Attention biases to trauma-related information contribute to symptom maintenance in Posttraumatic Stress Disorder (PTSD); this phenomenon has been observed through various behavioral studies, although findings from studies using a precise, direct bias task, the dot probe, have been mixed. PTSD neuroimaging studies have indicated atypical function in specific brain regions involved with attention bias; when viewing emotionally-salient cues or engaging in tasks that require attention, individuals with PTSD have demonstrated altered activity in brain regions implicated in cognitive control and attention allocation, including the medial prefrontal cortex (mPFC), dorsolateral prefrontal cortex (dlPFC) and amygdala. However, remarkably few PTSD neuroimaging studies have employed tasks that both measure attentional strategies being engaged and include emotionally-salient information. In the current study of attention biases in highly traumatized African-American adults, a version of the dot probe task that includes stimuli that are both salient (threatening facial expressions) and relevant (photographs of African-American faces) was administered to 19 participants with and without PTSD during functional magnetic resonance imaging (fMRI). I hypothesized that: 1) individuals with PTSD would show a significantly greater attention bias to threatening faces than traumatized controls; 2) PTSD symptoms would be associated with a significantly greater attentional bias toward threat expressed in African-American, but not Caucasian, faces; 3) PTSD symptoms would be significantly associated with abnormal activity in the mPFC, dlPFC, and amygdala during presentation of threatening faces. Behavioral data did not provide evidence of attentional biases associated with PTSD. However, increased activation in the dlPFC and regions of the mPFC in response to threat cues was found in individuals with PTSD, relative to traumatized controls without PTSD; this may reflect hyper-engaged cognitive control, attention, and conflict monitoring resources in these individuals. Additionally, viewing threat in same-race, both not other-race, faces was associated with increased activation in the mPFC. These findings have important theoretical and treatment implications, suggesting that PTSD, particularly in those individuals who have experienced chronic or multiple types of trauma, may be characterized less by top-down “deficits” or failures, but by imbalanced neurobiological and cognitive systems that become over-engaged in order to “control” the emotional disruption caused by trauma-related triggers.

The literature on clinical interventions for suicide prevention indicates that low-income, suicidal African American females are an historically underserved population. Contributing to this lack of service are the intersecting influences of race, ethnicity, culture, gender, sexual orientation, socioeconomic status and related oppressions (APA, 2007). In suicidal African American females, a higher level of reported symptoms of posttraumatic stress disorder has been found in suicide attempters as compared to nonattempters (Kaslow et al., 2000), and PTSD has been shown to be associated with heightened risk of an ensuing suicide attempt (Wilcox, Storr, & Breslau, 2009). One factor affecting manifestation of PTSD symptoms is attachment style. When a person with an insecure attachment style experiences a traumatic event(s), they are more likely to develop PTSD (Dieperink, Leskela, Thuras, & Engdahl, 2001). However, if effective coping methods are learned, more severe symptoms of PTSD are less likely (e.g., DeRoma et al., 2003; Johnsen, Eid, Laberg, & Thayer, 2002). Multiple studies examining the relationship between attachment style and coping find insecure attachment linked to poor coping skills (e.g., Schmidt, Nachtigall, Wuethrich-Martone, & Strauss, 2002; Yih-Lan, 2003). Those with insecure attachment styles are more likely to employ less effective coping methods leading to increased distress and interpersonal problems. However, there is research to support the possibility of insecure attachment style shifting to a more secure form, potentially through learning coping skills that offset maladaptive coping. This study examined the mediating role of coping on the relationship between attachment style and PTSD symptoms. One hundred and fifty African American women enrolled in a project designed to understand the experiences of low income, African American women completed a Demographic Data Questionnaire, The Relationship Style Questionnaire (RSQ) (Griffin & Bartholomew, 1994), The Ways of Coping, Revised (Folkman & Lazarus, 1985), and The Posttraumatic Diagnostic Scale (PDS) (Foa, Cashman, Jaycox, & Perry, 1997). The relationships among factors were examined using Structural Equation Modeling. Results indicated a significant direct path between Insecure Attachment and PTSD Symptoms of moderately weak strength, between Insecure Attachment and Emotion-Focused Coping of moderate strength, and between Insecure Attachment and Problem-Focused Coping of moderately weak strength. However, neither Emotion-Focused nor Problem-Focused Coping mediated the relationship between Insecure Attachment and PTSD symptoms. Clinical implications, limitations of the study, and future directions are discussed in terms of these results.

<p>Up to two million women worldwide have obstetric fistula, a maternal morbidity prevalent in developing countries that causes uncontrollable leaking of urine and/or feces and a persistent bad odor. There is both theoretical and empirical evidence for psychopathology in patients presenting for fistula surgery, albeit with methodological limitations. The current studies sought to improve on past limitations of study design. Study A compared psychological symptoms and social support between fistula patients and a comparison group recruited from gynecology outpatient clinics. Measures included previously validated psychometric questionnaires, administered orally by data collectors. Results showed that compared to gynecology outpatients, fistula patients had significantly higher levels of depression, traumatic stress, somatic symptoms and avoidant coping, and had lower social support. Study B investigated changes in psychological symptoms, stigma and social support between the time of admission for fistula repair and 3 months after discharge from the hospital. At follow-up, fistula patients reported significant improvements in all study outcome variables. Exploratory analysis revealed that the extent of leaking was associated with depression and PTSD. These results indicate the potential benefit of mental health interventions for this population. Additionally, future research may clarify the relationship between residual leaking after fistula surgery, and its effect on post-surgery mental health outcomes.</p> / Dissertation

No description available.

Das überwiegend männliche Einsatz- und Rettungspersonal (Polizei, Feuerwehr, Sanitäter, Justizvollzugsbedienstete) zeigt nach berufsbedingten Traumata häufig Schwierigkeiten bei der Akzeptanz von psychotherapeutischen Hilfsangeboten. Im vorliegenden Beitrag wird diese Problematik anhand von Fallbeispielen sowie konzeptuellen Überlegungen des Zusammenhangs zwischen Männlichkeit und Therapiemotivation diskutiert. Klinische Erfahrungen zu männerspezifischen Komplikationen der Posttraumatischen Belastungsstörung (PTBS) und das Modell eines Risikoprofils männlicher Traumaopfer in Einsatzberufen («Alpha-Männer») werden dargestellt, sowie theoretische Einordnungen in sozialkognitive Theorien der Männlichkeit und Entstehungsmodelle von Traumafolgen vorgenommen. Der Beitrag schließt mit der Skizzierung eines Interventionsvorschlags für berufsbedingte Traumata in den männertypischen Berufsbereichen. / Persons in the predominately male domains of high-risk occupational groups (police, fire department, rescue teams, prison guards) often show difficulties in accepting psychological help after traumatization. The paper presents case reports and conceptual discussion of the relationship between masculinity and treatment motivation. Clinical experiences on male-specific complications of posttraumatic stress disorder (PTSD) and a high risk profile of male work-related trauma victims (‘alphaman’) are discussed. Theoretical discussion furthermore includes social cognitive theories of masculinity and of development of PTSD. The paper concludes with suggestions for interventions relevant to the outlined problems. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O presente trabalho investiga os diferentes processos sociais relacionados ao surgimento do transtorno de estresse pós-traumático (TEPT) no contexto brasileiro. Categoria diagnóstica norte-americana instituída na década de 1980 pela terceira edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (Diagnostic and Statistical Manual of Mental Disorders DSM-III) uma publicação da Associação Americana de Psiquiatria (American Psychiatric Association APA) o TEPT tornou-se, desde a sua aparição, uma das categorias nosológicas mais difundidas, estudadas e diagnosticadas da psiquiatria contemporânea. A partir do cotidiano de um laboratório de pesquisa e tratamento do TEPT, de análises conversacionais dos atendimentos médicos, de um estudo das diferentes escalas psiquiátricas utilizadas no acompanhamento dos pacientes e de pesquisas sobre a mídia relacionada às experiências traumáticas buscou-se entender os entrelaçamentos entre os processos de difusão e a construção da legitimidade da categoria diagnóstica do TEPT. A abordagem aqui proposta pretende ir além do aparente dilema entre uma concepção medicalizada que assumem a existência o TEPT como um fenômeno natural e as abordagens sócio-antropológicas que veem o TEPT como uma experiência culturalmente construída. Por fim, pretendo mostrar, pela investigação dos alicerces políticos e culturais dos denominados transtornos mentais, que o estatuto social dos diagnósticos e dos tratamentos da moderna psiquiatria só pode ser compreendido tendo como referência as dinâmicas de longo prazo nas sociedades contemporâneas. / This dissertation examines the social processes related to the reception of the Post Traumatic Stress Disorder (PTSD) in Brazil. Originating in the United States during the 1980, this diagnostic category first appeared in the Diagnostic and Statistical Manual of Mental Disorders DSM-III, a publication of the American Psychiatric Association APA. It soon became one of the most studied and diagnosed syndrome of contemporary psychiatry. In order to map out the interrelated processes of diffusion and construction of PTSD I resorted to the analysis of a gamut sources: the daily operation of a research and treatment psychiatric institution, the verbal exchanges between psychiatrists and patients during medical appointments, psychiatric manuals and diagnostic tables and questionnaires, and mass media articles on PTSD. The approach adopted here intends to go beyond the apparent dilemma between a medicalized conception of PTSD as a natural phenomenon and an anthropological approach that sees PTSD as a culturally construed social experience. Finally, I also intend to show that the political and cultural underpinnings of the so called mental disorders cannot be correctly understood without taking into consideration the longue dureé dynamics of contemporary societies.

The stress response that is triggered in an organism when facing a stressor is crucial to maintain stability and health. However, exposure to a severe or a chronic stressor can be maladaptive and cause several impairments in the body, such as cardiovascular diseases, atrophy of the brain, and psychopathologies mainly characterized by anxiety and depression. Resilience or vulnerability to stress is mediated through different biopsychosocial factors, one of which is the use of coping strategies. Different types of coping strategies have been linked to either adaptive or maladaptive outcomes, and are an important factor to consider regarding stress resilience. Cultural differences in symptoms of stress, anxiety, depression, and coping strategies were assessed through self-report measurements in the form of two questionnaires. 75 Swedes and 67 Sri Lankans between the age of 18-50 took part in the study. The most significant findings of this study suggest that 1) Sri Lankans experience more symptoms of stress, anxiety, and depression compared to Swedes, 2) dysfunctional coping is correlated with higher levels of stress, anxiety, and depression in both Sweden and Sri Lanka, 3) higher levels of stress predicts higher levels of anxiety and depression in both Sweden and Sri Lanka, and 4) both countries tend to favor problem-focused coping over emotion-focused and dysfunctional coping. A discussion regarding the current findings, including limitations of the study is provided, as well as directions for future research.

This dissertation focuses on the field of psychosocial counselling intended for the people involved in traffic accidents. Traffic accidents often result in considerable whole-society damages and significant reduction in the life quality of affected individuals or their relatives. Traffic accidents may often represent nerve-racking, traumatic events which significantly go beyond the scope of common human experience. People involved in traffic accidents may suffer from mental problems which might impair an area of their social functioning. As a result, traffic accidents have significant impact not only to the lives of persons directly involved, but also to their relatives. Victims´ self-help may fail and, without the expert intervention, may lead to the whole-life misery. One of possible ways of how to help the people involved in the traffic accident is the psychosocial counselling which is the subject of this dissertation. This thesis, among others, aims to analyse the offer of psychosocial consulting services intended for traffic accident participants in the town of České Budějovice. To this end, the combination of qualitative and quantitative data collection techniques, questionnaire survey of experts and organizations and semi-standardized interviews with experts operating in České Budějovice were carried out. Other goals of the thesis included mapping of public awareness concerning the possible utilization of psychosocial counselling for traffic accident participants in České Budějovice, as well as, mapping the interest in using such services on the public{\crq}s part in this town. A public questionnaire survey was performed to reach these objectives. The findings revealed that there is a public demand for services of an organization providing the people involved in traffic accidents with psychosocial counselling. The public awareness of the possibility of using psychosocial counselling in this area, however, proved to be low in České Budějovice. The survey has also shown that the offer of psychosocial counselling focused on traffic accident participants does exist in this town. The dissertation may contribute to higher awareness of not only the professional employees who provide the assistance (psychologists, social workers, non-profit organization employees, physicians, police officers, fire fighters), students of humanities and volunteers involved in giving psychosocial assistance to the victims of disasters, but also of those people involved in traffic accidents whom anyone of us may become.

No description available.

Objectif. L’enquête Santé mentale en Population Générale a été réalisée, en 2003, par le centre collaborateur de l’OMS (CCOMS-Lille) en partenariat avec l’hôpital psychiatrique Mahfoud Boucebci (EHS-Alger). Les données portant sur le risque suicidaire sont exploitées dans le présent travail. Son objectif principal est d’étudier la relation entre le trouble de stress post-traumatique et le risque suicidaire. Méthode. Huit cent quatre-vingt-dix-neuf sujets vivant en Algérie (n=899) ont participé à cette enquête. Le Mini International Neuropsychiatric Interview (MINI) a été utilisé afin de recueillir des données relatives aux troubles mentaux. Résultats. 61 % de la population (n=548) a été exposée à des événements potentiellement « traumatisants ». La prévalence du PTSD est estimée à 13,5 % (n=121) dans l’échantillon global. 13,6 % des sujets (n=122) présentent un risque suicidaire. Aucune relation directe entre le PTSD et le risque suicidaire n’a été observée. Toutefois, le PTSD augmente significativement le risque suicidaire chez les non-pratiquants (OR=5.81 ; IC [1.948-17.328] ; p=0.001) en comparaison avec les sujets pratiquants. Le risque suicidaire est 10 fois plus élevé chez les sujets pratiquants souffrant de problème d’alcool (OR =10.26 ; IC [3.133-33.609] ; p<=0.0001). Conclusion. Cette première étude en population générale souligne la prévalence relativement élevée du risque suicidaire et de PTSD. La pratique religieuse est un élément protecteur contre les conduites suicidaires. Les résultats qui en découlent pourraient être exploités dans le but de fonder une démarche de prévention du risque suicidaire. / Objective. The Mental Health Survey on General Population was conducted in 2003 by the WHO collaborating centres in Lille (WHOCC-Lille) in partnership with the Mahfoud Boucebci psychiatric hospital (EHS-Alger). Data regarding suicidal risk are exploited in the present study. The main objective aims at studying the relationship between post traumatic stress disorder and suicidal risk.Method. Eight hundred ninety-nine subjects living in Algeria (n=899) took part in this survey. Mini International Neuropsychiatric Interview (MINI) was used to collect data related to mental disorders and suicidal behaviors. Results. 61% of the population (n=548) were exposed to « traumatic » events. PTSD prevalence is estimated to be 13.5% (n = 121) in the overall sample. 13.6% of the subjects (n = 122) present a suicidal risk. There is no direct relationship between PTSD and suicidal risk.However, PTSD significantly increases the suicidal risk in non-practising subjects (OR = 5.81, CI [1.948-17.328], p = 0.001) compared to practising subjects. Suicidal risk is 10 times higher in practising subjects suffering from alcohol problems (OR = 10.26, IC [3.133-33.609], p <= 0.0001). Conclusion. This first study in the general population highlights the relatively high prevalence of suicidal risk and PTSD. Religious practice is a protective element against suicidal behavior. These results could be exploited so that a preventive approach to suicidal risk can be put in place.