Background: As armed conflict grows increasingly complex, the involvement of children in armed violence across diverse roles is rising. Consequently, military personnel are more likely to encounter children during deployment. However, little is known about deployment-related encounters with children and their impact on the mental health of military personnel and Veterans.Objective: This study qualitatively examines the nature and impacts of deployment-related encounters with children.Methods: We conducted semi-structured interviews with 16 Canadian Armed Forces Veterans, eliciting rich information on the nature of child encounters on deployment, the psycho-social-spiritual impacts of these encounters, and perceptions of support. Interview transcripts were analysed using thematic analysis.Results: Six primary themes were identified: types of encounters (i.e. factual aspects of deployment-related encounters with children), contextual factors (i.e. aspects of the mission, environment, and personal context relevant to one\'s experience of the encounter), appraisals of encounters (i.e. sensory or sense-making experiences relevant to the encounter), impacts of encounters (i.e. psycho-social, existential, and occupational impacts), coping strategies engaged in both during and after deployment, and support experiences, describing both formal and informal sources of support.Conclusions: Encounters with children are diverse and highly stressful, resulting in impacts pertinent to mental health, including psychological and moral distress, and difficulties with identity, spirituality, and relationships. These impacts are prompted by complex interactions among appraisals, expectations of morality, cultural norms, and professional duties and are amplified by various personal factors (e.g. childhood maltreatment history, parenthood), feelings of unpreparedness, and lack of post-deployment support. Implications for prevention, intervention, and policy are discussed with the aim of informing future efforts to safeguard and support military personnel facing a high likelihood of encounters with children.
Deployment-related encounters with children result in diverse impacts, including psychological and moral distress, along with disruptions in identity, spirituality, and interpersonal relationships.Encounters with children during military deployments are diverse and highly stressful, characterized by complex interactions among appraisals and expectations of morality, cultural norms, and professional duties.Emphasis on feeling unprepared for encounters with children highlights the need for future efforts to safeguard and support military personnel facing such situations.

Background: Covering terror and catastrophes can be traumatic for journalists, potentially resulting in long-term impairment. This study investigated 10-year anniversary reactions among Norwegian journalists who covered the Oslo/Utöya terror incident in Norway, 2011.Objective: The study aimed to investigate whether level of traumatic exposure and support actions in 2011 were related to anniversary reactions and current psychological well-being in 2021. It also explored if magnitude of anniversary reactions was related to level of current well-being.Method: A cross-sectional survey was sent to journalists who still work within journalism, eight weeks after the 10-year anniversary (N = 200). Participants reported retrospectively on trauma exposure, ethical dilemmas and social support in 2011, as predictors, and attitude to media anniversary coverage, anniversary-related stress, and well-being, as outcome variables.Results: More ethical dilemmas in 2011 (r = .295, p < .001) were related to a larger degree of anniversary-related stress in 2021. Having received less workplace social support in 2011 was related to more stress reactions (r = -.196, p < .05), while the magnitude of overall traumatic exposure in 2011 was not related to stress. Social support also predicted a higher level of current well-being in 2021 (r = .381, p < .001). More severe anniversary-related stress symptoms were significantly associated with decreased level of current well-being (r = -.259, p < .001).Conclusion: Journalists can experience lasting consequences from demanding experiences at work, including fluctuating stress symptoms during incident anniversaries. It is crucial for both journalists and newsrooms to recognize and be aware of the potential impact of anniversaries on the well-being of those involved in the initial coverage.
In a cross-sectional study carried out in 2021, journalists who had faced more ethical dilemmas while covering terror in 2011 had more anniversary-related stress symptoms in 2021. A larger magnitude of overall traumatic exposure in 2011 was not related to stress reactions ten years later.Journalists who had received more workplace social support in 2011 had lower stress levels in 2021.Journalists who had received more support in 2011 had higher levels of current well-being in 2021.Journalists with lower levels of anniversary-related stress symptoms had higher current well-being.

Background: Cumulative exposure to violence can change the regulation of epigenetic and physiological markers. Although violence has been associated with accelerated cellular aging, little is known about associations with cardiac autonomic activity.Objective: The current study aimed to investigate the relationship of exposure to community and domestic violence (CDV) with vagal activity and epigenetic aging acceleration.Methods: A total of 86 adolescents (57% female) were evaluated and interviewed at two time-points in São Gonçalo (2014-2019), a Brazilian city with high levels of violence. Exposure to CDV was assessed in both time-points. GrimAge acceleration was calculated from saliva DNA methylation using Infinium HumanMethylation450K (Illumina) collected in the first assessment. Heart rate variability (HRV) was collected during two stress tasks at the second assessment.Results: The exposure to violence witnessed or directly experienced at home and in the community increased significantly (t = 4.87, p < .01) across two-time points, and males had reported higher violence exposure (t = 2.06, p = .043). Violence at 1st assessment was significantly associated with GrimAge acceleration (B = .039, p value = .043). Violence at both assessments were associated with HRV measured during the narration of the worst trauma (traumaHRV) (B = .009, p value = .039, and B = .007, p value = .024, 1st and 2nd assessment respectively). GrimAge acceleration was significantly associated with traumaHRV (B = .043, p value = .049), and HRV measured during a 3D roller coaster video (B = .061, p value = .024).Conclusions: We found relevant evidence that experiencing violence during adolescence is associated with epigenetic aging and stress-related vagal activity. Understanding these factors during this period could contribute to the development of early interventions for health promotion.HIGHLIGHTS Higher exposure to Community and domestic violence is associated with increased GrimAge acceleration.Higher GrimAge acceleration is associated with increased stress-related vagal activity.Exposure to community and domestic violence increased significantly over time.

Background: Stressful events during a pandemic are a major cause of serious health problems, such as burnout, depression and posttraumatic stress disorder (PTSD) among health care workers (HCWs). During three years, HCWs, on the frontline to fight the COVID-19 pandemic, have been at an increased risk of high levels of stress, anxiety, depression, burnout and PTSD. Regarding potential psychological interventions, Eye Movement Desensitization & Reprocessing (EMDR) is a structured, strongly recommended therapy based on its well-known efficacy in reducing PTSD symptoms and anxiety.Objectives: This study, designed as a trial within a cohort (TwiC), aims to 1) estimate the prevalence of depression, burnout and PTSD in a sample of HCWs after experiencing the COVID-19 emergency (cohort part) and 2) assess the efficacy and acceptability of \'EMDR + usual care\' for HCWs from the cohort who report significant psychological symptoms (trial part).Methods: The study, designed as a TwiC, consists of a prospective cohort study (n = 3000) with an embedded, pragmatic, randomized open-label superiority trial with two groups (n = 900). Participants included in the trial part are HCWs recruited for the cohort with significant symptoms on at least one psychological dimension (depression, burnout, PTSD) at baseline, 3 months or 6 months, determined by using the Patient Health Questionnaire (PHQ-9), Professional Quality of Life (ProQOL) scale, and PTSD Checklist for the DSM-5 (PCL-5). The intervention consists of 12 separate EMDR sessions with a certified therapist. The control group receives usual care. The trial has three primary outcomes: changes in depression, burnout and PTSD scores from randomization to 6 months. All participants are followed up for 12 months.Conclusions: This study provides empirical evidence about the impact of the COVID-19 pandemic and the mental health burden it places on HCWs and assesses the effectiveness of EMDR as a psychological intervention.Trial registration NCT04570202.
Health care workers are at increased risk of stress, anxiety, depression, burnout and PTSD following the COVID-19 pandemic.In this study, the effectiveness of EMDR in reducing depression, burnout and PTSD in health care workers exposed to COVID-19 is investigated.In this study, an original ‘trial within a cohort’ (TwiC) design that consists of a cohort study with an embedded pragmatic randomized trial is used.The study is fully web-based, including online screening, consent and assessments.

Background: Due to the job characteristics, firefighters are repeatedly exposed to trauma incidents. However, not all firefighters exhibit the same level of post-traumatic stress disorder (PTSD) or post-traumatic growth (PTG). Despite this, few studies have looked into firefighters\' PTSD and PTG.Objective: This study identified subgroups of firefighters based on their PTSD and PTG levels, and investigated the influence of demographic factors and PTSD/PTG-related factors on latent class classification.Method: Latent profile analysis was used to examine the patterns of PTSD and PTG among 483 firefighters in South Korea. Using a cross-sectional design, demographic factors and job factors were examined as group covariates through a three-step approach. PTSD-related factors such as depression and suicide ideation, as well as PTG-related factors such as emotion-based response were analysed as differentiating factors.Results: Four classes were identified and named \'Low PTSD-low PTG (65.2%),\' \'Mid PTSD-mid PTG (15.5%),\' \'Low PTSD-high PTG (15.3%),\' and \'High PTSD-mid PTG (3.9%).\' The likelihood of belonging to the group with high trauma-related risks increased with more rotating shift work and years of service. The differentiating factors revealed differences based on the levels of PTSD and PTG in each group.Conclusions: 34.8% of firefighters experienced changes due to traumatic events while on the job, and some required serious attention. Modifiable job characteristics, such as the shift pattern, indirectly affected PTSD and PTG levels. Individual and job factors should be considered together when developing trauma interventions for firefighters.
Firefighters were classified into four groups based on their levels of PTSD and PTG. 65.2% of the participants belonged to the ‘Low PTSD-low PTG’ group.The shift pattern and years of service predicted the likelihood of group classification.This implies that, despite being frequently exposed to threatening events, not all firefighters experience trauma, and that job characteristics influence trauma-related vulnerabilities.

Background: Childhood maltreatment (CM) is a common psychological stressor associated with multiple mental disorders. While CM is associated with vulnerability to depression and anxiety, little is known about the specific mechanism underlying this relationship.Objective: This study aimed to investigate the white matter (WM) of healthy adults with CM and their relationships with depression and anxiety to provide biological evidence for the development of mental disorders in subjects with childhood trauma.Methods: The CM group included 40 healthy adults with CM. The non-CM group included 40 healthy adults without CM. Diffusion tensor imaging (DTI) data were collected, and tract-based spatial statistics (TBSS) were applied to the whole brain to assess WM differences between the two groups; post-hoc fibre tractography was used to characterise the developmental differences; and mediation analysis was used to assess the relationships among the Child Trauma Questionnaire (CTQ) results, DTI indices, and depression and anxiety scores.Results: Relative to the non-CM group, the CM group revealed significantly lower fractional anisotropy (FA) in the right posterior corona radiata (PCR-R), right anterior corona radiata (ACR-R), left super corona radiata (SCR-L), anterior thalamic radiation (ATR), and right posterior limb of the internal capsule (PLIC-R). Additionally, shorter fibre bundles passed through the PCR-R, ACR-R, and ATR in the CM group compared with the non-CM group. Besides, the length of the ACR-R mediated the relationship between CM and trait anxiety.Conclusions: The alteration of white matter microstructure associated with childhood trauma in healthy adults may reflect biomarkers of childhood trauma. Besides, an alteration of WM microstructure in healthy adults with CM mediates the association between CM and trait anxiety, which may represent the vulnerability to developing mental disorders after childhood trauma experiences.
In this paper, we found specific alterations associated with CM in healthy adults, which may mediate the relationship between childhood trauma and trait anxiety in later life.

The coronavirus disease 2019 (COVID-19) pandemic has caused a high demand for health services, especially nursing. This workload can lead to emotional distress affecting their daily lives on a personal and professional basis.
To examine the prevalence of depression, anxiety, and stress in nurses and to analyze the factors associated with their presence during the COVID-19 pandemic.
An observational cross-sectional descriptive study was carried out in a second-level hospital in Mexico between September and October 2020. Within a population of 150 nurses invited to the study, 116 participated by answering a questionnaire regarding emotional aspects during their time caring for COVID-19 patients, as well as using the depression, anxiety, and stress scale (DASS-21).
Among de 116 participants, 77.6% were females, and 22.4% were males. The 91.4% reported fear of spreading the disease to their families, and 59.5% reported that the death of their patients infected with COVID-19 affected them deeply. The factors associated with moderate to extremely severe levels of depression were the attitude of indifference from the community to their work during the pandemic (OR:2.66) and the increase consumption of addictive substances (OR:9.80). In the stress subscale, the variables that conferred a significant association was working inside the COVID-19 area (OR:17.05), being severely affected by the death of patients infected (OR:4.23), and fear of entering the red zone (OR:19.47). The need for psychological care was associated with moderate to severe depression and anxiety (OR:7.38, OR:9.50, respectively). For the anxiety subscale, no association with the studied variables was found.
The study indicates a high prevalence of emotional distress among nurses, and that there were working, psychological and social factors associated with symptoms of depression and stress. Future research should focus on prevention measures and strategies to reduce psychological impact, as this could affect the quality of care provided to their patients.

The human circadian system creates and maintains cellular and systemic rhythmicity essential for the temporal organization of physiological processes promoting homeostasis and environmental adaptation. Sleep disruption and loss of circadian rhythmicity fundamentally affects master homeostasic regulating systems at the crossroads of peripheral and central susceptibility pathways, similar to acute or chronic stress and, thus, may play a central role in the development of stress-related disorders. Direct and indirect human and animal PTSD research accordingly suggests circadian-system-linked sleep, neuroendocrine, immune, metabolic and autonomic dysregulation, linking circadian misalignment to PTSD pathophysiology. Additionally, there is evidence that sleep and circadian disruption may represent a vital pre-existing risk factor in the prediction of PTSD development, while sleep-related symptoms are among the most prominent in trauma-associated disorders. These facts may represent a need for a shift towards a more chronobiological understanding of traumatic sequel and could support better prevention, evaluation and treatment of sleep and circadian disruption as first steps in PTSD management. In this special issue, we highlight and review recent advances from human sleep and chronobiological research that enhances our understanding of the development and maintenance of trauma-related disorders.
El sistema circadiano humano crea y mantiene la ritmicidad celular y sistémica esencial para la organización temporal de los procesos fisiológicos que promueven la homeostasis y la adaptación ambiental. La alteración del sueño y la pérdida del ritmo circadiano afectan fundamentalmente a los sistemas de regulación homeostáticos maestros en la encrucijada de las vías de susceptibilidad periféricas y centrales, similar al estrés agudo o crónico y, por lo tanto, pueden desempeñar un papel central en el desarrollo de trastornos relacionados con el estrés. Investigación directa e indirecta en TEPT en humanos y animales respectivamente, sugiere que el sueño ligado al sistema circadiano, la desregulación neuroendocrina, inmune, metabólica y autónoma vincula la desalineación circadiana con la fisiopatología del TEPT. Además, existe evidencia que el sueño y la alteración circadiana pueden representar un factor de riesgo vital preexistente en predicción del desarrollo de TEPT, mientras que los síntomas relacionados con el sueño se encuentran entre los mas importantes en los trastornos asociados a trauma. Estos hechos pueden representar la necesidad de un cambio hacia una comprensión más cronobiológica de la secuela traumática y podría apoyar una mejor prevención, evaluación y tratamiento del sueño y la alteración circadiana como primeros pasos en el manejo del TEPT. En este número especial, destacamos y revisamos los avances recientes del sueño en el ser humano y la investigación cronobiológica que pueda mejorar nuestra comprensión del desarrollo y mantenimiento de los trastornos relacionados con el trauma.
人类昼夜节律系统创造并维持细胞和全身节律FF0C这对于促进内稳态和环境适应生理过程的时间组织至关重要。类似于急性或慢性应激FF0C睡眠中断和昼夜节律的丧失从根本上影响外周和中枢易感性通路交叉的主要内稳态调节系统FF0C因此可能在应激相关疾病的发展中发挥核心作用。直接和间接的人类和动物 PTSD 研究表明FF0C昼夜节律系统相关的睡眠、神经内分泌、免疫、代谢和自主神经失调FF0C将昼夜节律失调与 PTSD 病理生理学联系起来。此外FF0C有证据表明FF0C睡眠和昼夜节律紊乱可能是预测 PTSD 发展的重要先存风险因素FF0C而睡眠相关症状在创伤相关疾病中最为突出。这些事实可能代表需要转向对创伤后遗症的更多时间生物学理解FF0C并且可以支持对睡眠和昼夜节律紊乱更好的预防、评估和治疗作为 PTSD 管理的第一步。在本期特刊中FF0C我们重点介绍并回顾了增强我们对创伤相关疾病发展和维持理解的人类睡眠和时间生物学研究的最新进展。.

Psychological resilience refers to the ability to maintain mental health or recover quickly after stress. Despite the popularity of resilience research, there is no consensus understanding or operationalization of resilience.
We plan to compare three indicators of resilience that each involve a different operationalization of the construct: a) General resilience or one\'s self-reported general ability to overcome adversities; b) Daily resilience as momentarily experienced ability to overcome adversities; and c) Recovery speed evident in the pattern of negative affect recovery after small adversities in daily life. These three indicators are constructed per person to investigate their cross-sectional associations, stability over time, and predictive validity regarding mental health.
Data will be derived from the prospective MIRORR study that comprises 96 individuals at different levels of psychosis risk and contains both single-time assessed questionnaires and 90-days intensive longitudinal data collection at baseline (T0) and three yearly follow-up waves (T1-T3). General resilience is assessed using the Brief Resilience Scale (BRS) at baseline. Daily resilience is measured by averaging daily resilience scores across 90 days. For recovery speed, vector-autoregressive models with consecutive impulse response simulations will be applied to diary data on negative affect and daily stressors to calculate pattern of affect recovery. These indicators will be correlated concurrently (at T0) to assess their overlap and prospectively (between T0 and T1) to estimate their stability. Their predictive potential will be assessed by regression analysis with mental health (SCL-90) as an outcome, resilience indicators as predictors, and stressful life events as a moderator.
The comparison of different conceptualizations of psychological resilience can increase our understanding of its multifaceted nature and, in future, help improve diagnostic, prevention and intervention strategies aimed at increasing psychological resilience.
Antecedentes: La resiliencia psicológica se refiere a la habilidad de mantener la salud mental o recuperarse rápidamente después de estrés. A pesar de la popularidad de las investigaciones sobre resiliencia, no existe consenso respecto a la comprensión u operacionalización de la resiliencia.Objetivos: Planificamos comparar tres indicadores de resiliencia en que cada uno involucra una operacionalización diferente del constructo: a) Resiliencia general o la habilidad general autoreportada para superar adversidades; b) Resiliencia diaria como la habilidad experimentada momentáneamente para superar adversidades; y c) Velocidad de recuperación evidente en el patrón de recuperación de afecto negativo tras pequeñas adversidades en la vida diaria. Estos tres indicadores son construidos por persona para investigar sus asociaciones transversales, estabilidad sobre el tiempo, y validez predictiva sobre la salud mental.Métodos: Los datos serán derivados desde el estudio prospectivo MIRORR que comprende 96 individuos a diferentes riesgos de psicosis y contiene cuestionarios aplicados una sola vez y datos intensivos longitudinales colectados 90 días tras el punto de referencia (T0) y tres puntos de seguimiento anuales (T1–T3). La resiliencia general fue evaluada utilizando la Escala de Resiliencia Breve (BRS) al punto de referencia. La resiliencia diaria se mide promediando los puntajes de resiliencia diaria a lo largo de 90 días. Para la velocidad de recuperación, se aplicarán modelos vectoriales autorregresivos con simulaciones de respuestas de impulsos consecutivas a los datos diarios sobre afecto negativo y estresores diarios para calcular el patrón de recuperación afectiva. Estos indicadores se correlacionaran concurrentemente (en T0) para evaluar su superposición y prospectivamente (entre T0 y T1) para estimar su estabilidad. Su potencial predictivo se evaluara mediante un análisis de regresión con salud mental (SCL-90) como resultado, indicadores de resiliencia como predictores, y eventos vitales estresantes como moderador.Conclusión: La comparación de diferentes conceptualizaciones de la resiliencia psicológica puede aumentar nuestra comprensión sobre su naturaleza multifacética y, en el futuro, ayudar a mejorar estrategias de diagnóstico, prevención e intervención enfocadas a aumentar la resiliencia psicológica.
背景: 心理韧性是指在应激后保持心理健康或迅速恢复的能力。尽管韧性研究很受欢迎, 但对韧性的理解或操作化还未达成共识。目的: 我们计划比较三个涉及构念不同操作化的心理韧性指标: a) 一般韧性或一个人自我报告克服逆境的一般能力; b) 日常韧性, 即暂时经历克服逆境的能力; c) 在日常生活中的小逆境后, 从负性情绪模式中恢复的明显恢复速度。这三个指标是为每个人构建的, 以考查其横断面关联, 随时间的稳定性以及对心理健康的预测有效性。方法: 数据将来自前瞻性 MIRORR 研究, 包括 96 名不同精神病风险水平的个体, 包含单次评估问卷和基线 (T0)及3年追踪 (T1–T3) 的 90 天密集纵向数据。在基线时使用简要韧性量表 (BRS) 评估一般韧性。通过平均 90 天内每天的韧性分数来测量日常韧性。对于恢复速度, 具有连续脉冲响应模拟的向量自回归模型将应用于有关负性情绪和日常应激源的每日数据, 以计算情绪恢复模式。这些指标将被同时相关 (在 T0) 以评估其重叠, 并被前瞻性相关 (在 T0 和 T1 之间) 以估计它们的稳定性。其预测潜力将通过回归分析进行评估, 以心理健康 (SCL-90) 作为结果, 韧性指标作为预测指标, 应激现场事件作为调节因素。结论: 对心理韧性不同概念的比较可以提高我们对其多方面性质的理解, 并有助于在未来改进旨在提高心理韧性的诊断, 预防和干预策略。.

OBJECTIVE: This multicenter cross-sectional study was conducted to assess the psychosocial impact of COVID-19 on patients with inflammatory bowel disease (IBD) in Spain during lockdown and the first wave of the pandemic.
METHODS: A self-report questionnaire that integrated the Spanish version of the Depression, Anxiety and Stress Scale-21 items (DASS-21) and the Perceived Stress Questionnaire (PSS) was designed to gather sociodemographic data and information related to the effects of lockdown on the lives of IBD patients. Twelve IBD units invited their patients to answer the anonymous online survey between the 1st July and the 25th August 2020.
RESULTS: Of the 693 survey participants with IBD, 67% were women and the mean age was 43 (SD 12). Sixty-one percent had ulcerative colitis, 36% Crohn\'s disease and 3% indeterminate colitis. DASS-21 scores indicate that during lockdown the estimated prevalence of depression was 11% [95% CI 8.2-13%], anxiety 20% [95% CI 17 to 23%] and stress 18% [95% CI 8.2-13%]. Multivariate analysis showed that the perceived high risk of COVID-19 infection because of having IBD and maladaptation to government measures to reduce the spread of disease doubled the risk of anxiety and stress during lockdown.
CONCLUSIONS: In the short-term, lockdown during the COVID-19 pandemic seemed to have an impact on the already affected mental health of our IBD patients in Spain.