BACKGROUND: The detrimental mental health effects which emerged from COVID-19 have profoundly affected healthcare workers (HCWs) worldwide. The aim of this study was to investigate the mediating effects of traumatic stress and loneliness on the fears of contracting and dying from COVID-19, and anxiety and depression of HCWs during the pandemic.
METHODS: A cross-sectional online survey was completed by HCWs in a province of Turkey. The Hospital Anxiety Depression Scale, Impact of Events Scale-Revised and numerical rating scales (for fears of COVID-19 and loneliness) were used and a bootstrap approach was used in the analyses with SPSS PROCESS macro software.
RESULTS: Of the HCWs evaluated, 150 (34.4%) were doctors, with a mean duration of work experience of 10.6 ± 7.5 years. The results indicated that fear of contracting COVID-19 was directly related to anxiety (β = 0.244, p < 0.001) and depression (β = 0.135, p < 0.01) and that traumatic stress and loneliness mediated the relationships between the fear of contracting COVID-19 and anxiety (β = 0.435, p < 0.001; β = 0.235, p < 0.001, respectively) and depression (β = 0.365, p < 0.001; β = 0.294, p < 0.001, respectively). The fear of dying from COVID-19 was determined to be directly associated with anxiety (β = 0.190, p < 0.001) but not with depression (β = 0.066, p = 0.116), and traumatic stress and loneliness mediated the relationships between the fear of dying from COVID-19 and anxiety (β = 0.476, p < 0.001; β = 0.259, p < 0.001, respectively) and depression (β = 0.400, p < 0.001; β = 0.311, p < 0.001, respectively).
CONCLUSIONS: The study results demonstrated the important roles of traumatic stress and loneliness in exacerbating the negative consequences of fears of COVID-19 on anxiety and depression, and provide insights for identifying HCWs at greater risk.

UNASSIGNED: Scalable PTSD screening strategies must be brief, accurate and capable of administration by a non-specialized workforce.
UNASSIGNED: We used PTSD as determined by the structured clinical interview as our gold standard and considered predictors sets of (a) Posttraumatic Stress Checklist-5 (PCL-5), (b) Primary Care PTSD Screen for the DSM-5 (PC-PTSD) and, (c) PCL-5 and PC-PTSD questions to identify the optimal items for PTSD screening for public sector settings in Kenya. A logistic regression model using LASSO was fit by minimizing the average squared error in the validation data. Area under the receiver operating characteristic curve (AUROC) measured discrimination performance.
UNASSIGNED: Penalized regression analysis suggested a screening tool that sums the Likert scale values of two PCL-5 questions-intrusive thoughts of the stressful experience (#1) and insomnia (#21). This had an AUROC of 0.85 (using hold-out test data) for predicting PTSD as evaluated by the MINI, which outperformed the PC-PTSD. The AUROC was similar in subgroups defined by age, sex, and number of categories of trauma experienced (all AUROCs>0.83) except those with no trauma history- AUROC was 0.78.
UNASSIGNED: In some East African settings, a 2-item PTSD screening tool may outperform longer screeners and is easily scaled by a non-specialist workforce.

Youth exposure to violence increases the risk of poor mental and physical health outcomes lasting into adulthood. Traumatic stress is an outcome of particular concern as the physiological stress response impacts the developing brain. Recently, youth exposure to police violence has been conceptualized as an adverse childhood experience that may impact traumatic stress. To examine this possibility, we conducted a systematic review, drawing upon five databases to gather the existing quantitative and qualitative peer-reviewed research on exposure to police violence and traumatic stress in youth. Searches yielded 27 relevant articles utilizing various study designs: thirteen quantitative, thirteen qualitative, and one mixed method. Twenty-six of the 27 studies found evidence of a relationship between police violence exposure and traumatic stress in youth. Police violence was associated with youth traumatic stress across three types of exposures: direct, vicarious, and anticipated. Studies also explored differential impacts by race and gender. The review revealed current gaps in the literature, such as a lack of data on select sociodemographic groups (e.g., rural youth, LGBTQ+ youth) and potential protective factors (e.g., resilience and school connectedness). In line with the findings, we put forth a research agenda as well as policy and practice recommendations to improve police interactions with youth and mental health services for youth who have been exposed to police violence. Recommendations include improving systematic data collection to track all types of police violence exposure, creating spaces for positive police interactions with youth, and training mental health practitioners to support youth exposed to police violence.

OBJECTIVE: To assess acute and long-term stress in men and women after the detection of fetal anomalies leading to pregnancy termination.
METHODS: Prospective observational study.
METHODS: Tertiary referral centre for fetal medicine.
METHODS: From the initial sample of 180 pregnant women with a fetal anomaly detected by ultrasound examination, a total of 87 women terminated their pregnancy, with 72 partners included in the sample. At the time of detection, the group of women (n = 93) and their partners (n = 81) who did not terminate the pregnancy following a diagnosis were included as a comparison group.
METHODS: These women and their partners were asked to complete the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale (IES) questionnaires, both at the time of initial detection and at 6 weeks after the termination of the pregnancy.
METHODS: Responses to the EPDS and the IES at the time of initial detection and at 6 weeks after pregnancy termination.
RESULTS: Women who underwent pregnancy termination reported higher symptom levels of depression, but not traumatic stress, prior to the termination than women who chose not to terminate their pregnancy. Among men, there was a difference across depression and all subscales of traumatic stress (e.g. IES intrusion: mean difference 5.31; 95% CI 2.32-8.31). Women experienced more depressive symptoms over time than men (β = 4.33, P < 0.001) and higher symptom levels on all subscales of traumatic stress (e.g. IES intrusion: β = 5.27; P < 0.001).
CONCLUSIONS: Overall, our study underscores the heightened levels of depression and traumatic stress experienced by prospective parents, particularly prior to the decision to terminate a pregnancy following the detection of a fetal anomaly. Although women generally report more pronounced symptoms, it is noteworthy that men also experience considerable traumatic stress during this challenging time.

BACKGROUND: Globally, there is an increasing trend of forcibly displaced people, of which over 40% are children. Unaccompanied asylum-seeking children (UASC) are at risk of experiencing psychological distress and developing mental health difficulties. However, in the UK, the approach from statutory mental health services is inconsistent across different geographical areas.
OBJECTIVE: This report outlines recommendations for statutory mental health services in the UK in relation to working with UASC.
METHODS: A rapid evaluation method was adopted including interviewing fifteen key informants as well as reviewing existing clinical guidelines. Key informants included clinicians, service managers, social workers and commissioners from Local Authorities, National Health Services, and third sector partners. Recommendations were synthesised using narrative synthesis.
CONCLUSIONS: Existing service provision and barriers to the implementation of interventions were summarised and compared against existing guidelines. The report presents recommendations on assessments, screening tools, and psychological interventions for developing a pathway for UASC within statutory services.
Globally, there is an increasing trend of asylum seekers and refugees, and 40% of which are children. Unaccompanied asylum-seeking children (UASC) are at risk of experiencing psychological distress and developing mental health difficulties. Yet, service provision for this population is inconsistent across different regions in the UK and may not be sufficient to meet their psychosocial needs. We hope to provide recommendations for services in England on how to better support UASC through reviewing the existing literature, clinical guidelines, and interviewing different service providers in the country in order to identify gaps in services. We interviewed key informants, including clinicians, service managers, social workers and commissioners from Local Authorities, National Health Services, and third sector partners. We present findings on how to improve the current assessment, screening and psychological interventions for UASC.

BACKGROUND: Compared to other occupational groups, first responders (FR) experience worse mental health outcomes due to duty-related trauma and occupational stressors. Despite their best efforts, they bring this stress home to friends and family. Consequently, FR and their supporters suffer from increased psychosocial difficulties and experience stigma and other barriers to help-seeking. Prior work offers little opportunity for open dialogue and shared understanding of the repercussions of this occupation for all members of the first responder community. In this qualitative study, we aimed to: (i) explore the lived experience of Irish FR and their family members (FM) related to occupational stressors, and (ii) identify opportunities to engage FM with existing organizational supports available for FR.
METHODS: Using a community based participatory research (CBPR) approach, we conducted six focus groups involving a total of fourteen participants comprising FR, organizational representatives, and FM. All focus groups were audio recorded, transcribed, and analyzed using reflexive thematic analysis.
RESULTS: FR and FM shared their experiences of both joining and learning to live as members of the FR community in Ireland. Through our analysis, we identified a main theme of \'crossing thresholds\', characterizing their transformative learning experiences. This learning experience includes recognizing the consequences of this new role for them as individuals and for their relationships. Participants also shared how they have learned to cope with the consequences of their roles and what they need to better support each other.
CONCLUSIONS: FM are often unheard, hidden members of the first responder community in Ireland, highlighting an unmet need for FR organizations to acknowledge FM role in supporting FR and to provide them with the appropriate training and resources required. Training for new recruits needs to move beyond the tokenistic involvement of FM and encourage knowledge sharing among experienced and novice members. Cultural change is required to support help-seeking among FR and foster a sense of peer support and community among families.

UNASSIGNED: Burnout syndrome usually begins with feelings of enthusiasm and idealized visualizations, and it is in contrast with subsequent disillusionment, disappointment, and symptoms which are related to chronic stress experienced later. This tendency to idealization is a parallel to the concept of \"mental splitting\" described by Kernberg with a pronounced \"black and white\" perceptual dichotomy between the early idealization and later disillusionment. This study intends examination of relationships between burnout syndrome, traumatic stress and Kernberg\'s concept of splitting.
UNASSIGNED: In this study we have assessed 90 health care professionals (50 women and 40 men) working with a population of diabetic patients utilizing Burnout Measure (BM), Splitting index (SI) and Traumatic Stress Checklist - 40 (TSC-40).
UNASSIGNED: Study results indicate significant Spearman correlations between burnout syndrome (BM) and traumatic stress (TSC-40) in population of men (R=0.75, p<0.01) and of women (R=0.61, p<0.01), as well as between burnout syndrome (BM) and splitting (SI) for both genders: men (R=0.40, p<0.01), women (R=0.51, p<0.01). These findings may have implications for prevention and treatment of burnout syndrome.
UNASSIGNED: The current study findings provide implications that the defensive mechanisms of splitting and traumatic stress may allow for the prediction of burnout symptoms. This relation may potentially be of use in both the potential detection and prevention of burnout syndrome.

Cambodian refugees resettled in the United States were severely affected by genocidal trauma and have been trapped in decades of intergenerational transmission of traumatic stress and relational disruptions without much public attention. This manuscript reports on data collected as part of a Cambodian needs assessment that employed methodological principles of critical ethnography and was grounded by a human ecological theoretical model. Eighteen professionals who served Cambodian communities were interviewed. The interviews were transcribed in Khmer or/and English and analyzed using the Developmental Research Sequence resulting in three domains (Pre-Migration, During Migration, and Post Resettlement in the United States) and four categories (i.e. Impact on Self, Couple Relationships, Parent-Child Relationships, and Context) within each domain. The thematic findings emphasize intergenerational transmission of psychopathology, disruptions in parent-child relationships, and a critical need to support parents to promote positive child development within Cambodian communities.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a psychiatric condition characterized by a prolonged stress response to potentially life-threatening events long after the event has passed. Understanding factors related to recovery from traumatic life events may inform novel targets for intervention. There is emerging preclinical evidence that creatine (Cr), a molecule critical to brain bioenergetics, may be a neurobiological marker of stress reactivity and recovery.
METHODS: 25 US Veterans (8 female) completed the Life Events Checklist for DSM-5, which assessed different types of traumatic events. Veterans were also asked to rate the subjective stress of each traumatic event on a 1-10 scale currently (Current Stress) and at the time the event occurred (Past Stress). Stress recovery was quantified as the difference between Current and Past Stress. Current PTSD symptoms were also assessed using the PTSD Checklist for DSM-5. Cr concentrations in the anterior cingulate cortex (ACC) were measured in the anterior cingulate cortex using proton magnetic resonance spectroscopy (1H-MRS).
RESULTS: Higher levels of Cr were associated with self-reported stress recovery from participants\' most traumatic life event. Cr was not related to number of different types of traumatic life events or current PTSD symptoms.
CONCLUSIONS: The sample size was relatively small. Stress recovery was measured via retrospective self-report. Future experimental work in humans should clarify the protective role of Cr in recovery from trauma.
CONCLUSIONS: ACC concentrations of Cr may be an important neurochemical factor related to stress recovery. Future work should investigate Cr as a possible protective factor against the effects of traumatic stress.

BACKGROUND: Childhood traumatic experiences may result in post-traumatic stress disorder. Although pediatricians are encouraged to address these traumas in clinical encounters, measures of childhood traumatic stress have not been adopted by primary care clinicians. In this study, we describe the feasibility and potential utility of the UCLA Brief Screen, a validated screener for childhood traumatic stress symptoms, in pediatric primary care clinics.
METHODS: Children 6-17 years of age presenting for routine well-child care in community-based pediatric clinics were eligible for traumatic stress screening. We described the feasibility and acceptability of screening based on screener adoption by eligible pediatric clinicians. We assessed the potential utility of screening based on prevalence and distribution of potentially traumatic events and traumatic stress symptoms in this general pediatric population. Finally, we compared results of the UCLA Brief Screen with those of the Patient Health Questionnaire-A to evaluate associations between symptoms of traumatic stress, depression, and suicidality among adolescents in this community setting.
RESULTS: 14/18 (77.8%) pediatric clinicians in two clinics offered an adapted UCLA Brief Screen during 2359/4959 (47.6%) eligible well-child checks over 14 months. 1472/2359 (62.4%) of offered screeners were completed, returned, and scored. One-third (32.5%) of completed screeners captured a potentially traumatic event experience described by either children or caregivers. Moderate to severe traumatic stress symptoms were identified in 10.7% and 5.2% of patients, respectively. Concurrent depression screening revealed that 68.3% of adolescents with depressive symptoms reported a potentially traumatic event (PTE) and 80.5% had concurrent traumatic stress symptoms. Adolescents reporting a PTE were 3.5 times more likely to report thoughts of suicide or self-harm than those without this history.
CONCLUSIONS: Results from this pilot study suggest that traumatic stress screening in the pediatric primary care setting may be feasible and may identify and classify mental health symptoms missed with current screening practices for depression. The prevalence of PTEs and traumatic stress symptoms associated with PTEs support the potential utility of a standardized screening in early identification of and response to children with clinically important symptoms of childhood traumatic stress. Future research should evaluate meaningful clinical outcomes associated with traumatic stress screening.