Posttraumatic stress disorder a greater risk in rich countries

By New Zealand Defence Force from Wellington New ZealandOne would think that people with few friends and living in poverty are more at risk for PTSD than those with a strong support network and many resources.

And that’s true.

However, it is a different story when you look at the country-, rather than the individual level. Countries with more resources, such as the USA and the Netherlands, have higher levels of PTSD than countries with fewer resources (e.g. Colombia, South Africa).

This is the key finding of our latest study, which has just been published in the British Journal of Psychiatry. For the analyses, we made use of international data on trauma exposure, PTSD and country vulnerability. They had been collected in 24 different studies, published between 2005 and 2014.

The information on exposure and PTSD came from one, well-established and (evidently) widely used measure, the Composite International Diagnostic Interview. The country resources, or vulnerability, information came from the annual World Risk Report. It includes a mix of country characteristics, such as number of hospital beds, malnutrition, and gross domestic product per capita.

Both trauma exposure and vulnerability were major determinants of PTSD, but the latter in an unexpected way. While a higher percentage of trauma exposure in the country related to higher levels of PTSD, more vulnerability was associated with less PTSD.

Michel Dückers, the lead author of the study, calls it the “vulnerability paradox”. Continue reading

Dysfunctional posttraumatic cognitions: Can we reduce the gap between research and practice?

Anke de Haan A new guestpost!

Anke de Haan from the University Children’s Hospital in Zurich talks about the place that children’s post-trauma cognitions have in clinical practice:

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Posttraumatic cognitions have been a topic in child trauma research for a few years now. Nevertheless, my impression is that they have not yet been established in clinical practice.

Why not? Are they not practically relevant? Are they too difficult to assess? Before I discuss these questions, I will briefly describe what I mean with dysfunctional posttraumatic cognitions. Continue reading

Trauma research must be Open Access

Open_Access_logo_PLoS_transparentWe recently examined how global and how open the literature on Posttraumatic Stress Disorder is.

Not so global, and not so open.

Only 13% of the publications of 2012 regarded samples in low- or middle-income countries and 58% were behind a paywall.

Today I want to talk about the latter, the paywall part.

It worries me that practicing psychologists can’t access the latest research on therapy effectiveness. Or on how to deal with drop-out from clinical interventions. Or on how children experience trauma recovery.

As you may know, the migration crisis and refugees are on my mind a lot these days. I can’t justify, in any way, why a large part of the relevant knowledge is unavailable to support those who are affected.

Not only practitioners have little access to the latest evidence. The same applies to many scholars in low-resource settings, policy makers, and citizens in general.

Much research is behind a paywall, even though it was funded with public money. This system is lucrative for the publishers of certain ‘traditional journals’, which charge extra-ordinary amounts of subscription money to university libraries.

Getting radical

Continue reading

A tornado in my head

“They didn’t even have nappies at the maternity ward,” she tells me
“I had to get my sister out of there: that hospital was a health risk.”

With our feet on the edge of a South-African fireplace, we are having a glass of wine. She is a beautiful woman from Lesotho who has made an impressive journey in life, now finishing her PhD while being an accomplished facilitator.

Twenty minutes ago, she asked me what I exactly try to find out with my research. So I told her about our projects on how parents support their children after a serious injury. About our research on care for children who lost a parent due to fatal domestic violence. And about our recent survey on emergency staff’s education needs regarding child traumatic stress.

She listened with interest, and then she started talking. About her experiences with hospitals in South Africa. Continue reading

Refugees in Europe: A crisis?

Fresh Eyes on the Refugee Crisis - image by Tom Turley

Over 1 million people arrived in Europe by sea in 2015. And since the conflict in Syria continues, this influx will not halt.

It is the biggest refugee crisis since World War II according to the UNHCR. The journey by sea is dangerous, the circumstances in refugee camps and asylum seeker centers are far from ideal – to say the least – and tensions between host countries make it difficult to find constructive solutions.

With such big numbers and their political, social and logistical complexities, it’s easy to feel powerless as an individual.

Still, there are opportunities. As Margaret Mead has famously been quoted:

“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it’s the only thing that ever has.”

Continue reading