Many trauma survivors seem to be reluctant to seek professional help. The aim of the current review was to synthesize relevant literature, and to systematically classify trauma survivors' perceived ...barriers and facilitators regarding mental health service utilization. The systematic search identified 19 studies addressing military personnel and 17 studies with trauma survivors of the general population. The data analysis revealed that the most prominent barriers included concerns related to stigma, shame and rejection, low mental health literacy, lack of knowledge and treatment-related doubts, fear of negative social consequences, limited resources, time, and expenses. Perceived facilitators lack attention in research, but can be influential in understanding mental health service use. Another prominent finding was that trauma survivors face specific trauma-related barriers to mental health service use, especially concerns about re-experiencing the traumatic events. Many trauma survivors avoid traumatic reminders and are therefore concerned about dealing with certain memories in treatment. These perceived barriers and facilitators were discussed regarding future research and practical implications in order to facilitate mental health service use among trauma survivors.
•Many trauma survivors seem to be reluctant to seek mental health treatment.•Trauma survivors perceive a number of barriers to treatment.•Facilitators are neglected in research but important to understand treatment use•Similarities between trauma survivors of general and military population•Highlights limitations in prior research and points to future directions
Abstract
Background
The present study examined Afghan asylum seekers’ and refugees’ self-perceived problems, and their experiences of treatment with an adapted version of the brief transdiagnostic ...psychological intervention “Problem Management Plus” (aPM+). Specifically, the study explored which problems trouble them most and how these problems influence their daily functioning. Further, it examined how various standardized outcome measures correlate with these subjectively perceived problems.
Method
This study is part of a larger RCT study (PIAAS study) in which 88 Afghan asylum seekers and refugees were randomly allocated either to aPM + in addition to treatment as usual (aPM+/TAU) or TAU alone. The presented study uses a multi-method approach consisting of two parts: First, we investigated participants’ self-identified problems and subjective functional impairment using quantitative and qualitative assessment in both the aPM+/TAU and TAU group (n = 88). Second, we conducted in-depth qualitative interviews with a subsample of the aPM+/TAU group (n = 24) to gain a deeper understanding of participants’ personal experiences with aPM + and to obtain suggestions for improvement. Spearman correlations were applied for quantitative data, and deductive and inductive approaches of thematic analysis were used for qualitative data.
Results
We identified six main themes of self-perceived problems (primary post-migration living difficulties, general mental health problems, interpersonal stressors, secondary post-migration living difficulties, mental health problems specifically associated with stress, and somatic problems) and their consequences, as well as subjective functional impairment. Standardized measures of general mental health, posttraumatic psychopathology, and quality of life did not correlate with the intensity of self-perceived problems. aPM + was mostly perceived positively, and few participants had recommendations for its improvement.
Conclusion
The study aimed at giving a voice to Afghan trauma survivors to inform service providers and policy makers about their needs. Based on their expertise, future interventions can be tailored to their actual needs and optimized in terms of practical use. aPM + proved to be a positively perceived intervention that reduces subjective symptom burden and facilitates daily functioning. Culture-sensitive treatments within (mental) health services should increase service utilization and improve (mental) health in the long term.
The WHO recently launched the proposal for the 11th version of the International Classification of Diseases (ICD-11) that also includes two diagnoses related to traumatic stress. In contrast to the ...Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ICD-11 will probably, in addition to posttraumatic stress disorder (PTSD), also define a new diagnosis termed "complex posttraumatic stress disorder" (CPTSD).
We aimed to apply the proposed ICD-11 criteria for PTSD and CPTSD and to compare their prevalence to the ICD-10 (International Classification of Diseases 10th revision) PTSD prevalence. In addition, we compiled a list of symptoms for CPTSD based on subthreshold PTSD so as to include a wider group of individuals.
To evaluate the appropriateness of the WHO ICD-11 proposal compared to the criteria of ICD-10, we applied the newly introduced criteria for PTSD and CPTSD deriving from the Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C) and the Brief Symptom Inventory (BSI) scales, to a sample of adult survivors (N=229) of childhood institutional abuse. We evaluated the construct validity of CPTSD using confirmatory factor analysis (CFA).
More individuals fulfilled the criteria for PTSD according to ICD-10 (52.8%) than the ICD-11 proposal (17% for PTSD only; 38.4% if combined with complex PTSD). The new version of PTSD neutralized the gender effects. The prevalence of CPTSD was 21.4%, and women had a significantly higher rate of CPTSD than men (40.4 and 15.8%, respectively). Those survivors who were diagnosed with CPTSD experienced institutional abuse for a longer time. CFA showed a strong model fit.
CPTSD is a highly relevant classification for individuals with complex trauma history, but surprisingly, effects of gender were apparent. Further research should thus address gender effects.
Potentially traumatic experiences and post-migration living difficulties (PMLDs) undoubtedly leave marks on mental health and psychosocial functioning. While PMLDs are recognised as a risk factor for ...posttraumatic stress disorder and complex posttraumatic stress disorder (described together here as C/PTSD), recent investigations have found that C/PTSD symptoms might also influence the experience of PMLDs. The subjective experience of and coping with PMLDs in the context of C/PTSD symptoms has not yet been explored.
Semi-structured, interpreter-assisted interviews exploring the subjective experience of post-migration living difficulties were conducted with treatment-seeking Afghan refugees and asylum seekers (N = 24) and transcribed verbatim. Participants were screened using the International Trauma Questionnaire (ITQ) and allocated to a C/PTSD group or non-C/PTSD group. We analysed the qualitative interviews using content analysis and then compared the results of the two groups.
Over half of the participants (58.3%) met the criteria for C/PTSD. While the two groups addressed numerous similar themes, the C/PTSD group more frequently mentioned themes associated with C/PTSD symptoms (e.g., intrusions, avoidance, sleep disturbances, affective dysregulation) that influenced their responses to PMLDs. The non-C/PTSD group more often experienced positive emotions such as gratitude and optimism, and showed more active, solution-oriented behaviour as well as positive self-verbalisation.
To achieve a deeper understanding of PMLDs, post-traumatic psychopathology should be taken into account, as C/PTSD symptoms influence the experience of and coping with PMLDs. The specifics of individual experiences need to be considered in order to promote adaptive coping with PMLDs and to set individual trauma-focused and transdiagnostic treatment targets. In addition, psychological interventions should incorporate psychoeducation to improve the understanding of the impact of C/PTSD on the current experience of PMLDs.
ObjectivesFoster children are disproportionately exposed to complex trauma, which may lead to multifaceted impairments that manifest in comorbid emotional and behavioural problems. As little is known ...about the interactions between comorbid disorders over time, the present study aims to explore the co-development of traumatic stress (TS) symptoms and externalising behaviour problems (EBP), as well as the influence of complex trauma operationalised as cumulative child maltreatment (CM).SettingAs part of a 3-year longitudinal study, children from six foster care facilities in Lower Austria were interviewed at three measurement points.ParticipantsOf, in total, 263 participating children, the data of 124 children aged 10–18 years (M=13.5, 28% female) could be analysed.Primary and secondary outcome measuresLatent growth curve models were used to examine the co-development of TS symptoms (International Trauma Questionnaire) and EBP (Child Behaviour Checklist) over time; gender, age and cumulative CM (Childhood Trauma Questionnaire) acted as time-invariant covariates.ResultsWhile average TS symptoms decreased over time, EBP remained stable. Findings revealed that the initial severity of EBP was both related to the initial severity of TS symptoms and predictive of their rate of change. Cumulative CM was a significant predictor of initial TS symptoms and EBP even after controlling for age and gender, but not for the rates of change.ConclusionsTaken together, our results indicate that EBP and TS symptoms are not only cross-sectionally associated but interact with each other over time. Furthermore, an underlying complex trauma could at least partly determine the severity of the two symptom groups. In accordance with a trauma-informed care approach, our study highlights the importance of trauma-specific screening of high-risk children with complex or diffuse symptoms and argues for the benefits of treatments that focus on improving emotion regulation and social skills in addition to addressing trauma.
Background: The International Trauma Questionnaire (ITQ) is a standardized and validated measure aligned with the 11th version of the International Classification of Diseases (ICD-11) diagnostic ...criteria to assess post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). It has been translated into 25 different languages, but is yet to be translated into Dari and validated for use in the Afghan population.
Objective: This study aimed (1) to translate and culturally adapt the ITQ for use in Dari; (2) to assess the construct validity and composite reliability of ICD-11 PTSD and CPTSD using the Dari ITQ; and (3) to examine the concurrent, convergent, and discriminant validity of the Dari ITQ.
Method: The Dari ITQ was validated through the completion of a set of standardized measures by 305 Afghan asylum seekers and refugees in Austria. Factorial analyses and psychometric properties of the Dari ITQ were assessed using confirmatory factor analysis (CFA), bivariate correlations, and multivariate regression.
Results: Asylum seekers showed significantly higher levels of ICD-11 CPTSD symptomatology and probable diagnoses of ICD-11 PTSD, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) PTSD, anxiety, depression, and psychological distress in comparison to refugees. CFA results supported the two-factor second-order model comprised of the PTSD and disturbances in self-organization (DSO) as the best fit to the data. The psychometric adequacy of this model in the Dari ITQ was evidenced by high factor loadings and excellent internal reliability. The Dari ITQ showed satisfactory concurrent, convergent, and discriminant validity.
Conclusion: The current study supports the statistical validity and cultural sensitivity of the Dari ITQ in identifying symptoms of ICD-11 PTSD and CPTSD among Afghan asylum seekers and refugees.
This study provides the first translation and validation of the ITQ in Dari with an Afghan refugee population in Austria.
The two-factor second-order model was supported as the best fit to the data.
Additional support for the composite reliability, and concurrent, convergent, and discriminant validity was provided, suggesting the statistical validity and cultural sensitivity of the Dari ITQ in identifying symptoms of ICD-11 PTSD and CPTSD among Afghan asylum seekers and refugees.
Children and adolescents in residential care often face multiple traumatic experiences. However, some individuals show resilient adaptation. To depict this heterogeneity, the person-centered ...examination of different classes of adaptation is a powerful tool. Up to date, resilience was insufficiently addressed in this population. Data from 141 children and adolescents in residential care institutions in Austria regarding trauma history, psychopathology, behavioral adjustment, and protective factors were assessed with standardized self-report questionnaires. Distinct classes of adaptation after traumatic experiences were examined with Latent Class Analysis. Class differences regarding traumatic experiences and protective factors were analyzed with χ
testing. Three classes were identified resilience (66.18%), mixed psychopathology (13.97%, mixed), high psychopathology (19.85%, high). Only males were classified into the resilient class and only females into the high class. The high class differed significantly from the resilient class regarding cumulative trauma history and protective factors. The mixed class did not differ from the resilient class regarding trauma history, however, they differed significantly regarding protective factors. The resilient class was associated with protective factors. Strong gender differences show the relevance of a differentiated evaluation of gender-specific protective factors and resilience indicators. Fostering protective factors may be a suitable approach for tailored intervention measures.
Confronting the loss of a loved one leads us to the core questions of human existence. Bereaved parents have to deal with the rupture of a widely shared concept of what is perceived to be the natural ...course of life and are forced into meaning reconstruction.
This study aims to expand upon existing work concerning specific themes of meaning reconstruction in a sample of bereaved parents. More specifically, the relationship between meaning reconstruction, complicated grief, and posttraumatic growth was analyzed, with special attention focused on traumatic and unexpected losses.
In a mixed methods approach, themes of meaning reconstruction (sense-making and benefit-finding) were assessed in in-depth interviews with a total of 30 bereaved parents. Posttraumatic growth and complicated grief were assessed using standardized questionnaires, and qualitative and quantitative results were then merged using data transformation methods.
In total 42 themes of meaning reconstruction were abstracted from oral material. It was shown that sense-making themes ranged from causal explanations to complex philosophical beliefs about life and death. Benefit-finding themes contained thoughts about personal improvement as well as descriptions about social actions. Significant correlations were found between the extent of sense-making and posttraumatic growth scores (r
s
=0.54, r
s
=0.49; p<0.01), especially when the death was traumatic or unexpected (r
s
=0.67, r
s
=0.63; p<0.01). However, analysis revealed no significant correlation with complicated grief. Overall results corroborate meaning reconstruction themes and the importance of meaning reconstruction for posttraumatic growth.
Background: Children and adolescents in foster care often experience many co-occurring subtypes of maltreatment. However, little is known about different combinations of maltreatment subtypes, ...referred to as maltreatment classes. Furthermore, the association between those maltreatment classes and ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) has not been investigated in children and adolescents. In previous studies, classes characterized by cumulative maltreatment were associated with severe psychopathological symptoms. So far, no study investigated ICD-11 PTSD and CPTSD.
Objective: The first aim of this study was the detection of distinct maltreatment classes by examining frequently co-occurring maltreatment subtypes. The second aim was the examination of the association between those maltreatment classes and ICD-11 PTSD and CPTSD.
Method: Participants were 147 children and adolescents currently living in foster care institutions in Lower Austria. Maltreatment history, ICD-11 PTSD and CPTSD were assessed using standardized self-report questionnaires. Latent class analysis was applied to examine maltreatment subtypes. χ
2
difference testing was used to examine class associations with PTSD and CPTSD.
Results: Three latent classes that comprised different subtypes of maltreatment were identified (limited maltreatment, n = 49; high neglect, n = 53; cumulative maltreatment, n = 45). Cumulative maltreatment was associated with higher symptom severity of PTSD and CPTSD than the limited maltreatment and the high neglect class, with effect sizes ranging from 0.62 to 0.93.
Conclusions: The association of the cumulative maltreatment class with the highest symptom severity of PTSD and CPTSD highlights the detrimental effect of cumulative maltreatment. The detection of a high neglect class identifies children and adolescents, who are at high-risk of experiencing future maltreatment because of their previous experiences of neglect and the associated lack of protection. The examination of the association of distinct maltreatment classes with ICD-11 PTSD and CPTSD might provide implications for targeted prevention, assessment and treatment.
* Three classes of childhood maltreatment were detected (limited maltreatment, high neglect, cumulative maltreatment).* Class membership was associated with ICD-11 PTSD and CPTSD.* Based on the findings, tailored prevention and intervention is possible for high-risk individuals.
Background: Child maltreatment is embedded in a complex system of familial, societal and cultural influences. However, the microsystemic framework in which child maltreatment occurs has not been ...sufficiently accounted for in previous measures of trauma history. In order to include this relational context, a novel survey method, the Childhood Attachment and Relational Trauma Screen (CARTS), was developed, focusing specifically on the familial environment and childhood attachment relationships. Prior validation studies of the English and Italian versions of the CARTS have tended to support its use.
Objective: The current study aims at evaluating the psychometric properties of the German version of the CARTS as well as conducting cross-cultural comparison analyses. It is part of an international research project of the Global Collaboration on Traumatic Stress which was initiated by the International Society for Traumatic Stress Studies (ISTSS).
Method: The sample consisted of n = 140 participants from the German general population aged 18 or older. Further trauma specific measures (GPS, BSI-18, CTQ-SF, ECR-R, PBI) were included for validation. Cross-cultural comparisons were conducted with a German subsample of students in reference to Italian- and English-speaking student samples.
Results: Most CARTS subscales showed acceptable internal consistency. Statistically significant relationships were observed with other measures of childhood trauma exposure and parental bonding, as well as PTSD- and other distress-related outcomes. Comparing the German-speaking sample with Italian- and English-speaking samples indicated significant differences with regard to childhood attachment and child maltreatment.
Conclusion: The present findings are consistent with previous results concerning the CARTS and advance the validation of this novel survey method within German-speaking samples. Further, the CARTS appears to be sensitive to cross-sample differences in childhood attachment and child maltreatment. Further psychometric evaluations of the CARTS in other languages and within further German-speaking samples are needed.
The Childhood Attachment and Relational Trauma Screen (CARTS) constitutes a novel survey method for the assessment of child maltreatment and childhood attachment.
Previous validation studies and present results have tended to support its use.
Global applicability and further psychometric evaluation will be objectives of future research.
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