Staying connected: a feasibility study linking American Indian and Alaska Native trauma survivors to their tribal communities

The objective of this investigation was to assess the feasibility of a culturally tailored care management intervention for physically injured American Indian/Alaska Native (AI/AN) patients. The intervention was initiated at a Level I trauma center and aimed to link AI/AN patients to their distant tribal communities. Thirty AI/AN patients were randomized to the intervention or to usual care. Assessments at baseline, 3 months, and 6 months included self-reported lifetime cumulative trauma burden, Native healing requests, and symptoms of posttraumatic stress, depression, and alcohol use. Generalized estimating equations ascertained differences between groups over time. Ninety-four percent of eligible patients participated; follow-up at 3 and 6 months was 83%. Participants had high numbers of lifetime traumas (mean = 5.1, standard deviation = 2.6). No differences between the intervention and control groups were observed in posttraumatic stress symptoms, depression symptoms, or alcohol use at baseline or follow-up time points. Among intervention patients, 60% either requested or participated in traditional Native healing practices and 75% reported that the intervention was helpful. This effectiveness trial demonstrated the feasibility of recruiting and randomizing injured AI/AN patients. Future efforts could integrate evidence-based interventions and traditional Native healing into stepped collaborative care treatment programs.     

Violence against Native women in substance abuse treatment

Many mental health problems among substance abusing populations are directly linked to high rates of abuse and trauma. There is increasing evidence of associations between childhood physical and sexual abuse to adult substance use and HIV-risk behavior. The relationship of abuse, mental health problems, substance abuse, and high-risk sexual behavior has rarely been studied in the female Native American population. Significant relationships were found among childhood abuse, trauma, substance abuse, and high-risk sexual behavior among urban Native women.     

The Circles of Care evaluation: doing participatory evaluation with American Indian and Alaska Native communities

Little information exists regarding mental health and special needs related to American Indian and Alaska Native (AI-AN) families. In this paper we emphasize the use of oral tradition during the Circles of Care initiative, which was essential in understanding cultural history and historical trauma of AI-ANs while giving a greater understanding of an AI-AN-based definition of severe emotional disturbance (SED). The success of these methods serves as a template for improving systems of care and may be useful in evaluation among a wide range of ethnic communities.     

Young, black, and male in foster care: relationship of negative social contextual experiences to factors relevant to mental health service delivery

Among a small, cross-sectional sample of young Black males transitioning from foster care (n=74), this study explored the relationship of their negative social contextual experiences to two factors relevant to the delivery of mental health services to them: cultural mistrust of mental health professionals and attitudes toward seeking professional help. Three domains of young Black male's negative social contextual experiences were measured: proximal negative experiences, distal negative experiences, and negative imagery experiences. Results of multivariate analysis of covariance (MANCOVA) controlling for custody status, counselling status and history, and psychiatric history showed that young Black males reporting a high frequency of negative social contextual experiences reported significantly greater cultural mistrust of mental health professionals and significantly less positive attitudes toward seeking professional help for mental health problems than young Black males reporting a low frequency of negative social contextual experiences. Implications and future research directions are discussed.     

The association of adverse childhood experiences with mid-life depressive symptoms and quality of life among incarcerated males: exploring multiple mediation

Objectives: To explore the association of experiencing death, trauma, and abuse during childhood with depressive symptoms and quality of life at mid-life among incarcerated men and to understand how current social support and coping strategies mediate the impact of childhood trauma histories on mental health.

Methods: Study participants were 192 male inmates in a maximum security prison. Participants completed measures of adverse childhood experiences related to death, trauma, and abuse, and depressive symptoms and quality of life. Data were analyzed using multiple mediation modeling.

Results: Men who reported having experienced adverse childhood experiences reported more depressive symptoms and lower quality of life than their counterparts. The results showed that in models both unadjusted and adjusted for age, race, education, number of years served, and whether the inmate had a life sentence, the association between adverse childhood experiences and quality of life were partially explained by the total of the indirect effects (point estimate = ?.5052; CI_.95 = ?1.0364, ?.0429 and point estimate = ?.7792; CI_.95 = ?1.6369, ?.0381), primarily via social support. However, the associations between adverse childhood experiences and depressive symptoms were not explained by social support and coping.

Conclusion: Adverse childhood experiences are associated with deleterious mental health effects in later life. Social support and coping partially mediate the association between adverse childhood experiences and quality of life. The high prevalence of childhood trauma among aging prison inmates warrants attention to increasing social support mechanisms to improve mental health.     

Different Traumatic Experiences are Associated with Different Pathologies

We tested the hypothesis that different traumatic experiences will contribute in variable degree to different mental pathologies. A total of 223 young adult non-patients were assessed with the help of self-reports. The role of six different trauma experiences (broken home, dysfunctional family, family violence, child sexual abuse, child severe sexual abuse and adult sexual abuse) in six different conditions/pathologies (alexithymia, depression, somatization, borderline, overall physical health and overall mental health) was tested in a series of multivariate analyses of variance and of Roy-Bargmann stepdown analyses. The hypothesis was confirmed: Individual traumatic experiences were indeed associated with different pathologies. Specifically, sexual abuse predicted borderline pathology, severe child sexual abuse somatization, and dysfunctional or broken family depression. Family violence was associated with worse overall mental health and alexithymia, whereas no trauma variable could be identified to be associated with overall physical health. Most of these individual relationships were reported in the literature, based on results obtained in different clinical samples. Our results were won in a sample of young non-patients controlling for overlap between pathologies.     

Lifetime history of traumatic events in a young adult Mexican American sample: Relation to substance dependence,affective disorder,acculturation stress,and PTSD

Mexican Americans comprise one of the most rapidly growing populations in the United States, and within this population, trauma and post-traumatic stress disorder (PTSD) are associated with physical and mental health problems. Therefore, efforts to delineate factors that may uniquely contribute to increased likelihood of trauma, PTSD, and substance use disorders over the lifetime in Mexican Americans are important to address health disparities and to develop treatment and prevention programs. Six hundred fourteen young adults (age 18–30 yrs) of Mexican American heritage, largely second generation, were recruited from the community and assessed with the Semi-Structured Assessment for the Genetics of Alcoholism and an acculturation stress scale. More males (51.2%) reported experiencing traumas than females (41.1%), however, a larger proportion of females received a PTSD diagnosis (15%) than males (8%). Alcohol dependence and affective disorders, but not anxiety disorders, antisocial disorders, nicotine, marijuana, or stimulant dependence, were significantly comorbid with PTSD. Endorsing higher levels of acculturation stress was also significantly associated with both trauma exposure and a diagnosis of PTSD. Logistic regression revealed that female gender, having an affective disorder, alcohol dependence, higher levels of acculturation stress, and lower levels of education were all predictors of PTSD status. Additionally, alcohol dependence generally occurred after the PTSD diagnosis in early adulthood in this high-risk population. These studies suggest that treatment and prevention efforts should particularly focus on young adult second generation Mexican American women with higher levels of acculturation stress, who may be at higher risk for PTSD, affective disorder, and alcohol dependence following trauma exposure.     

Use of mental health services by men injured through community violence

OBJECTIVE: The aim of this study was to assess the use of mental health services and predictors of use among men injured through community violence. METHODS: This one-year prospective study examined use of mental health services in a sample of 231 men who were injured through community violence and hospitalized at an urban trauma center. Predictors of mental health service use that were examined included age, ethnicity, income, neuroticism, injury severity, previous mental health service use, and need for services. Need for services was defined objectively by self-report of symptoms of posttraumatic stress disorder (PTSD) and subjectively by perception of an injury-related emotional problem. RESULTS: Univariate logistic regression analysis showed that older age, non-Latino ethnicity, previous use of services, and need for services predicted service use in the year after the injury. In a multivariate logistic regression analysis, objective and subjective need for services and older age predicted postinjury service use. In the subset of men who were symptomatic postinjury, only older age and objective need predicted use of mental health services. CONCLUSIONS: Despite high rates of need for services related to PTSD after violent injury in this sample, the rate of mental health service use was low. Psychoeducation about postinjury reactions and attention to structural barriers to services may help increase rates of care in this population.     

Service use patterns and mental health symptoms among adolescents exposed to multiple types of trauma

Few studies have explored how different trauma experiences influence service use. This study explores patterns of service use amongst 6483 adolescents aged between 13 and 18, and examines if such patterns are associated with trauma profiles, demographic variables, and mental health disorders. Data from the National Comorbidity Survey – Adolescent Supplement (NCS-A) were used. A latent class analysis identified four adolescent trauma sub-groups: ‘high risk’, ‘sexual risk’ ‘non-sexual risk’, and ‘low risk’. Regression analysis was used to explore the relationship between service use, trauma classes, and mental health outcomes. Significant relationships were found between service use, trauma sub-groups, demographics and mental health outcomes. Despite the effectiveness of mental health services, only a minority of adolescents exposed to different traumas use such resources. However, this study may go some way towards providing an understanding of the trauma backgrounds, demographic predictors and mental health disorders associated with service use.     

Strategies to address mental health through schools with examples from China

The World Health Organization estimates that approximately one in five young people under the age of 18 experiences some form of developmental, emotional or behavioural problem, and one in eight experiences a mental disorder. Because research shows that half of adult mental disorders begin before the age of 14 and that early intervention can prevent and reduce more serious consequences later in life, it is critical to expand the role of mental health professionals with schools worldwide. Schools have the potential to affect the mental health of millions of young people, as well as those who work in schools. Research indicates that programmes promoting mental health are among the most effective of health promoting school efforts. This paper discusses the health promoting schools framework, reviews effective strategies for promoting mental health in schools, and provides examples from Zhejiang Province, China. This article also discusses the key roles that mental health professionals can play in promoting mental health through schools. As advocates, policy makers, researchers and teachers, mental health professionals can bridge the sectors of education, mental health and public health. Developing common frameworks and interdisciplinary training will create a foundation of shared understanding to achieve this goal.     

Penile malformation and mental health

Aspects of mental health were investigated by means of interviews and register data in 34 men operated on for hypospadias in childhood and in 36 matched control subjects. Most hypospadiacs adjust well both in childhood and adult age. However, they reported more neurotic disturbances in their childhood than the controls. Shyness and enuresis were common troubles among the probands, and they had been more timid, isolated and mobbed. Similar although less striking differences in mental health were reported also in adult age. Depression and anxiety were dominating symptoms. The interviewer assessed the hypospadiacs to show more anxiety and to use more immature defence mechanisms and consequently to have less stress tolerance. The probands were further judged to have less capacity for social relations and their over-all capacity to utilize existent psychological resources was small as compared to the controls. The findings indicate that hypospadiacs are more prone to neurotic (but not psychotic) disturbances than other young men and have more disturbed social relations. The need for psychological guidance for the boys and their parents is stressed.     

Strategies to address mental health through schools with examples from China

The World Health Organization estimates that approximately one in five young people under the age of 18 experiences some form of developmental, emotional or behavioural problem, and one in eight experiences a mental disorder. Because research shows that half of adult mental disorders begin before the age of 14 and that early intervention can prevent and reduce more serious consequences later in life, it is critical to expand the role of mental health professionals with schools worldwide. Schools have the potential to affect the mental health of millions of young people, as well as those who work in schools. Research indicates that programmes promoting mental health are among the most effective of health promoting school efforts. This paper discusses the health promoting schools framework, reviews effective strategies for promoting mental health in schools, and provides examples from Zhejiang Province, China. This article also discusses the key roles that mental health professionals can play in promoting mental health through schools. As advocates, policy makers, researchers and teachers, mental health professionals can bridge the sectors of education, mental health and public health. Developing common frameworks and interdisciplinary training will create a foundation of shared understanding to achieve this goal.     

The Association Between Disaster-Related Experiences and Mental Health Outcomes Among Drug Using African American Hurricane Katrina Evacuees

This article provides a detailed examination of the relationship between disaster-related experiences and mental health outcomes among a sample of drug using African American Hurricane Katrina evacuees. Face-to-face structured interviews were administered to Hurricane Katrina evacuees (n = 350) residing in voucher assisted apartment complexes in Houston, Texas (2006–2007). We use Ordinary Least Squares and logistic regression models to examine both the relevance of disaster-related experiences and the interactive relationships between disaster-related experiences and post-disaster mental health outcomes including psychological distress, severe depression, somatic symptoms, and posttraumatic stress disorder. Results indicate that disaster-related experiences including negative life changes, disaster exposure, post-disaster stressors, and resource loss, have unique, inverse relationships with mental health. While resource loss has the strongest inverse relationship with mental health, disaster exposure has a negative interactive effect on psychological distress and anxiety. Although highly vulnerable populations report low levels of mental health nearly 2 years following a disaster experience, there is a convergence in mental health outcomes with high levels of disaster experiences and disaster exposure that suggests mental resiliency.     

Understanding the experiences and emotional needs of unaccompanied asylum-seeking adolescents in the UK

For adolescents who flee to the UK seeking asylum, the experience of leaving their home country puts them at risk of developing mental health problems. Although there is a research base exploring the mental health of asylum-seeking children and adolescents who arrive with their families, there is in contrast very little focusing on the mental health needs of children and adolescents who arrive in the UK alone. There has been ongoing debate about whether current theoretical models for understanding reactions to trauma and loss are helpful in supporting unaccompanied asylum-seeking children and adolescents with complex psychological and social issues as a result of fleeing their home countries. This article draws on young people's own understanding of their experiences of seeking asylum in the UK using a qualitative semi-structured interview. It attempts to develop a more contextually relevant understanding of their emotional reactions to adversity and to consider the sorts of support required. Interpretative Phenomenological Analysis was used to provide an in-depth understanding of six young asylum seekers' experiences, exploring themes of loss, negotiating a new life, psychological distress and the process of adjustment. Psychological interventions and future service provision for this group are discussed.     

Gender differences in traumatic experiences and mental health in active duty soldiers redeployed from Iraq and Afghanistan

The purpose of this study was to examine gender differences in combat exposure, military sexual trauma (MST), and their associations with mental health screen results among military personnel deployed in support of the wars in Afghanistan and Iraq. Data were collected as part of a pre- and post-deployment screening program at a large Army medical treatment facility. Cases included 7251 active duty soldiers (6697 men and 554 women) who presented for their pre- and post-deployment screening from March 2006 to July 2009. Pre-deployment mental health symptoms were statistically controlled for in our analyses. We found significant gender differences in demographic variables, exposure to combat, and MST. Women reported greater exposure to MST than did men. Although men reported greater exposure to high-intensity combat experiences than women, results indicate that women are experiencing combat at higher rates than observed in prior cohorts. Men were more likely to report problem drinking, and women were more likely to report depression symptoms. There were no gender differences with respect to PTSD symptoms. Although we found few differences between women and men in the impact of combat stressors on mental health, there was a stronger association between injury and PTSD symptoms for women than for men. Our findings indicate that it would be useful for clinicians to be aware of this difference and assess for exposure to a full range of traumatic combat experiences, particularly injury, as not all types of combat experiences may be equally experienced by men and women returning from military deployments.     

Developing a culturally and ecologically sound intervention program for youth exposed to war and terrorism

This article describes the public mental health approach used to develop and implement a school-based postwar trauma/grief intervention program for adolescents in Bosnia-Herzegovina. This approach includes development of multilateral partnerships with local and ministerial stakeholders, systematic assessment that yields a detailed understanding of the specific range and severity of trauma and loss experiences, current adversities and trauma reminders among the affected population, and a training program aimed at developing the capacities of local service providers and an indigenous support infrastructure so that the intervention program may be directed and sustained by people within the communities served. Concluding comments detail an expanded conceptual framework for public mental health interventions that may be appropriate for terrorist and mass-casualty events.     

The Use of Art Therapy in Alleviating Mental Health Symptoms in Refugees: A Literature Review

There are over thirty million refugees globally with severe experiences of trauma. Art therapy intervention allows for nonverbal expression and could alleviate mental health symptomatology among refugees. The present review’s aim was to integrate and summarize the previous research which examined the effects of visual arts on alleviating psychological conditions of refugees. However, due to the paucity of studies which solely used visual arts, we included studies that used visual arts alongside other modalities as part of an expressive arts therapy intervention. The present review synthesizes studies that examined the effect of art therapy on mental health issues of refugees from January 2000 to March 2021. Seven studies (child and adolescent sample, N = 5 and adult sample, N = 2) with a total of 298 refugee participants (n = 298) met our inclusion criteria. The participants were from the Middle East and North Africa (MENA), Southeast Asia, and Europe. We found three commonly reported mental health disorders, namely Post Traumatic Stress Disorder (PTSD), anxiety, and Major Depression Disorder. The research highlights how art therapy interventions could be a great starting point to alleviate symptomatology among refugees. Four additional benefits of art therapy which were commonly reported across the seven studies emerged from this review: working with traumatic experience/loss, rebuilding social connection and trust, nonverbal communication and self-expression of loss and trauma, and retelling stories. Art therapy interventions could be used as a starting point in the healing process of traumatized refugees to encourage verbal articulation of their feelings and reduce mental health symptoms. Despite these promising findings, due to a dearth of robust methodologies, further research is required to assess the long-term effectiveness of art therapy.     

Traumatic events and mental health: The amplifying effects of pre-trauma systemic inflammation

BackgroundTraumatic experiences are strongly predictive of adverse mental health outcomes. Experimental studies have demonstrated that systemic inflammation can increase reactivity to threatening stimuli. It is not known whether naturally occurring inflammation amplifies the impact of traumatic experiences on mental health. Here we test whether incident traumatic events are more predictive of adverse mental health outcomes for individuals with greater pre-trauma systemic inflammation in a racially and ethnically diverse cohort study of youth assigned male at birth who identify as sexual or gender minorities (ages 16–29, n = 518), a group at high risk for trauma exposure.MethodsMeasures of inflammation, depression symptom severity, and perceived stress were measured at baseline. One year later, depression symptom severity and perceived stress were measured again, and participants reported the traumatic events they had experienced in the intervening year.ResultsIn a model adjusted for baseline depression symptom severity and other key covariates, we found that higher baseline levels of interleukin-1β amplified the effect of incident trauma exposure on depression symptom severity at follow-up (β = 0.234, SE = 0.080, P = 0.004). In a model adjusted for baseline perceived stress and other key covariates, we found that higher baseline scores on a multi-marker inflammatory index amplified the effect of incident trauma exposure on perceived stress at follow-up (β = 0.243, SE = 0.083, P = 0.003).ConclusionsThese findings suggest that greater pre-trauma inflammation may predict poorer mental health following trauma exposure. Understanding how inflammation interacts with trauma to shape mental health may generate novel insights for preventing and treating the debilitating psychological consequences of trauma.     

Predictors of mental health service utilisation in a non-treatment seeking epidemiological sample of Australian adults

This study sought to replicate Parslow and Jorm’s (Aust N Z J Psychiatry 34(6): 997–1008, 2000) research on need, enabling and predisposing factors as predictors of mental health service use, with the addition of childhood trauma as a predisposing factor. It utilised a non-treatment seeking epidemiological sample of Australian adults (N = 822) to examine 25 variables covering psychiatric disorder, socio-demographics, physical health problems, and childhood trauma as predictors of mental health visits to general practitioners (GP’s), mental health specialists and non-mental health specialists. A consistent multivariate predictor of mental health visits to all types of professionals was psychological distress. Presence of an affective disorder, age, and number of health problems were additional predictors of visiting a GP. Being female, divorced, and exposure to childhood trauma predicted use of a mental health specialist, while rural living was associated with lower use of these services. Results highlight the importance of general psychological distress and need factors in seeking help for mental health, and reinforce the lifelong disadvantage arising from adverse childhood experiences and the need to address these issues in adult mental health services.