Trauma, depression, and comorbid PTSD/depression in a community sample of Latina immigrants.

Trauma exposure is frequently overlooked as a risk factor for psychiatric morbidity among studies with Latinos. The purpose of this study was to examine the relationships among trauma history, immigration-related factors, and mental health status among Latina immigrants. The current study used baseline data from a randomized clinical trial for the treatment of depression of 64 women with comorbid posttraumatic stress disorder and depression, 69 with depression-only, and 61 with no Axis I mental disorder. Sixty-four percent of the sample was Central American and 75% reported trauma exposure. Multinomial logit analysis suggested fewer years in the United States was associated with worse mental health status. Having a nonmarried marital status was also associated with worse mental health. Reporting four or more types of traumatic events was associated with an increase in the probability of comorbidity. These findings have important implications for future research and clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive processes in dissociation: Comment on Giesbrecht et al. (2008).

In their recent review “Cognitive Processes in Dissociation: An Analysis of Core Theoretical Assumptions,” published in Psychological Bulletin, Giesbrecht, Lynn, Lilienfeld, and Merckelbach (see record 2008-11487-001) have challenged the widely accepted trauma theory of dissociation, which holds that dissociative symptoms are caused by traumatic stress. In doing so, the authors have outlined a series of links between various constructs—such as fantasy proneness, cognitive failures, absorption, suggestibility, altered information-processing, dissociation, and amnesia—claiming that these linkages lead to the false conclusion that trauma causes dissociation. A review of the literature, however, shows that these are not necessarily related constructs. Careful examination of their arguments reveals no basis for the conclusion that there is no association between trauma and dissociation. The current comment offers a critical review and rebuttal of Giesbrecht et al.’s argument that there is no relationship between trauma and dissociation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychic retreats or psychic pits?: Unbearable states of mind and technological addiction.

New technologies are highly interactive. They promote imaginative involvement and allow the experience of different self-states, such as those involving withdrawal or “psychic retreat”. According to Steiner, psychic retreats are areas of the mind populated by imagination and ideas which are poorly aligned with reality. Psychic retreats are not necessarily pathological in themselves—for instance, they can be used positively for counteracting anxiety or enhancing creativeness. However, with technological addiction there is a misuse of psychic retreat: here the total absorption with computer applications serves to hide painful or unbearable states of mind, and to protect the patient from overwhelming feelings through segregating self-states with a disconnection in their representations. Therefore, in clinical work with individuals suffering from technological addiction exploring the use of psychic retreats can serve as an aid to both diagnosis and treatment. Where the dysfunctional use of new technologies constitutes a temporary withdrawal from a specific painful event, this can have the function of protecting the individual from inner conflict; in the most serious cases however, technological addiction is grounded in more chronic and pathological dissociative mechanisms, and serves to prevent the mind from reactivating traumatic states connected to childhood experience of emotional neglect or abuse. While it is likely that the first condition can be positively handled with appropriate identification and treatment, the latter is much more difficult to deal with, particularly where the addictive behavior hides the weakness of the self, and psychic retreats are pervasively used to protect the patient from mental breakdown. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of a mental health assessment in an African conflict population.

We studied the validity of the assessment of posttraumatic stress disorder (PTSD) and depression within the context of an epidemiological mental health survey among war-affected adolescents and young adults in northern Uganda. Local language versions of the Posttraumatic Diagnostic Scale (PDS) and the Depression section of the Hopkins Symptom Checklist (DHSCL) were administered by trained local interviewers. Correlations with probable predictor variables (i.e., trauma exposure), outcomes (e.g., impaired functioning), and local idioms of distress (i.e., spirit possession) were determined to estimate criterion-related construct validity. To assess convergent validity, expert clinicians reinterviewed a subsample using structured interviews (the Clinician Administered PTSD Scale [CAPS] and the Mini International Neuropsychiatric Interview [MINI]). Depression and PTSD symptoms as assessed by the local interviewers correlated with the context variables as predicted. After optimizing the scoring algorithm, we found good agreement between the PDS-based diagnoses and expert diagnoses. However, the concordance for depression diagnoses was not satisfactory. Results show that mental health assessments in African languages can produce reliable and valid data but that caution is warranted in the unevaluated transfer of cutoff scores and scoring algorithms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trends in head injuries associated with mandatory bicycle helmet legislation targeting children and adolescents

Background

Bicycling related head injuries (HIs) can be severe. Helmet use reduces head injury risk; however, there are few controlled studies of the effect of helmet legislation. We conducted this study to investigate changes in HIs after bicycle helmet legislation targeting those <18 in Alberta, Canada in 2002.

Methods

Bicyclist and pedestrian (control) HI rates and HIs as a proportion of all injuries were compared for the three years (1999–2001) before and four years (2003–2006) after bicycle helmet legislation in three age groups (children: <13, adolescents: 13–17, and adults: 18+).

Results

There were 41,270 ED visits and 2782 hospitalizations for bicyclists and 9836 ED visits and 2029 hospitalizations for pedestrians (excluding the legislation year 2002). The rate of ED HIs declined for child bicyclists and child pedestrians, while the rate of non-HIs declined in adult bicyclists and child pedestrians. The rate of hospitalized HIs declined in child bicyclists and all ages of pedestrians while non-HI rates declined for child and adult pedestrians. Non-HI rates for adolescent and adult bicyclists increased. After adjusting for sex and location, the proportion of ED bicycle HIs declined by 9% (APR = 0.91; 95% CI: 0.86, 0.95) in children, was unchanged among adolescents and increased in adults (APR = 1.08; 95% CI: 1.01, 1.15). The proportion of bicycle HI related hospitalizations decreased by 30% (APR = 0.70; 95% CI: 0.55, 0.90) in children, 36% (APR = 0.64; 95% CI: 0.49, 0.84) in adolescents and 24% (APR = 0.76; 95% CI: 0.63, 0.91) in adults. There were no observed changes in the proportion of pedestrian HIs resulting in ED visits or hospitalizations.

Interpretation

Our data indicate significant declines in the proportion of child bicyclist ED HIs and child, adolescent and adult bicyclist HI hospitalizations. This is in contrast to no significant trends in the proportion of ED or hospitalized HIs among pedestrians and the unexpected increases in the proportion of ED HIs for adult bicyclists. Comparing bicyclist and pedestrian trends in the proportion of child and adolescent HIs suggests a bicycle helmet legislation effect.     

A review of shape and size considerations in pinch grips

In handgrip-related studies, it has been theorised that modifying the design of object shapes and sizes to accommodate the hand can reduce risks of cumulative trauma disorders (CTDs). However, there appears to be a lack of theoretical groundwork to support this premise in the area of pinch grip research. Therefore, this article aims to provide a review of shape and size considerations in pinch grips. The literature reviews were first conducted individually on shape, size and pinch grip factors, followed by the development of a literature summary based on the theoretical connections among shape, size and pinch grips. Though further studies are still required, this review has provided fundamental knowledge on possible theoretical connections among shape, size and pinch grip factors. These preliminary efforts shed light on potential mechanisms that explain how shape and size can influence pinch grips towards preventing CTDs and maximising the human performance.     

A model of meaning-making coping and growth in combat veterans.

More than 1.6 million military men and women have deployed to fight the global war on terror. Although studies have suggested that approximately one third of these service men and women return with a mental health condition or a brain injury, a gap remains in our understanding about how these individuals cope with and grow from their experiences. In this article, we review the existing body of research related to growth and recovery from trauma and then propose an empirically informed and contextually sensitive model to guide future research with combat veterans. We draw from research focused on resilience, posttraumatic growth, and decline (negative or pathological) change trajectories, and we propose that meaning-making coping is a core mechanism of the posttraumatic growth process for combat veterans. Implications for practitioners and the next steps for future research are presented. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Treating trauma after dialectical behavioral therapy.

Many individuals who meet criteria for borderline personality disorder have histories of childhood trauma that may have contributed to their difficulty regulating affect. Dialectical behavioral therapy focuses on helping these patients to regulate emotional states and achieve behavioral control in Stage 1 so they can tolerate therapy that is focused on trauma and emotional experiencing in a Stage 2 treatment. Although there are effective, empirically validated treatments for posttraumatic stress disorder and its subclinical presentation, there are also a significant number of patients who find these treatments difficult to tolerate. The author discusses coupling dialectical behavioral therapy, an evidence-based therapy, with internal family systems, a therapy that is both clinically promising and compatible with dialectical behavioral therapy, as a Stage 2 therapy for trauma patients who avoid other modes of treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The importance of the peritraumatic experience in defining traumatic stress.

In the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM–IV–TR; American Psychiatric Association, 2000), posttraumatic stress disorder (PTSD) Criterion A2 stipulates that an individual must experience intense fear, helplessness, or horror during an event that threatened the life or physical integrity of oneself or others to be eligible for the PTSD diagnosis. In considering this criterion, we describe its origins, review studies that have examined its predictive validity, and reflect on the intended purpose of the criterion and how it complements the mission of the DSM. We then assert that the predictive validity of Criterion A2 may not be an appropriate metric for evaluating its worth. We also note that the current Criterion A2 may not fully capture all the salient aspects of the traumatic stress response. To support this claim, we review empirical research showing that individuals adapt to extreme environmental events by responding in a complex and coordinated manner. This complex response set involves an individual's appraisal regarding the degree to which the event taxes his or her resources, as well as a range of other cognitions (e.g., dissociation), felt emotions (e.g., fear), physiological reactions (e.g., heart rate increase), and behaviors (e.g., tonic immobility). We provide evidence that these response components may be associated with the subsequent development of PTSD. We then describe the challenges associated with accurately assessing an individual's traumatic stress response. We conclude with a discussion of the need to consider the individual's immediate response when defining a traumatic stressor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)