The relationships between early trauma, dissociation, and alexithymia in alcohol addiction

Objective Addiction is often considered a dissociative behavior that is related to alexithymia and developmental trauma. The study aims were to explore the relationships between early trauma, alexithymia, and dissociation. Methods A total of 117 (males=60; females=57) alcohol-addicted individuals and 117 healthy individuals (males=60; females=57) were administered a series of self-report questionnaires that assess traumatic experiences, alexithymia, and pathological dissociation. Results Correlation analyses indicated significant correlations between alexithymia, dissociation, and trauma and a significant difference between the target and control groups, with higher alexithymia and dissociation scores in the target group. Conclusion These findings suggest that trauma, alexithymia, and dissociation are predictors of alcohol addiction

Stressors, coping and symptoms of adjustment disorder in the course of the COVID-19 pandemic - study protocol of the European Society for Traumatic Stress Studies (ESTSS) pan-European study

Background: During the current COVID-19 pandemic, the people in Europe are exposed to self-isolation, quarantine, job loss, risk of contracting COVID-19, or grief of loved ones. Such a complex array of stressors may lead to symptoms of adjustment disorder or posttraumatic stress disorder. This research protocol describes a study launched by the European Society of Traumatic Stress Studies (ESTSS) to investigate the impact of the COVID-19 pandemic on symptoms of adjustment disorder across European countries. Objective: The longitudinal online cohort study aims (1) to explore psychosocial reactions to the COVID-19 pandemic across ten European countries; (2) to examine the relationships between risk and resilience factors, stressors and symptoms of adjustment disorder during the pandemic; and (3) to investigate whether these relationships are moderated by coping behaviours. Method: In ten countries (Austria, Croatia, Georgia, Germany, Italy, Lithuania, Netherlands, Poland, Portugal, and Sweden), between 1,000 and 2,000 participants will be recruited, depending on the size of the country. Participants will be assessed at two timepoints with a six-month interval. Following a conceptual framework based on the WHO's social framework of health, an assessment of risk and resilience factors, COVID-19 related stressors and pandemic-specific coping behaviours will be measured to estimate their contribution to symptoms of adjustment disorder. The Adjustment Disorder New Module 8 (ADNM-8) will be used to assess symptoms of adjustment disorder. As a secondary measure, symptoms of posttraumatic stress disorder will be measure using the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Data analysis: The relative contribution of risk factors, resilience factors, and stressors on symptoms of adjustment disorder or symptoms of posttraumatic stress disorder will be estimated using multilevel analysis. To determine the moderating effects of different types of coping behaviours on these relationships, a multilevel mediation analysis will be carried out

A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic

Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder. Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment. Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression. Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure. Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic

The role of youth mental health services in the treatment of young people with serious mental illness: two-year outcomes and economic implications

Aim: To evaluate the outcomes and economic case for a UK innovative youth-specific mental health service for 16 to 25 year olds. Methods: A pre-, during- and post-treatment comparative design for twenty young people at high risk of developing psychosis who received two years’ treatment with the service, using outcomes that concurred with the service aims: changes in mental health, employment rates and service use. Results: 45% of those at risk and with symptoms of serious mental illness commencing treatment were not receiving mental health services at baseline.. Compared to service use prior to treatment at the youth-specific service, hospital admissions, A&E and criminal justice system use appear to decrease over the two years of treatment and the year after treatment, with potential cost differences of £473,000. Mental health improved or stayed the same, compared to baseline. Employment rates improved, although the sample size for this is very small. Potential cost differences associated with service users moving into employment over the two years are £148,000. The estimated cost over two years of providing the youth-specific mental health service to these young people was £106,000. Conclusions: Given the extensive long-term negative consequences and high costs of untreated mental illness in the 16 to 25 age group and the documented problems young people have in receiving appropriate services, this youth-specific, age-appropriate service model appears to be successful, with improved outcomes and cost differences in the short-term, and with encouraging implications for the longer term

Risk and protective factors for posttraumatic stress disorder in trauma-exposed individuals during the COVID-19 pandemic – findings from a pan-European study

Background: The COVID-19 pandemic is a health emergency resulting in multiple stressors that may be related to posttraumatic stress disorder (PTSD). Objective: This study examined relationships between risk and protective factors, pandemic-related stressors, and PTSD during the COVID-19 pandemic. Methods: Data from the European Society of Traumatic Stress Studies (ESTSS) ADJUST Study were used. N = 4,607 trauma-exposed participants aged 18 years and above were recruited from the general populations of eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. We assessed sociodemographic (e.g. gender), pandemic-related (e.g. news consumption), and health-related (e.g. general health condition) risk and protective factors, pandemic-related stressors (e.g. fear of infection), and probable PTSD (PC-PTSD-5). The relationships between these variables were examined using logistic regression on multiple imputed data sets. Results: The prevalence of probable PTSD was 17.7%. Factors associated with an increased risk for PTSD were younger age, female gender, more than 3 h of daily pandemic-related news consumption (vs. no consumption), a satisfactory, poor, or very poor health condition (vs. a very good condition), a current or previous diagnosis of a mental disorder, and trauma exposure during the COVID-19 pandemic. Factors associated with a reduced risk for PTSD included a medium and high income (vs. very low income), face-to-face contact less than once a week or 3–7 times a week (vs. no contact), and digital social contact less than once a week or 1–7 days a week (vs. no contact). Pandemic-related stressors associated with an increased risk for PTSD included governmental crisis management and communication, restricted resources, restricted social contact, and difficult housing conditions. Conclusion: We identified risk and protective factors as well as stressors that may help identify trauma-exposed individuals at risk for PTSD, enabling more efficient and rapid access to care

Interventions to improve therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: systematic review

Background: Communication may be an influential determinant of inequality of access to, engagement with and benefit from psychiatric services. Aims: To review the evidence on interventions designed to improve therapeutic communications between Black and minority ethnic patients and clinicians who provide care in psychiatric services. Method: Systematic review and evidence synthesis (PROSPERO registration: CRD42011001661). Data sources included the published and the ‘grey’ literature. A survey of experts and a consultation with patients and carers all contributed to the evidence synthesis, interpretation and recommendations. Results: Twenty-one studies were included in our analysis. The trials showed benefits mainly for depressive symptoms, experiences of care, knowledge, stigma, adherence to prescribed medication, insight and alliance. The effect sizes were smaller for better-quality trials (range of d 0.18–0.75) than for moderate- or lower-quality studies (range of d 0.18–4.3). The review found only two studies offering weak economic evidence. Conclusions: Culturally adapted psychotherapies, and ethnographic and motivational assessment leading to psychotherapies were effective and favoured by patients and carers. Further trials are needed from outside of the UK and USA, as are economic evaluations and studies of routine psychiatric care practices

A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic

Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder. Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment. Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression. Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption &gt;30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure. Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.</p

Predictors of traumatic experiences among individuals experiencing pandemic-related stressors: a cross-sectional study in Europe during the COVID-19 crisis

The COVID-19 pandemic is a manifestation of trauma exposure that could eventuate in psychological distress, anxiety, depression, and various mental health disturbances, especially in people who have experienced an additional stressor such as a traumatic event. This cross-sectional study assessed the relationship between pandemic-related stressors, post-traumatic stress disorder (PTSD), the risk for severe or life-threatening symptoms, and resilience among individuals with a traumatic history amidst the coronavirus disease. This study is part of a longitudinal pan-European research, the ADJUST study. The present study consisted of 14.106 participants. The questionnaires utilized included: sociodemographics, health aspects, the Criterion A section of the PTSD Checklist for DSM-5 (PCL-5), the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), the Pandemic Stressor Scale (PaSS), and the Resilience Evaluation Scale (RES). For the analysis, descriptive statistics and logistic regression analysis were applied. 29% of the respondents reported a traumatic history. Fear of infection, burden of infection, crisis management and communication, restricted activity, risk for severe or life-threatening symptoms of the coronavirus disease, PTSD, and resilience were the predictive factors in the trauma-exposed population. This research provides insights into the stressors that individuals with a traumatic background might experience through the COVID-19 pandemic. Future interventions and worldwide health policies should target trauma-exposed populations to enhance psychological health amidst COVID-19 and other stressful events

Factores de riesgo y protectores para el trastorno de éstres postráumatico en individuos expuestos a trauma durante la pandemia COVID-19 – hallazgos de un estudio paneuropeo

Background: The COVID-19 pandemic is a health emergency resulting in multiple stressors that may be related to posttraumatic stress disorder (PTSD). Objective: This study examined relationships between risk and protective factors, pandemic-related stressors, and PTSD during the COVID-19 pandemic. Methods: Data from the European Society of Traumatic Stress Studies (ESTSS) ADJUST Study were used. N = 4,607 trauma-exposed participants aged 18 years and above were recruited from the general populations of eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. We assessed sociodemographic (e.g. gender), pandemic-related (e.g. news consumption), and health-related (e.g. general health condition) risk and protective factors, pandemic-related stressors (e.g. fear of infection), and probable PTSD (PC-PTSD-5). The relationships between these variables were examined using logistic regression on multiple imputed data sets. Results: The prevalence of probable PTSD was 17.7%. Factors associated with an increased risk for PTSD were younger age, female gender, more than 3 h of daily pandemic-related news consumption (vs. no consumption), a satisfactory, poor, or very poor health condition (vs. a very good condition), a current or previous diagnosis of a mental disorder, and trauma exposure during the COVID-19 pandemic. Factors associated with a reduced risk for PTSD included a medium and high income (vs. very low income), face-to-face contact less than once a week or 3–7 times a week (vs. no contact), and digital social contact less than once a week or 1–7 days a week (vs. no contact). Pandemic-related stressors associated with an increased risk for PTSD included governmental crisis management and communication, restricted resources, restricted social contact, and difficult housing conditions. Conclusion: We identified risk and protective factors as well as stressors that may help identify trauma-exposed individuals at risk for PTSD, enabling more efficient and rapid access to care.Antecedentes: La pandemia COVID-19 es una emergencia sanitaria que genera múltiples estresores que pueden estar relacionados con el trastorno de estrés postraumático (TEPT). Objetivo: Este estudio examinó las relaciones entre los factores de riesgo y protectores, estresores relacionados con la pandemia y TEPT durante la pandemia de COVID-19. Métodos: Se utilizaron los datos del estudio ADJUST de la Sociedad Europea de Estudios de Estrés Traumático (ESTSS por sus siglas en ingles). N=4.607 participantes mayores de 18 años expuestos a trauma fueron reclutados de la población general de once países (Austria, Croacia, Georgia, Alemania, Grecia, Italia, Lituania, Países Bajos, Polonia, Portugal y Suecia) desde junio a noviembre 2020. Evaluamos factores de riesgo y protectores sociodemográficos (p.ej. género), relacionados con la pandemia (p.ej. consumo de noticias) y relacionados con la salud (p.ej. estado de salud general), estresores relacionados con la pandemia (p.ej. temor a la infección) y TEPT probable (PC-PTSD-5 por sus siglas en ingles). Las relaciones entre estas variables se examinaron mediante regresión logística en múltiples conjuntos de datos imputados. Resultados: La prevalencia de TEPT probable fue del 17.7%. Los factores asociados con un mayor riesgo de TEPT fueron edad más joven, sexo femenino, más de 3 horas de consumo diario de noticias relacionadas con la pandemia (frente a ningún consumo), un estado de salud satisfactorio, malo o muy malo (frente a un estado muy bueno), un diagnóstico de trastorno mental actual o previo y exposición a un trauma durante la pandemia de COVID-19. Los factores asociados con un riesgo reducido de TEPT incluyeron ingresos medios y altos (frente a ingresos muy bajos), contacto cara a cara menos de una vez a la semana o de 3 a 7 veces por semana (frente a ningún contacto) y contacto social digital menos de una vez a la semana o de 1 a 7 días a la semana (frente a ningún contacto). Los estresores relacionados con la pandemia asociados con un mayor riesgo de TEPT incluyeron la gestión y comunicación de crisis gubernamental, recursos restringidos, contacto social restringido y condiciones de vivienda difíciles. Conclusiones: Identificamos factores de riesgo y protectores, así como estresores que pueden ayudar a identificar a las personas expuestas a traumas en riesgo de TEPT, lo que permite un acceso más eficiente y rápido a la atención

Trauma-informed care: is cultural competence a viable solution for efficient policy strategies?

Treatment and support needs within the public system require a systemic approach characterized both by traumaspecific diagnostic and treatment services and a "trauma-informed" environment capable of sustaining these services and supporting the positive outcomes to clients who receive these services. The paper provides a critique of what steps are needed to promote a dialogue between evidence-based practices and culture competence in trauma-informed services highlighting the strategic gaps that may maintain a disconnection between treatment and service delivery, and between cultural psychology and the traumatic stress field. The paper concludes with policy reccomendations and with a reflection on the challenges ahead, especially in terms of effectiveness and the task of integrating psychotraumatology into the routine of mental health service