Background: Internationally deployed humanitarian aid (HA) workers are routinely confronted with ... more Background: Internationally deployed humanitarian aid (HA) workers are routinely confronted with potentially traumatic stressors. However, it remains unknown whether HA deployment and related traumatic stress are associated with long-term changes in hypothalamic-pituitary-adrenal (HPA) axis function. Therefore, we investigated whether cortisol awakening response (CAR) decreased upon deployment and whether this was moderated by previous and recent trauma exposure and parallel changes in symptom severity and perceived social support. Methods: In this prospective study, n = 86 HA workers (68% females) completed questionnaires regarding trauma exposure, posttraumatic stress disorder (PTSD), anxiety and depressive symptoms and perceived social support, as well as salivary cortisol assessments at awakening and 30 minutes post-awakening at before, early and 3–6 months post-deployment. Results: Linear mixed models showed significantly decreased CAR (b(SE) = −.036(.011), p = .002) and awaken...
Happy New Year to our readers around the worldsome of them it just started, for others it will so... more Happy New Year to our readers around the worldsome of them it just started, for others it will soon beginfrom the European Journal of Psychotraumatology, the European Society for Traumatic Stress Studies (ESTSS) and the team at Taylor and Francis. According to Johan Norberg (here), a popular Swedish author, historian and expert in economic globalization, our progress has been unprecedented. On almost any index things are markedly better now than they have ever been. We are safer, healthier, there is more prosperity and less inequality. Yet, we have witnessed a dramatic increase in political, religious and ideological violence around the world. The year 2016 has not been an easy one for many individuals. Terrorist attacks have dominated the news and sadly, the first day of this year did not start well with another act of terrorism in Turkey. Fear is easily fostered. Although we are much more likely to be in a traffic accident than to find ourselves a victim of terrorism, our mind is not always rational about it. And the minds of those who have witnessed violence in the past are likely to be even more tuned in towards potential danger. A terrorist hidden in a stream of refugees easily feeds beliefs on the dangers of the stranger, making refugees and migrants easy topics dominating the elections all over Europe and in the US. Man-made or not, global warming has continued: 2016 was the third year in a row with record high global temperatures with floods, earthquakes and draughts affecting millions of people. This also leads to more global inequality and migration. The UNHCR reported that more people have been driven from their homes than at any time since records began, over 65 million displaced worldwide, with the shocking conclusion that 'one in every 113 people on earth is either an asylum-seeker, internally displaced or a refugee' (UNHCR, http://www.unhcr.org/ global-trends-2015.html). Relatively few asylum seekers find their way to Western Europe, by the way. Countries like Turkey, Pakistan, Lebanon, and Iran host most of them (Turner, 2015). While refugees and migrants are trying to escape from war, draught, poverty, or violence, they represent one of the most vulnerable populations. However, they have the same aspirations as any human beingto be safe, healthy, and with a better future (for their children).
It is estimated that more than 250,000 individuals are work-ing for humanitarian aid organization... more It is estimated that more than 250,000 individuals are work-ing for humanitarian aid organizations around the world (Stoddard, Harmer, & DiDomenico, 2009), and in the last decade, they have faced increased risk of violence in the set-tings where they work (Sheik et al., 2000; Stoddard et al., 2009). In 2008, the mortality rate of humanitarian aid work-ers was higher than that of UN peacekeeping troops; 260 humanitarian aid workers were killed, taken hostage, or injured in a serious assault during their service in that year (Stoddard et al., 2009). Between 2006 and 2009, attacks against expatriate humanitarian aid workers have shown a striking increase, likely due to increased political motives in attacks and high security risks in key areas (e.g., Sudan, Afghanistan, and Somalia; Stoddard et al., 2009). In the context of this increased risk of violence, aid orga-nizations have increasingly prioritized security and support of staff. Organizations such as People in Aid and the Antares...
View related articles View Crossmark data This article has been awarded the Centre for Open Scien... more View related articles View Crossmark data This article has been awarded the Centre for Open Science 'Open Data' badge.
This letter provides an update on the activities of "The Global Collaboration on Traumatic Stress... more This letter provides an update on the activities of "The Global Collaboration on Traumatic Stress" (GC-TS) as first described by Schnyder et al. in 2017. It presents in further detail the projects of the first theme, in particular the development of and initial data on the Global Psychotrauma Screen (GPS), a brief instrument designed to screen for the wide range of potential outcomes of trauma. English language data and ongoing studies in several languages provide a first indication that the GPS is a feasible, reliable and valid tool, a tool that may be very useful in the current pandemic of the coronavirus disease 2019 (COVID-19). Further multi-language and cross-cultural validation is needed. Since the start of the GC-TS, new themes have been introduced to focus on in the coming years: a) Forcibly displaced persons, b) Global prevalence of stress and trauma related disorders, c) Socio-emotional development across cultures, and d) Collaborating to make traumatic stress research data "FAIR". The most recent theme added is that of Global crises, currently focusing on COVID-19-related projects.
On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a f... more On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma. This editorial is part of a special issue celebrating the 10 years anniversary of the journal and acknowledging some of our most impactful articles of the past decade. In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline. These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience. We address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help us to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions 1. Where did we stand in 2010? 2. What did we learn in the past 10 years? 3. What are our knowledge gaps? We conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.
Birth experiences can be traumatic and may give rise to PTSD following childbirth (PTSD-FC). Peri... more Birth experiences can be traumatic and may give rise to PTSD following childbirth (PTSD-FC). Peripartum neurobiological alterations in the oxytocinergic system are highly relevant for postpartum maternal behavioral and affective adaptions like bonding and lactation but are also implicated in the response to traumatic events. Animal models demonstrated that peripartum stress impairs beneficial maternal postpartum behavior. Early postpartum activation of the oxytocinergic system may, however, reverse these effects and thereby prevent adverse long-term consequences for both mother and infant. In this narrative review, we discuss the impact of trauma and PTSD-FC on normal endogenous oxytocinergic system fluctuations in the peripartum period. We also specifically focus on the potential of exogenous oxytocin (OT) to prevent and treat PTSD-FC. No trials of exogenous OT after traumatic childbirth and PTSD-FC were available. Evidence from non-obstetric PTSD samples and from postpartum healthy or depressed samples implies restorative functional neuroanatomic and psychological effects of exogenous OT such as improved PTSD symptoms and better mother-to-infant bonding, decreased limbic activation, and restored responsiveness in dopaminergic reward regions. Adverse effects of intranasal OT on mood and the increased fear processing and reduced top-down control over amygdala activation in women with acute trauma exposure or postpartum depression, however, warrant cautionary use of intranasal OT. Observational and experimental studies into the role of the endogenous and exogenous oxytocinergic system in PTSD-FC are needed and should explore individual and situational circumstances, including level of acute distress, intrapartum exogenous OT exposure, or history of childhood trauma.
In the past few years the number of refugees worldwide has increased dramatically. Many of them w... more In the past few years the number of refugees worldwide has increased dramatically. Many of them were traumatized in their homelands due to violent conflict or persecution, as well as during their flight, and are confronted with ongoing stressors in the exile countries. In order to contribute to enhancing the clinical knowledge, this special issue of the European Journal of Psychotraumatology focuses on traumatized refugees. It includes three review articles as well as four original articles on the mental health burden, screening instruments and interventions in different groups of refugees. The articles published in this special issue focus on important aspects of better understanding the needs of traumatized refugees, as well as on identifying and offering appropriate mental health care for this population. Future research recommendations are provided in the hope to contribute to improving mental health care strategies of this still underserved population.
The objective of this study was to study mental health, coping, and support after work-related ad... more The objective of this study was to study mental health, coping, and support after work-related adverse events among pediatricians. Physicians are frequently exposed to adverse events. It makes them at risk for posttraumatic stress disorder (PTSD), depression, and anxiety disorders. Besides the personal impact, physicians could pose a threat towards patients, as mental health problems are associated with medical errors. A questionnaire was sent to all members of the Pediatric Association of The Netherlands in October 2016. The questionnaire focused on adverse events, coping, and support. The Hospital Anxiety and Depression Scale and the Trauma Screening Questionnaire were included for evaluation of anxiety, depression, and posttraumatic stress. Four hundred ten questionnaires (18.9%) were eligible for analysis. Seventy-nine % (n = 325) of the respondents experienced adverse events, with Bmissing a diagnosis^having the most emotional impact and Baggressive behavior^as the most common adverse event. Nine (2.2%) pediatricians scored above the cutoff value on the Trauma Screening Questionnaire, indicative of PTSD. In total, 7.3% (n = 30) and 14.1% (n = 58) scored above the cutoff values in the Hospital Anxiety and Depression Scale, indicative of depression and anxiety. Only 26.3% reported to have a peer support protocol available for emotional support following adverse events. Conclusion: Pediatricians experience a considerable amount of adverse and potentially traumatizing events associated with significantly higher mental health problems compared to the general high-income population. Aggression towards pediatricians seems to be a common problem. Protocolled (peer) support should be implemented.
Projected changes to post-traumatic stress disorder (PTSD) diagnostic criteria in the upcoming In... more Projected changes to post-traumatic stress disorder (PTSD) diagnostic criteria in the upcoming International Classification of Diseases (ICD)-11 may affect the prevalence and severity of identified cases. This study examined differences in rates, severity, and overlap of diagnoses using ICD-10 and ICD-11 PTSD diagnostic criteria during consecutive assessments of recent survivors of traumatic events. The study sample comprised 3863 survivors of traumatic events, evaluated in 11 longitudinal studies of PTSD. ICD-10 and ICD-11 diagnostic rules were applied to the Clinician-Administered PTSD Scale (CAPS) to derive ICD-10 and ICD-11 diagnoses at different time intervals between trauma occurrence and 15 months. The ICD-11 criteria identified fewer cases than the ICD-10 across assessment intervals (range -47.09% to -57.14%). Over 97% of ICD-11 PTSD cases met concurrent ICD-10 PTSD criteria. PTSD symptom severity of individuals identified by the ICD-11 criteria (CAPS total scores) was 31.38...
Posttraumatic stress disorder (PTSD) is a global public health problem. Unfortunately, many indiv... more Posttraumatic stress disorder (PTSD) is a global public health problem. Unfortunately, many individuals with PTSD do not receive professional care due to a lack of available providers, stigma about mental illness, and other concerns. Technology-based interventions, including mobile phone applications (apps) may be a viable means of surmounting such barriers and reaching and helping those in need. Given this potential, in 2011 the U.S Veterans Affairs National Center for PTSD released PTSD Coach, a mobile app intended to provide psycho-education and self-management tools for trauma survivors with PTSD symptoms. Emerging research on PTSD Coach demonstrates high user satisfaction, feasibility, and improvement in PTSD symptoms and other psychosocial outcomes. A model of openly sharing the app's source code and content has resulted in versions being created by individuals in six other countries: Australia, Canada, The Netherlands, Germany, Sweden, and Denmark. These versions are desc...
Police officers exposed to potentially traumatic events (PTE) are at a heightened risk of develop... more Police officers exposed to potentially traumatic events (PTE) are at a heightened risk of developing posttraumatic stress disorder (PTSD). Little is known about trauma-focused psychotherapy outcomes in the police. In this naturalistic study, we evaluated whether PTE exposure and baseline clinical characteristics predicted PTSD symptom reduction during treatment and residual PTSD symptoms posttreatment. In consecutive referrals to a specialized mental health service for police officers (N = 665), PTSD was measured pre- and posttreatment using structured clinical interviews. Treatment consisted of brief eclectic psychotherapy for PTSD. We grouped PTE as follows: injury/maltreatment, loss (colleague or private), other job-related, other private traumatic events. Data were analyzed multivariably using structural equation modeling and logistic regression. Treatment effect size was large, d = 3.6, 95% CI [3.4, 3.8]. Police officers who reported more injury/maltreatment or private traumatic had more baseline PTSD symptoms as well as larger symptom reduction during treatment; police officers who reported more losses of loved ones showed smaller PTSD symptom reduction. Concentration problems persisted in 17.7% of police officers posttreatment, and these were predicted by baseline PTSD symptoms and loss of loved ones. Proportions of variance explained by the multivariable models ranged from 0.08 to 0.14. Our findings increase insight into the type of PTE and clinical characteristics of police officers with PTSD who benefit most from trauma-focused treatment. Because loss of loved ones can be presumed to have a profound impact on social and interpersonal functioning, a more specific treatment focus on grief processes may further enhance efficacy.
Psychological resilience is a distinct factor that affects mental health outcomes after adversiti... more Psychological resilience is a distinct factor that affects mental health outcomes after adversities. This study describes the development, validity and measurement invariance (MI) of a Dutch and English scale on psychological resilience, called the Resilience Evaluation Scale (RES). Separate online surveys with the Dutch and English version of the RES and hypothesized related measures were distributed in a Dutch- and English-speaking group, both drawn from the general population. Exploratory factor analysis, using data from 522 respondents ( = 296 Dutch, = 226 English), yielded a two-factor structure for the final 9-item RES. The factors reflected the hypothesized underlying constructs of psychological resilience: and . The items and constructs of psychological resilience as measured by the RES were interpreted and conceptualized in the same way by both language groups, with the exception of one item. The RES showed good convergent validity and good internal consistency. The current...
Posttraumatic stress disorder (PTSD) is a significant comorbidity in substance use disorders (SUD... more Posttraumatic stress disorder (PTSD) is a significant comorbidity in substance use disorders (SUDs). While most studies have addressed trauma/PTSD in abstinent patients, little is known about trauma/PTSD in early detoxification treatment. The current study therefore addresses the systematic evaluation of trauma/PTSD in early inpatient detoxification. A cross-sectional survey was accomplished in three German-speaking clinics (n = 134) specialized in inpatient detoxification and motivation treatment. All measures are based on self-report using trauma-specific questionnaires and measures for general psychopathological burden. Participation rate was 60.1% and patients did not show clinically obvious psychological distress during or after assessment. DSM-IV traumatic events were reported by 66.4%. Of the total sample, 38.1% screened positive for PTSD, and 14.9% screened positive for subsyndromal PTSD. PTSD patients reported significantly more childhood adversities and significantly highe...
Trauma is a global issue. The great majority of the global burden of disease arising from mental ... more Trauma is a global issue. The great majority of the global burden of disease arising from mental health conditions occurs in low- and middle-income countries (LMICs), among populations in political, economic, and/or cultural transition and those struck by forced migration. These mental health problems frequently arise as a result of traumatic events that adversely affect adults, children, and families, including war, mass violence, natural disasters, and accidents. In response to this, the International Society for Traumatic Stress Studies (ISTSS) launched the Global Initiative to have a stronger global impact on trauma-related issues. As part of this initiative, the Global Collaboration was established by representatives of eight professional organizations active in the field of traumatic stress. The group decided to focus on childhood abuse and neglect as its first collaboration. They collected guidelines worldwide, providing the basis for a synthesized core guide for prevention a...
Disasters can have an enormous impact on the health and well-being of those affected. Internation... more Disasters can have an enormous impact on the health and well-being of those affected. Internationally, governments and service providers are often challenged to address complex psychosocial problems. Ideally, the potentially broad range of support activities include a coherent, high-quality mental health and psychosocial support (MHPSS) programme. We present a theory-driven quantitative analysis of the quality of 40 MHPSS programmes, mostly implemented in European disaster settings. The objective is to measure quality domains recognized as relevant in the literature and to empirically test associations. During the EU project "Operationalizing Psychosocial Support in Crisis" (OPSIC) an evaluation survey was designed and developed for this purpose and completed by 40 MHPSS programme coordinators involved in different mass emergencies and disasters. We analysed the survey data in two steps. Firstly, we used the data to operationalize quality domains of a MHPSS programme, test...
European journal of human genetics : EJHG, Jan 23, 2018
Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder that may develop afte... more Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder that may develop after a traumatic event. Here we aimed to identify epigenetic and genetic loci associated with PTSD. We included 73 traumatized police officers with extreme phenotypes regarding symptom severity despite similar trauma history: n = 34 had PTSD and n = 39 had minimal PTSD symptoms. Epigenetic and genetic profiles were based on the Illumina HumanMethylation450 BeadChip. We searched for differentially methylated probes (DMPs) and differentially methylated regions (DMRs). For genetic associations we analyzed the CpG-SNPs present on the array. We detected no genome-wide significant DMPs and we did not replicate previously reported DMPs associated with PTSD. However, GSE analysis of the top 100 DMPs showed enrichment of three genes involved in the dopaminergic neurogenesis pathway. Furthermore, we observed a suggestive association of one relatively large DMR between patients and controls, which was...
Background: Internationally deployed humanitarian aid (HA) workers are routinely confronted with ... more Background: Internationally deployed humanitarian aid (HA) workers are routinely confronted with potentially traumatic stressors. However, it remains unknown whether HA deployment and related traumatic stress are associated with long-term changes in hypothalamic-pituitary-adrenal (HPA) axis function. Therefore, we investigated whether cortisol awakening response (CAR) decreased upon deployment and whether this was moderated by previous and recent trauma exposure and parallel changes in symptom severity and perceived social support. Methods: In this prospective study, n = 86 HA workers (68% females) completed questionnaires regarding trauma exposure, posttraumatic stress disorder (PTSD), anxiety and depressive symptoms and perceived social support, as well as salivary cortisol assessments at awakening and 30 minutes post-awakening at before, early and 3–6 months post-deployment. Results: Linear mixed models showed significantly decreased CAR (b(SE) = −.036(.011), p = .002) and awaken...
Happy New Year to our readers around the worldsome of them it just started, for others it will so... more Happy New Year to our readers around the worldsome of them it just started, for others it will soon beginfrom the European Journal of Psychotraumatology, the European Society for Traumatic Stress Studies (ESTSS) and the team at Taylor and Francis. According to Johan Norberg (here), a popular Swedish author, historian and expert in economic globalization, our progress has been unprecedented. On almost any index things are markedly better now than they have ever been. We are safer, healthier, there is more prosperity and less inequality. Yet, we have witnessed a dramatic increase in political, religious and ideological violence around the world. The year 2016 has not been an easy one for many individuals. Terrorist attacks have dominated the news and sadly, the first day of this year did not start well with another act of terrorism in Turkey. Fear is easily fostered. Although we are much more likely to be in a traffic accident than to find ourselves a victim of terrorism, our mind is not always rational about it. And the minds of those who have witnessed violence in the past are likely to be even more tuned in towards potential danger. A terrorist hidden in a stream of refugees easily feeds beliefs on the dangers of the stranger, making refugees and migrants easy topics dominating the elections all over Europe and in the US. Man-made or not, global warming has continued: 2016 was the third year in a row with record high global temperatures with floods, earthquakes and draughts affecting millions of people. This also leads to more global inequality and migration. The UNHCR reported that more people have been driven from their homes than at any time since records began, over 65 million displaced worldwide, with the shocking conclusion that 'one in every 113 people on earth is either an asylum-seeker, internally displaced or a refugee' (UNHCR, http://www.unhcr.org/ global-trends-2015.html). Relatively few asylum seekers find their way to Western Europe, by the way. Countries like Turkey, Pakistan, Lebanon, and Iran host most of them (Turner, 2015). While refugees and migrants are trying to escape from war, draught, poverty, or violence, they represent one of the most vulnerable populations. However, they have the same aspirations as any human beingto be safe, healthy, and with a better future (for their children).
It is estimated that more than 250,000 individuals are work-ing for humanitarian aid organization... more It is estimated that more than 250,000 individuals are work-ing for humanitarian aid organizations around the world (Stoddard, Harmer, & DiDomenico, 2009), and in the last decade, they have faced increased risk of violence in the set-tings where they work (Sheik et al., 2000; Stoddard et al., 2009). In 2008, the mortality rate of humanitarian aid work-ers was higher than that of UN peacekeeping troops; 260 humanitarian aid workers were killed, taken hostage, or injured in a serious assault during their service in that year (Stoddard et al., 2009). Between 2006 and 2009, attacks against expatriate humanitarian aid workers have shown a striking increase, likely due to increased political motives in attacks and high security risks in key areas (e.g., Sudan, Afghanistan, and Somalia; Stoddard et al., 2009). In the context of this increased risk of violence, aid orga-nizations have increasingly prioritized security and support of staff. Organizations such as People in Aid and the Antares...
View related articles View Crossmark data This article has been awarded the Centre for Open Scien... more View related articles View Crossmark data This article has been awarded the Centre for Open Science 'Open Data' badge.
This letter provides an update on the activities of "The Global Collaboration on Traumatic Stress... more This letter provides an update on the activities of "The Global Collaboration on Traumatic Stress" (GC-TS) as first described by Schnyder et al. in 2017. It presents in further detail the projects of the first theme, in particular the development of and initial data on the Global Psychotrauma Screen (GPS), a brief instrument designed to screen for the wide range of potential outcomes of trauma. English language data and ongoing studies in several languages provide a first indication that the GPS is a feasible, reliable and valid tool, a tool that may be very useful in the current pandemic of the coronavirus disease 2019 (COVID-19). Further multi-language and cross-cultural validation is needed. Since the start of the GC-TS, new themes have been introduced to focus on in the coming years: a) Forcibly displaced persons, b) Global prevalence of stress and trauma related disorders, c) Socio-emotional development across cultures, and d) Collaborating to make traumatic stress research data "FAIR". The most recent theme added is that of Global crises, currently focusing on COVID-19-related projects.
On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a f... more On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma. This editorial is part of a special issue celebrating the 10 years anniversary of the journal and acknowledging some of our most impactful articles of the past decade. In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline. These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience. We address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help us to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions 1. Where did we stand in 2010? 2. What did we learn in the past 10 years? 3. What are our knowledge gaps? We conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.
Birth experiences can be traumatic and may give rise to PTSD following childbirth (PTSD-FC). Peri... more Birth experiences can be traumatic and may give rise to PTSD following childbirth (PTSD-FC). Peripartum neurobiological alterations in the oxytocinergic system are highly relevant for postpartum maternal behavioral and affective adaptions like bonding and lactation but are also implicated in the response to traumatic events. Animal models demonstrated that peripartum stress impairs beneficial maternal postpartum behavior. Early postpartum activation of the oxytocinergic system may, however, reverse these effects and thereby prevent adverse long-term consequences for both mother and infant. In this narrative review, we discuss the impact of trauma and PTSD-FC on normal endogenous oxytocinergic system fluctuations in the peripartum period. We also specifically focus on the potential of exogenous oxytocin (OT) to prevent and treat PTSD-FC. No trials of exogenous OT after traumatic childbirth and PTSD-FC were available. Evidence from non-obstetric PTSD samples and from postpartum healthy or depressed samples implies restorative functional neuroanatomic and psychological effects of exogenous OT such as improved PTSD symptoms and better mother-to-infant bonding, decreased limbic activation, and restored responsiveness in dopaminergic reward regions. Adverse effects of intranasal OT on mood and the increased fear processing and reduced top-down control over amygdala activation in women with acute trauma exposure or postpartum depression, however, warrant cautionary use of intranasal OT. Observational and experimental studies into the role of the endogenous and exogenous oxytocinergic system in PTSD-FC are needed and should explore individual and situational circumstances, including level of acute distress, intrapartum exogenous OT exposure, or history of childhood trauma.
In the past few years the number of refugees worldwide has increased dramatically. Many of them w... more In the past few years the number of refugees worldwide has increased dramatically. Many of them were traumatized in their homelands due to violent conflict or persecution, as well as during their flight, and are confronted with ongoing stressors in the exile countries. In order to contribute to enhancing the clinical knowledge, this special issue of the European Journal of Psychotraumatology focuses on traumatized refugees. It includes three review articles as well as four original articles on the mental health burden, screening instruments and interventions in different groups of refugees. The articles published in this special issue focus on important aspects of better understanding the needs of traumatized refugees, as well as on identifying and offering appropriate mental health care for this population. Future research recommendations are provided in the hope to contribute to improving mental health care strategies of this still underserved population.
The objective of this study was to study mental health, coping, and support after work-related ad... more The objective of this study was to study mental health, coping, and support after work-related adverse events among pediatricians. Physicians are frequently exposed to adverse events. It makes them at risk for posttraumatic stress disorder (PTSD), depression, and anxiety disorders. Besides the personal impact, physicians could pose a threat towards patients, as mental health problems are associated with medical errors. A questionnaire was sent to all members of the Pediatric Association of The Netherlands in October 2016. The questionnaire focused on adverse events, coping, and support. The Hospital Anxiety and Depression Scale and the Trauma Screening Questionnaire were included for evaluation of anxiety, depression, and posttraumatic stress. Four hundred ten questionnaires (18.9%) were eligible for analysis. Seventy-nine % (n = 325) of the respondents experienced adverse events, with Bmissing a diagnosis^having the most emotional impact and Baggressive behavior^as the most common adverse event. Nine (2.2%) pediatricians scored above the cutoff value on the Trauma Screening Questionnaire, indicative of PTSD. In total, 7.3% (n = 30) and 14.1% (n = 58) scored above the cutoff values in the Hospital Anxiety and Depression Scale, indicative of depression and anxiety. Only 26.3% reported to have a peer support protocol available for emotional support following adverse events. Conclusion: Pediatricians experience a considerable amount of adverse and potentially traumatizing events associated with significantly higher mental health problems compared to the general high-income population. Aggression towards pediatricians seems to be a common problem. Protocolled (peer) support should be implemented.
Projected changes to post-traumatic stress disorder (PTSD) diagnostic criteria in the upcoming In... more Projected changes to post-traumatic stress disorder (PTSD) diagnostic criteria in the upcoming International Classification of Diseases (ICD)-11 may affect the prevalence and severity of identified cases. This study examined differences in rates, severity, and overlap of diagnoses using ICD-10 and ICD-11 PTSD diagnostic criteria during consecutive assessments of recent survivors of traumatic events. The study sample comprised 3863 survivors of traumatic events, evaluated in 11 longitudinal studies of PTSD. ICD-10 and ICD-11 diagnostic rules were applied to the Clinician-Administered PTSD Scale (CAPS) to derive ICD-10 and ICD-11 diagnoses at different time intervals between trauma occurrence and 15 months. The ICD-11 criteria identified fewer cases than the ICD-10 across assessment intervals (range -47.09% to -57.14%). Over 97% of ICD-11 PTSD cases met concurrent ICD-10 PTSD criteria. PTSD symptom severity of individuals identified by the ICD-11 criteria (CAPS total scores) was 31.38...
Posttraumatic stress disorder (PTSD) is a global public health problem. Unfortunately, many indiv... more Posttraumatic stress disorder (PTSD) is a global public health problem. Unfortunately, many individuals with PTSD do not receive professional care due to a lack of available providers, stigma about mental illness, and other concerns. Technology-based interventions, including mobile phone applications (apps) may be a viable means of surmounting such barriers and reaching and helping those in need. Given this potential, in 2011 the U.S Veterans Affairs National Center for PTSD released PTSD Coach, a mobile app intended to provide psycho-education and self-management tools for trauma survivors with PTSD symptoms. Emerging research on PTSD Coach demonstrates high user satisfaction, feasibility, and improvement in PTSD symptoms and other psychosocial outcomes. A model of openly sharing the app's source code and content has resulted in versions being created by individuals in six other countries: Australia, Canada, The Netherlands, Germany, Sweden, and Denmark. These versions are desc...
Police officers exposed to potentially traumatic events (PTE) are at a heightened risk of develop... more Police officers exposed to potentially traumatic events (PTE) are at a heightened risk of developing posttraumatic stress disorder (PTSD). Little is known about trauma-focused psychotherapy outcomes in the police. In this naturalistic study, we evaluated whether PTE exposure and baseline clinical characteristics predicted PTSD symptom reduction during treatment and residual PTSD symptoms posttreatment. In consecutive referrals to a specialized mental health service for police officers (N = 665), PTSD was measured pre- and posttreatment using structured clinical interviews. Treatment consisted of brief eclectic psychotherapy for PTSD. We grouped PTE as follows: injury/maltreatment, loss (colleague or private), other job-related, other private traumatic events. Data were analyzed multivariably using structural equation modeling and logistic regression. Treatment effect size was large, d = 3.6, 95% CI [3.4, 3.8]. Police officers who reported more injury/maltreatment or private traumatic had more baseline PTSD symptoms as well as larger symptom reduction during treatment; police officers who reported more losses of loved ones showed smaller PTSD symptom reduction. Concentration problems persisted in 17.7% of police officers posttreatment, and these were predicted by baseline PTSD symptoms and loss of loved ones. Proportions of variance explained by the multivariable models ranged from 0.08 to 0.14. Our findings increase insight into the type of PTE and clinical characteristics of police officers with PTSD who benefit most from trauma-focused treatment. Because loss of loved ones can be presumed to have a profound impact on social and interpersonal functioning, a more specific treatment focus on grief processes may further enhance efficacy.
Psychological resilience is a distinct factor that affects mental health outcomes after adversiti... more Psychological resilience is a distinct factor that affects mental health outcomes after adversities. This study describes the development, validity and measurement invariance (MI) of a Dutch and English scale on psychological resilience, called the Resilience Evaluation Scale (RES). Separate online surveys with the Dutch and English version of the RES and hypothesized related measures were distributed in a Dutch- and English-speaking group, both drawn from the general population. Exploratory factor analysis, using data from 522 respondents ( = 296 Dutch, = 226 English), yielded a two-factor structure for the final 9-item RES. The factors reflected the hypothesized underlying constructs of psychological resilience: and . The items and constructs of psychological resilience as measured by the RES were interpreted and conceptualized in the same way by both language groups, with the exception of one item. The RES showed good convergent validity and good internal consistency. The current...
Posttraumatic stress disorder (PTSD) is a significant comorbidity in substance use disorders (SUD... more Posttraumatic stress disorder (PTSD) is a significant comorbidity in substance use disorders (SUDs). While most studies have addressed trauma/PTSD in abstinent patients, little is known about trauma/PTSD in early detoxification treatment. The current study therefore addresses the systematic evaluation of trauma/PTSD in early inpatient detoxification. A cross-sectional survey was accomplished in three German-speaking clinics (n = 134) specialized in inpatient detoxification and motivation treatment. All measures are based on self-report using trauma-specific questionnaires and measures for general psychopathological burden. Participation rate was 60.1% and patients did not show clinically obvious psychological distress during or after assessment. DSM-IV traumatic events were reported by 66.4%. Of the total sample, 38.1% screened positive for PTSD, and 14.9% screened positive for subsyndromal PTSD. PTSD patients reported significantly more childhood adversities and significantly highe...
Trauma is a global issue. The great majority of the global burden of disease arising from mental ... more Trauma is a global issue. The great majority of the global burden of disease arising from mental health conditions occurs in low- and middle-income countries (LMICs), among populations in political, economic, and/or cultural transition and those struck by forced migration. These mental health problems frequently arise as a result of traumatic events that adversely affect adults, children, and families, including war, mass violence, natural disasters, and accidents. In response to this, the International Society for Traumatic Stress Studies (ISTSS) launched the Global Initiative to have a stronger global impact on trauma-related issues. As part of this initiative, the Global Collaboration was established by representatives of eight professional organizations active in the field of traumatic stress. The group decided to focus on childhood abuse and neglect as its first collaboration. They collected guidelines worldwide, providing the basis for a synthesized core guide for prevention a...
Disasters can have an enormous impact on the health and well-being of those affected. Internation... more Disasters can have an enormous impact on the health and well-being of those affected. Internationally, governments and service providers are often challenged to address complex psychosocial problems. Ideally, the potentially broad range of support activities include a coherent, high-quality mental health and psychosocial support (MHPSS) programme. We present a theory-driven quantitative analysis of the quality of 40 MHPSS programmes, mostly implemented in European disaster settings. The objective is to measure quality domains recognized as relevant in the literature and to empirically test associations. During the EU project "Operationalizing Psychosocial Support in Crisis" (OPSIC) an evaluation survey was designed and developed for this purpose and completed by 40 MHPSS programme coordinators involved in different mass emergencies and disasters. We analysed the survey data in two steps. Firstly, we used the data to operationalize quality domains of a MHPSS programme, test...
European journal of human genetics : EJHG, Jan 23, 2018
Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder that may develop afte... more Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder that may develop after a traumatic event. Here we aimed to identify epigenetic and genetic loci associated with PTSD. We included 73 traumatized police officers with extreme phenotypes regarding symptom severity despite similar trauma history: n = 34 had PTSD and n = 39 had minimal PTSD symptoms. Epigenetic and genetic profiles were based on the Illumina HumanMethylation450 BeadChip. We searched for differentially methylated probes (DMPs) and differentially methylated regions (DMRs). For genetic associations we analyzed the CpG-SNPs present on the array. We detected no genome-wide significant DMPs and we did not replicate previously reported DMPs associated with PTSD. However, GSE analysis of the top 100 DMPs showed enrichment of three genes involved in the dopaminergic neurogenesis pathway. Furthermore, we observed a suggestive association of one relatively large DMR between patients and controls, which was...
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Papers by Miranda Olff