创伤暴露对青少年暴力行为和自杀意念的影响:创伤后应激障碍和抑郁的中介作用

采用创伤暴露问卷、基于DSM-5的创伤后应激障碍症状核查表、流调中心用抑郁量表和青少年行为问题调查表,在雅安地震3.5年后对地震极重灾区的703名中学生进行调查,考察创伤暴露对暴力行为和自杀意念的影响,并检验创伤后应激障碍和抑郁在其中的中介作用。结果发现：创伤暴露可以直接正向预测暴力行为和自杀意念,PTSD在创伤暴露对暴力行为和自杀意念的影响间起中介作用,抑郁仅在创伤暴露对自杀意念的影响间起中介作用,而在创伤暴露对暴力行为影响间的中介效应不显著。     

Mean Streets and Mental Health: Depression and Post‐Traumatic Stress Disorder at Crime Hot Spots

This study explores the relationship between mental health and place at microgeographic units of analysis. We examine self‐reported symptomology for depression and PTSD for 2,724 survey respondents interviewed in three types of randomly selected street segments: violent crime hot spots, cool spots, and cold spots. We find that the mean symptomology score is 61% higher for depression in violent crime hot spots than cold spots, and 85% higher for PTSD. Overall, we estimate that 14.8% of residents of violent crime hot spots meet thresholds for moderate depression or a diagnosis of PTSD. This can be compared to only 6.5% of residents at the cold spots. Using PSM and weighted negative binomial regression approaches we show that observable selection factors are not responsible for the relationships identified. Examining geographic influences, we find an important area effect of violent crime for both mental health measures, and an additional impact of the specific street of residence for PTSD.     

Women Living with Traumatic Brain Injury

Abstract

Women living with Traumatic Brain Injury (TBI) typically experience social and emotional sequelae that can be effectively addressed in the context of a psychotherapeutic relationship. Traumatic Brain Injuries can affect the full range of human functioning, from activities of daily living to experiencing a coherent sense of self. In this article, we focus on two issues, social isolation and emotional functioning, that encompass a number of key challenges facing women with TBI and are common and fruitful foci of psychotherapy. Social isolation includes marginalization in multiple communities, the invisibility of cognitive disabilities, difficulties in interpersonal relationships, and difficulties in employment and access to transportation. Emotional functioning includes posttraumatic stress symptoms, loss of self-esteem, anxiety, depression, anger, and shame. Two exemplary cases are used to illustrate the themes and underscore the complexities and realities of adjusting to TBI. Recommendations for therapists and consumers are woven throughout the paper.     

Trauma and the symbolic function of the mind

The relationship between trauma and the symbolic function of the mind is discussed in three parts. First, a short outline is given of the long‐lasting split within the field of trauma: it consists in a dichotomy between the symbolic and anti‐symbolic reading of the traumatic experience – as I have called it in a previous paper. In the second part, it is maintained that the work of Ferenczi represents an attempt at overcoming this split. In the third and last part, the notion of symbolic adaptation is introduced. The process of adaptation has to ensure the survival of the individual along lines capable to foster the hope that the lost equilibrium between the individual and his environment will one day be restored. This function is performed by symbols: by linking together the lost satisfaction and the hoped‐for wish‐fulfillment, by creating bridges between past and future, symbols enable us to adjust to the new environment without renouncing hope. Symbols are mediators between the pleasure principle and the reality principle. When a person is struck by trauma it is precisely this unifying function which is broken. A typical consequence of this situation is described by Ferenczi as a rupture between feeling and intelligence.     

Detecting performance invalidity in children: Not quite as easy as A,B, C, 1, 2, 3 but automatized sequences appears promising

In adult populations, embedded performance validity indicators are well established, as they are time efficient, resistant to coaching, and allow for more continuous monitoring of effort than standalone measures. Although several recent studies have demonstrated the appropriateness of using standalone validity tests with school-age children, a paucity of pediatric work has examined embedded indicators. The present study investigated the value of a simple automatized sequences task to detect performance invalidity in 439 clinically referred patients with mild head injury aged 8 through 17 years. Sixteen percent of the participants failed the Medical Symptom Validity Test (MSVT). Thirteen percent failed the MSVT and also performed below established cutoffs on either the Test of Memory Malingering or Wechsler Digit Span subtest. The group classified as providing invalid data performed significantly worse than the group passing the MSVT across all sequencing conditions. Sensitivity and specificity for the total time on the sequencing task compared favorably to data produced for many respected adult-based embedded indicators (i.e., sensitivity around 50% when specificity ≥ 90%). Classification statistics for any embedded performance validity test can be expected to be worse in more severely affected populations; however, the current sequencing task appears to have value in detecting invalid performance in relatively high-functioning older children and adolescents. The fact that the task takes less than a couple of minutes to administer makes it especially appealing.     

Prospective risk factors for subsequent exposure to potentially traumatic events

Abstract

In a sample of 1528 college students, we examined (1) whether several risk factors prospectively predicted exposure to potentially traumatic events (PTEs) over a 2-month period and (2) whether dependent events (i.e., those more likely to depend upon one's behavior or characteristics) and independent events were predicted by different risk factors. Logistic regression analyses indicated that overall subsequent PTE exposure was higher for women, those with more previous PTEs, and those who engaged in more binge drinking. Female gender and previous PTE exposure also predicted exposure to independent events. Subsequent dependent PTE exposure was predicted by more previous PTEs and binge drinking, and was somewhat higher in ethnic minority students. Implications for prevention efforts are discussed.     

Anticipatory Anxiety of an Imminent Economic Collapse

This article describes a prospective study of 1,200 participants, half of whom were offspring of trauma survivors, and their emotional symptom levels before and after the Corralito, an economic crisis that occurred in Argentina at the end of 2001. The authors report pre- and postcrisis data on anxiety and depression in a group of adult offspring of victims of the Dirty War (1976–1983) in an attempt to ascertain whether they are at greater risk than a control group for developing anxiety and depression in response to an economic crisis. The results indicated the offspring of war victims experienced greater emotional distress than the control subjects before, but not after the imposition of the Corralito.     

Enhancing Resilience Among Providers of Trauma-Informed Care: A Curriculum for Protection Against Secondary Traumatic Stress Among Non-Mental Health Professionals

Although the call to create trauma-informed services for youth has been clearly sounded, a relatively neglected part of this effort is the need to prepare non-mental health professionals to carry out trauma-informed programming in ways that protect them from secondary traumatic stress (STS). To this end, this article introduces Resilience for Trauma-Informed Professionals, a curriculum that introduces participants to techniques designed to promote resilience in the face of exposure to trauma-related material. Based on the existing evidence base regarding risk and protective factors for STS, six core elements targeted by the curriculum are described—appraisals, self-efficacy, emotional awareness, affect regulation, resilience, and prevention—as they are implemented across three stages: pre-exposure preparation, coping in the presence of trauma, and recovery in the aftermath of exposure.     

Traumatic Experiences and PTSD Among Adolescent Congolese Refugees in Uganda: A Preliminary Study

The study examined experienced traumatic events and the related Post-Traumatic Stress Disorder (PTSD) amongst a sample of 89 adolescent Congolese refugees (56 females and 33 males) at a refugee camp in Uganda. Data was collected using a questionnaire, and analyzed for trauma moderation by demographics and mediation by PTSD symptom scores. Findings indicate a prevalence of PTSD of 49.4% overall, with 75% of the female refugees meeting the PTSD criteria. The refugees with PTSD had high intrusive, avoidance and arousal scores, in addition to moderate to severe PTSD symptom severity scores. Trauma load was a significant predictor of PTSD among adolescent refugees. Our findings point to the high prevalence of PTSD resulting from an increased trauma load and being a female.