Search Results (246)

Background: The risk of violence is elevated in patients with Schizophrenia Spectrum Disorders (SSD). However, current violence risk assessment approaches rely predominantly on clinical and historical factors and remain limited in predictive accuracy, highlighting the need for more objective complementary markers. Methods: The present study examined the neurobiological differences between violent (n = 66) and non-violent (n = 166) SSD patients, and compared the predictive utility of these neurobiological markers and clinical risk factors, including childhood trauma and psychopathology, in distinguishing violent from non-violent individuals. We further aimed to construct a multimodal predictive model using the strongest predictors from both domains, evaluating whether combining neural and clinical variables improves predictive performance beyond either single domain. Structural and resting-state MRI scans were acquired for patients and healthy controls (n = 504), who were used to calibrate the normative model. Neuroimaging data were analyzed within a normative modelling framework, and univariate associations between neurobiological and clinical factors and violence were examined. Results: A multimodal model integrating neurobiological and clinical measures achieved moderate classification performance (74.7% balanced accuracy), outperforming all individual predictors. The strongest predictors included the medial orbitofrontal cortex, caudal middle frontal gyrus, limbic-default mode network functional connectivity, and childhood sexual abuse. Conclusions: Our findings suggest that alterations in fronto-limbic systems involved in goal-directed decision-making and emotion regulation may contribute to violent behaviour in SSD. Furthermore, the improved performance of the multimodal model supports the potential added utility of integrating neuroimaging markers with established clinical risk factors in violence risk assessment. Full article

Background/Objectives: Time perspective and resilience are both relevant to adolescent mental health, yet their association has rarely been examined in clinical adolescent populations. This study investigated associations between resilience and time perspective and tested their independent associations with depressive, anxiety, and PTSD symptoms beyond trauma-related variables. Methods: A total of 105 adolescents aged 14 to 20 years were recruited from a child and adolescent psychiatric outpatient department. Participants completed self-report measures of resilience, time perspective, trauma exposure, and PTSD, depressive, and anxiety symptoms. Discrepancy from the optimal balanced time-perspective profile was quantified using the revised Deviation from a Balanced Time Perspective coefficient (DBTP-r). Spearman correlations and linear regression models were computed using DBTP-r alone, DBTP-r plus resilience, and extended models including trauma-related variables. Results: Higher DBTP-r was associated with lower resilience. Higher resilience was associated with higher Future and Past Positive scores and lower Past Negative scores. DBTP-r accounted for substantial variance in symptom severity. When resilience was added, both DBTP-r and resilience were independently associated with depressive, anxiety, and PTSD symptoms. In the extended models, DBTP-r and resilience remained significant for all three outcomes. Of the trauma-related predictors, physical sexual abuse was associated with PTSD symptoms in the extended model, but this association was no longer significant after controlling for biological sex. The cumulative number of other potentially traumatic experiences was not independently associated with symptom severity in the extended models. Conclusions: Time perspective and resilience appear to be related but distinguishable constructs. Both were independently associated with symptom levels of depression, anxiety, and PTSD in adolescents. Full article

Background: The widespread use of digital technologies is beneficial to society but has also contributed to the growing prevalence of Technology-Facilitated Sexual Violence (TFSV) among youth. This study aimed to co-design youth-informed recommendations for preventing and responding to TFSV and its mental health consequences among racialized youth in Canada. Methods: Guided by the participatory research approach, 33 participants from Alberta and British Columbia, who were 15–24 years old and self-identified as racialized, participated in two virtual interactive workshops. Participants engaged in facilitated breakout group discussions using case studies and semi-structured prompts. Data were collected via Padlet and analyzed using content analysis. Results: Participants identified several gaps in existing support systems and recommended culturally responsive, multi-sectoral strategies to address and prevent TFSV. The key recommendations included awareness of families and educators about TFSV, training of healthcare and community service providers for trauma-informed care, integrated mental health support, and increasing youth awareness about legal support. Conclusions: Participants collectively designed recommendations to address TFSV and its related mental health outcomes. This study highlights perspectives of racialized youth for collaborative efforts across family, education, health, community, and legal systems to foster safer digital environments and equitable mental health support for youth affected by TFSV. Full article

Many university students have a history of exposure to adverse and potentially traumatic life events and may therefore experience Moral Injury (MI). University students exposed to trauma, and especially relational trauma, should be less impacted if they feel and know with certainty that they are valued and matter to other people. The current study uniquely examined MI distress and its correlates in 382 university students who reported the experience of at least one potentially traumatic event. Additionally, we examined the traumatic experiences faced by a subgroup of 2SLGBTQIA+ students and their associated reactions. Various self-report measures were administered including MI emotions, mattering, anti-mattering, and adverse childhood experiences (ACEs). Our analyses confirmed that MI distress was evident and was linked with ACEs and higher levels of anti-mattering. Main findings accord with the notion that traumatic interpersonal events are not only distressing but are connected with feeling unimportant and insignificant to others. In addition, comparisons with the sexual and gender non-minority subgroups established that 2SLGBTQIA+ students were exposed to higher rates of major life stressors and they had comparatively elevated feelings of not mattering to others and MI-related emotional distress. Collectively, the results underscore the heterogeneity that exists among students and that feelings of mattering versus feelings of not mattering can be a source of strength or vulnerability. Clinical and public health implications are discussed as relevant to addressing feelings of personal insignificance and moral-injury related shame and mistrust. Full article

Background/Objectives: Secondary victimization (SV) following sexual assault (SA) is known to compound negative health outcomes for survivors seeking help within formal systems, such as healthcare. While there have been advances in preventing SV and support for SA survivors seeking help within healthcare, experiences of SV persist alongside worsening health disparities, particularly among disenfranchised populations of women. This literature review aims to examine the literature on HCP approaches to practices that may contribute to the SV of SA survivors. Methods: Following the PRISMA 2020 guidelines, the literature from three databases (PubMed, CINAHL Plus, and PsycINFO) was collected, followed by the screening of the titles, abstracts, and full texts of primary data sources available in full text and published in English between 2009 and 2022. The articles included for synthesis were appraised using the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP), and the data extracted were analyzed using thematic analysis. Results: Four HCP approaches to practice were found to potentially contribute to the SV of SA survivors: (1) incomprehensive care in clinical practice; (2) a lack of collaboration between inter-agencies, healthcare organizations, interdisciplinary teams, and HCPs with SA survivors; (3) barriers to HCP training and preparedness to respond to SA; and (4) failures to implement trauma-informed care (TIC) frameworks. Conclusions: Based on these findings, we provide recommendations for the prevention and mitigation of the SV of SA survivors by integrating philosophical frameworks to guide healthcare practice, including person-centered care, trauma- and violence-informed care (TVIC), and cultural safety. We reflect on the current gaps identified from this systematic review and the need for future research to operationalize and measure SV after SA in healthcare. Full article

The study explores the trauma experiences and gendered labor of Ukrainian women working as local fixers for international major media outlets covering the Russian war. Using semi-structured interviews (N = 15) with Ukrainian women fixers and drawing on feminist standpoint epistemology and embodied journalism, this research investigates how they perceive and perform their roles in a male-dominated professional environment. Women fixers’ work is shaped by lived, embodied experiences and an alternative knowledge of conflict. The fixers have an unofficial leadership role in international news teams, describing themselves as producers who shape editorial decisions, ensure safety, and influence coverage. From a feminist standpoint, their experiences show how lived experiences afford them authority in war reporting, even when it is not formally recognized. However, they face gender inequalities, primarily from male foreign correspondents who question their competency, as well as from Ukrainian military personnel who undermine their expertise and authority. Women fixers have also received unwanted sexual propositions from other freelancers in the media teams. Participants acknowledged that they have been traumatized by the war coverage, and they do not receive sufficient institutional support, but they invest in self-funded coping strategies. Full article

Background: Childhood sexual abuse (CSA) is associated with long-term psychological and somatic consequences in adulthood. However, detailed clinical characterisations of female survivors remain limited from a public health perspective. Methods: This exploratory cross-sectional study was conducted in Spain (March 2022–June 2023) with 31 adult women (18–58 years) with a history of CSA. Participants were recruited through non-probabilistic sampling from clinical services and a survivors’ association. Sociodemographic and clinical variables were assessed using validated instruments, including the EGS-R, SCL-90-R, DERS, DES, RSE, and PID-5-BF, administered in structured online guided sessions. Descriptive statistics, Pearson correlations, and independent samples t-tests were performed. Results: The sample reported early-onset CSA (mean age = 7.17 years), predominantly intrafamilial, repeated, and prolonged, with high rates of revictimization and low disclosure. Participants reported clinically relevant levels of post-traumatic, psychological, and dissociative symptoms. The mean DES score was 11.89 (SD = 7.75). Women reporting a current somatic illness showed significantly higher levels of post-traumatic symptoms, general psychological distress, and dissociation, together with lower self-esteem. Earlier age of CSA onset and younger current age were associated with several indicators of greater symptom severity. Conclusions: In this exploratory clinical sample, adult female survivors of childhood sexual abuse reported substantial psychological distress, dissociative symptoms, and frequent somatic illness. The observed associations between trauma-related variables and clinical outcomes should be interpreted cautiously and require replication in larger and more diverse samples. Nevertheless, the findings support the potential relevance of trauma-informed and multidisciplinary approaches when working with clinically vulnerable survivors of childhood sexual abuse. Full article

Romantic relationships are central to adult life, yet contemporary social, cultural, and technological transformations have reshaped how individuals navigate intimacy. This study examines how Greek millennials conceptualize short- and long-term romantic relationships, situating partner preferences and relational strategies at the intersection of evolutionary predispositions, cultural scripts, and digital mediation. Using a qualitative design grounded in social constructionism, ten heterosexual Greek millennials aged 27–42 were recruited via convenience and snowball sampling. Semi-structured interviews explored traits prioritized in partners, self-presentation strategies, and the influence of social and digital contexts. Reflexive thematic analysis identified three main themes: (1) Gendered Moral Economies of Long-Term Partnership, (2) Negotiating Social Scripts in a Digitally Mediated and Disillusioned Context, and (3) Conditional Commitment and the Stratification of Intimacy. The findings indicate that while some partner preferences align with Sexual Strategies Theory, they are heavily mediated by patriarchal norms, digital performativity, personal experiences of trauma, and age-related reflexivity. Short-term relationships were valued for pleasure and autonomy yet morally differentiated from long-term commitments. Overall, the study highlights the dynamic, contextually embedded, and reflexively constructed nature of contemporary romantic strategies among Greek millennials, offering insights for evolutionary, sociocultural, and digital perspectives on intimacy. Full article

Background/Objectives: Survivors of sexual violence and domestic violence/intimate partner violence (IPV) often require support beyond the immediate emergency encounter; however, post-acute care remains inconsistently defined, unevenly organised or conceptualised, and fragmented across service systems. This scoping review mapped international post-acute follow-up, care, assistance, and support pathways, with particular attention to organisational models, continuity mechanisms, loss to follow-up after first access, and implications for the Italian context. Methods: We conducted an international health-services scoping review of post-acute follow-up, care, assistance, and support interventions for survivors of sexual violence and domestic violence/IPV. Searches were performed in PubMed/MEDLINE, Scopus, Web of Science Core Collection, Embase, APA PsycINFO via EBSCOhost, and CINAHL via EBSCOhost. Eligible studies were published from 2013 onward and had to describe an identifiable post-acute component beyond the initial emergency, forensic, or first-contact phase. The review followed a Population–Concept–Context framework and was reported in accordance with PRISMA-ScR. Results: Forty-four studies were included in the core synthesis, comprising 16 studies on sexual violence/sexual assault, 27 on domestic violence/IPV, and one mixed domestic, family, and sexual violence outreach model. The sexual violence literature clustered around early trauma-focused interventions, sexual assault care centre pathways, medical follow-up, follow-up attendance, and digital continuity tools. The IPV literature was broader and included psychotherapy, advocacy and case-management models, housing-first and trauma-informed stabilisation approaches, nurse-led and clinic-based services, outreach and safety-contact programmes, digital interventions, and programmes for system-involved survivors. Across both fields, the pathways most consistently described as supporting continuity combined structured re-contact, coordinated support, and multi-component responses over time. Conclusions: The mapped literature supports conceptualising post-acute responses to sexual violence and domestic violence/IPV as continuity pathways that extend beyond first contact and link healthcare, psychological, advocacy, and social supports. Systems may be better positioned to support continuity when they provide structured follow-up, warm handoffs, coordinated navigation, and context-sensitive recovery models. These findings point to provisional, evidence-informed organisational questions for strengthening post-acute pathways, including in Italy, particularly around structured re-contact, warm handoffs, survivor navigation, and integration between healthcare, anti-violence, psychological, and territorial social-support services. Full article

Background: The prior literature associates childhood sexual abuse (CSA), a profound early-life stressor, with long-term cardiometabolic and psychological effects. However, data on the distribution of CSA severity and patterns among different sociodemographic groups are limited. This study aimed to describe CSA prevalence, patterns, and severity among adults with hypertension and to examine its association with sociodemographic characteristics. Methods: This cross-sectional study evaluated a sample of 353 adults using various self-reported items. The analysis used individual responses and a binary variable indicating CSA exposure. A composite CSA severity score was determined by the number of reported abuse patterns and categorized into ordinal levels. Results: Of the participants, 42.2% reported exposure to CSA. The most frequently reported pattern was sexual contact or harassment (26.1%), followed by other sexual abuse acts (25.2%), forced sexual acts or exposure (18.7%), and coerced sexual activity (17.3%). Sexual assault or rape was reported by 20.7% of respondents. In terms of severity, 57.8% of respondents reported no CSA exposure, whereas 10.8% reported experiencing the highest severity. All examined sociodemographic factors were significantly associated with CSA exposure (p < 0.001). Conclusions: High CSA exposure and greater severity patterns were prevalent in this population, demonstrating notable sociodemographic gradients. These findings support the need for trauma-informed therapeutic awareness of CSA exposure among adults with hypertension. Nevertheless, the role of CSA as a risk factor for hypertension cannot be inferred from this study, as it only included subjects with preexisting hypertension. Longitudinal research is necessary to identify causal pathways. Full article

Background: Obsessive–compulsive disorder (OCD) frequently co-occurs with autism spectrum disorder (ASD), but the prevalence and clinical correlates of this comorbidity remain incompletely understood. Methods: We examined a clinical sample of 603 patients with a primary diagnosis of OCD, of whom 149 (24.7%) presented with comorbid ASD. Sociodemographic variables, clinical characteristics, comorbidities, and obsessive–compulsive symptom dimensions were compared between patients with and without ASD. Results: Patients with OCD + ASD reported an earlier onset of both obsessive–compulsive symptoms and full-blown disorder. While overall symptom severity (Y-BOCS, HAM-D, and HAM-A) was comparable, OCD + ASD patients were characterized by a higher exposure to stressful and traumatic life events, including severe trauma (e.g., death of a close family member, sexual abuse, physical violence, serious illness, and bullying). Severe traumatic events, in particular, were independently associated with ASD comorbidity in our OCD cohort (exploratory model). Comorbidities were also distinct: onychophagia (66.4% vs. 0.4%) and trichotillomania (8.7% vs. 0%) were markedly more prevalent in the OCD + ASD group. Phenomenologically, OCD + ASD patients more often exhibited religious and somatic obsessions, as well as repetition compulsions. Specifically, somatic obsessions were independently associated with ASD in our regression analysis. Conclusions: OCD with comorbid ASD represents a clinically distinct subgroup, characterized by greater vulnerability to trauma, earlier onset, unique symptom profiles, and specific comorbidities. Recognition of these features, and in particular a history of severe traumatic experiences and the presence of somatic obsessions, may support earlier consideration of ASD comorbidity during OCD assessment and may inform personalized treatment planning. Full article

Background: Young adult sexual minority men (SMM) disproportionately experience childhood interpersonal trauma. The Dimensional Model of Adversity and Psychopathology (DMAP) framework proposes that exposure to threat (i.e., emotional, physical, and sexual abuse) and deprivation (e.g., physical and emotional neglect) are differentially linked to adult psychopathology. Studies of predominantly heterosexual samples have revealed emotion regulation and mindfulness as mechanisms linking childhood trauma to mental health and health risk behaviors in adulthood. However, the influence of emotion regulation (ER) or mindfulness as associated with exposure to threat vs. deprivation has not been examined among SMM in adulthood. Objective: This study explored the relationships between childhood threat/deprivation and mental health and health risk behaviors among SMM with ER and mindfulness as mediators. Participants and Setting: The sample consisted of 317 SMM (M_age = 26.70; SD = 3.87; ages 18–35; 59.3% White) recruited from the community. Methods: Childhood experiences of threat and deprivation were assessed via the Childhood Trauma Questionnaire; ER difficulties and dispositional mindfulness were assessed using self-report. Mental health behaviors were assessed using a composite score consisting of self-reported depressive, anxiety, PTSD symptoms, and suicidality. Health risk behavior score included the Sexual Compulsivity Scale, Alcohol Use Disorders Identification Test, and smoking history (Y/N). Results: Threat and deprivation were both positively correlated with mental health and health risk behaviors. Threat was associated with both mental health and health risk behaviors via emotion regulation (ER) difficulties. Deprivation was associated with these outcomes through both ER difficulties and mindfulness. Conclusions: Treatment aimed at bolstering ER and mindfulness skills among those with histories of abuse and deprivation, respectively, may help reduce psychopathology risk among SMM. Full article

The conviction rate for sexual assault and rape in the UK has decreased since the 1980s. In part, this has been due to survivors’ negative experiences during their journey through the criminal justice system. While thorough reviews of the criminal justice system have taken place and recommendations have been made, there is a lack of psychological evaluation of the effects of this journey. In this study, we interviewed eight survivors who had gone through the criminal justice system, asking about their experiences and their impact. Thematic analysis, with triangulation, was undertaken, revealing that the negative experiences of feeling let down and the disjointed communication led to prolonged mental health difficulties. The interrelated subthemes highlighted how survivors’ expectations, potentially from seeking justice, were different from reality. Their reality of delayed, poor, and misguided communication from members of the criminal justice system made them feel abandoned, helpless, and powerless. The consequence of this was negative strain, additional trauma, and prolonged distress. These results are interpreted within a framework of the practicalities of investigating serious sexual assault and how best to support survivors of sexual violence while they are treated as witnesses under the criminal justice system in the UK. Full article

Background/Objectives: Sleep disturbance is common among youth in the child welfare system, yet the role of placement instability and placement setting in shaping sleep outcomes remains understudied. This study examined the association between placement instability, time spent in different care settings, and sleep disturbance among children in foster care. Methods: We conducted a retrospective cohort study using longitudinal administrative child welfare data from a Midwestern U.S. state, including 20,888 youth aged 5–18 years who entered foster care between 2010 and 2020. Sleep disturbance was assessed using the Child and Adolescent Needs and Strengths (CANS) sleep item. Baseline was defined as the first CANS assessment within one month of entry into care, and follow-up as the assessment closest to discharge or the end of a three-year observation window, whichever occurred first. We estimated association using a time-lagged linear mixed-effects model predicting sleep disturbance after each placement episode, including placement instability: 1 (reference), 2, 3, or ≥4 placement(s), time since placement, time spent in care settings (kinship, foster home, treatment foster home, congregate care, institutional care), and baseline trait factor scores derived from non-sleep CANS items, while controlling for sleep at the time of placement and demographics. Results: At baseline, 2016 children had actionable sleep disturbance (CANS sleep = 2 or 3; 1701 moderate and 315 severe). By the end of follow-up, this increased to 2884 children (2372 moderate and 512 severe). In linear mixed-effects models, placement instability demonstrated a dose–response association with higher subsequent sleep disturbance relative to one placement (2 placements: β = 0.025; 3 placements: β = 0.045; ≥4 placements: β = 0.067; all p ≤ 0.02). Time spent in kinship care was associated with lower sleep disturbance (β = −0.049; p < 0.001), whereas time spent in treatment foster homes was associated with higher sleep disturbance (β = 0.035; p < 0.001). Trauma in the family, medical/developmental needs, and internalizing/sexual issues were positively associated with sleep disturbance. Time and instability interactions showed modest attenuations of instability-associated sleep disturbance over time for higher placement counts. Conclusions: Placement instability is associated with progressively worse sleep disturbance over time among youth in foster care, even after controlling for sleep status at placement and baseline functioning. Sleep disturbance may represent an actionable indicator for the child welfare system, highlighting opportunities for targeted screening and support during placement transitions. Full article