Background Posttraumatic stress disorder (PTSD) brings with it diagnostic symptoms that can be debilitating and persist for years. Left untreated, PTSD can have far-reaching and damaging consequences – for the individual, families, communities, and society at large. While early detection and intervention is recognized as key to the effective treatment of PTSD, many who suffer from PTSD do not seek essential health services. The aim of this study was to answer the research question: based on existing literature, what are the barriers and facilitators to help-seeking for individuals with PTSD? Methods A systematic review, modeled on the Joanna Briggs Institute (JBI) methodology for systematic reviews, examined studies cited in PsycINFO, Medline, Embase, CINAHL and PILOTS published from January 2000 to November 2015. Eligible studies measured barriers and facilitators to help-seeking for adults with PTSD. Two reviewers independently screened citations and double data extraction was exercised. Results Of 1,759 potentially relevant citations, sixteen studies were included, published between 2003 and 2015 and based in five countries, predominantly within the United States (n=12). Thirteen studies focused on military as a target population. Eight principal barrier themes and seven principal facilitator themes were identified, under which supportive subthemes were categorized. Conclusions In identifying prominent barriers and facilitators to help-seeking for individuals with PTSD, this review highlights opportunities to inform policies and programs that educate and promote PTSD knowledge and recognition, reduce public and personal stigma, improve access and availability of care, and encourage social support for patients and families living with PTSD.

Human immunodeficiency virus (HIV) is a virus that affects the body’s immune system (Centers for Disease Control [CDC], 2016a). HIV is a worldwide epidemic and disproportionately impacts youth in the United States. Youth living with HIV (YLWH) face significant mental health problems, namely depression, anxiety, and posttraumatic stress disorder (PTSD) with rates of these disorders discrepant from those in the general population. In addition to psychological difficulties, health literacy is another factor that influences individuals with HIV and is a priority of research with adolescents (Kalichman et al., 2000; Manganello, 2008). The National HIV/AIDS Strategy: Update 2020 (White House Office of National AIDS Policy, 2015) identified youth, ages 13 to 24 years, as a key population needing broad support not only for HIV prevention but also engagement in care including improving mental health and health literacy. The current study explored the extent to which YLWH were health literate in addition to the extent to which they exhibited psychological symptoms of depression, anxiety, and posttraumatic stress disorder. Furthermore, the study examined the extent to which health literacy and psychological symptoms were associated with health outcomes. A total of 145 YLWH between the ages of 13 and 25 years participated in the study. Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977), Generalized Anxiety Disorder-7 Item Scale (GAD-7; Spitzer, Kroenke, Williams, & Lowe, 2006), Primary Care-PTSD Screen (PC-PTSD; Prins et al., 2003), and Brief Estimate of Health Knowledge and Action-HIV Version (Osborn, Davis, Bailey, & Wolf, 2010). Of the 145 participants, 103 completed the CES-D, 144 completed the GAD-7, 131 completed the PC-PTSD, and 102 completed the BEHKA-HIV. In addition, participants’ biological markers of immune functioning (i.e., CD4 count and viral load) were obtained from medical abstraction. Results indicated the sample reported high levels of symptoms of depression, anxiety, and PTSD. Thirty-five percent of participants screened positive for depressive symptoms, 26% screened positive for anxiety symptoms, and 21% screened positive for PTSD symptoms. Participants had a moderate amount of HIV knowledge and the majority reported taking their medications under most conditions. Age was a significant predictor of CD4 count and viral load such that increasing age was associated with worse immune system functioning. Educational attainment was a significant predictor of CD4 count and to a lesser extent viral load indicating that greater education was associated with better immune system functioning. There was an interaction between mode of transmission and psychological symptoms. For perinatally infected youth, greater psychological symptoms were associated with a decline in CD4 count. The same decline was not seen for behaviorally infected youth. Health literacy (knowledge and action) added significantly to the explanation of the variance in viral load. Decreasing action scores were statistically associated with an increased likelihood of having a detectable viral load. These findings point to the need for prevention and intervention mental health services for YLWH. Future research should determine prevention and intervention strategies for mental health issues with YLWH in particular. Additionally, health literacy is an important factor that should be addressed by practitioners working with YLWH. More research needs to be conducted to determine the best way to measure health literacy in YLWH and how to intervene with improving health literacy.

M.A. / The current social and political situation in South Africa has resulted in an extremely violent climate in which the incidence of highly stressful events experienced by people on the whole is extremely high. The severe and pathological negative symptoms that often follow the experience of highly stressful events are defined as Post-traumatic Stress Disorder (PTSD) in the Diagnostic and Statistical Manual for Mental Disorders - IV (DSM-IV)(APA, 1994). An improved understanding of the factors involved in the development, treatment and prevention of PTSD is important considering the potentially debilitating effects of this disorder. With the increasing emphasis being placed on 'positive' psychology, the salutogenic orientation was given focus in this study. Antonovsky (1979, 1987) defines salutogenesis as 'the origins of health', and the emphasis is on identifying those factors in which health originates and is promoted. This study aimed to investigate two specific variables, sense of coherence (Antonovsky, 1979, 1987) and self-efficacy (Bandura, 1977, 1986) as two potential psychological resilience factors that may positively contribute to effective functioning after the experience of a highly traumatic event. The research tested a postulated model which suggested that the two resilience variables influence the presentation of PTSD symptoms after exposure to a traumatic event. The research was conducted in a police and banking environment with 50 participants, all of whom had experienced a traumatic event as defined by the criteria in the DSM-IV. Three measuring instruments were used to measure the constructs of interest. PTSD symptomatology was measured by means of Horowitz's "Impact of Events Scale - Revised" (Weiss & Marmar, 1997), self-efficacy in the face of a traumatic event was measured by means of a specific questionnaire constructed by the researcher for this study (SEFTE), and sense of coherence was measured by means of Antonovsky's "Orientation to Life" questionnaire, or Sense of Coherence Scale (1983). The results of the study indicated that a relationship does exist between the three constructs of interest. A higher sense of coherence. contributes to higher selfefficacy expectations in the face of a traumatic event, and both these variables reduce the level of PTSD symptomatology after exposure to a traumatic event. In conclusion, the importance of understanding some of the psychological resilience factors which may help to prevent PTSD after exposure to a traumatic event, or at least reduce the severity of the symptoms, was highlighted. By doing so, emphasis can be moved from the treatment of PTSD after the event, to the prevention of the disorder, by strengthening the resilience of those people at risk of exposure to a highly traumatic event, before the event occurs.

M.A. / Hijacking has become so prevalent that the South African Police Service created a separate division to attend to these priority crimes, The Crime Information Analysis Centre. This division coordinates statistics and information and analyse factors leading to crime in order to plan a strategy to prevent it. The reasons for the multiplication of hijacking can be found in economic benefits, urbanization, dehumanization, inefficiency of law enforcement, the role of syndicates, security mechanisms in cars, and the ready availability of weapons. Few subjects are as relevant as trauma counseling, with few South Africans who have not experienced at some stage a crisis, shock or trauma due to crime, violent deaths, hijackings, rape, molesting and abuse, murder of farmers, and HIV and Aids. Trauma counseling is the professional treatment of a person experiencing problems, through constructive growth in faith and renewal, based on the atonement with God through Christ. It is important that the Bible be utilised in Christian counseling as the Spirit of God speaks through it. The counselor can help the traumatized patient by giving them the 12 opportunity to communicate their pain, anguish, fright, terror and anger in an honest way to God. Healing occurs when the traumatized find a (new) reason to live, through faith in the goodness of God. The counselor does not teach positive thinking but rather the truth of the Word of God instead of wrong thought processes and perceptions. In the end the client is taught to find meaning in their lives in the midst of tragic events and crises. With the help of God they are enabled top look back at what happened in the trauma and to realize that it makes sense. Even though Christians do not always understand God’s meaning with what He allows in their lives, they learn to trust Him. When they learn to look at their lives through God’s eyes, they realize the limitations of their own vision. Even pain has a purpose and can be the cause of growth and a sharper focus. It reminds us of the need to trust in God so that hijacking is not the end of life but the beginning of a new life.

M.A. / It is now well known that HIV/AIDS-sufferers face profound psychological, psychiatric and neurological sequelae as the disease progresses. However, studies indicate that women diagnosed with HIV-infection are twice more likely to be depressed, to suffer from PTSD and other psychiatric morbidity than men. Yet very few studies have attempted to investigate the role that gender plays in reacting to the illness. Finding out that one is HIV-infected is one of the most significant discoveries. This is due to the fact that in receiving an HIV-positive diagnosis individuals are exposed to news of prodigious personal consequence. And yet very few studies have focused on how the impact of finding out that one is HIV-positive may affect their adjustment to the illness. Moreover, how men and women are likely to react to such news. It is against this background that the current study was conducted. The aim of the current study was to compare post traumatic symptoms in men and women upon hearing news of their HIV-positive status and to investigate to what extent such reactions may be similar or different and to further assess how their reactions are likely to affect disease progression and adjustment. A total of one hundred participants (38 Male, 63 female) diagnosed with HIV/AIDS participated in the study. These men and women were obtained from support groups in the Gauteng region. The Impact of Event Scale-Revised and Mental Adjustment to HIV-Scale questionnaires were used to collect data over a period of a month. A large majority of 60.2% of the total sample (n = 87) reported experiencing feelings of shock upon hearing about their HIV-positive status, 66.0% of the total sample (n = 94) of those who responded to this item reported trying to remove the issue from their mind. A further 59.6% of the total sample of (n = 94) indicated feeling as though news about their HIV-positive status were not real suggesting that the incident was traumatic. There were no significant gender differences in how both men and women reacted to news of their HIV-positive diagnosis. However, significant differences were found in relation to adjustment. Men were found to be more likely to have more Fighting Spirit which is indicative of adaptive adjustment as compared to women. Women on the other hand were found to be more likely to be Hopeless which is indicative of maladaptive coping.

Magister Psychologiae - MPsych / This study focused on trauma and seeked to demonstrate that the application of a Buberian understanding to the experience of trauma can help shed light on the impact of trauma on a sufferer's life. The aim of the study was to gain an understanding of the impact of trauma on interpersonal relationships as well as to determine components of psychotherapy found most helpful in the recovering process. / South Africa

Magister Psychologiae - MPsych / Significant research efforts have focused on developing treatments for trauma survivors and evaluating their effectiveness. However, little attention has been given to understanding the impact of working with trauma survivors on psychologists. This research aimed to address this gap in the literature. In South Africa, there is a scarcity of published qualitative studies that focus on the experiences of VT among psychologists who work with survivors of trauma. Given the increasing prevalence of traumatic events in South Africa and increasing patient load, psychologists may be vulnerable to the development of VT. Beneficial treatments for trauma survivors largely depend on psychologists who can effectively handle their clients' intense traumatic material. If a psychologist is adversely affected by the work of trauma, the quality of treatment for trauma survivors will be compromised (Figley, 1999). Hence, it is critical that research continues to explore the effects of VT and ways to ameliorate them. Aim: to explore the experiences of VT among a group of psychologists from Cape Town, South Africa, who work with trauma survivors and the related coping strategies used by them. This research aimed to expand the local research on the phenomenon of VT. Findings of the study will help to facilitate a better understanding of vicarious impact of trauma work as well as the related coping techniques used by psychologists. Identification of protective factors and effective coping mechanisms of those professionals in this study was a distinct contribution to the South African literature base. This study has practical implications for training, supervision and clinical practice for psychologists in South Africa to enhance the efficiency of psychological service delivery. Exploring the challenges South African psychologists experience as a result of working with trauma survivors may help inform policy and develop effective programmes to address the effects of VT. As such, psychologists would be better equipped to care both for themselves and their clients, and to ensure ethical and professional practice.

South Africa as a country is known for its high crime rate which produces an ongoing traumatising environment for its multicultural nation. Posttraumatic stress disorder in the general South African population is thought to be more prevalent than most international norms which make this topic both relevant and important. Cultural diversity is seen to play a role in the experience of PTSD which means that it has become important to gain an understanding of the potential effect of the individual’s cultural background on the processing of a traumatic experience and the symptoms related to the experience. The proposed research focused on appraisals of the traumatic event and symptoms (in schematic and cultural terms). An interpretive (with current cognitive conceptions of the disorder as guiding theory) phenomenological approach was used. The sample consisted of eight isiXhosa-speaking adults that qualified for a diagnosis of PTSD with no prior psychiatric diagnosis. Data was gathered using a semi-structured interview and analysed using the Interpretive Phenomenological Analysis. Results indicated that participants understood their PTSD symptoms in a functional manner but struggled to make sense of their traumatic event. Not understanding their traumatic event was the variable that maintained their PTSD diagnosis. Most of the interpretations made by these participants were fairly universal and there were very few links to content that can directly be attributed to a traditional African worldview. Practitioners may not need to completely reinvent the wheel as far as treatment strategies for PTSD for isiXhosa-speaking individuals in an urban setting go.

Background: This study identified, addressed and validated risk factors that can be measured in the peri-traumatic period which may eventually be used in predicting the development of traumatic stress. Many people in South Africa possibly suffer from Posttraumatic Stress Disorder (PTSD) if we consider the extent of trauma exposures that is apparent within the South African population. Traumatised individuals are at risk but may remain undiagnosed and untreated. It makes sense for first line and primary health care practitioners (i.e., not highly qualified psychological practitioners) to screen for risk since they have the initial contact with trauma individuals. A relatively easy screening instrument that can be administered time efficiently would be useful in this regard. The principles of this instrument are that it needs to be objectively measurable, quick and easy to administer. No consistent measure geared towards identifying risk factors in such a manner immediately post trauma currently exists in South Africa. Objectives: The overall aim was to start a process of designing a psychometric instrument that is valid in predicting the development of traumatic stress. Since this is the initial stage of constructing a new measure, content validity was of utmost importance. It became imperative to ensure that items were not only relevant and appropriate, but also accurate and capable in identifying at-risk individuals. The proposed end goal is to develop effective identification strategies in South Africa geared towards helping victims of traumatic events. Method: A pilot psychometric questionnaire was compiled using three major international reviews, South African research on known risk factors, and literature on PTSD risk assessment considerations. This preliminary assembled item pool was used as a departure point and evaluated quantitatively as well as qualitatively by expert reviewers who have research and/or clinical experience with PTSD in a South African context. Their feedback resulted in either the omission or the modification of certain items; for some items, further exploration was recommended. The questionnaire was further scrutinised and modified accordingly after qualitative interviews with and critical feedback from the intended administrators or primary health care professionals, namely Registered Counsellors (RCs) and/or nursing staff from a participating general government hospital and a non-government organisation. Findings: Expert reviewers did not agree consistently across all the items. At times they rated certain items as relevant according to the necessity of the information rather than with regards to the relevance of the content of the item – in terms of prediction of PTSD. It was also observed that intended administrators did not always agree with expert reviewers.

Background: Recent Canadian Armed Forces operations involved multiple deployments and exposure to traumatic events that are associated with post-traumatic stress disorder, depression and substance abuse. Despite efforts to facilitate mental health care, some soldiers do not get the help they need. Objective: To understand soldiers’ experiences and explore barriers and facilitators they encountered accessing mental health care. Results: Qualitative descriptive interviews with 11 Canadian Armed Forces members revealed six major categories that provide insights into their experiences accessing mental health care. Participants’ revealed significant barriers to care including fear of damaging their career or being released, stigma beliefs and actions from peers and leaders, and physical and organizational barriers to care. Social support from family, military co-workers, and unit leaders facilitated care. Conclusions: Notwithstanding efforts to facilitate access to mental health care, some soldiers still perceive significant barriers to care.