Konstanz, Univ., Diplomarb., 2003.

Ulm, Univ. Diss., 2005.

Thesis (doctoral)--København, 1980.

Undergraduate honors paper--Mount Holyoke College, 2006. Dept. of Psychology and Education. / Includes bibliographical references (leaves 54-58).

Zugl.: Berlin, Charité, Universiẗat-Med., Diss., 2004.

Work-trauma, conceptually related to post-traumatic stress disorder (PTSD), can impact general pathology as well as traumatic reactivity. Whilst usually associated with the emergency services, work-trauma occurs in all personnel repetitively exposed, as part of their job, to actual or potential traumatic incidents (such as fatalities, serious injuries, fires, riots, harassment, shooting incidents, rape incidents etc.). The (limited) understanding of work-trauma is essentially predicated on mono-cultural (North American) data and approaches. Although a useful start, this does not accommodate underlying cultural differences. It is argued these differences fundamentally impact reliability. Two approaches are used here to begin the application of cross-cultural factors to work-trauma: 1. Using sources based on Hofstede's cultural differences in individualism/collectivism, masculinity/feminism, power distance, and uncertainty avoidance, a link is established with certain stages of the eco-systemic model of traumatic reaction (Peterson et al, 1991). 2. A detailed review of the emergency service environment including examination stressors, call-out rates, and general pressure to perform as well as broader social differences in economic conditions, working hours, quality of life and several other factors quantifies the extensive differences researchers need to acknowledge. Using unique data from three cultural settings (Japan, Hong Kong and the UK), preliminary analysis suggests nine variables consistently associate with work-trauma symptomatology: age, child-bearing status, usual alcohol consumption, change in alcohol consumption, exercise frequency, social support from a partner, social support from a close friend, contemplation of counselling, and action on counselling. When applied to a model, however, cultural variations in were large. This begins to suggest diverse cultural experiences are impacting work-trauma. Although phenomena such as resistance to counselling, the 'macho ethic' and alcohol habits within the emergency services are - as expected - culturally consistent, this is in itself inadequate for understanding work-trauma. At a theoretical level, researchers need to further explore the documented aspects of the emergency service and social environments with a view to developing instruments which measure cultural diversity. At a practical level, given the culturally consistent alcohol habits in emergency services, future researchers should consider the use of emergency service personnel as front-line diagnosticians of work-trauma. Counselling needs are assessed in this light.

The main aims and objectives of this Ph.D. by publication are: • To analyse, explore and contextualise the psychiatric response to trauma and aetiological issues • To analyse and explore the management of Post-Traumatic Stress Disorder (PTSD) • To critically analyse the wider historical, legal and political management of mental disorder. Five peer-reviewed publications from recent years are presented on the theme of psychiatric responses to traumatic events. Two papers focus on the aetiology, (where the Oxford definition of aetiology is the ‘cause, set of causes, or manner of causation of a condition’), of PTSD and therefore consider the injuries that cause PTSD and also potential vulnerability factors (Green & Griffiths, 2013). These papers contain a mixture of quantitative and qualitative methods – examining characteristics such as psychological conceptions of risk in relation to illness duration within a case series for instance and a comparative statistical analysis of birth order in differing samples. Two papers consider modern aspects of the treatment of PTSD – including pharmacological and psychotherapeutic and difficulties and use a methodology of a structured review of the literature including analysis of the evidence base for trauma-focused Cognitive Behavioural Therapy (CBT) including Numbers Needed to Treat (NNT) (Green 2013, Green 2014). A final paper looks at admissions trends for PTSD and a range of other mental disorders and uses a statistical analysis of national data looking for emerging trends against a historical and political background of changes in the management of mental disorder (Green & Griffiths, 2014). These recent papers are set in context against older papers from a career which has spanned epidemiological research into risk factors for depression over six years, writings about psychopharmacology, and planned future research into birth order and domestic violence, and an editorial for the British Journal of General Practice (Green & Gowans, 2014) seeking to promote future epidemiological research into unmet mental health needs in the community. The papers can be viewed as being within the context of a continuum of research interests and publications (represented diagrammatically below in Figure One). In the narrative text I refer to this earlier work and also explain my plans for progress in terms of future research and publications, thus setting the work in this Ph.D. by publication in context within a continuing pattern of interests.

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas, Programa de Pós-Graduação em Psicologia, Florianópolis, 2013. / Made available in DSpace on 2014-08-06T17:35:38Z (GMT). No. of bitstreams: 1 325605.pdf: 1646690 bytes, checksum: c753aaa0466231ff4e7679cf5f433e91 (MD5) Previous issue date: 2013 / O presente estudo tem como ponto de partida a interrogação sobre o trauma, considerando que no centro da experiência traumática existe um excesso que comporta a ideia de um "corpo estranho", de impossível assimilação e representação. A partir das investigações freudianas sobre o trauma e do registro do real, em relação ao traumático, na obra lacaniana, pretende-se traçar um diálogo com a poética de Paul Celan. A questão inicialmente formulada neste estudo parte do fato de que a escrita celaniana busca atravessar - por meio da linguagem e na própria linguagem - o horror da catástrofe vivida no território europeu nos anos 1933-1945, sendo esta uma forma de buscar orientar-se frente a esta violência. Interessa analisar de que maneira a escrita enfrenta a experiência traumática, considerada de impossível representação. No diálogo traçado com a psicanálise, os conceitos que balizam este percurso, em razão da sua aproximação com a lírica celaniana, são, além do trauma e do registro do real, os conceitos de compulsão à repetição (Wiederholungszwang), de letra e de significante, de Das Unheimliche, bem como a noção de temporalidade no psiquismo, passando, ainda, pela questão do endereçamento. A obra de Paul Celan caracteriza-se pela busca do Outro, mantendo-se aberta, comporta em si mesma o estranho, o estrangeiro.<br> / Abstract : The present study has the interrogation about the trauma as a starting point, considering the existence of some excess that holds the ideia of a "strange body" in the core of the traumatic experience, which is of impossible representation and assimilation. From the Freudian investigations about the trauma and the category of the real, in relation to the traumatic, in Lacan's works, we aim at establishing a dialogue with Paul Celan's poetics. The initially formulated question in this study starts off from the fact that Celan's writing seeks for crossing - through language and in language itself - the horror of the catastrophe experienced in the European territory between 1933-1945, being this a way of searching for orienting himself towards that violence. It is of our interest to investigate in which way writing faces the traumatic experience, considered of impossible representation. In the dialogue with psychoanalysis, the concepts that ground this path, due to their proximity to Celan's lyric, are, beyond the trauma and the order of the real, the concepts of compulsion to repetition (Wiederholungszwang), of letter and significant, and of Das Unheimliche, as well as the notion of temporality in the psyche, passing by the matter of addressing. Paul Celan's work is characterized by the search for the Other, and by keeping itself open, bears the strange, the stranger in itself.

Women and men who experience early interpersonal violence are at increased risk for subsequent victimization. Little is known about the mechanisms by which early trauma increases vulnerability for revictimization. According to Betrayal Trauma Theory, harm perpetrated by close others early in life may impair the ability to accurately decipher trust and identify betrayal, thus increasing risk for future violation. Dissociation, a state of cognitive, emotional, and experiential disconnectedness, is theorized to facilitate impaired betrayal awareness, and peritraumatic dissociation (i.e., dissociation at the time of a traumatic event) has been linked to revictimization. The present study extended this existing knowledge and tested predictions made by Betrayal Trauma Theory through the examination of the impact of high betrayal trauma on self-report and behavioral trust tendencies and betrayal awareness in a college sample of 216 individuals with and without histories of trauma high in betrayal. The impact of peritraumatic dissociation on betrayal awareness was examined. Participants completed self-report measures of peritraumatic dissociation and relational and general trust. The Trust Game, an experimental economics task, was used to investigate behavioral trust. A picture drawn to depict sexual abuse of a child was used as a betrayal stimulus to examine betrayal awareness in the sample. Results replicated prior work indicating an increased risk for revictimization among individuals who reported high betrayal trauma during childhood and/or adolescence. As predicted, high betrayal trauma exposure was associated with lower levels of self-reported general and relational trust. Self-reported general trust was positively correlated with behavior during the Trust Game. Participants with histories of high betrayal trauma reported higher levels of peritraumatic dissociation when confronted with the betrayal stimulus, and rates of peritraumatic dissociation contributed significantly to betrayal awareness. The findings of this study suggest betrayal trauma early in life disrupts developing socio-emotional functions, namely the ability to judge trustworthiness. The results provide evidence for the role of peritraumatic dissociation in awareness for betrayal. Despite the preliminary nature of this work, the results represent an important step toward better understanding the long-term consequences of high betrayal trauma, suggesting ways interventions may be tailored to subvert the effects of trauma.

Background: Trauma is a significant public health problem both in the UK and beyond. It can have a devastating impact on individuals, their family and society. The care of injured patients has long been thought to be sub-standard in the UK and patient outcomes were noted to be worse than other developed countries. Between 2010-12 regional trauma systems were introduced in England, with the aim of improving survival and long-term outcomes of injured patients. The aim of this study was to critically assess the implementation of these trauma systems on processes and outcomes of care in two regions of England. Methods: A systematic review was undertaken to identify studies evaluating the association between an inclusive trauma system and patient outcome. A mixed-methods approach was used for the study. Data on trauma deaths were obtained from the UK Office for National Statistics (ONS). The Trauma Audit and Research Network (TARN) database was interrogated to provide data on all patients who presented to hospital within two years before and two years after trauma system implementation. A time-series analysis and a before and after study, using a comparator region to control for temporal trends, was undertaken for each region. Twenty semi-structured interviews with Emergency Department (ED) staff were conducted to gain a broader understanding of the effect of this change. Data were then merged and areas of convergence and discrepancy highlighted. Results: The systematic review identified eight observational studies that all demonstrated a significant fall in the odds of death when patients presenting with traumatic injuries were treated within such a system. However, they were deemed to represent a very low-quality body of evidence. ONS data demonstrated that whilst trauma mortality rates were stable, between 30- 50% die outside of hospital. Analysis of TARN data demonstrated that, following system implementation, a greater proportion of injured patients were seen at Major Trauma Centres (MTCs), quality of care indices such as time to CT scan improved and mortality fell. Analysis of the interviews revealed seven main themes and whilst all staff welcomed the commitment to improve trauma care, some, especially outside of the MTCs, expressed concerns about disengagement and being unable to provide the level of care expected. Conclusions: This study adds to the body of evidence supporting the role of inclusive trauma systems in improving quality of care indices and patient outcomes. Contrary to some other studies, this study has shown improvements within two years, particularly at MTCs. Whilst most ED staff interviewed corroborated this view, some barriers to delivering high quality trauma care were felt to remain. Whilst trauma was once seen as a disease of young men and motor vehicle collisions, it is now dominated by falls in the elderly population and trauma systems must be able to meet their needs. Further research is warranted to learn more about the large population of trauma patients that do not survive to reach hospital. Perhaps some of the greatest future improvements of trauma systems are to be found here.