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1.
Post-traumatic stress disorder (PTSD) is diagnosed commonly in Israeli children following violent episodes of the ongoing Arab–Israeli conflict. Research has suggested that as many as 70% of war-affected children present symptoms of PTSD. This study examined two factors that may contribute to resiliency: perceived social support and sense of hope. The research participants (n?=?311) were children who experienced the rocket attacks during Israel's Second Lebanon War and a control group of Israeli children from a town that was not affected directly by the 2006 war. It was hypothesized that a complex relationship would be demonstrated between presentation of symptoms of PTSD and perceived social support. It was hypothesized further that an inverse relationship would be measured between sense of hope and presentation of symptoms of PTSD in the children who experienced the rocket attacks and that those in the control group would show less symptoms of PTSD than those in the experimental group. Finally, females were expected to show more symptoms of PTSD than males. The results showed a negative correlation between sense of hope and PTSD, while family support was correlated positively with PTSD.  相似文献   

2.
Researchers have tried to determine and verify the effects of violent conflicts on the mental health of those affected by focusing on war trauma, posttraumatic stress disorder (PTSD), and other trauma-related disorders. This, in turn, led to the development of different kinds of theories and aid programs that aim at preventing and treating the consequences of violence and mental health. Until now, there is no agreement on the public health value of the concept of PTSD and no agreement on the appropriate type of mental-health care. Instead, psychiatrists have engaged in sometimes fierce discussions over the universality of war trauma, PTSD, and other trauma-related disorders. The two most polar positions are those who try to validate PTSD as a universal and cross-culturally valid psychopathological response to traumatic distress which may be cured or ameliorated with (Western) clinical and psychosocial therapeutic measures, and those who argue that the Western discourse on trauma only makes sense in the context of a particular cultural and moral framework and, therefore, becomes problematic in the context of other cultural and social settings. Although these positions seem mutually exclusive, their debates have led to the development of less radical approaches toward war-trauma and PTSD. The purpose of this literature review is to analyse the discourses on and debates over war-trauma and PTSD in the psychiatric literature in order to establish a better understanding for the diverse conceptualizations, interpretations and proposed healing strategies. Moreover, I discuss the cultural construction and conceptualization of war-trauma and PTSD from an anthropological perspective and show how anthropologists contribute to psychiatric debates so as to ensure more sophisticated diagnoses and healing strategies in culturally diverse contexts.  相似文献   

3.
PURPOSE We undertook a study to describe factors related to depression and posttraumatic stress disorder (PTSD) among pregnant Latinas who were or were not exposed to intimate partner violence.METHODS We interviewed 210 pregnant Latinas attending prenatal clinics located in Los Angeles, California. Latinas who did and did not have histories of intimate partner violence were recruited. We then assessed the women for strengths, adverse social behavioral circumstances, posttraumatic stress disorder (PTSD), and depression.RESULTS Significantly more women exposed to intimate partner violence scored at or above the cutoff point for depression than women who were not (41% vs 18.6%; P<.001). Significantly more women exposed to intimate partner violence scored at or above the cutoff point for PTSD than women who were not (16% vs 7.6%; P <.001). Lack of mastery, which measures feelings of being in control of forces that affect life (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.62–0.84), a history of trauma not associated with intimate partner violence (OR, 1.33; 95% CI, 1.08–1.63), and exposure to intimate partner violence (OR, 2.43; 95% CI, 1.16–5.11) were associated with depression after adjusting for age, language of interview, and site effects. Stress (OR, 1.72; 95% CI, 1.34–2.2) and a history of trauma (OR, 1.45; 95% CI, 1.03–2.04) were independently associated with PTSD, whereas higher income was associated with decreased risk of PTSD (OR, 0.10; 95% CI, 0.02–0.63), after adjusting for age, language of interview, and site effects.CONCLUSIONS Intimate partner violence was significantly associated with depression and PTSD but was associated with depression only after controlling for other factors in the multivariate model. The risk for depression declined with greater mastery but increased with a history of trauma or exposure to intimate partner violence. Stress, a history of trauma not associated with intimate partner violence, and lower income were all independently associated with increased risk for PTSD.  相似文献   

4.
PurposeCommunity violence disproportionally impacts Black youth. Experiences of racism and discrimination may create additional challenges for youth recovering from violence exposure. This study used ecological momentary assessment to elucidate how perceptions of racism and social support influence health and safety outcomes among Black youth following violence exposure.MethodsTwenty-five Black youth (14–19 years old, 60% female) who had witnessed violence within the past three months completed a baseline survey that assessed discrimination experiences, social support, post-traumatic stress symptoms (PTS), and perceived safety. Youth completed ecological momentary assessments three times daily for two weeks about the place they were in, people they were with, their current emotional state, and in-the-moment racism perceptions. Multilevel models estimated the relationship between overall and time-varying perceptions of racism and social support, PTS symptoms, and perceived safety.ResultsOverall, 76% of youth reported at least one discrimination experience at baseline. Prior discrimination was associated with higher PTS (B = 1.86, p = .001) and depressive symptoms (B = 0.13, p = .013) at baseline. Youth who reported higher overall perceptions of racism in-the-moment reported higher PTS (B = 0.50, p = .002) and lower perceived safety (B = ?0.53, p = .001). In-the-moment perceptions of racism were associated with lower perceived safety in that place (B = ?0.09, p < .01). Emotional and instrumental support were associated with lower PTS and higher perceived safety (p < .05).DiscussionExperiences of racism and being in discriminatory places impacted youth’s depressive symptoms, PTS symptoms, and perceived safety. Interventions attuned to in-the-moment experiences of racism, and that leverage social support, are needed to support Black youth exposed to violence and discrimination.  相似文献   

5.
USA is experiencing a paradigm shift in public housing policy: while policies used to place people who qualified for housing assistance into spatially concentrated housing complexes, they now seek to geographically disperse them, often to voucher-subsidized rental units in the private market. Programs that relocate residents from public housing complexes tend to move them to neighborhoods that are less impoverished and less violent. To date, studies have reached conflicting findings about the relationship between public housing relocations and depression among adult relocaters. The present longitudinal multilevel analysis tests the hypothesis that pre-/postrelocation improvements in local economic conditions, social disorder, and perceived community violence are associated with declines in depressive symptoms in a cohort of African-American adults; active substance misusers were oversampled. We tested this hypothesis in a cohort of 172 adults who were living in one of seven public housing complexes scheduled for relocation and demolition in Atlanta, GA; by design, 20 % were dependent on substances and 50 % misused substances but were not dependent. Baseline data captured prerelocation characteristics of participants; of the seven census tracts where they lived, three waves of postrelocation data were gathered approximately every 9 months thereafter. Surveys were administered at each wave to assess depressive symptoms measured using the Center for Epidemiologic Studies Depression Scale (CES-D), perceived community violence, and other individual-level covariates. Participants' home addresses were geocoded to census tracts at each wave, and administrative data sources were used to characterize tract-level economic disadvantage and social disorder. Hypotheses were tested using multilevel models. Between waves 1 and 2, participants experienced significant improvements in reported depressive symptoms and perceived community violence and in tract-level economic disadvantage and social disorder; these reductions were sustained across waves 2–4. A 1 standard deviation improvement in economic conditions was associated with a 1-unit reduction in CES-D scores; the magnitude of this relationship did not vary by baseline substance misuse or gender. Reduced perceived community violence also predicted lower CES-D scores. Our objective measure of social disorder was unrelated to depressive symptoms. We found that relocaters who experienced greater pre-/postrelocation improvements in economic conditions or in perceived community violence experienced fewer depressive symptoms. Combined with past research, these findings suggest that relocation initiatives should focus on the quality of the places to which relocaters move; future research should also identify pathways linking pre-/postrelocation changes in place characteristics to changes in mental health.  相似文献   

6.
We estimate the cumulative occurrence of traumatic events and posttraumatic stress disorder (PTSD), using Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria, in a high-risk sample of young people in urban United States. The epidemiological sample (n=2,311) was recruited in 1985–1986 at entry into first grade of a public school system of a large mid-Atlantic city. Participants were interviewed about history of trauma and PTSD in 2000–2002 when their mean age was 21 years (n=1,698). We found that the lifetime occurrence of assaultive violence was 62.6% in males and 33.7% in females. The risk of assaultive violence in males (but not females) varied by childhood area of residence within the city; the occurrence of other traumas did not vary by area of childhood residence. Females had a higher risk of PTSD than males following assaultive violence (odds ratio=4.0, 95% confidence interval 2.0–8.3), but not following other traumas. A comparison of the results from this largely inner-city sample with the results from a recent study of a largely suburban sample in another region of the United States in which the same criteria and measures of trauma and PTSD were used suggested the possibility that males’ risk for assaultive violence and females’ risk for PTSD following exposure to assaultive violence might vary by characteristics of the social environment.  相似文献   

7.

Background  

The Niger Delta region of Nigeria has been undergoing collective violence for over 25 years, which has constituted a major public health problem. The objectives of this study were to investigate the predictors of women's attitudes toward intimate partner violence in the Niger Delta in comparison to that of women in other parts of Nigeria.  相似文献   

8.
《Global public health》2013,8(1):90-105
Abstract

Urgent need exists for improved psychological services among HIV-infected women in post-genocide Rwanda. Psychological problems associated with trauma and sexual violence (i.e., depression, posttraumatic stress disorder [PTSD]) place women at increased risk for sexual risk behaviour, low health-seeking behaviour, delay of antiretroviral therapy (ART) and reduced ART adherence. We explored experiences of HIV-infected Rwandan women attending psychosocial support groups and their narratives about how participation affected their mental health and HIV treatment. Focus group discussions examined participants' reasons for support group attendance, perceived psychological benefit of support groups, influence on ART adherence, and other influences on health behaviors and attitudes. Rwandan women (aged 18–65) were randomly selected from 10 health clinic-facilitated support groups for HIV-infected trauma survivors in Kigali. Results identified positive psychological and physical changes as well as behaviour changes in relationships with men, which participants attributed to support group attendance. Data showed significant improvement in mental health, ART adherence and HIV serostatus disclosure resulting from group attendance. Participants acknowledged limitations of support groups with respect to addressing poverty and hunger. Implementing psychosocial support groups may leverage clinical outcomes and rejuvenate the well-being of HIV-infected women with interpersonal trauma and/or PTSD and depressive symptoms, particularly those from post-conflict countries.  相似文献   

9.
Abstract Purpose: It is unclear why rates of depression differ by race/ethnicity among young women. This study examines whether racial/ethnic differences in depressive symptoms are reduced by intimate partner violence (IPV), traumatic events, and posttraumatic stress disorder (PTSD) symptoms among a clinical sample of low-income women. Methods: A cross-sectional sample of 2414 young African American, Hispanic, and white women completed a survey that included questions about depression, PTSD symptoms, IPV, and trauma. Binary logistic regression and Poisson regression determined whether reports of PTSD symptoms, IPV, and trauma among white, African American, and Hispanic women affected the differences in depression found in these groups. Results: Twenty-four percent reported a level of depressive symptoms that warranted further evaluation for major depressive disorders. White women had elevated levels of depressive symptoms and were more likely to report ≥4 symptoms. White women also reported higher rates of PTSD symptoms, IPV, and traumatic events than African American or Hispanic women. Differences in the likelihood of reporting ≥4 depressive symptoms by race/ethnicity were reduced after controlling for PTSD symptoms and trauma. PTSD symptoms attenuated the differences in the count of depressive symptoms between white and African American women. After controlling for PTSD symptoms, trauma attenuated the difference in the count of depressive symptoms between Hispanic and white women. Conclusions: Elevated levels of trauma and PTSD symptoms among white women compared to African American or Hispanic women may play a role in observed racial/ethnic differences in depressive symptoms.  相似文献   

10.
We examined posttraumatic stress disorder (PTSD) and depression symptom trajectories during ongoing exposure to political violence, seeking to identify psychologically resilient individuals and the factors that predict resilience. Face-to-face interviews were conducted with a random sample of 1196 Palestinian adult residents of the West Bank, Gaza, and East Jerusalem across three occasions, six months apart (September 2007-November 2008). Latent growth mixture modeling identified PTSD, and depression symptom trajectories. Results identified three PTSD trajectories: moderate-improving (73% moderate symptoms at baseline, improving over time), severe-chronic (23.2% severe and elevated symptoms over the entire year); and severe-improving (3.5% severe symptoms at baseline and marked improvement over time). Depression trajectories were moderate-improving (61.5%); severe-chronic (24.4%); severe-improving (14.4%). Predictors of relatively less severe initial symptom severity, and improvement over time for PTSD were less political violence exposure and less resource loss; and for depression were younger age, less political violence exposure, lower resource loss, and greater social support. Loss of psychosocial and material resources was associated with the level of distress experienced by participants at each time period, suggesting that resource-based interventions that target personal, social, and financial resources could benefit people exposed to chronic trauma.  相似文献   

11.
A critical health-related issue in war-affected areas is how people make sense of adversity and why they show resilience in a high-risk environment. In Afghanistan, the burden of poor mental health arises in contexts of pervasive poverty, social inequality, and persistent violence. In 2006, we conducted face-to-face interviews with 1011 children (age 11–16) and 1011 adult caregivers, randomly selected in a school-based survey in three northern and central areas. Participants narrated their experiences as part of a systematic health survey, including an open-ended questionnaire on major life stressors and solutions to mitigate them. Responses were analysed using an inductive thematic approach and categorised for quantitative presentation, producing a conceptual model. For adults, the primary concern is repairing their “broken economy,” the root of all miseries in social, educational, governance, and health domains. For students, frustrations focus on learning environments as well as poverty, as education is perceived as the gateway to upward social and economic mobility. Hope arises from a sense of moral and social order embodied in the expression of key cultural values: faith, family unity, service, effort, morals, and honour. These values form the bedrock of resilience, drive social aspirations, and underpin self-respect and dignity. However, economic impediments, social expectations, and cultural dictates also combine to create entrapment, as the ability to realise personal and social aspirations is frustrated by structural inequalities injurious to health and wellbeing. This study contributes to a small but growing body of work on resilience in public health and conflict settings. It demonstrates that culture functions both as an anchor for resilience and an anvil of pain, and highlights the relevance of ethnographic work in identifying what matters most in formulating social and public health policies to promote a hopeful future.  相似文献   

12.
汶川大地震重灾区中学生震后心理状况   总被引:1,自引:0,他引:1  
目的 了解汶川大地震后3个月重灾区中学生的心理状况.方法 选取汶川大地震重灾区3所中学共38个班级的1966名学生,采用创伤后应激障碍(post-traumatic stress disorder, PTSD)症状清单平民版筛查PTSD阳性,同时采用领悟社会支持量表(perceived social support scale, PSSS)判断领悟社会支持程度.结果 共收回有效问卷1958份.PTSD筛查总阳性率为78.29%(1533/1958).女生PTSD阳性率为82.30%(851/1034),高于男生[73.92%(683/924),χ~2=20.22,P<0.01];少数民族学生PTSD阳性率为80.27%(1375/1713),高于汉族学生[64.98%(154/237),χ~2=28.75,P<0.01];农村学生FISD阳性率为83.52%(872/1044),高于城镇学生[72.43%(662/914),χ~2=35.37,P<0.01];地震中受伤者PTSD阳性率为90.38%(94/104),高于未受伤者[77.66%(1439/1853),χ~2=9.40,P<0.01].研究对象领悟家庭内支持和领悟社会支持总体程度较高,得分中位数分别为21分和60分,领悟家庭外支持处于中等水平,得分中位数为39分.研究对象PTSD严重程度与总体领悟社会支持、领悟家庭内支持、领悟家庭外支持的得分之间存在线性负相关(r值分别为-0.191、-0.130、-0.190,P值均<0.01).结论 重灾区中学生灾后PTSD阳性率高,且不同特征学生症状与严重程度不同,良好的社会支持能减少PTSD的发生.  相似文献   

13.
Posttraumatic stress disorder (PTSD) is one of the emblematic psychiatric conditions in contemporary public consciousness, indexing not only disordered minds, but also disordered human relations. With efforts currently mounting to refine criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), an important task is to re-examine the emotional foundations of trauma and their elaboration in social context. A body of clinical research on psychological trauma indicates that the emotion shame is central to the development and course of PTSD. However, current diagnostic criteria and bio-behavioral research do not account for these findings. In light of an emerging understanding of PTSD as a disturbance of affect systems ( Stone, 1992), this paper proposes a novel theoretical model that describes how shame underlies peri-traumatic and posttraumatic experiences of threats to the social self. It first presents a rationale for investigating traumatic shame that draws on affect theory and current findings in PTSD research. Next, it discusses the foundations of shame in perceptions of status inferiority and failure to conform to normative expectations and their elaboration in PTSD. Then it describes psychological, social, and cultural domains that are critical for contextualizing shame meanings and expressions. Finally, it recommends revisions to the diagnostic criteria for PTSD in DSM-V.  相似文献   

14.
There has been increasing global concern about the level of violence against pregnant women. Anecdotal evidence from general observations shows that there may be higher prevalence in the Niger Delta region of Nigeria. Unfortunately, in spite of the emerging and alarming social indicators for violence against women in the area, little effort has been made to address this dangerous trend. One major concern has been the effects of violence on pregnancy and the difficulty in protecting the pregnant women, since managing violence is often unsuccessful. There is therefore the need to evaluate the magnitude, as well as the risk factors for violence and the sociodemographic characteristics of the women, for purposes of prevention.  相似文献   

15.
PurposeAdolescents exposed to multiple forms of psychological trauma (“poly-victimization,” Finkelhor et al. Child Abuse Negl 2007;31:7–26) may be at high risk for psychiatric and behavioral problems. This study empirically identifies trauma profiles in a national sample of adolescents to ascertain correlates of poly-victimization.MethodsLatent Class analyses and logistic regression analyses were used with data from the National Survey of Adolescents to identify trauma profiles and each profile's risk of posttraumatic stress disorder, major depressive disorder, substance use disorders, and delinquency involvement and deviant peer group relationships. Poly-victimization classes were also compared to classes with trauma exposure of lesser complexity.ResultsSix mutually exclusive trauma profiles (latent classes) were identified. Four classes were characterized by high likelihood of poly-victimization, including abuse victims (8%), physical assault victims (9%), and community violence victims (15.5%). Poly-victimization class members, especially abuse and assault victims, were more likely than do youth traumatized by witnessing violence or exposure to disaster/accident trauma to have psychiatric diagnosis and (independent of psychiatric diagnoses or demographics) to be involved in delinquency with delinquent peers.ConclusionsPoly-victimization is prevalent among adolescents and places youth at high risk for psychiatric impairment and for delinquency. Moreover, poly-victimized youths' risk of delinquency cannot be fully accounted for by posttraumatic stress disorder, depression, or substance use problems, suggesting that adolescent healthcare providers should consider poly-victimization as a risk for behavioral and legal problems even when PTSD, depression, or addiction symptoms are not clinically significant.  相似文献   

16.
Assessment, diagnosis and treatment of preschoolers with post-traumatic stress disorder (PTSD) is an understudied domain, and translational research assisting practitioners in the real-life identification of PTSD symptoms is critical. The current study examined therapists’ behavioural notes of 56 children participating in a 10-session intervention following exposure to intimate partner violence. The notes were analysed to identify themes in children's expression of re-experiencing symptoms and examine the overlap of these symptoms with emotional and behavioural dysregulation. The majority of re-experiencing in the therapeutic context was verbally expressed (e.g. storytelling), but physical re-enactments had the most overlap with in-session emotional and behavioural dysregulation. Session content that addressed who is to blame for the violence, characteristics about families, and conflict resolution techniques elicited particularly high levels of re-experiencing symptoms. The findings indicate that re-experiencing symptoms are both evident and recognisable in the therapeutic context, and practitioners should be careful not to misdiagnose children with behaviour disorders when dysregulation is explained by the presence of re-experiencing symptoms. Potential safety mechanisms that can be put in place to support young children during “high triggering” sessions are also considered.  相似文献   

17.
Mass violence, armed conflict, genocide, and complex humanitarian emergencies continue to create major social and public health disasters at the dawn of the 21st Century. Transitional justice, a set of policies designed to address the effects of war on traumatized communities and bring justice, lies at the nexus of public health, conflict, and social reconstruction. Despite the paucity of empirical evidence, advocates of transitional justice have claimed that it can alleviate the effects of trauma, deter future violence, and bring about social reconstruction in war-affected communities. Empirical evidence – including new data and analyses presented in this article – suggests a link between trauma, mental health and attitudes towards and responses to transitional justice programs, but there has been little theoretical discussion about the intersection between public health and transitional justice, and even less empirical research to generate discussion between these two fields. Yet, public health professionals have an important role to play in assessing the impact of transitional justice on communities affected by mass violence. In this paper, we offer a conceptual model for future research that seeks to examine the relationship between transitional justice programs and their potential value to the fields of medicine and public health and discuss the methodological issues and challenges to a comprehensive evaluation of this relationship. To illustrate the discussion, we examine new data and analyses from two cases of contemporary conflicts, eastern Democratic Republic of Congo (DRC) and northern Uganda.  相似文献   

18.
Post-traumatic stress disorder (PTSD) is a psychiatric condition that can result from experiencing or living through traumatic events. This can include medical events, such as a heart attack or surgery, or witnessing a life-threatening event, such as combat, a natural disaster, a car accident, terroristic events, domestic violence, early childhood trauma, or sexual assault. The U.S. Department of Veterans Affairs reports about 60% of all men and 50% of all women will experience trauma at some point in their lives. It is estimated 7–8% of the population will additionally experience PTSD. Identifying symptoms and managing treatment is an imperative aspect for recovery. In addition to formal treatment, there are a variety of resources available for survivors of PTSD which extend beyond hospital walls. This article will describe post-traumatic stress disorder and present online resources, mobile applications, and peer support groups for the assistance of survivors’ recovery.  相似文献   

19.
Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and PTSD development. Survival analysis was used to determine if PTSD developed from assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance.  相似文献   

20.
目的 了解武汉市社区妇女家庭暴力的流行特征,分析家庭暴力与创伤后应激障碍(PTSD)的关系,为提高女性心理健康水平提供依据。方法 采用横断面研究方法,以在武汉市某社区卫生服务中心进行妇科检查的女性作为研究对象,调查其一般特征、社会支持、伤害情况、家庭暴力及PTSD流行情况。采用 χ2检验、t检验、Cochran-Armitage趋势检验分析PTSD组与健康组间差异,logistic回归分析PTSD与家庭暴力的关系。结果 家庭暴力终身发生率为29.36%,心理暴力、身体暴力和性暴力的发生率分别为28.28%、6.60%和3.55%;PTSD的总患病率为4.73%。遭受家庭暴力的女性患PTSD的风险是未遭受暴力女性的2.11倍(OR=2.11,95%CI:1.04~4.29);同时遭受身体与心理暴力的女性发生PTSD的风险是未受暴力女性的5.06倍(OR=5.06,95%CI:1.91~13.42)。结论 家庭暴力与PTSD存在较强的相关性,对遭受家庭暴力的妇女应进行心理疏导,降低PTSD的发生风险。  相似文献   

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