Background An increasing body of research is suggesting that childhood trauma and adversity may be associated with various adverse mental health outcomes, including psychosis. Cognitive functioning is often compromised in psychosis, and research has shown that there may be a link between early trauma and cognitive impairment in people with psychosis. No systematic review of the literature of this link has been undertaken, and very few studies have examined samples of individuals at high clinical risk for psychosis, to assess whether the potential link between adversity and cognitive functioning exists, without the confounding factors of length of illness, antipsychotic medication and chronicity of symptoms. Method The systematic review of all relevant electronic databases investigates the research to date on the association between childhood adverse experiences and cognitive ability in psychosis, and the conclusions that can be drawn from the existing literature, taking into account relevant considerations regarding sample, methodology and statistical analysis. The subsequent empirical study utilizes a sample at clinical high risk of developing psychosis, and a healthy control group to investigate whether any putative association in specific domains of cognitive functioning, or global cognitive ability and childhood adversity exist in those at clinical high risk, compared to controls. Results The systematic review indicated that at present, the literature looking into childhood adversity and cognitive ability in relation to psychosis is heterogeneous, with some studies finding that this association only occurs in patients, whilst others suggest it only occurs in the control groups. Some studies found it to be specific to certain cognitive domains, whilst others suggest it was a more global impairment. Methodology, samples and analysis differed considerably across studies, and likely contribute to the heterogeneity of the literature. The empirical paper showed a significant interaction effect between group (high risk versus controls) in the high childhood adversity group, in relation to global cognitive ability. Interestingly, this was not related to psychotic symptom severity or distress. Conclusion Several limitations of the existing studies limit the conclusions that can be drawn from the existing evidence regarding the link between childhood adversity and cognitive ability, and future research in prodromal samples is essential. The empirical study showed that there is a link between childhood adversity and cognitive ability in those at clinical high risk of developing psychosis, before disorder onset, that is not present in controls. This suggests that this may form a vulnerability in those at high risk for psychosis, rather than a more general mechanism present in the typical population.

The focus of this thesis is to investigate the use of art therapy in the treatment of an individual diagnosed with schizophrenia. In this qualitative narrative single case study, eleven art therapy sessions are described using non-directive spontaneous art making with a 37-year-old man residing in a psychosocial rehabilitation program. The research study describes this client�s delusional world, and explores the struggle of making sense of his traumatic experiences in early childhood. The themes that emerge in this exploratory study are many and grief and bereavement are the focus as the client uncovers the connections between the past and the present. The process of the art therapy sessions and the progression in the imagery from chaos to serenity is described as the client moves from darkness into light, and as we witness his exploration of space in the images of the whirlwind that reappear throughout the sessions.

The focus of this thesis is to investigate the use of art therapy in the treatment of an individual diagnosed with schizophrenia. In this qualitative narrative single case study, eleven art therapy sessions are described using non-directive spontaneous art making with a 37-year-old man residing in a psychosocial rehabilitation program. The research study describes this client�s delusional world, and explores the struggle of making sense of his traumatic experiences in early childhood. The themes that emerge in this exploratory study are many and grief and bereavement are the focus as the client uncovers the connections between the past and the present. The process of the art therapy sessions and the progression in the imagery from chaos to serenity is described as the client moves from darkness into light, and as we witness his exploration of space in the images of the whirlwind that reappear throughout the sessions.

This dissertation concerns the legacy of the Nazi forced enlistment during World War II and focuses more precisely on the case of Alsace/Moselle. Many of these French men, enlisted by force from 1942 in the German army, were sent to the Eastern Front and experienced Soviet prison camps. The aim of this thesis is to examine how knowledge and memories about forced enlistment and Soviet captivity have been remembered, commemorated, communicated and passed on since the Alsatian/Mosellan POWs (Prisoners of War) carried the tokens of enemies or traitors when reintegrating their motherland, France. Four strategies dealing with the experiences of forced enlistment and of internment in Soviet prison camps are examined. I present how the first and most common strategy, i.e. avoidance, is contributing to an individual and collective construction of silence. Then I argue that a second strategy, the constitution of families of remembrance, is helping them to articulate and narrate their experiences (third strategy). The fourth strategy is the organisation of pilgrimages (emic term) to the former prison camp of Tambov, where the majority of the Alsatian/Mosellan POWs were gathered during the war. This last strategy actualises the issue of the transmission of the war experiences given that pilgrimages bring together three to four generations. Through fieldwork observations of the journeys I show how the pilgrims engage with a sense of the past. They remember and reassess the meaning of the past in terms of the social, cultural and political needs of the present. The importance of place and the aspect of self-in-place are thoughtfully analysed in order to highlight the process of passing on the memory of Tambov. I conclude by arguing that the agents of remembrance interviewed for the purpose of this thesis are engaged in turning the tangible and intangible legacies of World War II into heritage. This is done by releasing the legacy of forced enlistment and internment in Soviet prison camp from the private/familial sphere and inscribing it in the public sphere. Yet, the agency of the former POWs and their descendants shows how to let pass a past “that does not want to pass” in a contemporary European context.

p. 1-153 / Submitted by Antonio Geraldo Couto Barreto (ppgms@ufba.br) on 2013-10-17T13:03:10Z No. of bitstreams: 1 TESE raimunda defesa.pdf: 1794902 bytes, checksum: 4018e1421325f5abd35b35d0ba20c5bc (MD5) / Approved for entry into archive by Patricia Barroso (pbarroso@ufba.br) on 2013-10-30T19:33:36Z (GMT) No. of bitstreams: 1 TESE raimunda defesa.pdf: 1794902 bytes, checksum: 4018e1421325f5abd35b35d0ba20c5bc (MD5) / Made available in DSpace on 2013-10-30T19:33:36Z (GMT). No. of bitstreams: 1 TESE raimunda defesa.pdf: 1794902 bytes, checksum: 4018e1421325f5abd35b35d0ba20c5bc (MD5) Previous issue date: 2013 / comprometer a saúde física e mental dos indivíduos é necessária, para respaldar programas de suporte ao docente. O estudo objetivou descrever características clínico-comportamentais de professores universitários no sertão paraibano, tendo como objetivos secundários: avaliar correlação entre Resiliência, História de Trauma, Transtorno do Estresse Pós-traumático - TEPT, Impulsividade, Religiosidade, e Qualidade de Vida na população estudada; determinar a frequência de transtornos psiquiátricos em professores, nas diferentes áreas acadêmicas; e avaliar associação entre resiliência e transtornos mentais. Mediante estudo transversal, de natureza censitária, foram coletados dados de variáveis sociodemográficas. Aplicou-se escala de Resiliência e de TEPT (PCL-C), questionários de História de Trauma, de Qualidade de Vida SF 36 e entrevista M. I. N. I. Plus (Mini International Neuropsychiatric Interview), que explorou os transtornos mentais. Análise estatística descritiva da caracterização demográfica dos 240 professores, mostrou que 81,3% tinham menos de 50 anos de idade e 52,5% eram do sexo masculino; Correlação de Spearman indicou associação negativa e significativa (p< 0, 001) entre todos domínios do SF - 36 e TEPT; Comparação entre Resiliência e História de Trauma, mostrou associação significativa entre Resiliência e eventos traumáticos relacionados a experiências físicas e sexuais (p=0,040). Foi evidenciada baixa pontuação para TEPT; alta pontuação para Resiliência e maior exposição a trauma e desastres em geral na população de professores. Episódio Depressivo Maior Atual (EDM), Transtorno Misto de Ansiedade– Depressão e Transtorno de Ansiedade Generalizada (TAG) apresentaram maior prevalência. Teste qui–quadrado mostrou que área de Sociais Aplicadas apresentou o maior percentual (13,9%) para EDM atual. Ser mais ou ser menos resiliente não estava associado com o EDM. Professores universitários expostos a peculiaridades ambientais específicas e com Episódio Depressivo Maior Atual, apresentaram alta pontuação em todos os domínios de Qualidade de Vida. / Salvador

Denna kvantitativa enkätstudie riktar sig till yrkesverksamma pedagoger i förskolan. Syftet är att undersöka kunskapsläget hos pedagoger i Sveriges förskolor och deras behov av stöd och resurser i förhållande till barns traumatiska erfarenheter utifrån pedagogernas utbildningsnivå, år i yrket och vilket socioekonomiskt område de arbetar i. Undersökningen visar att barndomsrelaterade trauman är vanligt förekommande och att det råder en kunskapsbrist hos pedagoger i Sveriges förskolor om barns traumatiska erfarenheter. Studien visar inga signifikanta skillnader beroende på pedagogernas utbildningsnivå. Emellertid är pedagogernas antal år i yrket av betydelse då pedagoger med mer yrkeserfarenhet av förskolans verksamhet i större utsträckning fått tillräckliga stöd och resurser för att möta barn med traumatiska erfarenheter, jämfört med pedagoger med mindre erfarenhet. Mer yrkeserfarna pedagoger och de som arbetar i områden med socioekonomiska utmaningar har mött fler barn med traumatiska erfarenheter. Resultatet visar att pedagoger efterfrågar mer utbildning i form av kompetensutveckling samtidigt som tidigare forskning visar att det finns kunskap att tillgå. Detta indikerar att pedagogerna antingen inte är medvetna eller inte har tillgång till relevant fortbildning och kompetensutveckling för att möta barn med traumatiska erfarenheter. / This quantitative survey study is aimed at professional educators in preschools. The aim is to examine the level of knowledge among educators in Swedish preschools and their needs for support and resources regarding children's traumatic experiences, based on the educators' level of education, years in the profession, and the socioeconomic areas in which they work. Our survey shows that childhood-related traumas are commonly prevalent, and there is a lack of knowledge among educators in Swedish preschools regarding children's traumatic experiences. The study reveals no significant differences based on the educators' level of education. However, the number of years in the profession is significant as educators with more experience in preschool activities have received adequate support and resources to address children with traumatic experiences to a greater extent compared to those with less experience. More experienced educators and those working in socioeconomically challenging areas have encountered a higher number of children with traumatic experiences. The results indicate that educators demand more education in the form of professional development, despite previous research suggesting the availability of knowledge. This indicates that educators are either unaware or do not have access to relevant further education and professional development to address children with traumatic experiences.

No / Existing research on the impact of growing up in care focuses upon either the care experience itself or the period of transition from care to independence. Our knowledge of outcomes largely ceases when former residents of the care system reach their early twenties. There are strong social justice reasons for extending research into the older adult lives of such young people. We know a great deal about the multiple disadvantages that such individuals face as children. But research is largely silent about their subsequent adult lives. While we must be cautious in drawing causal links to the childhood care experience as the time period since life in care extends, we know that early experiences can affect care-leavers across their life coursejust as childhood experience affects all adults in a variety of ways. In this review, we highlight evidence drawn from research in Australia, the United Kingdom, Canada, Ireland, and the United States, with particular attention paid to the first two of those countries. We use a wide range of sources and identify areas for further consideration, including access to personal records, mental health, education, and parenting. By doing so, we seek to open up this area for further research with the hope that such research will lead to an increasing recognition of care-leavers' needs and thus to improvements in social policy and service provision.

Whenever there have been wars, children were a result of intimate relationships between deployed (foreign/ enemy) soldiers and local women ranging from love affairs to systematic sexual violence. These children born of war (CBOW) are a common phenomenon of war, yet their fate has not experienced much attention in research during the last decades (Lee, 2012). At the end of World War II (WWII) and thereafter, maximum 400,000 children were born to German women fathered by soldiers of the four occupying forces (Britain, France, USA, Soviet Union) (Stelzl-Marx & Satjukow, 2015). These are called “children born of occupation” or “occupation children” in research, yet the term is still under debate, since after all, these individuals are not children anymore today. Several archival and case studies from historical and social sciences have been describing the hardship these children had to face, being born “child of the enemy” and “born out of wedlock” into a defeated and contrite former National Socialist society, where losing the war however did not necessarily mean a change in mindset. Their results hint at disorientation regarding the question of belonging, and emotional as well as mental distress in the experiences of many of these children (Glaesmer, Kaiser, Freyberger et al., 2012; Mochmann et al., 2009; Satjukow, 2009, 2011; Stelzl-Marx, 2009). Nevertheless, a psychosocial perspective had been missing so far. When assessing psychosocial consequences of growing up as child in this societal context, a study needs to focus on three main aspects: Identity development, stigmatization/ discrimination, and child maltreatment (Glaesmer, Kaiser, Freyberger et al., 2012). In 2013, the study “Occupation children: identity development, stigma experience, and psychosocial consequences growing up as a ‘German occupation child’” launched and recruited 164 people via press release (App. 8.6) and contact to platforms of occupation children of which 146 were included in the analyses (mean age 63.4, 63.0% women). Since GOC are difficult to reach, their population size is small and can only be estimated; they can be considered a „hidden population“. These populations cannot be investigated by standardized instruments only but need a participative research approach to tailor instruments to their reality (Heckathorn, 1997; Salganik & Heckathorn, 2004). Participative research enhances chances of acceptance and compliance among the target population (Brendel, 2002). Therefore, the applied instrument (App. 8.7) consists of two parts: a self-developed part on experiences specific for this group of CBOW deducted from literature and developed in a participative approach with the help of occupation children themselves as well as experienced researchers in this field. Part two contains standardized psychometric instruments assessing current mental distress and traumatic childhood experiences among others (please refer to publication I for a detailed description of the instruments). This dissertation focused on the specific living and developmental conditions for GOC in post-WWII Germany (change of attachment figures, financial situation, knowledge of biological background etc.) as well as experiences of stigmatization/ discrimination and traumatic experiences during their life and childhood specifically. Furthermore, this work investigated current mental distress and attachment in close adult relationships. The following is a summary for each of the five articles this dissertation is based on: 1. Growing up as an occupation child of World War II in Germany: Rationale and methods of a study on German occupation children A specific instrument was developed in a participative research approach to investigate German occupation children as a hidden population. It consists of a self-developed part assessing specific experiences described for CBOW during childhood and adolescence (e.g. attachment figures and change of attachment figures, knowledge about biological father and his background, housing situation, experiences of stigmatization) and a second part with standardized instruments assessing mental disorders, attachment in close adult relationships, traumatic experiences, and childhood maltreatment. Overall, the developed questionnaire was well accepted by the target group and topics covered were of high relevance. Finally, N=146 subjects with fathers from all four occupation forces were included in the study (48.6% American, 22.6% French, 21.9% Soviet, 4.1% British). The distribution of each subgroup can be ascribed to the sampling method of contacting platforms of occupation children. Concerning their procreation background the majority (75.3%) stated their parents had a positively defined relationship. Only 10 (6.8%) children born out of rape participated. 2. Depression, Somatization, and Posttraumatic Stress Disorder in Children Born of Occupation After World War II in Comparison With a General Population The comparison of findings for GOC with a representative birth-cohort-matched sample (BCMS) from the German general population (N=977) showed that GOC report significantly higher prevalence rates of most traumatic experiences, higher one-month prevalence rates of full and partial PTSD, depression and somatization than the control group. Especially high impact traumatic events (e.g. childhood abuse, rape, and physical violence) were more frequent among GOC. Furthermore, GOC reported growing up under difficult conditions (e.g. poverty, single mothers, change of attachment figures in childhood, and stigmatization). These findings show that even decades after these experiences have ended, they suffer from higher rates of depression, somatization and posttraumatic stress as well as comorbid conditions. The results thereby underline the complex and long-term impact of their burdened social, financial and familial conditions on current mental health. 3. Long-term effects on adult attachment in German occupation children born after World War II in comparison with a birth-cohort-matched representative sample of the German general population The linear and binary logistic regression analyses of adult attachment and its association with current depression in GOC (N=146) in comparison to a birth-cohort-matched representative sample (BCMS) of the German population (BCMS; N=786) show that GOC are less comfortable with closeness/ intimacy and report a lowered ability to depend on others in close relationships. This shows in more dismissive and fearful attachment compared to BCMS. In line with existing research, insecure adult attachment is associated with current depression. These results are discussed in relation to the difficult circumstances under which GOC grew up (e.g. single mothers, change of attachment figures in childhood, adverse events, stigmatization) and thus underline the complex and long-term impact of the developmental conditions on attachment and current mental health. 4. German Occupation Children: Experiences of Stigmatization after World War II Experiences of stigmatization and discrimination were a shared truth for GOC. More than half of the sample (54.6%) stated having experienced stigmatization, one-fifth of them „frequently“ or „constant­ly“. Major reasons were father’s origin, physical attributes or illegitimacy at birth. Stigmatization took place in children’s immediate social environment, in public institutions and in their own families, mostly in childhood and adolescence. The majority stated withdrawal and avoidance as coping behaviors. Findings indicate the magnitude of stigmatizing experiences in this subgroup of the German population in frequency of experiences as well as in terms of impact on all levels of social interaction. 5. Childhood maltreatment in children born of occupation after WWII in Germany and its associ­ation with mental disorders Experiences of emotional abuse/ neglect, physical and sexual abuse are significantly higher in GOC compared to the representative birth-cohort-matched sample (BCMS) from the German general population (N=920). All five subtypes of childhood maltreatment (CM) increase the risk of PTSD and somatoform syndrome. Depressive syndromes are associated with emotional abuse/ neglect and physical abuse. GOC were at high risk of CM. Findings underline the complex, long-term impact of developmental conditions and CM on mental disorders even decades later.:Table of contents 1. Background 1.1 Historical background 1.2 Theoretical background 2. Research objectives 3. Methods 3.1 Study design & samples 3.2 Instruments 4. Outline of publications 5. Discussion 5.1 Limitations 5.2 Outlook 6. Summary/ Zusammenfassung 7. References 8. Appendix 8.1 Erklärung über die eigenständige Abfassung der Arbeit 8.2 Darstellung des eigenen Beitrags 8.3 Curriculum vitae 8.4 Publikationsverzeichnis 8.5 Danksagung 8.6 Press release 8.7 GOC Questionnaire

Objective: Many women experience traumatic events already prior to or during pregnancy, and delivery of a child may also be perceived as a traumatic event, especially in women with prior post-traumatic stress disorder (PTSD). Birth-related PTSD might be unique in several ways, and it seems important to distinguish between lifetime PTSD and birth-related traumatization in order to examine specific consequences for mother and child. This post-hoc analysis aims to prospectively examine the relation of both, lifetime PTSD (with/without interpersonal trauma) and birth-related traumatization (with/without postpartum depression) with specific maternal and infant outcomes. Methods: In the prospective-longitudinal Maternal in Relation to Infants’ Development (MARI) study, N = 306 women were repeatedly assessed across the peripartum period. Maternal lifetime PTSD and birth-related traumatization were assessed with the Composite International Diagnostic Interview for women. Maternal health during the peripartum period (incl. birth experience, breastfeeding, anxiety, and depression) and infant outcomes (e.g., gestational age, birth weight, neuropsychological development, and regulatory disorders) were assessed via standardized diagnostic interviews, questionnaires, medical records, and standardized observations. Results: A history of lifetime PTSD prior to or during pregnancy was reported by 25 women who indicated a less favorable psycho-social situation (lower educational level, less social support, a higher rate of nicotine consumption during pregnancy). Lifetime PTSD was associated with pregnancy-related anxieties, traumatic birth experience, and anxiety and depressive disorders after delivery (and in case of interpersonal trauma additionally associated with infant feeding disorder). Compared to the reference group, women with birth-related traumatization (N = 35) indicated numerous adverse maternal and infant outcomes (e.g., child-related fears, sexual problems, impaired bonding). Birthrelated traumatization and postpartum depression was additionally associated with infant feeding and sleeping problems. Conclusion: Findings suggest that both lifetime PTSD and birth-related traumatization are important for maternal and infant health outcomes across the peripartum period. Larger prospective studies are warranted. Implications: Women with lifetime PTSD and/or birth related traumatization should be closely monitored and supported. They may benefit from early targeted interventions to prevent traumatic birth experience, an escalation of psychopathology during the peripartum period, and adverse infant outcomes, which in turn may prevent transgenerational transmission of trauma in the long term.

This study aimed at exploring the impact of early traumatic experiences on bariatric patients with the intent to give "voice" to their experiences. The impact of morbid obesity and the lack of quality of life among those suffering from this form of chronic illness can be devastating. Meaningful support systems and bariatric surgery are therefore considered as forced behavioural interventions to remediate the impact of childhood trauma and subsequent development of morbid obesity among this group of bariatric patients. Through a process of social constructivism and dialogue between the researcher and the five participants, the co-construction according to themes was supported by a qualitative research approach and the case study method. For the analysis of the themes according to the participants' "voices", the thematic content analysis method was used to analyse the data and was finally linked to supportive literature. It is hoped that the results from this study will contribute to the development of a unique assessment and support programme to those who have to endure the burden of morbid obesity associated with early childhood trauma; and that the process prior to and post bariatric surgery will be an important contribution to finding quality of life and giving new meaning to patients after suffering through their bodies and traumatised minds. / Psychology / D.Litt. et. Phil (Psychology)