Reducing barriers to trauma inquiry in substance use disorder treatment – A cluster-randomized controlled trial

Background: Despite of the high rate of trauma in clients with substance use disorders, trauma often remains undetected in a majority of treatment-seeking clients. Improving professionals’ knowledge and competences in the inquiry of traumatic events is therefore of utmost importance to appropriately address the specific trauma-related treatment needs. However, professionals in substance use disorder treatment settings frequently report barriers to inquiring about traumatic events, e.g., the fear of offending or harming the client. Such barriers should be addressed by trainings to improve the systemtic inquiry of traumatic events in clients. Methods: In this cluster-randomized trial, we examined whether a one-day training in trauma inquiry (‘Learning How to Ask’) would reduce professionals’ perceived barriers to trauma inquiry. 148 professionals working in outpatient substance use disorder treatment centers were randomized to an intervention (n = 72) or a control group (n = 76). The professionals of the intervention group received a one-day training plus a refresher session 3 months later, the professionals of the control group received no training. Professionals rated their level of six common barriers to trauma inquiry on four-point Likert scales at baseline, at 3-month and 6-month follow-up, namely ‘Feeling uncomfortable when asking about traumatic events’, ‘Fear of offending the client’, ‘Fear of retraumatizing the client’, ‘Fear that client may terminate treatment’, ‘Unsure whether authorities have to be informed when perpetrator is known’, and ‘No trauma-specific treatment available’. Results: Five of the six perceived barriers to inquiring about traumatic events significantly decreased from baseline to 6-month follow-up to a greater extent in the trained group than in the control group (‘Feeling uncomfortable’: b = -0.32, 95% CI [-0.52, -0.12]; ‘Fear of offending the client’: b = -0.33, 95% CI [-0.56, -0.09]); ‘Fear of retraumatizing the client’: b = -0.45, 95% CI [-0.69, -0.22]; ‘Fear that client may terminate treatment’: b = -0.28, 95% CI [-0.49, 0.07]; ‘No trauma-specific treatment available’: b = -0.25, 95% CI [-0.51, -0.01]). Conclusions: Our findings provide first evidence that a one-day training in trauma inquiry is effective in reducing common barriers to trauma inquiry, which may improve detection of traumatic events

Prevalence of psychological distress among Ukrainian refugees in Germany : examination of gender differences

Hintergrund Der Krieg in der Ukraine hat die weltweite Anzahl von Vertriebenen erhöht. Fluchterfahrungen und traumatische Erlebnisse können zu langfristigen psychischen Problemen führen. Die Prävalenz und der Schweregrad psychischer Belastungen variieren jedoch angesichts unterschiedlicher demografischer Faktoren. Weibliche Flüchtlinge erfahren aufgrund ihres Geschlechts häufig eine besonders starke Benachteiligung und psychische Belastung. Methode Im Rahmen einer Querschnittstudie wurden n = 389 Personen ab 18 Jahren befragt, die nach dem Ausbruch des Krieges in der Ukraine in Deutschland Zuflucht gesucht haben. Zur Erhebung des allgemeinen Gesundheitszustands und der psychischen Belastungen sowie der sozioökonomischen und soziodemografischen Merkmale der Befragten wurde ein standardisierter Fragebogen, übersetzt in die ukrainische Sprache, eingesetzt. Ergebnisse Frauen bewerteten ihre psychische Gesundheit negativer als Männer. Etwa 52 % der Männer und 69 % der Frauen schliefen aufgrund von Sorgen „schlechter“ oder „viel schlechter“ als üblich. Von leichten bis schweren depressiven Symptomen sowie von Angst berichteten 85 % aller Teilnehmenden. Im Vergleich zu den Männern gaben die Frauen mehr als doppelt so häufig an, unter schweren Depressions- oder Angstsymptomen zu leiden. Diskussion Ein hoher Anteil der aus der Ukraine Geflüchteten weist psychische Belastungen auf. Bei den geflüchteten Frauen sind psychische Belastungen signifikant stärker ausgeprägt als bei den Männern. Weitere geschlechtersensible Studien sind erforderlich, um Faktoren zu ermitteln, die die Vulnerabilität von aus der Ukraine geflüchteten Frauen erklären können und Ansatzpunkte für präventive Angebote liefern. Schlussfolgerung Zur Sichtbarmachung von und Sensibilisierung für psychische Belastungen bei unkrainischen Frauen sollten Interventionen unter Berücksichtigung des Zusammenwirkens von (biologischen) Vulnerabilitätsfaktoren, geschlechtsspezifischen Postmigrationsstressoren und intersektionalen Diskriminierungen geplant und angeboten werden.Background The war in Ukraine has increased the number of displaced people worldwide. Experiences of flight and trauma can lead to long-term mental health problems. The prevalence and severity of mental distress vary, given different demographic factors. Female refugees often experience particularly severe disadvantages and psychological distress due to their gender. Methods In a cross-sectional study, n = 389 participants aged 18 years and older who sought refuge in Germany after the outbreak of war in Ukraine were interviewed. A standardized questionnaire in Ukrainian was used to assess the general health status and psychological distress as well as the socioeconomic and sociodemographic characteristics of the participants. Results Women respondents rated their mental health more negatively than men. About 52% of men and 69% of women slept worse or much worse than usual because of worries. Mild to severe depressive symptoms and anxiety were reported by 85% of all participants. Compared with men, women were more than twice as likely to report severe depressive or anxiety symptoms. Discussion A high proportion of refugees who fled from Ukraine show psychological distress. Among refugee women, psychological distress is significantly more pronounced than among men. Further gender-sensitive studies are needed to identify factors that can explain the vulnerability of women who have fled from Ukraine and provide starting points for preventive services. Conclusion In order to emphasize and sensitize (psychological) stress in Ukrainian women, interventions should be planned and offered, taking into account the interaction of (biological) vulnerability factors, gender-related post-migration stressors and intersectional discrimination.PeerReviewe

The current state of international research on the effectiveness of school nurses in promoting the health of children and adolescents: An overview of reviews.

ObjectiveSchool nurses are engaging worldwide to promote and protect children's health. Many researchers who examined the effectiveness of the school nurse criticized the inadequate methodology employed in many of the studies. We therefore carried out an evaluation on the effectiveness of school nurses based on a rigorous methodological approach.MethodsIn this overview of reviews we performed an electronic databank search and global research results on the effectiveness of school nurses were sought. We identified 1,494 records through database search. Abstracts and full texts were screened and summarized using the dual control principle. We summarized the aspects of quality criteria as well as the significance of the effectiveness of the school nurse. In the first step, k = 16 systematic reviews were summarized and evaluated following the AMSTAR-2 guidelines. In a second step, j = 357 primary studies included in these k = 16 reviews were summarized and assessed following the GRADE guidelines.ResultsResearch results on the effectiveness of school nurses show that school nurses play a key role in improving the health of children with asthma (j = 6) and diabetes (j = 2), results on combating obesity are less certain (j = 6). The quality of identified reviews is mostly very low with only six studies of medium quality, of which one identified as a meta-analysis. A total of j = 289 primary studies were identified. Approximately 25% (j = 74) of identified primary studies were either randomized controlled trials (RCT) or observational studies, of which roughly 20% (j = 16) had a low risk of bias. Studies with physiological variables such as blood glucose or asthma labeling led to higher quality results.ConclusionThis paper represents an initial contribution and recommends further evaluation of the effectiveness of school nurses, particularly in the areas of mental health or children from low socioeconomic backgrounds. The general lack of quality standards in school nursing research should be integrated into the scientific discourse of school nursing researchers to provide robust evidence for policy planners and researchers

Short-term eye movement desensitization and reprocessing (EMDR) therapy to treat children with posttraumatic stress symptoms after single trauma: A case series

Background Traumatic experiences can lead to posttraumatic stress disorder (PTSD). For young children, even minor, inconspicuous looking events can lead to posttraumatic stress symptoms. Trauma-focused treatment with Eye Movement Desensitization and Reprocessing (EMDR) offers children an age-adapted intervention to help them successfully process traumatic experiences. So far, there has been a lack of well evaluated trauma-focused treatments for young children. Methods These case series examine the effectiveness of a short-term treatment with EMDR therapy for children showing PTSD symptoms after experiencing a single incident induced trauma. Five children between 5 and 10 years of age who developed PTSD after a single incident trauma received a manualized EMDR treatment for 6 weeks (mean number of sessions: seven including a mean number of EMDR sessions: 3.4). Posttraumatic stress symptoms were assessed prior to treatment, following treatment and at a 3-month follow-up with standardized instruments for caregivers and children. Results PTSD symptoms decreased for all children after completing the treatment from clinical to non-clinical level. Reductions in vegetative hyperarousal, fears and clinging behaviour were achieved. Furthermore, reductions in the parental stress levels, as well as a recovery of everyday routine and everyday stability were observed. Conclusion Short-term EMDR treatment appears to be a promising treatment for single incident trauma in young children providing a potentially successful quick and safe psychological treatment for children. Results contribute to the knowledge of feasibility and acceptability of short-term, trauma-focused treatments of children with EMDR. Replication of the results of these case series in larger samples using a randomized controlled design is warranted

The current state of international research on the effectiveness of school nurses in promoting the health of children and adolescents: An overview of reviews

Objective School nurses are engaging worldwide to promote and protect children’s health. Many researchers who examined the effectiveness of the school nurse criticized the inadequate methodology employed in many of the studies. We therefore carried out an evaluation on the effectiveness of school nurses based on a rigorous methodological approach. Methods In this overview of reviews we performed an electronic databank search and global research results on the effectiveness of school nurses were sought. We identified 1,494 records through database search. Abstracts and full texts were screened and summarized using the dual control principle. We summarized the aspects of quality criteria as well as the significance of the effectiveness of the school nurse. In the first step, k = 16 systematic reviews were summarized and evaluated following the AMSTAR-2 guidelines. In a second step, j = 357 primary studies included in these k = 16 reviews were summarized and assessed following the GRADE guidelines. Results Research results on the effectiveness of school nurses show that school nurses play a key role in improving the health of children with asthma (j = 6) and diabetes (j = 2), results on combating obesity are less certain (j = 6). The quality of identified reviews is mostly very low with only six studies of medium quality, of which one identified as a meta-analysis. A total of j = 289 primary studies were identified. Approximately 25% (j = 74) of identified primary studies were either randomized controlled trials (RCT) or observational studies, of which roughly 20% (j = 16) had a low risk of bias. Studies with physiological variables such as blood glucose or asthma labeling led to higher quality results. Conclusion This paper represents an initial contribution and recommends further evaluation of the effectiveness of school nurses, particularly in the areas of mental health or children from low socioeconomic backgrounds. The general lack of quality standards in school nursing research should be integrated into the scientific discourse of school nursing researchers to provide robust evidence for policy planners and researchers

Haushaltsklima, Alleinleben und gesundheitsbezogene Lebensqualität während des COVID-19-Lockdowns in Deutschland

Hintergrund: Zur Eindämmung der COVID19-Pandemie ('coronavirus disease 2019') wurden im Frühjahr 2020 Ausgang und Kontakte in Deutschland stark beschränkt. Studien weltweit lassen die Vermutung zu, dass die krisenbedingt angeordnete soziale Isolierung das Wohlbefinden der betroffenen Menschen signifikant beeinflusst. Um die gesundheitlichen Konsequenzen des Lockdowns verstehen und diesen präventiv begegnen zu können, wurde die gesundheitsbezogene Lebensqualität (gLQ) im Zusammenhang mit der Wohnsituation und dem subjektiv wahrgenommenen Haushaltsklima in diesem Zeitraum untersucht. Methodik: Eine durch vier Strategien deutschlandweit rekrutierte Stichprobe von n= 541 Erwachsenen (MW = 34 Jahre; 67 % weiblich) wurde mit standardisierten Instrumenten zu der gLQ und dem Haushaltsklima während des Lockdowns mittels eines Online-Surveys befragt. Ergebnisse: In der Stichprobe wurde im Mittel eine als mäßig einzustufende gLQ während des Lockdowns gefunden, die signifikant durch das subjektiv wahrgenommene Haushaltsklima vorhersagt wurde (p< 0,001). Alleinlebende Teilnehmende meldeten eine signifikant niedrigere gLQ zurück als Teilnehmende, die mit anderen Menschen zusammen in einem Haushalt lebten. Das Haushaltsklima sagte 26 % der Varianz der gLQ vorher; soziodemographische Merkmale klärten einen zusätzlichen Varianzanteil von 5 % auf. Diskussion: Die Hinweise dafür, dass ein besser eingeschätztes Haushaltsklima mit einer höheren gLQ während des Lockdowns zusammenhing, betonen die Bedeutung des häuslichen Umfelds. Bei zukünftigen Maßnahmen zur Pandemieeindämmung, die soziale Kontakte einschränken, sollten in der Bevölkerung das Bewusstsein für den Zusammenhang zwischen Wohlbefinden und Haushaltsklima erhöht werden sowie Hilfen für Menschen mit einem konfliktbelasteten häuslichen Umfeld zugänglich bleiben

Protective mental health factors in children of parents with alcohol and drug use disorders: A systematic review

<div><p>Children of parents with drug and alcohol use disorders often grow up under severe stress and are at greater risk of developing psychological and social problems. However, a substantial proportion of affected children adapt to their distressing life conditions and show positive development in terms of their mental health. These children are described as resilient. One difference between resilient and maladapted children is the presence of protective factors. The aim of this systematic review is to provide an overview of the current state of the research concerning protective mental health factors in children of parents with alcohol or drug use disorders (COPAD). For that purpose, the PsychInfo, PubMed, CINAHL and ISI Web of Science databases were searched through January 2017. All the identified publications were screened using previously developed inclusion criteria. The search yielded 3,402 articles. Eleven of these publications (2003–2013) met the criteria for inclusion in the present review. Information on the studies was extracted using an extraction form. A narrative analysis was performed, and the methodological quality was examined using a checklist based on the Mixed Methods Appraisal Tool. The research identified familial, parental, child-related and biological factors that influenced mental health outcomes in affected children (N = 1,376, age range = 1–20 years). Overall, protective mental health factors are understudied in this target group. Most of the included studies were conducted in the United States and employed a cross-sectional design. A comparison of the included cross-sectional and longitudinal studies indicated consistent results related to a secure parent-child attachment. Based on the current state of the research, no causal conclusions with regard to the effectiveness of protective factors can be drawn. To develop effective prevention programs, further longitudinal studies and studies assessing the interactions between risk and protective factors are needed.</p></div

The multicultural conceptualisation of well-being

Abstract Background Exploring and understanding indicators of better life outcomes have remained popular among social and health researchers. However, the subjective approach to measuring well-being has raised questions on the appropriateness of standard measures of well-being in multicultural settings. The current study examines generalised well-being and its dependence on the implicit understanding of individual culture and circumstances. Methods A mixed-method approach with a cross-sectional design and focus group discussions was adopted. Fifteen focus group discussions with 66 participants were conducted in four provinces of South Africa. Descriptive statistics, correlations, regression analysis and analysis of variance were computed for quantitative data. The focus group discussions were analysed using a content analysis approach. The recorded focus group discussions were transcribed using the intelligent verbatim technique. Data analysis was done stepwise using open, axial, and selective coding techniques. Results Quantitative analysis showed a strong and significant association between quality of life and income and a moderate association with educational attainment. The open coding technique for qualitative data confirmed 11 different subconstructs of well-being, mentioned 403 times during the 15 focus group discussions. Furthermore, well-being indicators varied based on participants’ racial identity. Conclusions The findings confirm personal circumstance and culture as significant for interpreting results from well-being research. Furthermore, it supports Maslow’s Hierarchy of Needs, highlighting the movement from deficiency needs to growth needs after deficiency needs are met. Research must adopt a more sociological approach to improve the accuracy and implementibility of findings when using standardised measures of well-being