Background: The prevalence of mental disorders is high among refugees and asylum seekers due to past traumatic experiences and post-migration stressors, such as uncertain asylum status. Specialized psychosocial treatment centers aim to address this complex interplay between clinical symptoms and social stressors. Thus far, evidence for the effectiveness of such multidisciplinary treatment approaches is mixed, and the influence of post-migration stressors like asylum status changes over the course of treatment has not yet been thoroughly investigated.Objective: The present study aimed to evaluate the outcomes of a multidisciplinary trauma- and migration-focused treatment and to examine whether changes in asylum status moderate therapeutic effects.Method: As part of a standardized diagnostic procedure, self-report questionnaires assessing post-traumatic stress disorder and depression were administered to 90 patients at baseline (T1 = 90), at an intermediate assessment (T2 = 59), and at post-treatment (T3 = 90) in two psychosocial centers providing trauma-focused interventions for refugees in Germany.Results: Linear mixed models revealed significant improvements in psychopathology by the end of treatment. Changes in asylum status did not emerge as a significant moderator of treatment outcomes.Conclusions: These findings suggest that (multidisciplinary) treatment can be effective in reducing trauma-related symptoms among refugees. The results further cautiously hint towards the robustness of therapeutic gains across challenging legal circumstances. Nonetheless, asylum insecurity may still pose substantial barriers to long-term recovery and integration. Future research should therefore explore whether sustained legal stability enhances the durability of treatment effects.
Background: Genital responses during sexual abuse memory recall are rarely studied, but may be clinically relevant in individuals with PTSD following sexual abuse.Objective: This study examined both the prevalence of genital responses related to sexual abuse memories, and the emotional valence and impact of such responses on daily life, and their association with PTSD severity.Method: A total of 1057 patients with PTSD and a history of sexual abuse (84.7% female, M = 38.81 years, SD = 12.59 years), referred for trauma-focused treatment between August 2024 and May 2025, underwent clinician-administered assessment of PTSD severity and completed self-report measures to assess the presence of genital responses linked to sexual abuse memories, their emotional valence, and impact on daily life.Results: Genital responses related to sexual abuse memories were reported by 34.4% (n = 364). These individuals showed significantly higher PTSD severity, a younger age at the time of sexual abuse and more repeated occurrences of sexual abuse than those without such responses. Negative emotional valence with regard to the genital responses was prevalent: 91.8% reported shame, 87.6% disgust, and 70.6% self-hatred. Disgust and self-hatred, but not shame, were significantly correlated with greater PTSD severity. Positive affect was reported by 23.1% and was negatively associated with PTSD severity. Among those reporting genital responses, 38.2% described its impact on daily life as (very) strong.Conclusions: Genital responses during sexual trauma recall occurred in one-third of individuals with PTSD and a history of sexual abuse and were linked to higher PTSD severity after controlling for age at time of abuse and abuse frequency. Given their frequent emotional burden and interference with daily functioning, systematic assessment of these responses is recommended in clinical practice to improve treatment planning and to address associated appraisal.
Background: Research has increasingly focused on how trauma-exposed youth achieve positive adaptation despite adversity, leading to the development of multiple theoretical frameworks of resilience. However, the extent to which these frameworks reflect current understandings and operationalisations of resilience in routine clinical practice remains unclear.Objective: This qualitative study examined how therapists conceptualised and applied resilience in routine therapeutic practice for trauma-exposed youth.Method: Twenty-three trauma therapists from four tertiary academic centres for child and adolescent psychiatry in the Netherlands participated in qualitative focus groups. Data were analysed using inductive thematic analysis.Results: Therapists emphasised resilience as both multidimensional, referring to the structure of resilience and its key dimensions, and multifactorial, referring to the multiple determinants shaping resilience. A third theme, clinical ambiguity, highlighted the different challenges trauma therapists face when attempting to adopt and integrate resilience into everyday therapeutic practice.Conclusions: Resilience remains difficult to conceptualise in a clearly delineated manner, complicating its application in therapeutic contexts. This underscores the need for more concrete guidance; actively engaging therapists in defining and implementing resilience may help translate it from a contested theoretical concept into a clinically meaningful and youth-relevant target for intervention. Such an approach facilitates the effective integration of both current and emerging resilience-based interventions into routine therapeutic practice, as well as their systematic evaluation.
Background: Trauma is a far-reaching experience, with consequences that can extend long after the inciting event. The link between adverse childhood events and neuropsychiatric conditions are relevant to providers performing a neurologic exam, as a person’s trauma can influence their medical diagnoses (as in functional neurologic disorder) and their receptivity to medical care.Objective: To provide a framework for clinicians to approach neurologic exams and procedures in a trauma-informed manner.Method/Results: Both prior to and during the visit, every effort should be made to create a welcoming environment with signage, correct language, and thorough intake. Prior to neurologic exams and procedures, a thorough explanation is required to ensure patient comfort and every effort should be made to empower the patient. Various aspects of the neurologic exam and procedures such as lumbar punctures, electromyography, electroencephalography are discussed further in the paper.Conclusion: Providers should take a trauma-informed approach to medical care and treatment to ensure an environment that meets all of patients’ needs.
Child abuse is highly prevalent globally and associated with profound consequences for children, underscoring the need for timely and coordinated responses such as the Children's Advocacy Centres (CAC) and the Barnahus (BH). Existing research on these models has primarily examined organisational structures and legal outcomes with significantly less attention given to children's lived experiences. In line with the United Nations Convention on the Rights of the Child, which emphasises both protection and participation, we argue in this editorial for a shift towards centreing children's voices and agency in research. Drawing on three research initiatives - 'Joining the Dots', 'Creating Spaces for Children', and 'Putting the Child First' - this editorial provides examples of how to meaningfully engage children in research. These projects employ creative, participatory, and trauma-informed methods to balance the children's right to protection and right to be heard when capturing the children's perspectives. They illustrate the importance of involving children in research and hence underline the risks of overlooking important insights into how support systems work in practice when children are not involved in research. This calls for greater investment in participatory approaches seeking to actively engage the children's perspectives to inform research, policy, and practice.
Background: Posttraumatic stress disorder (PTSD) is a multifactorial condition shaped by numerous biopsychosocial risk and protective factors. Machine learning methods provide powerful tools to model these complex and interacting influences on symptom expression, although many existing approaches rely on data that are impractical for large-scale application.Objective: In this study, we combined accessible psychometric measures with heart rate variability (HRV) to model vulnerability and resilience factors associated with PTSD symptoms in trauma-exposed individuals from a nonclinical sample. Importantly, a longitudinal follow-up complemented the cross-sectional design, allowing us to examine whether early psychological and physiological markers predict subsequent PTSD symptoms.Method: Regression models were implemented using a sparse multiple kernel learning (MKL) approach, allowing an estimation of the relative contribution of predictors both at the construct level (e.g. psychometric and HRV measures) and at the individual item level. The sample comprised 176 undergraduate students who completed psychometric scales assessing tonic immobility, optimism, positive and negative affect, coping strategies, and childhood maltreatment. HRV during exposure to negative stimuli was included as an autonomic predictor. PTSD symptom severity (PCL-5) was assessed cross-sectionally (T1) and after 18 months (T2).Results: MKL successfully predicted PTSD symptom severity at both time points. Across cross-sectional and longitudinal models, negative affect was identified consistently as the most influential predictor at T1 and T2. Additional relevant predictors included tonic immobility, childhood maltreatment, and coping strategies.Conclusions: These findings emphasise the potential of combining easily measurable predictors to enhance the early detection of PTSD risk and to guide the development of more personalised prevention and intervention strategies.
Background: Sibling sexual abuse (SSA) creates particular challenges for practitioners working with affected families, as it damages multiple family relationships, generates loyalty conflicts among parents and children, and produces ambiguity around responsibility. These challenges may necessitate a specific treatment for the impact of SSA. However, information on how to approach the challenges during treatment is scarce.Objective: This study qualitatively investigated, from a practitioner’s perspective, helpful elements for tailoring the treatment of families that had been exposed to SSA.Participants and setting: Twelve practitioners from different treatment centres in the Netherlands with experience in the treatment of families exposed to SSA.Methods: Online one-on-one interviews were conducted and thematic analysis was used to identify central themes.Results: Four themes were generated: (1) family crisis; (2) guilt, shame, and secrecy; (3) balancing act; and (4) restoration of family relationships. Practitioners highlighted the importance of tailoring treatment to the specific dynamics related to the SSA. Families starting treatment after the disclosure of SSA are often in ‘shambles’, as the situation affects the relationships between all family members. Restoration of family relationships was described as both the most challenging and the most essential aspect of treatment, with parents having a central role in this recovery process. Professionals needed to assist them with offering appropriate support for all their children and re-establishing trust and safety within the family.Conclusions: The findings offer initial practical considerations and recommendations for the treatment of families that have experienced SSA, thereby providing a first step towards developing a practical framework for applying systemic therapy to families that have experienced SSA.
Background: Childhood maltreatment (CM) is associated with an increased risk of mental disorders, with oxidative stress (OS) being proposed as a potential mediator. However, it remains unclear whether exposure to specific types of CM during distinct developmental periods is associated with altered OS levels.Objective: This study aimed to explore the association between CM type and timing and OS in young adulthood.Methods: We studied 116 adults (30.5% women; mean age = 26.3 years) with previous residential care placements. CM exposure was assessed with the Maltreatment and Abuse Chronology of Exposure (MACE-X) scale, capturing types (parental abuse, neglect, peer violence, sexual abuse), overall severity, multiplicity, and duration. OS was measured via blood-based biomarkers: superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GRed), and GPx/GRed ratio. Conditional random forest regressions and Spearman correlations were used to test effects of CM types and timing on OS.Results: Abuse and neglect during adolescence showed the highest variable importance (VI) for GRed. Abuse was associated with increased, and neglect with decreased GRed. Neglect at ages 8 and 12 showed the highest VI for GPx/GRed and were positively associated with the biomarker ratio. Furthermore, no significant associations were found between overall CM severity, multiplicity, or duration and any of the OS biomarkers examined.Conclusion: Type- and timing-specific characteristics may be important when examining associations between CM and OS in adulthood. More research is needed to test whether such associations can inform preventive strategies that aim to mitigate mental health impairments following CM.
Background: Posttraumatic stress disorder (PTSD) is characterized by daily fluctuations in cognitive and affective processes. Little is known about how these processes relate to PTSD severity before and after individuals engage in a therapeutic intervention.Objective: This study used a daily diary design to examine same-day and next-day associations of affect and posttrauma cognitions with posttraumatic stress symptoms (PTSS) during a novel PTSD intervention focused on processing positive memories.Methods: Participants were 70 trauma-exposed adults who completed four sessions of the Processing of Positive Memories Technique (PPMT). Participants completed 21 daily surveys pre - and post- PPMT on PTSS, positive and negative affect, and posttrauma cognitions. Multilevel models and multilevel interrupted time series analyses were used to examine same-day and next-day associations between study variables and changes over time.Results: Multilevel models showed that more negative affect, less positive affect, and more posttrauma cognitions were associated with higher same-day PTSS (ps < .001). In contrast, daily fluctuations in negative affect, positive affect, and posttrauma cognitions did not predict next-day PTSS after accounting for prior-day PTSS. Multilevel interrupted time series models revealed that the same-day association between negative affect and PTSS weakened over time following PPMT (p = .035).Conclusion: Findings emphasize the importance of daily affective and cognitive processes in shaping short-term PTSS trajectories and suggest that PPMT may have its most enduring effects on the association between negative affect processes and PTSS.
Background: The experience of childhood maltreatment of women has been identified as an important predictor for the occurrence of health-related and psychosocial risk factors during pregnancy that might increase the risk for mental health problems in offspring. Little is known yet about how different types of maternal childhood maltreatment contribute to the occurrence of these health-related and psychosocial risk factors during pregnancy.Objective: The aim of this study was to investigate how specific types of childhood maltreatment (emotional, physical and sexual abuse, and emotional and physical neglect) relate to the occurrence of health-related and psychosocial risk factors during pregnancy.Method: A sample of N = 305 pregnant women in their second or third trimester, drawn from the general German-speaking population, completed an online survey assessing childhood maltreatment and a range of health-related (e.g. medical complications) and psychosocial (e.g. maternal antenatal depression) factors. Multiple linear regression analyses were performed to examine the specific predictive effect of each type of childhood maltreatment on different health-related and psychosocial risk factors during pregnancy.Results: The regression analyses indicated that the combined predictor emotional abuse/neglect predicted health-related and psychosocial factors during pregnancy, including perceived stress, antenatal depression, relationship quality and psychiatric symptoms. Sleep problems were predicted by sexual abuse. Sensitivity analyses with emotional abuse and emotional neglect as separate predictors revealed emotional abuse as the only significant predictor of perceived stress, antenatal depression and psychiatric symptoms.Conclusions: Future research should focus on the underlying mechanisms linking emotional abuse and neglect to health-related and psychosocial risk factors during pregnancy. Routine screening for childhood maltreatment and early interventions for women who experienced emotional abuse and neglect in childhood may substantially reduce the occurrence of health-related and psychosocial risk factors during pregnancy that might affect children's mental health, thereby promoting healthy psychological development in offspring.
Background: Observational research has revealed an association between post-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA), but their shared genetic architecture remains unclear. This study aimed to characterise their shared genetic architecture and evaluate potential causal relationships.Methods: Genome-wide association study (GWAS) summary statistics for PTSD and OSA were analyzed. Genetic correlations were estimated using linkage disequilibrium score regression (LDSC). Cross-trait meta-analyses were applied to explore pleiotropic loci, and Bayesian colocalization was performed to identify shared causal variants. Tissue enrichment and gene-level associations were evaluated using stratified LDSC and Multi-marker Analysis of Genomic Annotation (MAGMA). Bidirectional causality was tested with two-sample Mendelian randomization (MR). Transcriptome-wide association studies (TWAS) were used to identify shared gene expression patterns across enriched tissues.Results: Significant global genetic correlations were found between PTSD and OSA, with rg = 0.336 (constrained-intercept LDSC, p = 2.56 × 10-⁴⁴) and rg = 0.301 (unconstrained LDSC, p = 5.47 × 10-¹¹³). Cross-trait meta-analyses identified 12 novel pleiotropic SNPs with concordant effect directions across traits. Colocalization detected two shared causal loci with high posterior probabilities: TRAF3 at 9q33.3 (PP.H4 = 96.35%) and TMEM106B at 7p21.3 (PP.H4 = 95.63%). Tissue-specific SNP heritability enrichment was observed in the cerebellum, cerebellar hemisphere, and cortex. MR showed that genetically predicted PTSD was significantly associated with increased risk of OSA (IVW OR = 3.24, 95% CI: 2.42-4.34, p = 2.84 × 10-15), while no significant reverse causal effect was observed. TWAS consistently identified TRIM72, VDAC2P4, EFCAB5, and NSRP1 across the cerebellum, cerebellar hemisphere, and cortex.Conclusion: This study reveals a shared genetic basis of PTSD and OSA, characterised by genetic correlation, shared novel variants, tissue enrichment, and causal relationships, providing evidence for genetic overlap underlying their biological mechanisms.
Background: Bereavement due to fatal family violence (e.g. intimate partner homicide, filicide, parricide, siblicide) is a profoundly disruptive experience for children, with lifelong psychosocial consequences. Although the need for fatal family violence prevention is increasingly recognised internationally, support for bereaved children in the aftermath remains fragmented, inconsistent and largely dependent on local service availability rather than individual needs. Caregivers, often coping with their own grief, face extraordinary demands without adequate guidance or resources.Objective: This paper seeks to draw attention to the urgent need to focus on children bereaved by fatal family violence and develop an international, collaborative agenda that places the voices of young survivors and their caregivers at the centre.Methods: We held a workshop in Caen, Normandy, France, in 2025, to mark the launch of the international component of the five-year research programme Homicide at Home: Minimising the Impact on Young Survivors, funded by the Australian National Health and Medical Research Council. This workshop convened 33 researchers, clinicians, policymakers and advocates, including with lived experience, from 11 countries to develop a roadmap.Results: The envisaged agenda aims to centre the perspectives of people with lived and/or caregiving experience and comprises three interconnected components: (a) identifying existing knowledge, practices and resources; (b) shaping and curating an international repository; and (c) supporting the development of new research. The description of these elements is intended as both a starting point and an invitation.Conclusions: Fatal family violence leaves behind a significant number of children whose needs are urgent yet under-addressed. By working collectively across disciplines and countries, together with those who are the most affected, we can begin to address the long-term impact of these traumatic losses. We invite colleagues to join this initiative.
Background: Adverse childhood experiences (ACEs) are known to contribute to increased long-term cancer risk. However, the specific association between childhood exposure to interparental physical violence and the incidence of cancer in adulthood remains poorly understood.Methods: This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), which included 11,825 participants aged 45 years or older enrolled from 1 June 2011, and followed until 31 December 2020. Exposure to interparental physical violence during childhood was assessed via a life history questionnaire evaluating the frequency of witnessing physical violence between parents. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale. The primary outcome was physician-diagnosed cancer (excluding minor skin cancers), identified through follow-up self-reports. Multivariable Cox proportional hazards regression models with attained age as the time scale were employed for analysis.Results: Among the 11,825 participants (mean age 58.4 ± 9.0 years; 52.2% female), childhood exposure to interparental violence was significantly associated with an elevated risk of cancer (HR = 2.97, 95% CI: 1.52-5.80). A significant dose-response relationship was observed (p for trend < 0.01). Depressive symptoms were more prevalent in the exposed group and mediated approximately 28.9% of the total association between violence exposure and cancer risk (HR = 2.40, 95% CI: 1.13-5.11).Conclusions: In a national cohort, childhood exposure to interparental violence was associated with an elevated risk of adult cancer incidence, partly through depressive symptoms. Preventing domestic violence and early psychological intervention may reduce long-term cancer burden.
Background: Adolescents with attention-deficit/hyperactivity disorder (ADHD) may be particularly vulnerable to trauma; however, patterns of trauma exposure and psychological responses in East Asian contexts remain underexplored.Objective: To examine associations among ADHD, trauma exposure, and psychological outcomes, and to differentiate trauma-specific reactions from broader internalising symptoms.Methods: This cross-sectional study included 295 adolescents aged 12-18 years (149 with ADHD and 146 controls). Adolescents and their caregivers completed validated measures of trauma exposure (Trauma Exposure Experience Questionnaire), trauma reactions (Revised Child's Reaction to Traumatic Events Scale), anxiety (Multidimensional Anxiety Scale for Children), depression (Centre for Epidemiological Studies Depression Scale), and self-esteem (Rosenberg Self-Esteem Scale). All measures demonstrated excellent internal consistency (Cronbach's α = .92-.95). Intergroup differences were examined using chi-square tests and t-tests. Hierarchical regression models incorporating ADHD × trauma exposure interaction terms, along with sex-stratified analyses, were used to evaluate associations.Results: Adolescents with ADHD reported stronger trauma reactions (p = .039), greater depressive symptoms (p = .032), and lower self-esteem (p = .002) than controls. Logistic regression analyses indicated that physical assault (odds ratio = 3.11) and threats of violence (odds ratio = 3.77) were significantly associated with ADHD. Trauma reactions were strongly predicted by anxiety, depression, and trauma exposure across the sample. The interaction between ADHD and trauma exposure was not significant in the total sample (p = .600) or in stratified analyses.Conclusion: Adolescents with ADHD in Taiwan are highly vulnerable to interpersonal trauma. Although ADHD does not moderate the association between trauma exposure and subsequent reactions, trauma responses are closely associated with comorbid anxiety and depression. These findings highlight the need for trauma-informed ADHD care that addresses internalising symptoms within relevant familial and cultural contexts.
Background: The twin earthquakes that struck Türkiye on 6 February 2023 (magnitudes 7.7 and 7.6) were among the most devastating in the nation's history, mobilising thousands of mental health professionals to address survivors' acute psychological needs alongside medical and humanitarian teams.Objective: This phenomenological study aimed to explore the lived experiences of counsellors who provided psychosocial support during the early response phase (i.e. the first 40 days following the earthquakes).Method: Data were collected through semi-structured interviews with 18 counsellors (aged 30-49; 33.3% male) and analyzed using a phenomenologically informed thematic analysis.Results: Five overarching themes and 17 subthemes were identified: (1) Moral and Professional Imperatives, reflecting ethical-humanitarian responsibility and professional commitment; (2) Multilevel Challenges, including physical hardship, emotional burden, role ambiguity, communication barriers, and organisational and coordination challenges; (3) Sustaining Professional Functioning under Crisis Conditions, involving collective coping, emotional regulation, adaptive practice, and task-focused engagement; (4) Post-Response Impact: Growth, Distress, and Moral Tension, encompassing delayed stress reactions alongside personal and professional growth; and (5) Systemic Lessons for Disaster Preparedness, highlighting the need for improved interinstitutional coordination and organisational structure, enhanced professional preparedness through psychological readiness and training, and strengthened resource and intervention capacity.Conclusions: These findings contribute to the field of psychotraumatology by providing an in-depth understanding of how mental health professionals experience, make sense of, and cope with providing psychosocial support in large-scale disaster contexts. The study extends existing research by highlighting the coexistence of vulnerability and resilience, shaped by personal, professional, and systemic factors. The findings also have practical implications for early interventions, trauma-informed training, and coordinated disaster response systems.
ABSTRACTBackground: Complex posttraumatic stress disorder (PTSD) symptom profile, prevalence, and risk factors have been studied in various populations across the lifespan. However, the longitudinal course of complex PTSD symptoms is unknown.Objective: The current study aimed to investigate the ICD-11 PTSD and complex PTSD symptom trajectories and trauma disorders diagnostic changes in a longitudinal study of a trauma-exposed community sample of adolescents.Method: The five-year, three-wave longitudinal study included 156 adolescents (58.3% girls, 40.4% boys, and 1.3% non-binary); age M(SD) = 17.10(0.43) years, who completed self-report questionnaires. The Repeated Measures ANOVA was used to identify changes in complex PTSD symptom clusters in adolescents meeting diagnostic criteria for PTSD, complex PTSD, or no trauma disorder at wave 3.Results: 21 diagnostic pathways of PTSD, complex PTSD, and no trauma disorder were observed across the three biannual study waves. Almost half of the participants (46.8%) met diagnostic criteria for PTSD or complex PTSD at least at a single wave over the course of the study. However, complex PTSD (2.6%) or PTSD (0.6%) diagnostic pathways across all three waves were rare. In adolescents with complex PTSD at the last wave, all symptom cluster trajectories were elevated through time in comparison to the no current trauma disorder status group. Also, the stability in time of affect dysregulation and disturbed relationships symptoms was indicated in adolescents with complex PTSD status in wave 3.Conclusions: The longitudinal study of complex PTSD symptom trajectories reveals heightened complex PTSD symptoms across five years of the study in participants meeting diagnostic criteria for complex PTSD at the last study wave. These findings reveal the importance of early recognition of complex PTSD symptom patterns in adolescents to provide trauma care and treatment. Further studies are needed to explore complex PTSD symptom trajectories in other adolescent populations.
Background: Estimating the association between childhood emotional maltreatment (CEM) and trauma-related outcomes is important for prevention and intervention.Objective: We synthesised the evidence by differentiating between emotional abuse and emotional neglect, examining post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) and exploring moderators and mediators.Method: Following PRISMA guidelines, seven databases were searched up to 19/03/2026 (PROSPERO-CRD42024598358) for studies on the association between CEM and PTSD/CPTSD. Study quality was assessed using an adapted Newcastle-Ottawa Scale (NOS), and certainty of evidence was evaluated using the GRADE framework.Results: Of 11,479 records, 62 were included in the review, of which 57 studies provided 132 effect sizes for a random-effects multilevel meta-analysis (N = 323,776). Study quality was overall fair (Mean NOS = 5.8). A positive association between CEM and PTSD/CPTSD (k = 132, r = .27, 95% CI [.23, .30]) 95% PI [-.04, .53] with substantial heterogeneity (I² = 86.5%). Higher estimates were identified for emotional abuse (k = 71, r = .29, 95% CI [.25, .33]) compared to emotional neglect (k = 55, r = .24, 95% CI [.19, .28]). Effect sizes were similar for CPTSD (k = 29, r = .29, 95% CI [.24, .35]) and PTSD (k = 103, r = .26, 95% CI [.22, .30]). No differences were observed by sex, age, or population type (clinical vs. non-clinical). However, higher estimates were identified in high-income settings and more developed contexts. Narrative synthesis identified cognitive, affective, physiological and interpersonal mechanisms as potential mediators. The certainty of the evidence was generally low. Limitations include the predominance of cross-sectional designs, reliance on self-report measures of CEM and variability across outcome measures.Conclusions: These findings underscore the importance of CEM in trauma-related symptomatology and support the need for its systematic assessment in clinical and research settings, particularly by highlighting differences between emotional abuse and emotional neglect.
Background: Military sexual trauma (MST) disproportionately impacts women veterans globally. UK research highlights that these in-service experiences may contribute to unique mental and physical health needs. Yet, service providers are often perceived to be unaware of and unable to meet these needs.Objective: To evaluate a national training programme that synthesised evidence to support UK women veterans. Situated within a wider knowledge mobilization (KMb) initiative and guided by the Knowledge-to-Action (KTA) framework, a three-part programme was developed for different professional audiences to enhance understanding of and support for women veterans.Method: Co-produced and grounded in KMb theory. Course 1 aimed to enhance knowledge of women veterans' health needs. Course 2 targeted healthcare professionals and veteran specialist providers, exploring evidence-based considerations for promoting service engagement. Course 3 aimed to increase UK clinical capacity in the best-evidenced treatment for post-traumatic stress disorder associated with MST in women veterans, through training mental health professionals in cognitive processing therapy (CPT). Mixed-methods data were collected from all programme attendees. CPT attendees completed pre- and 3-month post-training measures; quantitative data were analysed using a Wilcoxon signed-rank test and qualitative data using manifest content analysis.Results: Course 1 was completed by 526 individuals, 363 completed Course 2, and 98 completed Course 3. Course 3 attendees were split across two cohorts (n = 57; n = 41). Compared with pre-training, 3-month post-training self-efficacy in delivering CPT across cohort one increased significantly (p < .001, r = 0.915). Content analysis identified three themes: (1) Clinician confidence delivering CPT; (2) Clinicians' perceptions of CPT; and (3) CPT in a service system.Conclusions: The education programme addressed gaps in UK service provider knowledge and increased CPT clinical capacity. The wider KMb initiative demonstrates how research can be translated into impact for military populations and highlights the value of co-produced KMb approaches.
Background: While prior studies have examined linguistic markers of PTSD using everyday discourse or autobiographical narratives, comparative studies identifying specific markers across different projective personality tests remain limited.Objective: To investigate whether language features in projective personality tests differentiate individuals with PTSD from non-PTSD controls and assess their predictive value for symptom severity.Method: Verbatim transcripts from 283 participants (183 PTSD, 100 controls) across the Rorschach, TAT, and SCT were analysed using NLP across six categories: negative emotion, positive emotion, insight, causation, body-related, and self-focus. ANCOVAs with Bonferroni correction compared linguistic indicators between groups controlling for age and sex. Hierarchical regression analyses assessed predictive validity for symptom severity.Results: Following Bonferroni correction (α = .0028), four indicators showed significant group differences (ηp² = .036-.092): Rorschach Negative Emotion, SCT Positive Emotion, SCT Insight, and TAT Negative Emotion. In the PTSD group, TAT Negative Emotion was the strongest cross-symptom predictor of PTSD, depressive, and anxiety severity. Reduced Rorschach Body-related language and elevated SCT Insight were associated with greater symptom burden. TAT Positive Emotion negatively predicted symptom severity. In the non-PTSD group, SCT Self-Focus was the strongest predictor of PTSD-related severity, and SCT Positive Emotion negatively predicted anxiety. A sensitivity analysis revealed that SCT Positive Emotion and TAT Negative Emotion did not replicate under a more conservative Core Lexicon and should be treated as exploratory; only Rorschach Negative Emotion and SCT Insight were robust across lexicon configurations.Conclusions: Individuals meeting PTSD criteria showed reduced somatic language and elevated negative emotional expression, while self-referential processing and positive emotional expression emerged as salient markers in non-clinical individuals, though these differences should be interpreted cautiously given substantial demographic imbalances. These preliminary findings suggest that projective linguistic analysis may have potential as a supplementary approach in trauma-related research, pending external validation and replication in independent datasets.
Background: Physiotherapists played central roles in high-risk 'red-zone' care during COVID-19 and reported substantial distress, yet mechanisms linking exposure to burnout remain unclear.Objective: To examine whether the association between direct patient contact and burnout operates through a stress-related behavioural mediator (feeling like quitting/taking a break) and whether organisational resources moderate this pathway.Methods: We conducted a secondary analysis of a nationwide, multicentre, web-based survey of Japanese physiotherapists engaged in COVID-19 care (March 2021). Burnout was defined using the Japanese MBI-GS case algorithm. Counterfactual mediation analysis with bias-corrected and accelerated (BCa) bootstraps (5,000 resamples) was used to estimate the average causal mediation effect (ACME), average direct effect (ADE), and total effect on the risk-difference scale. Models were adjusted for age, sex, years in practice, and cohabitation.Results: Burnout prevalence was 19.4%. A small indirect effect was observed (ACME = 0.00932; 95% CI 0.00188-0.0200), whereas the direct and total effects were not statistically significant. Appreciation/respect was associated with attenuation of the indirect effect (ACME = 0.00007), whereas endorsement of enhanced reimbursement for two-therapist care of critically ill patients was associated with a larger indirect effect (ACME = 0.00637; 95% CI 0.00122-0.0100). Because the primary mediation analysis used a binary mediator and binary outcome with logistic link functions, a formal ρ-based sensitivity analysis for unmeasured mediator-outcome confounding was not available under this specification.Conclusions: Among Japanese physiotherapists, the association between direct COVID-19 patient contact and burnout was consistent with an indirect pathway operating through a stress-related behavioural mediator. Recognition appeared to buffer this pathway, whereas reimbursement-linked resource strain appeared to amplify it. These findings suggest potentially relevant organisational targets for future intervention, but should be interpreted cautiously given the cross-sectional design and the causal assumptions required for mediation analysis.
