Background Post Traumatic Stress Disorder (PTSD) is a psychiatric debilitating condition that can occur in individuals who experience extremely stressful or traumatic life events. Sexual assault is considered as one of the most traumatic stressor in life. Although few studies investigated the association between history of sexual assault and PTSD, no studies have examined the impact of age at sexual assault on PTSD.Method A cross-sectional telephone survey was conducted among adult female residents of Virginia from November 2002 to February 2003. A total of 1,769 women aged 18 and older were interviewed using a random digit dialing method. Detailed screening questionnaire was utilized to ascertain the occurrence of sexual assault, age at sexual assault and PTSD. The DSM-IV diagnostic criteria were used to define PTSD.Result The prevalence of PTSD among women with no history of sexual assault, those victimized before the age of 18 and 18 and above was 8.1%, 35.3%, and 30.2% respectively. Multivariate logistic regression model showed an increase risk of PTSD among women assaulted at a younger age. Compared to women with no history of sexual assault, women who were victimized before their 18th birthday were 2.8 times more likely to suffer from PTSD [OR=2.78 (95% C1=1.87- 4.23)]. The risk of PTSD among women victimized as adults was 2.6 times higher compared to women with no history of sexual assault [OR=2.59 (95%CI =1.43-4.70)].Conclusion This study provided important information on the association between PTSD and age at sexual assault. The risk of PTSD is relatively higher among those assaulted before the age of 18. The adverse effect of sexual assault as a risk for PTSD in addition to other negative health problems is a major public health concern. Primary prevention strategies should be in place to detect sexual assault victims and prevent the occurrence of PTSD.

ETUDE 1- Le traumatisme de l’accouchement prématuré et de la césarienne, un sentiment de culpabilité, une anxiété et une ambivalence envers l’enfant et l’équipe médicale ont été rapportés. Des difficultés dans l’investissement du lien mère-enfant et dans l’accès au rôle de mère ainsi que l’importance du partage d’expérience avec des femmes ayant accouché avant-terme ont également été identifiés. Enfin, des signes de dépression postnatale et de stress posttraumatique ont été relevés. ETUDE 2- 53% des participantes ont rapporté un score à l’IES-R indiquant un probable ESPT. La présence de symptômes de dépression postnatale (ß = 0,40, p< 0,05), de difficultés pendant la grossesse (ß= 0,20, p< 0,05), la perception maternelle de l’enfant comme étant vulnérable (ß = 0,17, p< 0,05), l’insatisfaction de la grossesse (ß = -0,13; p< 0,05) et des cognitions maternelles mal-adaptées (ß = -0,12, p< 0,05) étaient indépendamment associés à l’intensité des symptômes d’ESPT. ETUDE 3- 3 profils de femmes ont été identifiés: les parturientes au profil « dépressif », « faible niveau de symptômes » et les mères du groupe « dépressif anxieux traumatisé ». Nos résultats démontrent également une forte comorbidité entre troubles anxieux et dépression postnatale ainsi que l’influence négative des symptômes de dépression postnatale sur le lien mère-enfant. ETUDE 4- 64,3% des femmes de l’échantillon ont rapporté un score à l’EPDS indiquant une possible dépression postnatale. Le placement de l’enfant sous assistance respiratoire (ß = 0,23, p< 0,05), le type de prématurité (ß= 0,16, p< 0,05), et la baisse de la qualité de la relation conjugale (ß = -0,39, p< 0,05) étaient indépendamment associés à l’intensité des symptômes de dépression postnatale. / STUDY 1- Trauma of premature birth and c-section, feelings of guilt, anxiety, ambivalence towards the infant, the medical staff and the infant’s hospital discharge, were all part of their perception. Furthermore, difficulties for mothers to define themselves as such and the importance of sharing with women who have been through the same experience were evidenced. Postpartum depression and PTSD symptoms were also highlighted. STUDY 2- 53% of participants scored above the cut-off for probable PTSD. Increased postpartum depressive symptoms (ß = 0.40, p< .05), difficulties during pregnancy (ß= 0.20, p< .05), maternal perception of infant vulnerability (ß = 0.17, p< .05), decreased satisfaction with delivery (ß = -0.13; p< .05) and cognitions relating to role change (ß = -0.12, p< .05) were independently associated with PTSD symptoms. STUDY 3- 3 profiles were highlighted: “depressive”, “low level of symptoms” and “anxious-depressive-traumatized” mothers. Our findings also evidenced a high comorbidity between anxious and depressive symptoms as well as a negative impact of postpartum depression on mother-infant bond. STUDY 4- 64.3% of our sample reported a score on the EPDS highlighting a probable postpartum depression. Having an infant who experienced ventilator support (ß = 0.23, p< 0,05), type of prematurity (ß= 0.16, p< 0,05), and decreased quality of marital relationship (ß = -0.39, p< 0,05) were independently associated with the intensity of postpartum depressive symptoms.

Doctor of Philosophy / Department of Human Nutrition / Mark D. Haub / Mark D. Haub / Psychological problems and human error are leading causes of death and disability among military service members. Strategies to improve the psychological health and cognitive performance of those in the military are much needed. Recent advances in neuroscience suggest that omega-3 fatty acids may play an important role in the psychological well-being of those in the military. The purpose of this research was to explore the relationship between omega-3 status and psychological outcome variables among soldiers deploying to combat. Data collection was preceded by the development and reliability testing of a novel food frequency questionnaire (FFQ) designed to capture intake from contemporary sources of omega-3 fatty acids including functional foods and supplements. Based on the instrument assessment study (Chapter 2) conducted among university students (n = 165), this FFQ appears to be a comprehensive and reliable (n = 54, ρ = 0.86, p < 0.001) instrument for measuring docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) intakes in young adults. As described in Chapter 3, intake of EPA + DHA as estimated by the FFQ was positively correlated (r = 0.39, p < 0.001) with biomarker measurements of omega-3 status. Primary data were obtained from a volunteer sample of soldiers (n = 272) scheduled for deployment to Iraq. Preliminarily analyses revealed relationships between attention deficit hyperactivity disorder (ADHD) screening scores and psychological outcome variables (Chapter 4). Primary analyses (Chapter 5) indicated intake of EPA + DHA was not significantly correlated with mood, nor were omega-3 exposure variables correlated with cognitive performance based on the required p value (< 0.001) calculated using the Bonferroni correction for multiple tests. Among participants with EPA + DHA intakes at or below the median, omega-3 HUFA was related (p < 0.002) to happiness (β = -0.46), depression (β = 0.44), and fatigue (β = 0.43). Although exploratory in nature, the results of this study suggest a relationship between omega-3 fatty acids and mood. Given the current concerns regarding the psychological health of those in the military, additional research is warranted.

D.Litt. et Phil. / The negative psychological effect of rape on survivors has been extensively researched, with most studies emphasising rape-related Post Traumatic Stress Disorder (PTSD) its symptoms, diagnosis and treatment. Interventions described in the current literature mainly aim at measuring and reducing symptoms, and restoring functioning in rape survivors. Group art therapy has been used with adult and adolescent survivors of incest with encouraging results, but little research has been published regarding its use with rape survivors. My intention in the current study is to examine the utility of a group art therapy intervention with adult female rape survivors in a South African context. I selected a postmodern feminist theoretical basis for the study, and examined the societal discourses that promote women’s disadvantaged status and high levels of rape in South Africa. I used qualitative methods to analyse the art works, journals and transcripts produced by three participants during seven weekly group art therapy sessions. I used postmodern feminist research methods, such as participant observation, reflexivity, and concepts such as situatedness, bodiliness, relatedness and plurality of explanations to assess the women’s lived experience of rape, their recovery from it, and the intervention itself. The current study proposes that analysing the data reveals metaphors, symbols and meanings that represent the lived experience of the women participants in the group art therapy intervention. I used a grounded theory approach to data analysis, as well as methods from content analysis, visual anthropology, iconography, social semiotics and visual cultural studies in order to assist with triangulation of the visual and verbal data. The data was voluminous and rich, and fourteen strands of meaning emerged from the data, consisting of vivid metaphors, visual and verbal symbolic language, and insights into the challenges and victories of each of the participants. I gathered these strands under two overarching themes: one of themes related to the rape, and the other related to the group art therapy experience. I conclude that group art therapy was useful to the participants, and that the data analysis gave considerable insight into the individual nature of recovery from rape, such as coping mechanisms, influence of personality on recovery, the dialectical nature of recovery and the difficulty of recovering from a trauma that affects every area of functioning. The current study provides a structured format for clinicians interested in group art therapy, and I have provided suggestions for those who wish to replicate the intervention. My findings propose that the intervention was a powerful therapeutic tool for the participants, and that it provides a structured short-term group outline for use with the vast numbers of rape survivors in South Africa.

D. Ed. / Trauma can be described as the emotional shock response to a physical or emotional injury that is overwhelming and has a lasting effect on a person. Based on this definition, trauma can be considered an integral part of life in South Africa. The consequences and effects of trauma are severe, both on individual and society levels. Nobody escapes the effects of trauma, but women and children are particularly vulnerable. Unfortunately the vast majority of South Africans have little or no access to mental health services. Some people, however, seem to be resilient in response to trauma and hardship. Although various definitions of resilience can be found in the literature, resilience is defined in this thesis as the ability and characteristics that enable a person to endure, recover from, and be strengthened to grow personally, regardless of exposure to traumatic life events. Women are generally the primary educators of children in the South African society, whether it be their own children, grandchildren or others. If South African women were equipped with skills that could enable them to deal more effectively with trauma, they would – as primary educators – naturally transfer their skills and knowledge to the children in their care. There exists a need for preventative interventions that may equip women to cope effectively with trauma. Certain educational interventions may provide avenues through which this may be achieved. Educational drama is one such avenue through which women of diverse educational, socio-economical, and cultural backgrounds may be reached in a comprehensible, accessible and non-discriminatory way. In this study a number of issues pertaining to the prevalence of resilience in South African women have been explored and described. The purpose of this study was to create an interactive educational play aimed at facilitating mental health in women exposed to traumatic life events.

M.Cur.

Iris Fitzgerald struggles to make it day to day after she is raped and stabbed while out on an early morning run. Her story is told through her relationships, not only with her new, scared self, but also with her overbearing mother, her best friend, her rescuer and her antagonistic roommate. She has just moved to a strange city and still has not found a job. So, she has the overwhelming stress of the attack to contend with and the added pressure of running quickly out of money in the expensive city of San Francisco. She uses her painkillers as an escape from her stab wound as well as her emotional pain. Claiming Iris is about self-preservation, relationships, addiction and continuing on with life.

M.A. / The Truth and Reconciliation Commission (TRC) Act was passed in 1995 and the TRC started its hearings in 1996. The purpose of the TRC was to promote national unity and reconciliation by establishing as complete a picture as possible of the human rights violations that had occurred during the apartheid era and to offer reparations to those who had been affected, as well as to grant amnesty to those who had committed these human rights violations. The TRC had to appoint people to help carry out its functions and deliver a report about human rights violations. Most of the people employed by the TRC to help carry out these functions were South African. Furthermore every South African had been involved in the past in one way or another, purely by being a South African. In this project the author explores, analyses and interprets the experiences of some of the people who were employed by the TRC. The focus of this project is to find out whether being employed by the TRC and having to listen to the stories being brought to the TRC exposed anyone to the possibility of developing what is called secondary traumatisation. This kind of traumatisation is different from the traumatisation that the people relating the stories had gone through during the apartheid years. This kind of traumatisation is said to develop from being exposed to traumatised people.

Thesis (M.A.(Industrial Psychology)--University of the Witwatersrand, Arts Faculty, 1996 / At a primary level the current study sought to investigate the post-traumatic stress responses of a sample of black township residents who were victims and witnesses of continuous civil violence [Abbreviated abstract. Open document to view full version]

La thèse a pour objectifs d’étudier les liens entre les mécanismes de régulation émotionnelle (RE) et les psychotraumatismes de type I et II. Elle s’intéresse également aux indicateurs physiologiques caractérisant ces processus de RE et leurs éventuelles modifications dans les cas de Stress Post-Traumatique (SPT) ou d’exposition à des événements aversifs (trauma complexe). Pour cela nous avons mené trois études. La première étude s’intéresse à mettre en évidence des prédicteurs du développement d’un SPT complet ou subsyndromique, suite à un accident de la voie publique. Les résultats font apparaître que plus d’un quart des participants présente un subsyndrome traumatique ; pour 7,7% de patients avec un SPT complet. Parmi de nombreuses variables, le meilleur prédicteur est la perception d’une menace vitale. Des liens forts sont également observés entre d’une part, la détresse péritraumatique et les symptômes de reviviscence et d’hyperactivité neurovégétative, et d’autre part entre la dissociation traumatique et l’évitement. La seconde étude s’intéresse à évaluer la variabilité du rythme cardiaque (VRC) comme biomarqueur des difficultés de régulation émotionnelle (DRE) en population non-clinique. Les résultats montrent que le groupe qui a peu de DRE présente une diminution de la VRC durant une phase d’induction émotionnelle puis une augmentation jusqu’à un niveau statistiquement équivalent à sa ligne de base en phase de récupération post-induction. Cette réponse sympathoexcitatrice adaptative est modifiée dans le groupe avec beaucoup de DRE : la VRC n’augmente pas en récupération. Ces données suggèrent que la VRC est un biomarqueur pertinent des DRE. Enfin, la dernière étude cherche à évaluer l’impact d’un trauma complexe (TC) sur plusieurs processus émotionnels. Les DRE et la dissociation somatoforme discriminent le mieux les groupes d’adolescentes présentant un TC des adolescentes contrôles. De plus, les mesures physiologiques montrent que le niveau de VRC au repos est plus faible dans le groupe TC et que le pattern typique de réaction sympathoexcitatrice est absent, à la différence du groupe contrôle. Les analyses de régressions précisent que le manque de conscience émotionnelle prédit le niveau de VRC au repos alors que c’est le niveau de dépression qui prédit le mieux la diminution phasique de VRC. Ajoutée à un taux d’erreur plus important pour évaluer subjectivement les stimuli émotionnels dans le groupe TC, les événements aversifs répétés semblent perturber à la fois des processus liés à l’évaluation des signaux émotionnels et leur intensité, mais aussi les processus psychologiques et physiologiques liés à la régulation des émotions. Ces résultats qui confirment le rôle important des DRE dans les psychotraumatismes seront discutés par rapport à la littérature actuelle pour proposer des pistes thérapeutiques spécifiques. / This thesis aims to explore the links between emotion regulation (ER) mecanisms and type 1 and 2 psychotrauma. We also investigate physiological marker of those ER processes and the potential disturbances caused by Post-Traumatic Stress Disorder (PTSD) and adverse life events (complex trauma). Three studies were carried out. The first study assesses some predictors of the development of a complete or subsyndromic PTSD following a motor vehicule accident. Results reveal that more than one quarter of the sample exhibits subsyndromic PTSD and 7.7% was diagnosed with complete PTSD. Among several variables, the strongest predictor is the perceived life threat. Also, strong correlations are observed between 1) peritraumatic distress and persistent re-experiencing or hyperarousal and 2) dissociation score and avoidance strategy. The second study evaluates Heart Rate Variability (HRV) as a potential biomarker of emotion regulation difficulties (ERD) in a non-clinical population. Results for the low ERD group show that HRV decreases from baseline to elicitation and then increases from elicitation to recovery (no difference between recovery and baseline levels). This adapatative sympato-excitatory pattern is altered in the high ERD group in which HRV do not increase from elicitation to recovery. Those data suggests that HRV could be an unbiased biomarker of ERD. The last study examines the effects of complex trauma (CT) on several emotional processes. ERD and somatoform dissociation best discrimate between CT and control teenagers. Moreover, physiological measures show that HRV level at rest is lower in CT than control and typical sympato-excitatory response is not observed in CT contrary to control group. Regressions analyses further reveal that the lack of emotional awareness predicts HRV level at baseline whereas the level of depression best predicts phasic HRV decrease. Added to greater errors in the subjective assessment of emotional stimuli in the CT group, adverse life events seem to disrupt processes involved in the labelling of emotions and intensity as well as psychological and physiological processes linked to ER. These results which confirm the importance of ERD in psychotrauma are discussed in regard to contemporary literature in order to suggest some specific therapeutic approaches.