on April 16, 2007. Data were gathered from surveys given to students at Virginia Tech three months following the shootings and at a one year follow-up. Logistic regression was used to determine variables that predicted service use. Female gender, prior exposure to traumatic events, higher pre-event functioning, higher social support, higher levels of posttraumatic stress and higher psychological distress were found to be predictive of higher probability of service use. Exploratory hypotheses related to the prediction of outcomes as well as service use as a mediator between predictors and outcomes were also examined. Implications for the use of Andersen's model in predicting service use and equitable and efficient distribution of services are discussed. / Ph. D.

Women with histories of interpersonal trauma (physical, sexual, or psychological abuse experienced during childhood, adolescence, and adulthood) are more likely to experience posttraumatic stress symptoms (PTSS) and to develop physical health problems than women without trauma histories. In fact, PTSS and posttraumatic stress disorder (PTSD) have been established in the literature as mediators of the relation between interpersonal trauma and physical health outcomes (e.g., Resnick et al., 1997; Schnurr & Green, 2004). What remains to be determined is a clear understanding of the various mechanisms explaining why individuals with trauma histories, and subsequently PTS symptoms, go on to develop physical health problems. The purpose of this study was to examine the role of health risk behaviours, specifically sexual risk taking and substance use, as possible mechanisms through which interpersonal trauma and PTSS might influence physical health. These relations were examined, through structural equation modelling, in a sample of 475 women currently attending university. Models were tested separately for sexual traumas (childhood sexual abuse and sexual assault experienced during adolescence and adulthood) and nonsexual interpersonal traumas (physical and psychological maltreatment by parents in childhood, witnessing violence between parents, and intimate partner violence in their own relationships). Results indicated that PTSS severity partially mediated pathways from both types of interpersonal trauma, sexual and nonsexual, to adverse health outcomes, contributing to the existing theory that one’s psychological response to a trauma may be more important in determining physical health outcomes than the trauma itself. Furthermore, a significant indirect pathway was found to link nonsexual trauma to risky sexual behaviours through PTSS severity. In addition, PTSS severity fully mediated the relation between nonsexual trauma and substance use behaviours. These latter findings suggest that the likelihood of engaging in substance use and/or risky sexual behaviours may be greater in trauma survivors who are suffering from posttraumatic stress symptoms. Contrary to hypotheses, no significant pathways were found from risky sexual behaviours or substance use to physical health outcomes in the context of trauma variables and PTSS severity. Consequently, these health risk behaviours were not found to operate as mechanisms explaining the link from PTSS severity to physical health outcomes. Limitations and alternative hypotheses are presented. Implications for clinical interventions and recommendations for future research are discussed. / Graduate / 0621 / 0622 / 0384

People all over the world do experience some kind of trauma during their lives. Some may experience more than one trauma, and some may experience more intense trauma, but sooner or later we all experience trauma. Sadly, our children are not excluded. The first aim of this study, was to investigate the influence of trauma on the lives of children in their mid childhood years. The following questions were asked: · What are the specific developmental tasks for middle childhood, regarding their physical, cognitive, affective, social, religious, moral and esthetical development? · What about trauma is so traumatic? · Are there any recognisable and predicted effects, present in children who experienced trauma? · And last, but not least, how do children understand and experience a traumatic death? The second aim of this study was to develop a trauma counselling program for children who experienced a trauma. The program had to focus on the specific needs of children in their mid childhood years. In order to do this, the following points were looked at: · What is the current understanding of trauma? Are there any counselling programs for children available, and how do they work? · There are a vast majority of intervention techniques available, the most popular techniques – playtherapy, bibliotherapy, grouptherapy, arttherapy and narrative therapy, were briefly discussed. · Finally a graphic presentation of a new trauma counselling program was included. To see whether this trauma counselling program could help children to overcome posttraumatic symptoms and prevent posttraumatic stress-disorder, it was implemented during two case studies. · The first case study was a girl that had been bitten by dogs twice. As a result of this trauma, she developed an unnatural fear of dogs. The trauma counselling program was implemented, and after a few weeks the girl was able to conquer and control her fear of dogs. · The second case study was a boy who needed to accept his father’s suicide. The trauma counselling program was adapted to suit his specific needs, and once again the program helped the boy to understand and accept his father’s suicide. The success of these two case studies, lead to the acceptance of this study’s hypothesis, namely, that if one developed a trauma counselling program that are compatible with the needs of children in their mid childhood years, it will help children to accept and overcome trauma. Therefore posttraumatic stress symptoms will be reduced and post-traumatic disorder will be prevented. / Dissertation (MEd (Learning Support, Guidance and Counselling))--University of Pretoria, 2006. / Educational Psychology / unrestricted

Every day people are exposed to crimes in Sweden, which can lead to both emotional and practical difficulties. Having the opportunity to get support and help after a traumatic incident can reduce the negative consequences of a crime, such as posttraumatic stress disorder and secondary victimization. In many communities in Sweden there are local support services for the crime victims, but in the district of Östra Norrbotten there are no support activities that specifically address this issue. The purpose of this thesis is to investigate if the police in Östra Norrbotten feel that they can offer the crime victim sufficient support or refer to such support. Eight police officers in the district were interviewed to learn about their experiences. The results show that the majority of respondents felt that there are gaps in the field they can´t provide the crime victims to a support that they deem as sufficient or refer to such support. The fact that crime victims do not receive support can lead to negative impact on the recovery from all events. / <p>Validerat; 20130317 (global_studentproject_submitter)</p>

Children in the child welfare system comprise a group characterized by their exposure to trauma via experiences of maltreatment, under circumstances presenting multiple risk factors for traumatic stress. High rates of posttraumatic stress have been observed in this population. However, there is currently no standard for the universal screening of children in child welfare for trauma exposure and traumatic stress. The purpose of this study was to analyze the trauma experiences of a sample of maltreated children and examine whether child welfare workers are effective screeners of traumatic stress symptoms with children from their caseloads. Method: A sample of children (N= 131) with trauma screenings completed by their child welfare workers and clinical measures of traumatic stress symptoms based on self or caregiver report was analyzed. Descriptive and correlational analyses were conducted. Hypotheses were tested with a series of four hierarchical regression models to determine whether workers’ screening information regarding child age, trauma exposure history and symptoms of traumatic stress were predictive of outcomes on the clinical measures completed. Results: Findings from the analyses revealed complex trauma exposure histories and high rates of traumatic stress symptoms among this generally younger sample of maltreated children. Additionally, the models tested supported workers’ efficacy in screening for symptoms of total posttraumatic stress and specific trauma symptoms of intrusion and avoidance. Workers were less effective in screening for the traumatic stress symptoms associated with arousal. Implications: These findings support the importance of identifying the trauma recovery needs of maltreated children and the utility of child protection workers in assisting with the trauma screening process. Implications are provided for associated practices, policies and training efforts regarding the implementation of a trauma screening protocol in child welfare. This would serve as a critical pathway for creating trauma-informed systems that better address the needs of maltreated children and their families.

Re-experiencing trauma in the form of intrusive, image-based memories (here referred to as flashbacks) is a hallmark symptom of Post-Traumatic Stress Disorder (PTSD). There are successful treatments available for full-blown PTSD; however, these can only be administered one month post trauma. There are limited interventions that can be administered to reduce flashbacks in the early aftermath of trauma. The overarching aim of this thesis was to use an experimental psychopathology approach, the trauma film paradigm, to investigate the reduction of flashbacks post-trauma using the cognitive task, Tetris. Chapter 1 provides a literature review of experimental research that has used the trauma film paradigm. Chapter 2 reviews experimental work on disrupting memory reconsolidation in humans. Chapter 3 details pilot work on the development of an experimental protocol based upon these literature reviews. Experiment 1 (Chapter 4) investigated disrupting reconsolidation for a 24 hour old analogue trauma (aversive film material) using the cognitive task, Tetris. A procedure designed to disrupt flashback reconsolidation (a memory reactivation task for the film followed by playing the computer game Tetris) was compared with a no-task Control. Compared to Control, those in the Tetris condition reported fewer flashbacks to the film in an intrusion diary across the subsequent week and on convergent measures of flashback frequency. Experiment 2 (Chapter 5) provided a test of replication for findings from Experiment 1, in addition to extending findings by dismantling the procedure’s component parts. Participants who underwent Tetris only (without memory reactivation) or memory reactivation (without Tetris) did not demonstrate a reduction in flashbacks and were comparable to the no-task control condition. Both a memory reactivation task plus Tetris in combination were critical for reducing subsequent flashbacks for a consolidated memory for a trauma film. Experiment 3 (Chapter 6) tested whether playing Tetris could help disrupt flashback memories for an analogue trauma (film) if administered prior to film viewing, relative to a no-task control condition. Results showed that playing Tetris before a trauma film did not reduce flashbacks, as demonstrated via an intrusion diary and convergent flashback measures. Chapters 7 reviews email feedback relating to playing Tetris after experiencing real-life adversity from members of the public. Chapter 8 explores a form of treatment for trauma in a NHS, complex patient setting. Chapter 9 discusses the findings from all chapters with reference to their implications and limitations, and new directions for future research. Overall, findings using analogue trauma suggest that memory reactivation followed by playing Tetris may be promising for development as a post-trauma ‘cognitive vaccine’ to disrupt the both the consolidation and potential reconsolidation of flashback memories.

Background: Preliminary evidence suggests there are differences in how older people and younger people with posttraumatic stress disorder (PTSD) present. However, currently little robust evidence exists relating to the presentation, assessment and intervention of PTSD in a rapidly ageing population. Faced with limited and conflicting evidence, clinical psychologists are reliant on their clinical expertise to make decisions in this context. Method: Eight studies reporting current prevalence of PTSD in older people were systematically reviewed. Semi-structured interviews with eight clinical psychologists with experience of assessment and intervention of post-traumatic stress symptomology in older people were analysed according to grounded theory methods. The analysis abstracted categories of data to construct a substantive theory of clinical decision making in this context. Results: Current and 12 month prevalence of PTSD ranged from 0.7% to 4.0% and 0.2% to 0.4% respectively. Partial PTSD was estimated at 1% to 10%. The quality of evidence limits the generalisability of the results. ‘Balancing complexity, resources and demand’ emerged from participants’ accounts as the core theoretical category, underpinning decision making in this context. Seven sub-categories comprise the model, ‘culture’; ‘NHS’; ‘clinician competencies’; “what the client brings”; ‘reconciling understanding’; ‘tailoring’ and ‘therapeutic relationship’. Conclusions: PTSD appears to be relatively rare among older people but more research is required to better understand the presentation and prevalence of full and partial PTSD. The theoretical model is broadly consistent with extant literature pertaining to the adaptation of psychological therapy for older people, offering further detail on implementation and the influence of treatment non-specific factors.