Perceived Acceptability of Child Maltreatment as a Moderator of the Association Between Experiences of Child Maltreatment and Post-Traumatic Symptoms: A Cross-Cultural Study

Despite the well-documented link between child maltreatment (CM) and mental health, evidence suggests substantial variability in the post-traumatic sequelae of CM across cultures. The perceived acceptability of CM in one's community might moderate the association between CM and mental health, but little research has been conducted on it so far. This study examined how the perceived acceptability of CM may influence the relationship between CM experiences and post-traumatic symptoms in individuals from four different continents and if the pattern of associations is the same across countries. We recruited a sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122). We administered online questionnaires and performed multiple group moderation analyses for total CM, neglect, physical abuse, emotional maltreatment, sexual abuse, and exposure to domestic violence (DV). A significant positive main effect of CM on post-traumatic symptoms was found in the overall sample and in Cameroon; in Germany, only neglect and emotional maltreatment were positively associated to post-traumatic symptoms. Moderation effects were identified; the perceived acceptability of neglect in Cameroon and Germany and of exposure to DV in Cameroon had a dampening effect on the relationship between CM experiences and post-traumatic symptoms. Our findings confirm that CM experiences entail long-term post-traumatic sequelae that can vary across cultures and CM subtypes and further our understanding of this issue by showing that the perceived acceptability of CM may be an understudied moderator.

Role of Heart Rate Variability in the Association between Myocardial Infarction Severity and Post-Myocardial Infarction Distress

OBJECTIVE

Myocardial infarction (MI) results in mental health consequences, including depression and post-traumatic stress disorder (PTSD). The risk and protective factors of such mental consequences are not fully understood. This study examined the relation between MI severity and future mental health consequences and the moderating role of vagal nerve activity.

METHODS

In a reanalysis of data from the Myocardial Infarction-Stress Prevention Intervention (MI-SPRINT) study, 154 post-MI patients participated. MI severity was measured by the Killip Scale and by troponin levels. Depression and PTSD symptoms were assessed with valid questionnaires, both at 3 and 12 months. Vagal nerve activity was indexed by the heart rate variability (HRV) parameter of the root-mean square of successive R-R differences (RMSSD). Following multivariate analyses, the association between MI severity and distress was examined in patients with low and high HRV (RMSSD = 30 ms).

RESULTS

In the full sample, the Killip index predicted post-MI distress only at 3 months, while troponin predicted distress at 3- and 12-months post-MI. However, HRV moderated the effects of the Killip classification; Killip significantly predicted symptoms of depression and PTSD at 3- and 12-months post-MI, but only in patients with low HRV. Such moderation was absent for troponin.

CONCLUSION

MI severity (Killip classification) predicted post-MI depression and PTSD symptoms, but only in patients with low HRV, suggesting that the vagal nerve is a partial protective (moderating) factor in the relation between Killip score and post-MI distress.

Functional recovery after reduced pediatric fractures of the forearm with respect to perceived limitations, common post-traumatic symptoms, range of motion, and dexterity: a prospective study

PURPOSE

Studies on functional recovery after pediatric forearm fractures are scarce. Outcome measures are usually (retrospectively) incorporated to compare treatments. How these parameters recover has only rarely fallen within the scope. Aim was to provide insight into "normal recovery" by evaluating how limitations, post-traumatic symptoms, range of motion (ROM) and dexterity recuperate.

MATERIALS AND METHODS

Prospective observational study regarding children 4 and 18 years with a reduced forearm fracture. Limitations, post-traumatic symptoms, ROM, and dexterity were evaluated 6 weeks, 3 and 6 months post-trauma. ROM of the unaffected side was used as a baseline.

RESULTS

Of 54 participants 25.9% and 5.9% perceived limitations after 3 respectively 6 months. Pain, swelling and hypertrichosis were common symptoms. Movements distal from the elbow were restrained 6 weeks post-trauma. Supination and palmar flexion were most affected, followed by dorsal flexion and pronation. Palmar flexion and pronation were still affected after 3 months and associated with treatment invasiveness. Dexterity was diminished at 6 weeks only.

CONCLUSIONS

Mild limitations are common. Further investigation of the association between pain, reduced sensitivity and hypertrichosis with treatment invasiveness is warranted. Regarding ROM supination, pronation, palmar and dorsal flexion should be incorporated in future studies. Dexterity is an unsuitable outcome measure.IMPLICATIONS FOR REHABILITATIONThis study relates to monitoring recovery from pediatric forearm fractures.Physicians ought to realize that one in four children experience limitations preceding 3 months post-trauma, in which case involvement of a hand therapist should be considered.Pain, swelling and especially hypertrichosis are common post-traumatic symptoms in children and should on itself not immediately raise concerns for complex regional pain syndrome (CRPS).To assess recovery of range of motion measuring pronation, supination, dorsal, and palmar flexion is sufficient.

Using Social Media for Social Motives Moderates the Relationship between Post-Traumatic Symptoms during a COVID-19-Related Lockdown and Improvement of Distress after Lockdown

Previous research reported inconsistent results on the relationship between social media (SM) use and psychological well-being, suggesting the importance of assessing possible moderators, e.g., motives for SM use. However, no longitudinal study has yet investigated whether, among people who use SM, specific motives for using SM may represent protective/risk factors for the development of psychological distress, especially after a stressful event. Our longitudinal study aimed at assessing the moderating role of motives for using SM (i.e., coping, conformity, enhancement, social motives) in the relationship between COVID-19 pandemic-related post-traumatic stress symptoms during the lockdown and changes in general distress after lockdown. At Time 1 (during the first lockdown in Italy), 660 participants responded to an online survey, reporting their post-traumatic symptoms, motives for using SM, and general distress (i.e., anxiety, depression, and stress symptoms). At Time 2 (three months later, following lockdown), 117 participants volunteered to continue with the follow-up survey assessing general distress symptoms again. Results showed that among those who had experienced more severe post-traumatic symptoms at Time 1, using SM for social motives was associated with more improvement of general distress symptoms. No evidence was found of moderating effects of other motives for SM use. The findings suggest that social connections may have helped to cope with stress during forced confinement, and that SM use may be beneficial for mental health when motivated by maintaining social interactions.

Media Exposure to Armed Conflict: Dispositional Optimism and Self-Mastery Moderate Distress and Post-Traumatic Symptoms among Adolescents

BACKGROUND

Rapid technological developments enable the immediate transmission of armed conflict events through a variety of media channels, inducing mass anxiety, fear, and helplessness. Youth are particularly vulnerable and face new challenges as a result of this exposure. The effects of media exposure to such events on psychological distress and post-traumatic symptoms were examined.

METHODS

A total of 161 participants aged 13-18 years completed a questionnaire battery that included measures of media exposure to armed conflict events, previous direct exposure to armed conflict events, psychological distress, post-traumatic symptoms, dispositional optimism, and self-mastery. A structural equation model (SEM) approach was employed for data analysis.

RESULTS

The extent of media exposure to armed conflict was directly associated with psychological distress and post-traumatic symptoms. Dispositional optimism moderated the association between media exposure and psychological distress, while self-mastery moderated the association between media exposure and post-traumatic symptoms. The effects of the Internet factor of media exposure, which included social media, were particularly disturbing as neither of the resilience factors moderated negative outcomes.

CONCLUSIONS

The findings suggest that clinical interventions to enhance dispositional optimism and self-mastery as well as other potential resilience factors can protect adolescents from the severe effects of media exposure to violent armed conflict events. Developmental and public health implications related to vulnerabilities and resilience during adolescence are discussed.

The COVID-19 Stress Perceived on Social Distance and Gender-Based Implications

The COVID-19 pandemic is an unprecedented event entailing long-term consequences on population health and welfare. Those who contracted the coronavirus may have suffered from both physical and mental health issues that unfold the need for tailored intervention strategies. Hence, our study aims to investigate the psychological and social consequences of COVID-19 on a sample of 86 participants, encompassing 43 patients (clinical group; 25 women; mean age = 50.4 ± 10.1 years) recruited from Bari University Hospital, 19 of whom were hospitalized due to the disease. The remaining 43 were individuals not fallen ill with COVID-19 to date (control group; 25 women; mean age = 50.4 ± 10.1 years). The investigation yielded significant gender differences in post-traumatic stress symptoms, depression, and representation of interpersonal distance (IPD), evaluated through the IES-R, the BDI-II, and the IVAS task, respectively. This pattern of results was not replicated in the control group. In general, participants who reported having experienced the most intense post-traumatic symptoms also presented a greater mood deflection and, more specifically, within the clinical group women obtained the highest scores on both scales. Women reported higher IES-R and BDI-II scores compared to men, that could indicate that women who have contracted COVID-19 are more exposed to post-traumatic and depressive symptoms. Our results also showed a significant effect of COVID-19 on IPD with a tendency of disease-experienced individuals to increase their preferred IPD from adults, children, and elderly people. Regarding gender differences in mood and proxemic behavior, a correlation between depressive symptoms and probable PTSD and a further correlation between probable PTSD and greater IPD were found in women from both clinical and control group. Overall, these findings might contribute to a better understanding of gender-based implications of the current pandemic on mental health, also leading to the development of integrated yet personalized intervention strategies.

Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study

Symptom endorsement after traumatic brain injury (TBI) is common acutely post-injury and is associated with other adverse outcomes. Prevalence of persistent symptoms has been debated, especially in mild TBI (mTBI). A cohort of participants ≥17 years with TBI (n = 2039), 257 orthopedic trauma controls (OTCs), and 300 friend controls (FCs) were enrolled in the TRACK-TBI study and evaluated at 2 weeks and 3, 6, and 12 months post-injury using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). TBI participants had significantly higher symptom burden than OTCs or FCs at all times, with average scores more than double. TBI cases showed significant decreases in RPQ score between each evaluation (p < 0.001), decreasing ∼1.7 points per month between 2 weeks and 3 months and 0.2 points per month after that. More than 50% of the TBI sample, including >50% of each of the mild and moderate/severe TBI subsamples, continued to endorse three or more symptoms as worse than pre-injury through 12 months post-injury. A majority of TBI participants who endorsed a symptom at 3 months or later did so at the next evaluation as well. Contrary to reviews that report symptom resolution by 3 months post-injury among those with mTBI, this study of participants treated at level 1 trauma centers and having a computed tomography ordered found that persistent symptoms are common to at least a year after TBI. Additionally, although symptom endorsement was not specific to TBI given that they were also reported by OTC and FC participants, TBI participants endorsed over twice the symptom burden compared with the other groups.

A Promotive Process of Resource Gain Against Harsh and Inconsistent Discipline in Mothers Coping With Breast Cancer: A Serial Mediation Model

Breast cancer is a life-threatening disease and a source of enduring stress. The Family Stress Model posits that psychological distress provoked by stressful conditions may spill over and intensify harsh and inconsistent parental discipline. However, the Conservation of Resources theory posits that having more resources may lead to further resource gain, which may promote adaptive coping with adversities. Therefore, this study examined a serial mediation model in which financial resources (income) are predicted to be associated with more interpersonal resources (paternal involvement). The latter is expected to be linked with less maternal post-traumatic stress symptoms, which, in turn, should be associated with less harsh and inconsistent discipline in mothers coping with breast cancer. A sample of 100 Israeli mothers receiving breast cancer treatments was recruited through social media. The participants completed online self-report questionnaires. Structural Equation Modeling indicated significant serial mediation, in which a greater income level was associated with more paternal involvement, which was linked to a lower level of maternal post-traumatic symptoms. The latter, in turn, was associated with less harsh and inconsistent maternal discipline practices. We controlled for illness severity and the time since diagnosis, which did not predict maternal discipline practices. The study suggests that although breast cancer is a stressful condition for any family, having more financial resources can be a significant promotive factor predicting a cascading process by which paternal functioning facilitates better mental health of mothers, and, in turn, better maternal parenting practices.

Activity engagement and psychological distress among Holocaust survivors during the COVID-19 pandemic

OBJECTIVES

The COVID-19 pandemic may pose a specific threat for Holocaust survivors, as such threats may be linked with increased psychological distress. Moreover, research has demonstrated that engaging in planful problem-solving activities is associated with reduced distress. Accordingly, we aimed to examine the link between engaging in activities during COVID-19 and psychological distress among Holocaust survivors with varying levels of post-traumatic symptoms (PTS) and comparisons (not directly exposed to the Holocaust).

DESIGN

A cross-sectional design composed of Holocaust survivors and a comparison group.

SETTING

Participants were interviewed face-to-face, over the telephone, or filled the scales online at their leisure.

PARTICIPANTS

Data were collected from 131 older Jewish Israelis (age range 76-94, M = 82.73, SD = 4.09), who were divided into three groups (comparisons; low-PTS survivors; high-PTS survivors).

MEASUREMENTS

Participants completed scales assessing PTS, activity engagement, and psychological distress and provided additional sociodemographic, medical, and COVID-19-related information.

RESULTS

When activity engagement was low, high-PTS survivors reported extremely high levels of psychological distress relative to low-PTS survivors and comparisons. However, when activity engagement was high, these group differences were considerably reduced, as the psychological distress of high-PTS survivors was significantly lower.

CONCLUSIONS

The study highlights the importance of daily planning and activity engagement for Holocaust survivors with high PTS levels in reducing psychological distress. Clinicians are urged to take this factor into account when dealing with the psychological effects of COVID-19 on survivors and on traumatized older adults in general.

The Relationship Between Depression, Perceived Social Support, and Suicide Risk in Natural Disaster Survivors

Objective

Natural disasters often cause a wide array of post-traumatic psychological difficulties among survivors. Increased suicide risk was recently added to the list of lingering traumatic reactions that interfere with natural disaster survivors' adjustment and recovery. The purpose of this study was to investigate the relationship between psychological symptoms, perceived social support, and the risk of suicide among natural disaster survivors in Korea.

Methods

A total of 451 Korean national disaster survivors participated in this study. Their depressive and post-traumatic stress symptoms, perceived social support, and suicide risk were measured. The participants were classified into three groups (minimal, low, and high suicide risk), and the psychosocial factors of the three groups were compared.

Results

The risk of suicide increased with the severity of depressive symptoms and decreased as social support (particularly family support) increased. Depressive symptoms were identified as the most potent predictor of suicidality.

Conclusion

Several psychosocial factors, particularly depressive symptoms, may have an impact on suicide risk in natural disaster survivors. Therefore, it is essential to focus on their depressive symptoms when assessing and treating natural disaster survivors.

Hopelessness and Post-Traumatic Stress Symptoms among Healthcare Workers during the COVID-19 Pandemic: Any Role for Mediating Variables?

The Coronavirus-19 (COVID-19) pandemic has many psychological consequences for the population, ranging from anxious-depressive symptoms and insomnia to complex post-traumatic syndromes. This study aimed to evaluate the impact of the Covid-19 pandemic on the mental well-being of healthcare workers, focusing on the association between hopelessness, death anxiety, and post-traumatic symptomatology. Eight hundred forty-two healthcare workers were recruited between 21 March 2020 and 15 May 2020. A specific questionnaire was administered to assess socio-demographic and clinical characteristics, together with psychometric scales: Beck Hopelessness Scale, Death Anxiety Scale (DAS), and Davidson Trauma Scale (DTS). Respondents with hopelessness scored higher in the DAS and DTS than respondents without hopelessness. Furthermore, death anxiety was identified as a potential mediator of the significant association between hopelessness and post-traumatic symptomatology. The impact of death anxiety should be recognized in vulnerable populations, such as frontline healthcare workers. Therefore, pharmacological and non-pharmacological strategies could be useful to attenuate the negative psychological consequences and reduce the burden worldwide.

The Moderating Role of Caregiving on Fear of COVID-19 and Post-Traumatic Stress Symptoms

Caregiving has been associated with increased levels of fear and post-traumatic stress symptoms (PTSS) during COVID-19 pandemic. However, there is a lack of studies that analyze when the relationship between fear and PTSS occur, using informal caregiving as a moderator variable. To explore this moderating role, we conducted a cross-sectional online study between November 2020 and January 2021. A total of 503 men and women from the Spanish general population completed the survey. Sociodemographic and Covid-19-related data, fear of COVID-19, PTSS symptoms, and current psychological history were assessed. Prevalence of informal caregiving in the sample was 16.5%. Increased levels of fear and PTSS were found in caregivers compared to non-caregivers. Female gender and high number of COVID-19 related risk factors was also associated with fear and PTSS severity. The moderation analyses showed an interaction effect between caregiving and fear of COVID-19 when predicting PTSS symptoms. Particularly, results showed that informal caregivers reported greater PTSS symptoms, when compared to non-caregivers with same levels of fear of COVID-19. This evidence suggests that being a caregiver could increase the fear's impact on PTSS severity in the context of pandemics. Further studies with larger samples are needed to confirm these findings.

Across the COVID-19 Waves; Assessing Temporal Fluctuations in Perceived Stress, Post-Traumatic Symptoms, Worry, Anxiety and Civic Moral Disengagement over One Year of Pandemic

This study aimed at investigating the psychological effect of the COVID-19 pandemic in Italy by analysing the trends of perceived stress, post-traumatic symptoms, state anxiety, worry, and civic moral disengagement in four different moments from March 2020 to March 2021. The study involved a total of 1827 Italian participants (30% men and 70% women; M_age = 34.72; SD = 12.40) divided into four groups to which an online survey was administered. The first group completed the survey in March 2020, the second one in August 2020, the third one in November 2020, and the fourth one in March 2021. Results highlighted significant decreases in post-traumatic symptoms and a significant increase in civic moral disengagement over the first year of the COVID-19 pandemic. The levels of perceived stress, worry, and state anxiety remained constant. The correlations between the variables at different times were also explored, as well as gender differences over the year. The COVID-19 emergency has had significant effects on the mental state of the population, with important repercussions for individual and collective well-being during but probably also after the pandemic. This study offers a clear snapshot of the psychological outcomes over one COVID-19 pandemic year, providing important information that may contribute to tailor more effective interventions for mental health.

Social capital and mental health problems among Syrian refugee adolescents: The mediating roles of perceived social support and post-traumatic symptoms

BACKGROUND

Social capital is one of the prominent components of refugee mental health. However, its role on mental health is poorly understood.

AIMS

The aim of the present study was to investigate the nature of the association between social capital and mental health problems in refugee adolescents.

METHOD

A cross-sectional study with three hundred twenty-one 12- to 18-year-old Syrian refugee adolescents was conducted in Turkey. We administered the Arabic versions of the following instruments in school settings: The Social Trust, Multidimensional Scale of Perceived Social Support (MSPSS), The Children's Impact of Event Scale (CRIES-8) and The Strengths and Difficulties Questionnaire (SDQ).

RESULTS

The mediation analyses with Hayes' PROCESS Macro revealed that perceived social support and the intensity of post-traumatic stress disorder (PTSD) symptoms fully mediated the relationship between social capital and mental health problems.

CONCLUSION

The results suggested social trust's two distinct functions which impair the likelihood of mental health problems: (a) social trust might help to facilitate perceived social support from family and friends and (b) social trust might impair the intensity of traumatic experiences.

Burnout Status of Italian Healthcare Workers during the First COVID-19 Pandemic Peak Period

The pandemic of 2019 coronavirus disease (COVID-19) has burdened extraordinary psychological stress on the healthcare workforce. The present survey aimed to examine the personal resources and psychological symptoms associated with burnout in 933 healthcare workers in Italy during the COVID-19 outbreak period. Sociodemographic and occupational data, depression, anxiety, burnout, and post-traumatic symptoms, as well as psychological well-being, were cross-sectional assessed through an online questionnaire. A considerable part of the sample scored over the clinical levels of depression (57.9%), anxiety (65.2%), post-traumatic symptoms (55%), and burnout (25.61%). Working in the front-line (p < 0.05), being part of the medical staff (p < 0.05), experiencing lower levels of psychological well-being (p < 0.001), and higher levels of post-traumatic symptoms (p < 0.001) independently explained 38% of burnout variance. The healthcare industry, services, and professionals should be aware of the harmful effects of COVID-19 on healthcare workers and take adequate preventive measures.

Pathways to post-traumatic growth in cancer patients: moderated mediation and single mediation analyses with resilience, personality, and coping strategies

BACKGROUND

Cancer diagnosis is a potentially traumatic experience, which could generate significant long-lasting emotional distress, but also positive changes linked to post-traumatic growth (PTG). This study aimed to analyze the role of resilience, coping, and personality in determining PTG or post-traumatic symptoms, and to test a moderated mediation model and a single mediation model in a sample of individuals diagnosed with cancer.

METHODS

A sample of 154 individuals diagnosed with cancer (M_age = 51.4, SD = 11.25) completed the Post-Traumatic Growth Inventory, Impact of Event Scale, Connor-Davidson Resilience Scale, Ten Item Personality Inventory, and Coping Orientation to Problems Experienced after providing written informed consent.

RESULTS

Results showed that the impact of resilience in PTG is partially mediated by positive attitude, with a significant and negative moderating effect of openness on the relationship between resilience and positive attitude. Furthermore, resilience negatively predicted the impact of trauma, with a partial mediation of avoidance strategies.

LIMITATIONS

The cross-sectional nature of the study, the use of only self-report measures, heterogeneity of the sample, and the risk of influence of unobserved prognostic variables should be kept in mind while interpreting the results.

CONCLUSIONS

The findings showed that the level of resilience predicted PTG or post-traumatic symptoms, both directly and indirectly, with different coping strategies as mediators. Furthermore, the lower the level of openness reported by participants, the higher the resilience induced by positive attitude. These findings may significantly contribute toward tailoring interventions for improving the mental health of cancer patients.

A Web-based Psychoeducation Program for People with Pathological Dissociation: Development and Pilot Testing

PURPOSE

Although people with pathological dissociation (PD) can benefit from specific interventions, there are challenges in providing suitable interventions for them in the field (e.g., high cost, lack of specialized services, stigma). Many people with PD cannot receive dissociation-focused services in their current service locations. It is important to develop easily-accessible interventions that can support people with PD, especially for those who cannot access dissociation-specific treatment. The authors developed a web-based psychoeducation program to support people with PD, and examined its feasibility and acceptability.

METHOD

A single-group pretest-posttest pilot study was conducted.

RESULTS

Findings showed that most of the intended psychosocial outcomes were achieved as planned, which initially proved the feasibility and acceptability of the program.

DISCUSSION

This is one of the first studies that report the use of web-based interventions to support people with PD, especially those who are in the early stages of recovery. The findings suggest that information and communication technology can contribute to different aspects of clinical practice, including recruitment, engagement, assessment and interventions. Further discussion and research are required.

'Caring for children who have experienced trauma' - an evaluation of a training for foster parents

BACKGROUND

Foster children, mostly maltreated in their birth families, may be fostered by parents who know little about the impact of traumatic experiences.

OBJECTIVE

The present study investigated whether the training Caring for Children who Have Experienced Trauma for foster parents can break the negative circle of traumatic stress. The hypothesis was that improvement in parents' knowledge on trauma and mind-mindedness would be associated with a reduction of their parenting stress, children's post-traumatic stress symptoms, and behaviour problems.

METHOD

Forty-eight foster parents (n female = 35) participated in a pre-test (T1), post-test (T2), and follow-up (T3) assessment. Questionnaires on knowledge on trauma, parenting stress, child post-traumatic stress symptoms, the child's behaviour, and the evaluation of the training were administered. Parents' mind-mindedness was assessed using the describe-your-child interview.

RESULTS

Foster parents highly appreciated the training, their knowledge on child trauma increased at T2 and this growth persisted at T3. The parents who gained most knowledge experienced a small decrease in parenting stress at T2. Although the general mind-mindedness did not significantly change, foster parents' mind-mindedness with positive valence substantially increased at T2 and T3, while their mind-mindedness with neutral valence decreased. Foster parents' report on child PTSS declined at T3 compared to T2, but not compared to T1. No changes were found in children's behaviour as reported by the foster parents. The proportion of foster children receiving trauma-focused treatment increased at T2 and T3.

CONCLUSION

This study provides evidence that training in trauma-informed parenting can be effective in improving foster parents' knowledge on the impact of traumatic experiences and in increasing a positive mental representation of their foster child as well as in reducing children's post-traumatic symptoms.

The long-term effects of early-life trauma on psychological, physical and physiological health among the elderly: the study of Holocaust survivors

Objectives: To study post-traumatic stress symptoms and post-traumatic growth and heart rate variability among elderly Holocaust survivors and a matched comparison group and the mediational effect of post-traumatic stress symptoms and post-traumatic growth on the association between Holocaust experience and heart rate variability. Method: 159 Holocaust survivors and 87 matched participants without Holocaust experience answered post-traumatic stress symptoms and post-traumatic growth questionnaires. Heart rate variability time and frequency parameters were measured for a subsample of N = 133. Results: Holocaust survivors reported higher levels of post-traumatic stress symptoms and post-traumatic growth. Most heart rate variability measures were similar in the two groups, except for better heart rate variability measured by the ratio of low frequency/high frequency among Holocaust survivors. Structural equation modeling showed that belonging to the Holocaust survivor group was associated with higher post-traumatic stress symptoms and higher post-traumatic growth, as well as better heart rate variability scores (standard deviation of normal to normal R-R intervals, high frequency and the ratio of low frequency/high frequency) through the mediation of post-traumatic stress symptoms and post-traumatic growth. Conclusions: The study emphasized the duality of the association between post-traumatic stress symptoms and post-traumatic growth and their integrated effect on heart rate variability.

Impact of Stressful Events on Motivations, Self-Efficacy, and Development of Post-Traumatic Symptoms among Youth Volunteers in Emergency Medical Services

During the last decades, Israeli emergency medical services (EMS) personnel has been exposed to different potentially traumatic events, including mass terror attacks. The aims of the present study were to identify how potentially traumatic events affect young volunteers in their motivation to volunteer and their perceived self-efficacy while being at risk of developing post-traumatic symptoms. The final sample included 236 Magen David Adom (MDA, the "Israeli Red Cross") youth volunteers. The study evaluated their motivational factors for volunteering, perceived self-efficacy, participation in potentially traumatic events, and post-traumatic symptoms. Over two-thirds of the volunteers participated in a traumatic event on duty. Volunteers who were involved in potentially stressful events scored higher levels of post-traumatic symptoms, though still very low and subclinical. Nonetheless, participating in stressful events contributed to an increased sense of self-efficacy. No difference in post-traumatic symptom levels was observed between volunteers who partook in mass casualty incidents and those who did not. The results demonstrate that MDA youth volunteers may mostly benefit from participating in situations requiring the administration of emergency medicine, even stressful ones. They may help to find ways to empower the volunteers and increase their resilience.

Emotion Regulation in Rescue Workers: Differential Relationship With Perceived Work-Related Stress and Stress-Related Symptoms

Rescue workers are exposed to enduring emotional distress, as they are confronted with (potentially) traumatic mission events and chronic work-related stress. Thus, regulating negative emotions seems to be crucial to withstand the work-related strain. This cross-sectional study investigated the influence of six emotion regulation strategies (i.e., rumination, suppression, avoidance, reappraisal, acceptance, and problem solving) on perceived work-related stress and stress-related depressive, post-traumatic, and somatic symptoms in a representative sample of 102 German rescue workers. Multiple regression analyses identified rumination and suppression to be associated with more work-related stress and stress-related symptoms. Acceptance was linked to fewer symptoms and, rather unexpectedly, avoidance was linked to less work-related stress. No effects were observed for reappraisal and problem solving. Our findings confirm the dysfunctional role of rumination and suppression for the mental and physical health of high-risk populations and advance the debate on the context-specific efficacy of emotion regulation strategies.

Mild Traumatic Brain Injury: Longitudinal Study of Cognition, Functional Status, and Post-Traumatic Symptoms

More than 75% of traumatic brain injuries (TBIs) seeking medical attention are mild, and outcome in that group is heterogeneous. Until sensitive and valid biomarkers are identified, methods are needed to classify mild TBI into more homogeneous subgroups. Four hundred twenty-one adults with mild TBI were divided into groups based on Glasgow Coma Scale (GCS) 13-15 without computed tomography (CT) abnormalities, GCS 15 with CT abnormalities, and GCS 13-14 with CT abnormalities, and were compared with 120 trauma controls on 1-month and 1-year outcomes. At 1 month post-injury, almost all neuropsychological variables differed significantly among the groups. Compared with trauma controls, the GCS 13-15 CT normal group showed no significant differences on any neuropsychological measure or Glasgow Outcome Scale (GOS). The GCS 15 CT abnormal group performed significantly worse on only a measure of episodic memory and learning (Selective Reminding Recall [SRCL]) and GOS, and the GCS 13-14 CT abnormal group performed significantly worse on most neuropsychological measures and GOS. At 1 year post-injury, except for an isolated difficulty on SRCL in the GCS 13-14 CT abnormal group, no differences were observed on any neuropsychological measures nor on GOS. Mean percent of total post-traumatic symptoms endorsed as new or worse and percent endorsing three or more symptoms differed significantly (p < 0.001), with each TBI subgroup reporting significantly more symptoms than the trauma controls at both 1 month and 1 year. In conclusion, this subgrouping improves granularity within mild TBI. While most neuropsychological and functional differences abate by 1 year, reporting three or more post-traumatic symptoms remain for about half of individuals.