Military-connected mothers (MCM; mothers who are either service members or veterans or spouses of a service member or veteran) experience significant trauma exposure associated with post-traumatic stress symptoms and ultimately deficits in parental functioning. Maternal trauma and its mental health and functional sequelae can have significant consequences for children, including adverse mental health outcomes. Existing evidence-based treatments (EBT) available to MCM to address trauma have not been adapted for military culture and do not fully resolve symptoms or address the bidirectional relationship between symptoms and parental functioning. In this project, preliminary data will be collected on a newly adapted version of an innovative intervention: Parenting-STAIR Modular (PSTAIR-M), which addresses trauma symptoms and parenting among MCM. PSTAIR is a novel intervention, combining two existing EBTs: Skills Training in Affective and Interpersonal Regulation Narrative Therapy (STAIR), targeting maternal emotion dysregulation and mental health symptoms, and dyadic Parent–Child Care (PC-CARE), targeting parental functioning. This study is a two-arm randomized controlled trial in which we will randomly assign N = 120 trauma-exposed MCM who exhibit elevated symptoms of PSTD or depression and/or low parenting self-efficacy, and one identified child (ages 2–10) to PSTAIR-M or treatment as usual. This trial will be conducted at three community mental health clinics operated by the Cohen Veterans Network. Assessments will occur at three timepoints: (1) Pretreatment, (2) mid-treatment (following session 11 in the treatment condition), and (3) posttreatment (following session 16 in the treatment condition). Assessments will include data on mental health and parenting outcomes as well as mechanisms which may account for observed effects of PSTAIR-M. Each assessment will also include a dyadic observation of mother and child, independently coded to capture parenting skills. Data collection will establish initial efficacy and will set the stage for further study of this intervention. Successful treatment with an efficient, personalized intervention has the potential to prevent adverse outcomes for MCM and their children and to interrupt the intergenerational cycle of trauma in military family systems. ClinicalTrials.gov NCT06262178. Registered on February 15, 2024

The mother–social worker working alliance is critical to the success of mental health interventions delivered within the child welfare system. Maternal characteristics may influence alliance development, yet few studies have examined these dynamics from both mother and social workers’ perspectives. Guided by ecological theory, this study explores how micro-level factors (e.g., demographics, socioeconomic status, trauma history) and macro-level factors (e.g., prior involvement with the foster care or family court systems) shape the quality of the working alliance between mothers and social workers participating in the Parenting-STAIR (P-STAIR) program, a trauma-focused parenting intervention for mothers and children involved in child welfare. Data were drawn from 112 mothers enrolled in an open trial of P-STAIR. Participants were referred by four preventive service agencies and met criteria for PTSD. Working alliance was assessed separately by mothers and social workers using the WAI-S. Multiple linear regression analyses examined associations between micro- and macro-level factors and working alliance outcomes. Sixty-one mother–social worker dyads contributed to the working alliance assessment. Mothers who speak Spanish reported higher working alliance scores (b = 3.67, p < .05), while social workers rated mothers with prior foster care involvement lower on alliance (b = − 8.94, p < .01). Trauma history was not a significant predictor of working alliance. Micro- and macro-level factors differentially shape the mother–social worker alliance. Clinicians should consider potential language barriers and clients’ prior system involvement when fostering engagement in child welfare–related interventions.

Posttraumatic stress disorder (PTSD) is well-documented as impacting functional impairment (FI), and research has demonstrated that clusters of PTSD symptoms as defined by the DSM-5 are differentially associated with FI domains. However, few studies have examined PTSD and complex PTSD (CPTSD) as defined by the ICD. ICD-11 PTSD consists of three symptom clusters (re-experiencing, avoidance, and sense of threat) while CPTSD consists of the three PTSD clusters as well as disturbances in self-organization (DSO) consisting of an additional three clusters (affect dysregulation, negative self-concept, and disturbances in relationships). The current study examined the use of the International Trauma Questionnaire (ITQ) PTSD and DSO subscales as predictors of functional impairment in a women veteran sample, considering the dimensional scoring of both the PTSD and DSO subscales, as well as standard diagnostic scoring for PTSD and CPTSD. Trauma symptom total was predictive of overall impairment measured by the WHODAS 2.0, and predicted impairment in difficulties getting along with people, life activities, and participating in society. The DSO subscale of the ITQ was more predictive of difficulties getting along with others. The cumulative impact of PTSD and DSO subscales uniquely contributed to life activities. Both DSO and PTSD symptoms were uniquely predictive of difficulties participating in society. Participants whose diagnostic scores were consistent with CPTSD had significantly greater FI compared to those whose diagnostic scores were consistent with PTSD. These data suggest the potential benefit of the ITQ in assessing the relative contributions of specific types of symptoms to FI.

Background: Child abuse (CA) is a significant risk factor for trauma-related psychopathology, with potential outcomes that extend beyond posttraumatic stress disorder (PTSD) to include complex PTSD (CPTSD) - a condition characterized by disturbances in self-organization (DSO). This trauma can also lead to identification with the aggressor (IWA), where survivors internalize the perpetrator's beliefs, perspectives, and behaviors, as well as doubt regarding abuse-related appraisals (DARA), which reflects uncertainty in interpreting aspects of the abuse. Although IWA and DARA have been proposed as potential contributors to trauma-related symptomatology, their predictive roles have not been empirically examined.Objective: This two-wave study explored the implications of IWA and DARA for subsequent PTSD and DSO symptoms.Method: The current study was conducted among 273 adult female CA survivors, aged 18-53 (M = 33.01, SD = 9.78). Participants completed online self-report measures assessing IWA and DARA at the first measurement (T1) and PTSD and DSO symptoms at two time points (T1 and T2).Results: The results revealed positive associations between IWA and DARA at T1 and PTSD and DSO symptoms at T2. Analyses further indicated that the IWA component, which involves the replacement of one's agency with that of the perpetrator at T1, predicted variance in PTSD and DSO at T2 (ES = 0.15 and 0.15, respectively). Additionally, the DARA component, which reflects doubt regarding the abuse at T1, predicted variance in DSO symptoms at T2 (ES = 0.17). These effects remained significant even after accounting for polyvictimization, PTSD, and DSO at T1.Conclusions: IWA and DARA may be important psychological factors contributing to survivors' vulnerability to trauma-related psychopathology.

BACKGROUND:LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual +) individuals face higher rates of posttraumatic stress disorder (PTSD) due to increased trauma exposure. Further, they may experience factors that complicate treatment, like exposure to minority stress and increased substance use. No prior large-scale clinical trial has compared the effectiveness of PTSD treatments among LGBTQIA+ populations. STUDY OBJECTIVES:We are conducting a comparative effectiveness study that will compare two evidence-based psychotherapeutic interventions to reduce PTSD and depression symptoms and improve quality of life in LGBTQIA+ populations. Treatment dropout and satisfaction will be compared between the interventions. Minority stress and substance use will be examined as moderators for treatment effectiveness. We will also examine heterogeneity of treatment effects by gender subgroups, participant residence (urban versus suburban or rural), and race and ethnicity. METHODS:Participants will be recruited from community mental health settings, from the community, and through organizations throughout California. Eligibility will be based on PTSD symptom severity as determined by PTSD Checklist for DSM-5 (PCL-5) scores ≥33 during an initial phone screening. Each participant will be randomized to receive either Cognitive Processing Therapy (CPT) or STAIR Narrative Therapy (SNT). Study participants will complete survey assessments at baseline, 3 months, 6 months, and 12 months. DISCUSSION:This study will fill critical research gaps to inform effective PTSD treatments for LGBTQIA+ communities.

Complex posttraumatic stress disorder (CPTSD) is recognized as a distinct diagnosis in the ICD-11. The International Trauma Questionnaire for Children and Adolescents (ITQ-CA) assesses CPTSD symptoms in youth aged 7-17 years; however, no validated Italian version is currently available. This study evaluated the psychometric properties of the Italian ITQ-CA in 488 children and adolescents from community (n = 432) and high-risk residential-care (n = 56) samples. Confirmatory factor analyses compared competing models, and measurement invariance was tested across sex assigned at birth, age, and risk status. The correlated second-order posttraumatic stress disorder (PTSD) and disturbances in self-organization (DSO) model was the best-fitting admissible hierarchical solution, CFI = .990, TLI = .986, RMSEA = .045. Reliability was good, ω = .866-.900; ωH = .800-.823; OHC = .947-.952. Approximate or partial measurement invariance supported latent-mean comparisons: Girls and adolescents had higher PTSD and DSO means than boys and younger participants, ΔM = .554-.879, whereas risk groups did not differ, ΔM = -.055-.006. Concurrent and convergent associations were moderate to large, and regression models identified partially differentiated external correlates, R2 = .563-.618. The findings support the factorial validity and reliability of Italian ITQ-CA symptom scores and their use in Italian youth, and future research should examine functional impairment, longitudinal validity, and clinical replication.

Brief, effective treatments for posttraumatic stress disorder (PTSD) may broaden access to treatment. Brief treatments may fit well within stepped care approaches to treatment, reserving more intensive therapies for those who need them. To assess a first step option for PTSD treatment, we randomized primary care patients to one of two brief formats of Skills Training in Affective and Interpersonal Regulation (STAIR), a psychoeducation and coping skills treatment. Participants were randomized to a clinician (Brief STAIR) or web (webSTAIR) administered version of the treatment. Patients were recruited from primary care clinics that primarily serve low income, publicly insured, and racial and ethnic-minoritized patients. The primary clinical outcome, change in PTSD symptom severity, was assessed using the PTSD Checklist for the DSM-5 (PCL-5) administered at 0, 3, and 9 months. We used linear mixed models for intent to treat analysis (N = 60), imputing missing data with most recent available values. ANCOVA was used to analyze the main effects of treatment. Participants reported significant improvements in PTSD symptoms with large effect sizes (partial η2) at 3 (0.57) and 9 months (0.56), as well as large effect sizes for improvements in overall mental functioning (0.19) and depression (0.18) at 9 months, measured by the Brief Symptom Inventory (BSI-18). There was a large effect for group differences in retention (Brief STAIR [73%] > webSTAIR [30%]; η2 = 0.28). Though inferior to Brief STAIR retention, webSTAIR retention was higher than most digital mental health interventions. Treatments may be suitable early step treatments.

Background: Cognitive behavioural therapy with a trauma focus (CBT-TF) is the gold-standard treatment for military post-traumatic stress disorder (PTSD), but access is limited by high costs, therapist shortages, and the demands of in-person delivery. Guided digital CBT-TF, delivered via an app or website with therapist support, offers a scalable alternative.Objective: This study aimed to adapt Spring PTSD, an evidence-based guided digital therapy, for military veterans and conduct an initial pilot test of the adapted version.Method: A two-stage process was used. In Stage 1, veterans with lived experience of PTSD (n = 11) participated in focus groups to guide adaptations. Key themes included the need for a relatable narrator, authentic military representation, diverse visuals, and military-inspired design. Veterans also emphasised addressing emotional regulation. These insights shaped the development of Spring Military-PTSD, which incorporated techniques from Enhanced Skills Training for Affective and Interpersonal Regulation (ESTAIR). In Stage 2, treatment-seeking veterans with PTSD (n = 10) took part in a pilot study that collected qualitative and quantitative data. The primary outcome was change in PTSD severity measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Participants received an average of 3 h and 50 min of therapist support.Results: Eight participants completed the pilot; two dropped out. Of the completers, four no longer met diagnostic criteria for PTSD, and six showed reliable improvement on CAPS-5. Statistically significant reductions were also seen in self-reported PTSD, disturbance in self-organisation (DSO), anxiety, and depression. Qualitative feedback supported the relevance and acceptability of the intervention.Conclusions: Findings provide preliminary evidence for the efficacy and acceptability of Spring Military-PTSD. The adapted intervention shows promise as a scalable and engaging treatment for veterans with PTSD. Further research is warranted to evaluate its effectiveness and potential for broader implementation.

Background: Responses to evidence-based interventions for posttraumatic stress disorder (PTSD) in refugees vary considerably. Emotion regulation difficulties are associated with greater PTSD severity in refugees and thus represent a potential treatment target.Objective: This study aimed to test the efficacy of Skills Training in Affective and Interpersonal Regulation for Refugees (STAIR-R) and Narrative Exposure Therapy (NET) or Supportive Problem-Solving (SPS) and NET. An exploratory aim was to examine relative efficacy in refugees with high and low levels of visa and family insecurity.Methods: Seventy-one participants were randomly assigned to STAIR-R (6 sessions) + NET (7 sessions) or SPS (6 sessions) +NET (7 sessions). Assessments occurred at baseline, post-treatment, and 3-month follow-up, with additional self-report at mid-treatment. The primary outcome was clinician-assessed PTSD symptom severity (CAPS-5) and secondary outcomes included self-reported PTSD symptoms, depression symptoms, emotion regulation difficulties, difficulties in relationships and environmental quality of life.Results: Intent-to-treat linear mixed models showed no significant between-group differences at mid-treatment, post-treatment, or follow-up. Both groups demonstrated significant improvements at 3-month follow-up in clinician-assessed (STAIR-R + NET, g = -1.41; SPS + NET, g = -1.54, p < .001) and self-reported (STAIR-R + NET, g = -0.49; SPS + NET, g = -0.44, p = .006) PTSD symptoms. Moderatorg analyses revealed that those with high insecurity (n = 16) obtained greater benefits in STAIR-R + NET from pre-treatment to follow-up on self-reported PTSD (g = 1.35), depression (g = 1.11), emotion regulation difficulties (g = 1.24), relationship difficulties (g = 1.12) and quality of life (g = -1.05).Conclusions: While there were no overall between group-differences, refugees in both conditions showed reduced PTSD symptoms. There is preliminary evidence that those with high insecurity showed a better response to STAIR-R + NET than SPS + NET across several clinical outcomes, although the small sample size necessitates replication of these. These findings highlight the potential importance of tailored intervention approaches for refugees living in different environmental circumstances.

Background: Child maltreatment (CM), i.e. neglect and abuse of children by their caregivers, has been linked to reduced psychological safety and a sense of disrupted body boundaries (DBB), both of which have been proposed to impair social functioning. However, evidence-based interventions to increase psychological safety and to reduce DBB are lacking.Objectives: We conducted two experiments across two separate studies. Study I examined the effect of a brief (60-minute) body-oriented intervention, derived from Somatic Experiencing (SE), on psychological safety. Study II investigated the effect of the same intervention on DBB.Methods: In both studies, adults with varying levels of CM exposure, based on total self-report scores across subtypes, were randomized to an SE group or to a psychoeducation control group. Study I included participants with a lack of psychological safety (n = 89); Study II included participants with DBB (n = 55).Results: In Study I, compared to controls, the SE group showed an increase in psychological safety (d = -.95, p < .001). SE group-specific changes were also found for different types of positive and negative affect and for social connectedness. Heart Rate (HR) decreased, and Heart Rate Variability (HRV) increased across groups. In Study II, compared to controls, the SE group showed a reduction in DBB (d = 1.13, p < .001) and an increase in interoceptive awareness, a proposed mechanism of action.Conclusions: A brief, SE-based intervention can facilitate momentary states of perceived safety and improve social connectedness in adults with different levels of CM. Future research should explore longer-lasting positive effects of SE.

Objectives With Complex Post Traumatic Stress Disorder (CPTSD) as a new diagnostic category, there is a diversity of interventions and influences on clinical practice, it is prudent that we gather information about current 'treatment as usual'. This study aims to address this need by describing the current clinical landscape of CPTSD treatments offered in NHS services in Scotland.Methods An online survey was distributed via heads of service managers to clinicians working with adults. The survey posed questions about psychological therapy models, professional experience and, for the clinicians' latest 3 discharged cases, the length of therapy and perceived patient outcomes.Results Forty-nine clinicians, most of whom were clinical psychologists, took part and provided data about 139 clinical cases. Twenty-three different therapeutic models were cited by clinicians, with phase-based approaches described by 64% of clinicians. The modal number of sessions was 21-30. Most cases were described as completed, with 28% ending before therapy was completed, and a further 7% dropped out. Of those who completed therapy, 86% were judged to have improved after therapy, with 11% judged to have deteriorated.Conclusions There is a wide variety of treatments available for complex PTSD, and innovative interventions and trials are required to support future clinical decision-making about the optimal treatment components and therapy length.

Body dysmorphic disorder (BDD) is common in childhood abuse survivors. Nonetheless, the relation between symptoms of BDD, posttraumatic stress disorder (PTSD), and complex PTSD, as well as the effects of different forms of childhood abuse in explaining these symptoms, remains unclear. This study explored (a) BDD scores as a function of childhood abuse; (b) the relationship between symptoms of BDD, PTSD, and disturbances in self-organization (DSO) in childhood abuse survivors; and (c) the effect of levels of different forms of childhood abuse on BDD, PTSD, and DSO symptoms. An online survey was conducted among a convenience sample of 404 Israeli adult women, of whom 53.7% (n = 217) were classified as having a history of childhood abuse. Background variables, BDD symptoms, and the classification and symptoms of PTSD and complex PTSD were assessed online via self-report measures. Results indicated elevated BDD scores in childhood abuse survivors and relationships between symptoms of BDD, PTSD, and DSO in childhood abuse survivors. Levels of emotional abuse served as a trans-diagnostic risk factor for PTSD, DSO, and BDD symptoms, whereas sexual abuse was associated with PTSD symptoms, and physical abuse had no significant effect. The strongest noncausal effect was found for PTSD and DSO symptoms, followed by BDD and DSO symptoms and BDD and PTSD symptoms. The present findings suggest that childhood abuse may be a risk factor for BDD and that trauma-related disorders and BDD are strongly associated in childhood abuse survivors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Our study investigates clinical and psychosocial factors associated with the completion of treatment with Parenting-STAIR (PSTAIR), an intervention to address maternal mental health, parenting skills, and child maltreatment recidivism. We analyzed data from an open pilot trial that included mothers and an identified child involved in child welfare family preservation services. We examined the relationship between baseline levels of PTSD and depression symptomatology, parenting stress, emotion regulation, and child behavior with treatment completion for mothers enrolled in the study (n = 112). All mothers met criteria for PTSD at baseline. Participants endorsed 5.4 categories of trauma exposure on average; 39

Background: The International Trauma Interview (ITI) is a structured clinician-administered measure developed to assess posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined in the 11th version of the International Classification of Diseases (ICD-11). This study aimed to investigate a psychometric evaluation of the ITI and to finalise the English language version.Method: The latent structure, internal consistency, interrater agreement, and convergent and discriminant validity were evaluated with data from a convenience sample, drawn from an existing research cohort, of 131 trauma exposed participants from the United Kingdom reporting past diagnosis for PTSD or who had screened positively for traumatic stress symptoms. A range of self-report measures evaluating depression, panic, insomnia, dissociation, emotion dysregulation, negative cognitions about self, interpersonal functioning and general wellbeing were completed.Results: Confirmatory factor analysis supported an adjusted second-order two-factor model of PTSD and disturbances in self-organisation (DSO) symptoms, allowing affect dysregulation to also load onto the PTSD factor, over alternative models. The ITI scores showed acceptable internal consistency, and interrater reliability was strong. Findings for convergent and discriminant validity were mostly as predicted for PTSD and DSO domains. Correlations with the ITQ were good but coefficients for the level of agreement of PTSD diagnosis and CPTSD diagnosis between the ITI and the ITQ were weaker, and item level agreement was variable.Conclusion: Results provide support for the reliability and validity of the ITI as a measure of ICD-11 PTSD and CPTSD. Final revisions of the ITI are described.

OBJECTIVE:This individual participant data meta-analysis aimed to investigate the effectiveness of cognitive behavioral therapy with a trauma focus (CBT-TF) for posttraumatic stress disorder (PTSD). Furthermore, we examined the effect of moderators on PTSD symptom severity. METHOD:This study included randomized controlled trials comparing CBT-TF to an inactive or active comparison group for adults with PTSD. The primary and secondary outcomes were PTSD symptom severity and remission, respectively. Moderators included sociodemographic and clinical variables. RESULTS:Twelve studies compared CBT-TF with inactive (n = 625) and 11 with active comparison conditions (n = 706). The one-stage individual participant data meta-analysis found that CBT-TF was more effective than inactive comparison conditions (β = -0.78; OR = 2.34) and not significantly different from active comparison conditions (β = 0.02; OR = 0.53) in reducing PTSD symptom severity and achieving PTSD remission, respectively. When comparing CBT-TF with inactive treatments, moderator analysis found that divorced participants had greater PTSD symptoms postintervention following CBT-TF than participants who were single, cohabitating, or married receiving CBT-TF, both in the completer (β = 0.93) and full-sample (β = 0.59) analyses. For the active treatment comparison, moderator analysis found that participants taking psychotropic medication had lower PTSD symptoms following CBT-TF than those not taking psychotropic medication in the completer analysis (β = -0.39). CONCLUSION:Based on our moderator analyses, further research is needed to understand the effect of psychotropic medication on the CBT-TF intervention process. Moreover, divorced participants with PTSD receiving CBT-TF might benefit from enhanced support. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

OBJECTIVE:Posttraumatic stress disorder and depression adversely affect psychosocial functioning, both separately and especially when they co-occur. Despite the high prevalence of these conditions in veterans, it is unclear which specific posttraumatic stress disorder and depression symptoms contribute most to psychosocial functioning impairment. Network analysis can help elucidate these associations by examining symptoms and functioning difficulties as components of a dynamic system. METHOD:Using cross-sectional data from 3,847 trauma-exposed U.S. veterans in the National Health and Resilience in Veterans Study, we constructed a Gaussian graphical model of individual posttraumatic stress disorder and depression symptoms and psychosocial functioning impairment. RESULTS:The cardinal symptoms of depression-anhedonia and depressed mood-showed the strongest associations with functioning impairment, followed by restricted affect, suicidal ideation, and irritability/anger. CONCLUSIONS:These five symptoms may serve as potential targets of interventions to bolster psychosocial functioning among trauma-exposed veterans. Future research should include the application of network models to intensive longitudinal data to gain insights into whether these symptoms may have a causal role in impairing psychosocial functioning. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

BACKGROUND:The International Trauma Questionnaire (ITQ) is the most widely used measure of ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). This self-report scale has been used to estimate prevalence rates of these disorders in general populations and clinical samples, but concerns abound that prevalence estimates derived from self-report measures are too high. To address this concern, we previously introduced the concept of adding "clinical checks" to self-report measures to ensure initial responses reflected the intended clinical meaning of the scale item. Here we provide a rationale for adding clinical checks to the ITQ, describe the process of developing them, and demonstrate their effect at the symptom, cluster, and disorder levels in a general population sample. METHODS:A team of researchers and clinicians, including those who developed the ITQ, developed clinical checks for all ITQ items. These were tested using data from a non-probability quota-based representative sample of adults from the United Kingdom (N = 975). RESULTS:Use of clinical checks led to decreases in symptom endorsements ranging from 18.0% to 43.9%, and symptom cluster requirements from 19.1% to 35.9%. Disorder prevalence estimates without the clinical checks were 5.4% for PTSD and 9.5% for CPTSD. With the clinical checks, prevalence estimates dropped to 3.8% for PTSD (relative decrease = 29.6%) and 4.9% for CPTSD (relative decrease = 48.4%). CONCLUSION:Clinical checks can be easily embedded into the ITQ and have a significant effect on prevalence estimates. We contextualize these results in relation to existing literature on population prevalence estimates derived from clinical interviews and discrepancies between clinical interviews and self-report measures.

Posttraumatic stress symptoms are very high among sexual and/or gender minority (SGM) people. Development and testing of trauma interventions with SGM people is needed, but first we need to understand who among SGM people are at greatest risk of posttraumatic stress symptoms, how minority stress may contribute, and the frequency of substance use comorbidity with significant posttraumatic stress symptoms among SGM people. General linear models and logistic regressions were used to examine demographic differences, minority stress, and substance use related to posttraumatic stress symptoms among a national sample of SGM people (N = 4,589, M age = 32.1, 55% cisgender). All gender groups had greater posttraumatic stress symptoms than the reference group of cisgender men. All sexual orientation groups, except for straight/heterosexual SGM people, had greater posttraumatic stress symptoms than participants in the reference gay/lesbian group. Younger age or identifying as American Indian or Alaska Native, or Hispanic, Latino, or Spanish was associated with more posttraumatic stress symptoms. Non-specific and SGM-specific minority stress were each related to greater odds of significant posttraumatic stress symptoms, even after accounting for Criterion A events. Among participants with significant posttraumatic stress symptoms, 13.6% were at risk for alcohol use disorder, and 56.4% were at risk for other substance use disorder. Marginalized SGM subgroups have more posttraumatic stress symptoms. Interventions for SGM people should consider minority stress coping strategies and substance use comorbidities.

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals’ age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].