LifeSpan Developmental Trauma

Risk and Prevention and Trauma

Title: Prevention of anxiety disorders: The case of post-traumatic stress 

  disorder.

Author(s)/Editor(s): Stock, Saundra L.; Werry, John S.; McClellan, Jon M.

Source/Citation: Anxiety disorders in children and adolescents:  Research, 

  assessment and intervention., New York, NY, US: Cambridge University Press; 

  2001, (xv, 402), 368-391 Cambridge child and adolescent psychiatry.

Abstract/Review/Citation: Deals with preventive intervention for children aimed 

  at reactive psychopathology that arises as a result of exposure to traumatic 

  events. Emphasis is on trauma experienced collectively. It is maintained that 

  the potential 'clients' for Type I preventive intervention are: (1) children 

  and educational/care systems at high risk for experiencing traumatic events; 

  (2) groups of children who have been exposed to traumatic events and do not 

  seek help but are proactively approached as part of a community-wide, 

  post-disaster intervention; (3) individual children recently exposed to 

  sudden, unpredictable stressors and/or victimizing experiences, who either 

  initiate and seek help themselves or are referred for help by caretakers; and 

  (4) caretakers/care providers who may  become, or are vicariously traumatized 

  and/or exhibit compassion fatigue. The interventions outlined in this chapter 

  can be applied both directly and indirectly in home and community settings for 

  prevention of posttraumatic stress disorder (PTSD) in children. 

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Title: Behavioral perspectives on child homicide: The role of access, 

  vulnerability, and routine activities theory.

Author(s)/Editor(s): Boudreaux, Monique C.; Lord, Wayne D.; Jarvis, John P.

Source/Citation: Trauma Violence & Abuse: Special Issue:  ; Vol 2(1) Jan 

  2001, US: SAGE Publications; 2001, 56-78

Abstract/Review/Citation: This article reviews existing research on the topics 

  of child abduction and child homicide and attempts to identify and assess 

  potential victim risk factors through a discussion of victim access, 

  vulnerability, and routine activities theory. For example, are children of 

  certain ages or genders more likely to be targeted by offenders? Who are the 

  offenders in child homicides and what are the relationships between the 

  offenders and their victims? Does motive or crime technique differ between 

  offenders who have familiarity with victims versus those who are strangers? 

  Ecological perspectives on child homicide are also discussed, including the 

  concepts of competition, predation, and developmental victimology. Research 

  that addresses these questions directly benefits law enforcement personnel, 

  social workers, and forensic scientists actively working child homicide cases, 

  and social scientists involved in the formulation of child homicide prevention 

  programs and policies. In addition, this information helps improve prevention 

  programs designed to protect children, helps children protect themselves, and 

  provides potential avenues for identifying offenders in such cases. 

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Title: Gender differences in risk factors for trauma exposure and post-traumatic 

  stress disorder among inner-city drug abusers in and out of treatment. .

Author(s)/Editor(s): Cottler, Linda B.; Nishith, Pallavi; Compton, William III

Source/Citation: Comprehensive Psychiatry: Special Issue:  ; Vol 42(2) Mar-Apr 

  2001, US: WB Saunders & Co; 2001, 111-117

Abstract/Review/Citation: Examined, in a population of drug users, the role of 

  gender in (1) predicting the nature of the traumatic event and posttraumatic 

  stress disorder (PTSD) symptoms, (2) pattern of substance use disorders in 

  relation to trauma exposure and PTSD symptoms, (3) comorbidity of other 

  psychiatric disorders with trauma exposure and PTSD, and (4) the temporal 

  association of substance use disorder, exposure to trauma, and PTSD. 464 drug 

  abusers were interviewed using the Diagnostic Interview Schedule for DSM-III-R 

  and the Composite International Diagnostic Interview-Substance Abuse Module. 

  Although more women than men met criteria for Mental Disorders-III-Revised 

  (DSM-III-R) PTSD, there were no gender differences on endorsement for a 

  traumatic event. Adult antisocial behavior, affective disorder, schizophrenia, 

  other anxiety disorder and polysubstance use predicted exposure to an event, 

  whereas only schizophrenia and other anxiety disorder predicted PTSD. In men, 

  drug use preceded the exposure to an event, while in women, the onset age for 

  both drug use and exposure to an event were nearly identical. Implications for 

  gender-based education and prevention interventions are discussed. 

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Title: Violence exposure, psychological trauma, and suicide risk in a community 

  sample of dangerously violent adolescents. .

Author(s)/Editor(s): Flannery, Daniel J.; Singer, Mark I.; Wester, Kelly

Source/Citation: Journal of the American Academy of Child & Adolescent 

  Psychiatry: Special Issue:  ; Vol 40(4) Apr 2001, US: Lippincott Williams 

  & Wilkins Co; 2001, 435-442

Abstract/Review/Citation: Examined violence exposure, violent behaviors, 

  psychological trauma, and suicide risk in a community sample of dangerously 

  violent adolescents compared with a matched community sample of nonviolent 

  adolescents. Anonymous self-report questionnaires were administered to 

  students in grades 9 through 12, in 6 public high schools (N = 3,735). From 

  this sample, 484 adolescents (349 males, 135 females) who reported attacking 

  someone with a knife or shooting at someone within the past year (i.e., 

  dangerously violent adolescents) were drawn. 484 controls were also selected 

  and matched on gender, age in years, ethnicity, area of residence, and family 

  structure. Dangerously violent adolescents reported higher levels of exposure 

  to violence and victimization than did matched controls. Dangerously violent 

  females were more likely to score in the clinical range of depression, 

  anxiety, posttraumatic stress, anger, and dissociation than were control 

  females and violent males; they also had significantly higher levels of 

  suicide potential. It is concluded that students who have been known to commit 

  violent acts should be adequately assessed for violence exposure and symptoms 

  of psychological trauma, with special attention given to the suicide potential 

  of violent females. 

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Title: Risk and preventive factors of post-traumatic stress disorder (PTSD): 

  Alcohol consumption and intoxication prior to a traumatic event diminishes the 

  relative risk to develop PTSD in response to that trauma.

Author(s)/Editor(s): Maes, Michael; Delmeire, Laure; Mylle, Jacques; Altamura, Carlo

Source/Citation: Journal of Affective Disorders; Vol 63(1-3) Mar 2001, 

  Netherlands: Elsevier Science Publishers BV; 2001, 113-121

Abstract/Review/Citation: Examined the effects of selected pre-, peri- and post 

  exposure risk factors and preventive factors, such as alcohol consumption, on 

  the development of posttraumatic stress disorder (PTSD). An epidemiological 

  cohort study was carried out on 127 victims trapped in a ballroom fire. Data 

  were collected, 7-9 months after the traumatic event, by means of the 

  Composite International Diagnostic Interview (CIDI) and structured interviews, 

  aimed to assess the above pre-, peri- and post-exposure factors. Logistic 

  regression analysis was used to examine the association of PTSD with the 

  etiologic factors and to delineate those risk factors which contribute most to 

  the development of PTSD. Female gender, the number of previous trauma, a past 

  history of simple phobia, threatened death, trauma exposure, hospitalization 

  for trauma-induced injuries and the presence of burns increased the odds of 

  PTSD, whereas a sense of control during the trauma, and alcohol consumption 

  and intoxication decreased the odds of PTSD. 

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Title: A review of psychological debriefing after extreme stress. .

Author(s)/Editor(s): Zeev, Kaplan; Iancu, Iulian; Bodner, Ehud

Source/Citation: Psychiatric Services: Special Issue:  ; Vol 52(6) Jun 2001, US: 

  American Psychiatric Assn; 2001, 824-827

Abstract/Review/Citation: Preventive intervention after exposure to traumatic 

  events is a subject of increasing interest among mental health professionals. 

  Psychological debriefing, which aims to reduce the risk of posttraumatic 

  stress disorder and other psychopathological sequelae of traumatic 

  experiences, is an example of such an intervention. The authors review the 

  history of psychological debriefing and examine its efficacy. They conclude 

  that psychological debriefing might be an effective intervention after extreme 

  stress, although more support from controlled studies is required. 

========================================

Title: The employee victim of violence: Recognizing the impact of untreated 

  psychological trauma.

Author(s)/Editor(s): Flannery, Raymond B. Jr.

Source/Citation: American Journal of Alzheimer's Disease; Vol 16(4) Jul-Aug 

  2001, US: Prime National Publishing Corp; 2001, 230-233

Abstract/Review/Citation: Outlines briefly some common presentations of 

  untreated psychological trauma in employees, as well as basic ways to provide 

  needed support to employee victims of violence and to introduce 

  risk-management strategies that may reduce the risk for further traumatic 

  events. The impact of psychological trauma in the workplace is seen as often 

  going unaddressed. The untreated aftermath of these critical incidents may 

  manifest itself in various states of anxiety, depression, substance use 

  disorders, and even subsequent violence by the victims. Suggestions are also 

  made for reducing the risk of violence in health care facilities, including 

  long-term care and special care units for dementia patients. 

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Title: Untangling the impact of sexual abuse on HIV risk behaviors among youth 

  in foster care.

Author(s)/Editor(s): Elze, Diane E.; Auslander, Wendy; McMillen, Curtis; Edmond, 

Tonya; Thompson, Ron

Source/Citation: AIDS Education & Prevention; Vol 13(4) Aug 2001, US: 

  Guilford Publications; 2001, 377-389

Abstract/Review/Citation: Investigates the interrelationships among childhood 

  sexual abuse, other types of child maltreatment (emotional and physical abuse 

  and neglect), emotional and behavioral problems, and HIV risk behaviors in a 

  sample of 167 adolescents (aged 15-19 yrs) participating in an independent 

  living preparation program in 1 midwestern county. Lifetime and recent (last 2 

  mo) HIV risk behaviors assessed included several categories of sexual risk 

  taking behaviors (5 lifetime and 8 recent) and 3 items assessing use of 

  unclean needles for iv drug usage, piercing, or tattoos. 33% of the Ss 

  identified as white and 67% as youths of color. 59 Ss (33%) reported some form 

  of sexual abuse; 21 reported unwanted touching, with no unwanted intercourse, 

  and 38 reported unwanted intercourse. Multivariate analyses demonstrated a 

  significant relationship between the severity of sexual abuse and Ss' recent 

  HIV risk behaviors, after accounting for the contribution of other childhood 

  trauma and emotional and behavioral problems. The findings support the need 

  for HIV prevention programs targeting sexually abused youths. 

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Title: Exposure therapy in the treatment of PTSD among cocaine-dependent 

  individuals: Description of procedures.

Author(s)/Editor(s): Back, Sudie E.; Dansky, Bonnie S.; Carroll, Kathleen M.; Foa, Edna B.; Brady, Kathleen T.

Source/Citation: Journal of Substance Abuse Treatment; Vol 21(1) Jul 2001, US: 

  Elsevier Science Inc; 2001, 35-45

Abstract/Review/Citation: An estimated 30% to 50% of cocaine-dependent 

  individuals meet criteria for lifetime posttraumatic stress disorder (PTSD). 

  Cocaine dependence is associated with increased rates of exposure to trauma, 

  more severe symptoms, higher rates of treatment attrition and 

  retraumatization, and greater vulnerability to PTSD when compared to other 

  substance use disorders. These associations underscore the need for effective 

  treatments that address issues particular to PTSD in a manner tolerable to 

  cocaine-dependent individuals. This article describes a manualized 

  psychotherapy developed specifically for individuals with PTSD and cocaine 

  dependence. Concurrent Treatment of PTSD and Cocaine Dependence (CTPCD) 

  provides coping skills training, cognitive restructuring techniques, and 

  relapse prevention strategies to reduce cocaine use. In-vivo and imaginal 

  exposure therapy techniques are incorporated to reduce PTSD symptom severity. 

  Primary treatment goals include psychoeducation specific to the 

  interrelationship between PTSD and cocaine dependence, and clinically 

  meaningful reductions in cocaine use and PTSD symptomatology. Secondary goals 

  include a reduction in HIV high-risk behaviors and improved functioning in 

  associated areas, such as anger and negative affect management. 

========================================

Title: Acute psychosocial preventive interventions for posttraumatic stress 

  disorder.

Author(s)/Editor(s): Rauch, Sheila A. M.; Hembree, Elizabeth A.; Foa, Edna B.

Source/Citation: Advances in Mind-Body Medicine: Special Issue:  ; Vol 17(3) Sum 

  2001, US: John E Fetzer Institute Inc; 2001, 187-190

Abstract/Review/Citation: Reviews research on outcomes of short-term preventive 

  interventions soon after trauma and predictors of chronic posttraumatic stress 

  disorder (PTSD). Only a handful of studies have found positive outcomes for 

  acute preventative interventions for PTSD. Studies are briefly noted with 

  survivors of rape/sexual assault, earthquake and motor vehicle accidents that 

  have employed cognitive behavioral procedures, supportive counseling and 

  debriefing. A common component of interventions that have demonstrated 

  positive effects is psychoeducation. These interventions are seen to allow for 

  normalization of posttrauma reactions. Whether psychoeducation is the 

  effective ingredient in early interventions has not been consistently 

  demonstrated, however. Findings that general debriefing interventions are 

  ineffective may be explained by research on the developmental course of 

  chronic PTSD, which has suggested that most trauma survivors recover over time 

  with no intervention. Factors that have predicted development of PTSD among 

  female assault victims include low perceived control, high acute PTSD symptom 

  severity, dissociation, physical injury and interpersonal friction. It is 

  concluded that data do not support the routine delivery of early prevention 

  intervention for PTSD. 

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Title: When disater strikes--the need to be "wise before the event": 

  Crisis intervention with children and adolescents. .

Author(s)/Editor(s): Yule, William

Source/Citation: Advances in Mind-Body Medicine: Special Issue: Vol 17(3) Sum 

  2001, US: John E Fetzer Institute Inc; 2001, 191-196

Abstract/Review/Citation: Addresses issues in providing crisis intervention to 

  children and adolescents affected by a traumatic event or disaster. These 

  include the need for risk analysis and preparation, cross-agency disaster 

  plans, coordinated efforts to provide evidence-based intervention packages for 

  local implementation with a modicum of training and supervision, and 

  psychological debriefing for children. Although few studies have evaluated the 

  effects of debriefing on children, the author makes several recommendations 

  for how to respond to children traumatized by an emergency event. The key to 

  improvements in crisis interventions is seen to be forward planning and better 

  outcome measurement studies. 

========================================

Title: Does a threat appeal moderate reckless driving? A terror management 

  theory perspective.

Author(s)/Editor(s): Ben-Ari, Orit Taubman; Florian, Victor; Mikulincer, Mario

Source/Citation: Accident Analysis & Prevention; Vol 32(1) Jan 2000, United 

  Kingdom: Elsevier Science Inc/Pergamon; 2000, 1-10

Abstract/Review/Citation: A series of 2 studied examined the effects of threat 

  appeals on reckless driving from a terror management theory perspective. In 

  both studies, all the male participants (N = 109; aged 18-21 yrs) reported on 

  the relevance of driving to their self-esteem, and then, half of them were 

  exposed to a road trauma film and the remaining to a neutral film. In Exp 1, 

  the dependent variable was the self-report of intentions to drive recklessly 

  in hypothetical scenarios. In Exp 2, the dependent variable was actual 

  behavior (driving speed) in a driving simulator. Findings indicate that a road 

  trauma film led to less reported intentions of reckless driving but to higher 

  driving speed than a neutral film. A discussion emphasizing the self-enhancing 

  mechanisms proposed by the terror management theory is presented. 

========================================

Title: Debriefing following trauma.

Author(s)/Editor(s): Fullerton, Carol S.; Ursano, Robert J.; Vance, Kelley; Wang, Lemming

Source/Citation: Psychiatric Quarterly; Vol 71(3) Fal 2000, US: Kluwer 

  Academic/Plenum Publishers; 2000, 259-276

Abstract/Review/Citation: Reviews literature on clinical intervention after 

  trauma using debriefing and examined who attends debriefings and the effect of 

  natural debriefing, i.e., talking to family and friends, on psychiatric 

  outcomes by looking at 2 occurrences of plane crashes. A cohort of 254 medical 

  workers (mean age 32 yrs) who were either present at the scene or responded to 

  a plane crash at a 1989 air show in Germany were surveyed. Also, surveys were 

  distributed to 207 Sioux City Air National Guard disaster workers (mean age 37 

  yrs) one mo after a passenger plane crash in Iowa, also occurring in 1989. 

  Data suggest that those with high exposure and females were more likely to 

  attend a debriefing. People most likely to talk about the disaster with 

  spouse/significant other, coworker and/or another person were those with acute 

  posttraumatic stress disorder (PTSD), higher total and intrusive Impact of 

  Event symptoms, higher levels of education, higher levels of disaster 

  exposure, and those who were older and/or married. It is stated that better 

  understanding of who attends formal debriefings will help identify potential 

  high-risk groups. Similarly, whether talking about the disaster is associated 

  with fewer or greater psychological symptoms is important to understanding the 

  outcome, mechanisms, and risks of debriefing. 

========================================

Title: Stress and trauma: Coping in today's society.

Author(s)/Editor(s): Miars, Russell D.

Source/Citation: Youth risk:  A prevention resource for counselors, teachers, 

  and parents (3rd ed.)., Alexandria, VA, US: American Counseling Association; 

  2000, (xvii, 526), 167-191

Abstract/Review/Citation: This chapter examines what is currently known about 

  human stress, trauma, and coping processes in general, giving special 

  attention to causes and prevention of stress in youth. The chapter first 

  reviews the predominant ways stress and trauma have been conceptualized over 

  the past 3 decades and then concentrates on causal factors, that is, on the 

  sources of stress and trauma in children and adolescents, with consideration 

  of how developmental stages interact with the experience of stress as well as 

  the coping strategies used by youth when faced with stress and trauma. The 

  chapter next addresses approaches to prevention of stress and trauma from 

  family, individual, school, and community perspectives. It concludes with a 

  brief consideration of stress and trauma from a cultural perspective. In this 

  chapter the term  children  refers to ages preschool to 10, and the term  

  adolescents  refers to ages 11 to 19. 

========================================

Title: The lived experience of adult male survivors who allege childhood sexual 

  abuse by clergy.

Author(s)/Editor(s): Fater, Kerry; Mullaney, Jo Ann

Source/Citation: Issues in Mental Health Nursing; Vol 21(3) Apr-May 2000, US: 

  Taylor & Francis; 2000, 281-295

Abstract/Review/Citation: Phenomenological study that describes the essential 

  structure of the lived experience of adult male survivors of childhood sexual 

  abuse by clergy. A purposive sample of seven survivors (aged 28-48 yrs old) 

  related their subjective experiences in semistructured interviews. P. 

  Colaizzi's (1978) phenomenological method was used for data analysis. 

  Survivors describe a bifurcated rage and spiritual distress that pervades 

  their entire "lifebeing."  Learning about adult survivors of 

  childhood sexual abuse by clergy will assist nurses to identify potential risk 

  factors, design prevention strategies, and enhance empathy for a healing 

  relationship. 

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Title: Posttraumatic stress intervention:  Challenges, issues, and perspectives.

Author(s)/Editor(s): Violanti, John M.; Paton, Douglas; Dunning, Christine

Source/Citation: Springfield, IL, US: Charles C Thomas, Publisher; 2000, (xvii, 

  225)

Abstract/Review/Citation: Since the 1980s, posttraumatic stress intervention has 

  focused primarily on psychological debriefings to help prevent posttraumatic 

  stress disorder. While debriefing is said to be important, mental health 

  professionals are uncertain about outcomes, and there is agreement that 

  debriefing may be somewhat hindered by its pathogenic nature rather than being 

  a positive method for preventing trauma stress. This book demonstrates the 

  need for alternatives to this prevailing model of posttrauma prevention, 

  providing a theoretically and ecologically sound intervention that facilitates 

  recovery and growth in those who have faced adversity. By concentrating on 

  alternative ways of thinking about patterns of interaction between people and 

  adversity, the adoption of a salutogenic paradigm for conceptualizing, 

  researching, designing, and delivering effective trauma intervention is 

  advocated. This paradigm offers opportunities for intervention to mitigate 

  traumatic stress reactions, develop resilience, and establish necessary 

  individual and organizational resources.  This book will be useful for 

  disaster workers, emergency worker counselors, police counselors, mental 

  health professionals, and any group or individual that works with people 

  exposed to trauma. 

Notes/Comments:  Preface Posttraumatic stress intervention: Challenges, issues, and 

perspectives Douglas Paton, John M. Violanti and Chris Dunning Challenging the mainstream: 

From pathogenic to salutogenic models of posttrauma intervention Cynthia Stuhlmiller and 

  Christine Dunning The integration of traumatic experiences: Culture and 

  resources Gisela Perren-Klingler Brief prevention programs after trauma I. V. 

  E. Carlier and B. P. R. Gersons There are no simple solutions to complex 

  problems Richard Gist and Joseph Woodall The effects of traumatic disclosure 

  on physical and mental health: The values of writing and talking about 

  upsetting events James W. Pennebaker Hardiness as a resiliency factor for U.S. 

  forces in the Gulf War Paul T. Bartone Early posttraumatic interventions: 

  Facilitating possibilities for growth Lawrence G. Calhoun and Richard G. 

  Tedeschi Scripting trauma: The impact of pathogenic intervention John M. 

  Violanti The future is always brighter: Temporal orientation and adjustment to 

  trauma Malcolm D. MacLeod Work-related traumatic stress: Risk, vulnerability 

  and resilience Douglas Paton, Leigh M. Smith, John M. Violanti and Liisa 

  Eraenen Posttrauma stress intervention: Pursuing the alternatives Douglas 

  Paton, John M. Violanti and Christine Dunning Author index Subject index 

  approaches to posttraumatic stress interventions that facilitate recovery 

  & growth, people who have faced adversity

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Title: Child maltreatment: What we know in the Year 2000.

Author(s)/Editor(s): MacMillan, Harriet L.

Source/Citation: Canadian Journal of Psychiatry; Vol 45(8) Oct 2000, Canada: 

  Canadian Psychiatric Assn; 2000, 702-709

Abstract/Review/Citation: This paper provides an overview of child maltreatment 

  within a public health framework. A brief historical perspective is followed 

  by a discussion of the burden of suffering associated with child maltreatment. 

  Evidence about the prevention and treatment of child abuse and neglect is 

  reviewed. Evidence supports a program of nurse home visits as effective in 

  preventing abuse and neglect among first-time, at-risk mothers. Sexual abuse 

  education programs improve children's knowledge and prevention skills; whether 

  such programs reduce the occurrence of child sexual abuse remains to be 

  established. In the area of treatment, therapeutic daycare programs improve 

  cognitive skills among physically abused and neglected children. 

  Abuse-specific cognitive-behavior therapy has been shown to be effective in 

  reducing symptoms among sexually abused children in both preschool and older 

  age groups. Further research is necessary across all subcategories of child 

  maltreatment, particularly neglect and emotional abuse. 

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Title: Critical incident response in the railroad industry:  A standardized 

  intervention.

Author(s)/Editor(s): Rapa, Ralph Edward

Source/Citation: Dissertation Abstracts International: Section B: The Sciences 

  & Engineering; Vol 60(9-B) Apr 2000, US: Univ Microfilms International; 

  2000, 4904

Abstract/Review/Citation: In recent years, a large body of clinical research has 

  been undertaken in the areas of trauma, crisis intervention, and disaster 

  management.  Selye (1956) originally coined the term 'stress,' and he 

  described the stress reaction as a three stage process. Beginning with an 

  initial alarm reaction that is physiological in nature, an individual will 

  experience increased heart rate, respiration, and perspiration in reaction to 

  a stimulus. The next stage is the individual's response to the stressors, 

  which was known as the 'resistance.' This stage could include adaptive coping 

  strategies or maladaptive responses. Should an individual not successfully 

  manage to cope with the stressor, 'exhaustion,' Selye's final stage, would 

  manifest in negative health effects.  Researchers generally agree that 

  excessive stress can diminish the health and quality of work-life for 

  employees. The practical reality is that stress is neither good or bad. There 

  are optimal levels of stress at work as there are in life. The issue is not 

  one of presence or absence, but rather of the nature, intensity, and duration 

  of stress and the resources available to respond to it.  Certain fields have 

  received more research attention than others regarding occupational stress. It 

  is clear from the research conducted in the transportation industry that 

  high-levels of perceived occupational stress can negatively impact 

  performance, job satisfaction, and quality of life of employees. This 

  dissertation focuses on the development of a structured post-trauma 

  intervention for American railroad personnel, individuals who work day-to-day 

  in a high risk industry. This program is specifically designed to address the 

  posttraumatic stress response in order to assist an individual in 

  reestablishing psychological and physiological homeostasis more quickly. The 

  program is unique in its application to rail crews and locomotive engineers 

  who have been involved in serious accidents. In addition to a structured 

  debriefing intervention, the program includes the use of a psychoeducational 

  segment, peer counseling and dynamic group therapy with a systematic follow-up 

  process. It is the belief of this writer that developing a structured pre- and 

  post-trauma intervention can assist an individual in reestablishing 

  psychological, and physiological, homeostasis more quickly. A systematic 

  follow-up process will then provide longitudinal assessment of individuals for 

  any long-term negative psychological effects. The program will attempt to 

  bridge the gap between railroad labor and management's current methods and 

  rationale in handling critical incidents, while providing a timely and unique 

  psychological service to a population with demonstrated need. (Abstract 

  shortened by UMI.) 

========================================

Title: Vulnerability and resistance to traumatic stress: Psychological responses 

  to the Northridge earthquake.

Author(s)/Editor(s): Hillig, Justine Angela

Source/Citation: Dissertation Abstracts International: Section B: The Sciences 

  & Engineering; Vol 60(12-B) 2000, US: Univ Microfilms International; 2000, 

  6367

Abstract/Review/Citation: Although humankind has endured devastating natural 

  disasters throughout the ages, the relatively young field of disaster mental 

  health still requires a great deal of research. Further investigations are 

  needed to explore psychological consequences of disasters, identify risk 

  factors, and help prevent or reduce psychological disturbance. The present 

  study expands knowledge about disaster mental health by examining the early 

  impact of a disaster on individuals with qualitatively different types of 

  trauma exposure and subcommunity membership.  The study investigated 

  psychological and behavioral responses during the first three weeks after the 

  6.7 Northridge earthquake struck Los Angeles, California, on January 17, 1994. 

  The Impact of Event Scale and supplementary data were used to examine acute 

  traumatic stress symptomatology. Responses were obtained from 434 students at 

  the University of California, Los Angeles. A total of 378 individuals 

  experienced primary exposure (i.e., direct exposure to both to the initial 

  disaster and its aftermath). The remaining 56 individuals returned to Los 

  Angeles within days after the earthquake and experienced secondary exposure 

  (i.e., exposure to the disaster aftermath without exposure to the initial 

  disaster). A total of 92 individuals worked as paraprofessional counselors, 

  and 342 individuals from the sample were not members of the counselor 

  subcommunity. Mann-Whitney U tests and chi-square analyses were used to 

  compare groups.  The results indicate that 81% of respondents reported 

  experiencing traumatic stress symptoms three weeks after the disaster. Women 

  and individuals with greater injury and damage reported greater stress 

  symptoms. Individuals with primary exposure to the earthquake reported higher 

  levels of intrusive and total traumatic stress symptoms than did individuals 

  with secondary exposure. There was no difference in avoidant stress symptoms 

  following primary or secondary exposure. Counselors reported lower levels of 

  avoidant and total stress symptoms than did non-counselors, but there was no 

  difference in intrusive stress symptoms. Non-counselors with primary exposure 

  reported greater total and avoidant symptoms than did counselors with primary 

  exposure, but no difference in intrusive symptoms. There were no differences 

  in reported traumatic stress symptoms among counselors and non-counselors who 

  experienced secondary exposure. Implications for disaster mental health 

  counseling and suggestions for future research are discussed. 

========================================

Title: Mental representations of attachment and caregiving in women sexually 

  abused during childhood:  Links to the intergenerational transmission of 

  trauma?

Author(s)/Editor(s): Fisher, Natalie K.

Source/Citation: Dissertation Abstracts International: Section B: The Sciences 

  & Engineering; Vol 61(2-B) Aug 2000, US: Univ Microfilms International; 

  2000, 1079

Abstract/Review/Citation: Recent empirical studies indicate that children of 

  survivors of childhood sexual abuse are at greater risk of being sexually 

  abused than are children whose mothers have never been abused. Using 

  attachment theory as a foundation, this study explored the relationships 

  between mental representations of attachment and caregiving among women 

  sexually abused during childhood to better understand individual differences 

  in the intergenerational transmission of trauma. The study also looked at how 

  the resolution of trauma and use of dissociative defenses can impact those 

  representations so as to influence variables believed to be related to a 

  child's risk of second-generation sexual abuse.  This was an exploratory, 

  qualitative study that examined whether attachment theory could offer any new 

  perspectives on the intergenerational transmission of trauma between women 

  sexually abused during childhood and their children. Ten women who were 

  sexually abused during childhood by a significant caregiver responded to the 

  Adult Attachment Interview (AAI) and Experiences of Caregiving Interview (CI) 

  in order to examine mental representations of attachment and caregiving. The 

  Traumatic Antecedents Interview (TAI) and Dissociative Experiences Scale (DES) 

  were also administered to look at overall exposure to trauma and current use 

  of dissociative processes.  Several findings from this study were noteworthy 

  and indicate the need for further investigation. First, mental representations 

  of attachment in this study were related to age at onset of the sexual abuse. 

  Women in this sample who were Unresolved with respect to trauma were more 

  likely to have been sexually abused beginning around age 3, while those who 

  displayed organized mental representations of attachment were more likely to 

  be older when the abuse began. Second, a relation was noted between overall 

  exposure to trauma and mental representation of caregiving; however, a lack of 

  correspondence was found between mental representations of past attachments 

  and representations of current caregiving relationships. This suggests that, 

  when in an ongoing relationship, trauma and its associated affects can be 

  evoked and may influence parenting. Use of attachment theory in the 

  interpretation of the findings from this study showed the relevance of using 

  this theoretical framework to help understand individual differences in the 

  intergenerational transmission of trauma. 

========================================

Title: Developing a suicide prevention strategy based on the perspectives of 

  people with brain injuries, .

Author(s)/Editor(s): Kuipers, Pim; Lancaster, Ann

Source/Citation: Journal of Head Trauma Rehabilitation: Special Issue: Vol 

  15(6) Dec 2000, US: Aspen Publishers Inc; 2000, 1275-1284

Abstract/Review/Citation: Examined the development of a community-based strategy 

  regarding suicide risk and prevention. 10 brain injury outreach service 

  clients (mean age 32.2 yrs) with moderate to severe brain injuries and 

  previously exhibiting suicidal orientations and 4 family members completed 

  interviews. Results show that informal relationships played a key role in 

  preventing suicide. While clients emphasized relationships and informal 

  support, family members looked to formal service solutions to prevent suicide. 

  Secondary themes included the potential role of specialist brain injury 

  rehabilitation services in suicide prevention and the need for provision of 

  more information about brain injury to family and friends to promote 

  understanding. 

========================================

Title: Evaluating interventions for children exposed to family violence.

Author(s)/Editor(s): Graham-Bermann, Sandra A.

Source/Citation: Journal of Aggression, Maltreatment & Trauma: Special 

  Issue: Vol 4(1) 2000, US: Haworth Press; 2000, 191-215

Abstract/Review/Citation: This paper presents a critical overview of the state 

  of evaluation research with regard to intervention programs for children who 

  witness family violence. The range and types of programs include universal 

  preventive interventions as well as targeted interventions designed to prevent 

  problems for at-risk children who have observed and experienced violence in 

  their families. While few programs have been assessed to date, a summary of 

  what appear to be the best ways to intervene in the prevention of and 

  aftermath of family violence with children is offered, followed by ten 

  suggestions for improving research in this area. 

========================================

Title: Assessment and intervention for PTSD in children exposed to violence. .

Author(s)/Editor(s): Kerig , Patricia K.; Fedorowicz, Anne E.; Brown, Corina A.; 

Warren, Michelle

Source/Citation: Journal of Aggression, Maltreatment & Trauma: Special 

  Issue: Children exposed to domestic violence: Current issues in research, 

  intervention, prevention, and policy development; Vol 3(1) 2000, US: Haworth 

  Press; 2000, 161-184

Abstract/Review/Citation: Notes that research has established that exposure to 

  domestic violence is a risk factor for posttraumatic stress disorder (PTSD) in 

  children. However, one issue that has been relatively neglected in research 

  conducted to date concerns developmental differences: both in the expression 

  of PTSD symptoms across childhood and adolescence, and in the techniques 

  appropriate for assessing and intervening with PTSD in children at different 

  ages. The available literature was reviewed concerning the conceptualization, 

  measurement, and treatment of PTSD in children, with special attention to the 

  case of children of battered women. Guidelines are provided for 

  developmentally sensitive approaches to assessment and treatment. 

========================================

Title: Trauma and suicide.

Author(s)/Editor(s): Chu, James A.

Source/Citation: The Harvard Medical School guide to suicide assessment and 

  intervention., San Francisco, CA, US: Jossey-Bass Inc, Publishers; 1999, (xiv, 

  704), 332-354

Abstract/Review/Citation: This chapter discusses the relationship between 

  post-traumatic and other types of trauma and acute and chronic suicidal 

  behavior. Topics include: the legacy of chronic traumatization; silent cries: 

  parasuicidal behavior (meanings of self-harming behavior, therapeutic 

  responses to self-harming behavior); suicide intervention with severely 

  traumatized patients (assessing ambivalence concerning suicide, using safety 

  contracts, coping with suicidal impulses, managing crises with suicidal 

  patients); countertransference responses to suicidal trauma patients 

  (overidentification, anger); trauma-related comorbidity and suicide risk; 

  psychopharmacology for trauma-related disorders; and implications for the 

  clinician. 

========================================

Title: Prevention of posttraumatic reactions: Debriefing and frontline treatment.

Author(s)/Editor(s): Neria, Yuval; Solomon, Zahava

Source/Citation: Posttraumatic stress disorder:  A comprehensive text., Needham 

  Heights, MA, US: Allyn & Bacon, Inc; 1999, (xiv, 434), 309-326

Abstract/Review/Citation: In the field of trauma, prevention generally refers to 

  secondary prevention, that is, efforts to keep persons who were exposed to 

  traumatic stress from developing long-term disorders. This chapter focuses on 

  secondary prevention. A brief discussion of the possible outcomes of exposure 

  to traumatic stress is discussed first.  Topics include: reactions to 

  traumatic stress (immediate responses, long-term responses, relationship 

  between acute and long-term stress responses: problems of prediction); 

  prevention of long-term stress reactions (debriefing, effectiveness of 

  debriefing, implications for debriefing research and intervention); and 

  frontline treatment (effectiveness of frontline treatment, implications for 

  research and intervention). 

========================================

Title: Histories of childhood trauma and the effects on risky HIV behaviors in a 

  sample of women drug users.

Author(s)/Editor(s): Medrano, Martha A.; Desmond, David P.; Zule, William A.; Hatch, 

John P.

Source/Citation: American Journal of Drug & Alcohol Abuse; Vol 25(4) Nov 

  1999, US: Marcel Dekker Journals; 1999, 593-606

Abstract/Review/Citation: A cross-sectional study was conducted to examine the 

  association between childhood trauma and current HIV risk behaviors of 181 

  active illicit-drug-using women (aged 18+ yrs) in San Antonio, Texas. Ss were 

  given a Risk Behavior Assessment (R. Needle et al, 1995) which included 

  sections on sociodemographics, injection behavior, sexual behavior, drug use, 

  drug treatment, health problems, and criminal history. The Childhood Trauma 

  Questionnaire (D. P. Bernstein et al, 1994) was used to quantify five types of 

  childhood trauma: physical and/or emotional abuse, physical and/or emotional 

  neglect, and sexual abuse. The authors found very few statistically 

  significant associations, which could be explained by (a) childhood trauma 

  subtypes not being mutually exclusive, (b) clustering of mild-to-severe forms 

  of abuse, and (c) childhood trauma having an indirect, rather than direct, 

  effect on HIV risk behavior. Public health implications from this study are 

  that prevention programs need to consider past and current individual and 

  environmental factors that influence HIV sexual risk behaviors in women drug 

  users. 

========================================

Title: Traumatic grief:  Diagnosis, treatment, and prevention.

Author(s)/Editor(s): Jacobs, Selby C.

Source/Citation: Philadelphia, PA, US: Brunner/Mazel, Inc; 1999, (xix, 112) The 

  series in trauma and loss.

Abstract/Review/Citation: Traumatic Grief is an emerging disorder. Conceptually, 

  the loss of an intimate exposes the afflicted person to a higher risk for 

  several types of psychiatric disorders. In addition to potential 

  complications, including major depression, the existence of pathologic forms 

  of grief cannot be denied. S. Jacobs introduces the term Traumatic Grief as a 

  descriptor of this diagnostic entity, and develops the concept as a new 

  nosologic entity. Diagnostic criteria, descriptive features, and the clinical 

  course of Traumatic Grief are detailed. The treatment literature is reviewed, 

  and a diagnosis and treatment algorithm is presented, based on the author's 

  experience in the treatment of clinical complications of bereavement. The 

  epidemiology, social and cultural variation, and the prevention of Traumatic 

  Grief are also discussed.  Using this book, professional 

  caregivers--psychiatrists, clinical psychologists, social workers, nurse 

  clinicians, bereavement counselors, and students in these fields--will be 

  better able to identify Traumatic Grief and utilize a framework for 

  professional help and prevention. 

Notes/Comments: Preface Acknowledgments Attachment behavior and theory Definition 

of traumatic grief as a disorder Diagnosis of traumatic grief Comorbidity: Psychiatric 

disorders associated with traumatic grief Treatment of traumatic grief A diagnosis/treatment 

  algorithm for traumatic grief Epidemiology and prevention of traumatic grief 

  Conclusion and future directions diagnosis & treatment & prevention of 

  traumatic grief, bereaved patients

========================================

Title: Police trauma:  Psychological aftermath of civilian combat.

Author(s)/Editor(s): Violanti, John M.; Paton, Douglas

Source/Citation: Springfield, IL, US: Charles C Thomas, Publisher; 1999, (xxiv, 327)

Abstract/Review/Citation: This book focuses on the psychological impact of 

  police civilian combat. During a police career, the men and women of our 

  police agencies are exposed to distressing events that go far beyond the 

  experience of the ordinary citizen. There is an increased need today to help 

  police officers deal with these traumatic experiences. As police work becomes 

  increasingly complex, this need will grow. Mental health and other 

  professionals need to be made aware of the conditions and precipitants and 

  trauma stress among the police. A goal of this books it to provide such 

  information.  Our perspective in this book is based on the idea that trauma 

  stress does not necessarily occur within the vacuum of the individual. 

  Instead, trauma is a product of the rather complex interaction of person, 

  place, situation, support mechanisms, and interventions. To effectively 

  communicate this to the reader, we included some new conceptual and 

  methodological considerations, essays on special cases and groups in policing, 

  and innovative ideas on recovery and treatment of trauma. Our hope is that 

  this information will be used to prevent or minimize trauma stress in police 

  officers and, if this is not possible, that it be used to help in establishing 

  improved support and therapeutic measures for police officers. 

Notes/Comments: Preface Introduction Police 

  trauma: Psychological impact of civilian combat Section I: Conceptual and 

  methodological issues Assessment, conceptual and methodological issues in 

  researching traumatic stress in police officers Douglas Paton and Leigh Smith 

  Police officers and violent crime: Social psychological perspectives on impact 

  and recovery Malcolm D. MacLeod and Douglas Paton Police compassion fatigue 

  (PCF): Theory, research, assessment, treatment, and prevention Charles R. 

  Figley Police psychological burnout and trauma Cedric Alexander Vulnerability 

  to psychological disorder: Previous trauma in police recruits Christine 

  Stephens, Nigel Long and Ross Flett Chronic exposure to risk and trauma: 

  Addiction and separation issues in police officers Douglas Paton, John 

  Violanti and Eugene Schmuckler Trauma in police work: A psychosocial model 

  John Violanti Section II: Special police populations Effects of exposure to 

  violence in South African police Heidi Kopel and Merle Friedman The emotional 

  aftermath of the Waco raid: Five years revisited Roger M. Solomon and Peter 

  Mastin Incident response and recovery management Douglas Paton, Rhona Flin and 

  John Violanti Death on duty: Police survivor trauma John M. Violanti Impact of 

  duty-related death on officers children: Concepts of death, trauma reactions, 

  and treatment Mary Beth Williams Intergenerational legacies of trauma in 

  police families Yael Danieli Trauma of world policing: Peacekeeping duties 

  Clay Foreman and Liisa Eraenen Section III: Recovery and treatment Trauma 

  prevention in the line of duty Joseph M. Rothberg and Kathleen Wright Coping 

  effectiveness and occupational stress in police officers George T. Patterson 

  Finding meaning in police traumas Ingrid V. E. Carlier Police suicide: The 

  ultimate stress reaction Robert Loo A current view from the UK on post 

  incident care: "Debriefing," "defusing" and just talking 

  about it Margaret Mitchell Post-intervention strategies to reduce police 

  trauma: A paradigm shift Chris Dunning Trauma stress in policing: Issues for 

  future consideration Douglas Paton and John M. Violanti Appendix Compassion 

  satisfaction/fatigue self-test for helpers Author index Subject index role of 

  person & place & situation & support mechanisms & 

  interventions in & treatment of stress related trauma, police officers

========================================

Title: Trauma, substance use, and HIV risk among urban American Indian women.

Author(s)/Editor(s): Walters, Karina L.; Simoni, Jane M.

Source/Citation: Cultural Diversity & Ethnic Minority Psychology: Special 

  Issue: HIV/AIDS and ethnic minority women, families, and communities. Vol 

  5(3) Aug 1999, US: Educational Publishing Foundation; 1999, 236-248

Abstract/Review/Citation: A survey of 68 American Indian women (aged 18-75 yrs) 

  in New York City--aimed to inform community based HIV prevention 

  approaches--revealed that respondents indicated generally high levels of HIV 

  knowledge and self-efficacy for safer behavior and low levels of perceived 

  risk. Few had ever injected drugs, and 54% had been tested for HIV. However, 

  38% had used alcohol or other drugs in the last 6 months, and among the 59% 

  who reported sexual activity in this period, 80% had had unprotected sex. 

  Alarmingly, 44% reported lifetime trauma, including domestic violence (25%) 

  and physical (27%) or sexual (27%) assault by a family member or stranger. 

  Consistent with a postcolonial theoretical framework, trauma was a better 

  predictor of HIV risk behavior than social cognitive variables. Moreover, 

  preliminary logistic regression analyses indicated the use of alcohol or other 

  drugs may mediate the relationship between nonpartner sexual assault and 

  sexual risk behaviors. Implications for future research and culturally 

  relevant community-based interventions are considered. 

========================================

Title: Cycle helmet effectiveness in New Zealand.

Author(s)/Editor(s): Povey, L. J.; Frith, W. J.; Graham, P. G.

Source/Citation: Accident Analysis & Prevention; Vol 31(6) Nov 1999, United 

  Kingdom: Elsevier Science Inc/Pergamon; 1999, 763-770

Abstract/Review/Citation: Since late 1989, the cycle helmet wearing (CHW) rate 

  in New Zealand has risen from around 20% for adults and teenagers, and 40% for 

  younger children, to more than 90% in all age groups. CHW became mandatory 

  under New Zealand law in January 1994. This paper considers the effect of CHW 

  on hospitalized head injuries between 1990 and 1996, using cyclist limb 

  injuries as a measure of exposure to the risk of cycling trauma. Non-motor 

  vehicle crashes were treated separately from those involving a motor vehicle. 

  Non-motor vehicle crashes were further subdivided by age group (5-12, 13-18, 

  and 19+ yr olds). Cyclist head injuries decreased with increasing CHW rates 

  for non-motor vehicle crashes in all age groups, and for motor vehicle 

  crashes. For an increase of 5 percentage points in the CHW rate, the 

  corresponding decreases in head injuries in non-motor vehicle accidents were 

  estimated to be 10.2, 5.3, and 3.2% for children of primary school age, 

  secondary school age, and adults, respectively. The corresponding decrease in 

  hospitalizations for motor vehicle crashes was 3.6%. The relatively large 

  increase in CHW associated with the passing of a compulsory CHW law in 1994 

  reduced head injuries by between 24 and 32% in non-motor vehicle crashes, and 

  by 20% in motor vehicle crashes. 

========================================

Title: Comment prevenir l'apparition d'un trouble de stress post-traumatique 

  avant un traumatisme./ How to prevent the onset of posttraumatic stress 

  disorder before trauma occurs?

Author(s)/Editor(s): Melancon, Geoffroy; Boyer, Richard

Source/Citation: Canadian Journal of Psychiatry; Vol 44(3) Apr 1999, Canada: 

  Canadian Psychiatric Assn; 1999, 253-258

Abstract/Review/Citation: Attempted to provide an update on methods of 

  preventing the onset of PTSD before trauma occurs. Methods and resources used 

  for this article included survey and analysis of literature found mainly in 

  Medline, PsycINFO, and Pilot databases. The authors indicate that most 

  research focuses on identifying risk factors and reinforcing individual 

  resistance as the prime means of preventing PTSD. It is argued that the 

  severity of the trauma is the most serious risk factor. The authors continue 

  that to reinforce resistance and prevent the onset of PTSD, the army has 

  favored psychoeducational approaches. However, the literature survey performed 

  for this article found no pretrauma prevention program for other high-risk 

  occupations. The authors suggest that the usefulness of identified risk 

  factors for the primary prevention of PTSD is limited, since, it is argued, 

  with the exception of the trauma itself, these factors play a minor role in 

  the onset of severe PTSD. The authors conclude that other methods of primary 

  prevention (pretrauma) of PTSD that could be researched include possible 

  protection factors, the influence of genetic makeup and of biological 

  variables, the cumulative effects of exposure to stressors, and the presence 

  of chronic stressors. 

========================================

Title: Secret-keeping behaviors in Black and White children as a function of 

  interviewer race, racial identity, and risk for abuse.  .

Author(s)/Editor(s): Dunkerley, Glorious K.; Dalenberg, Constance J.

Source/Citation: Journal of Aggression, Maltreatment & Trauma: Special 

  Issue: Vol 2(2) 1999, US: Haworth Press; 1999, 13-35

Abstract/Review/Citation: The tendency for children to keep the secret of child 

  abuse is an important practical impediment to adequate research, prevention, 

  assessment, and treatment. While some studies have established that children 

  will readily keep adult secrets, few have investigated the predictors of ease 

  of disclosure. This study used 4 female graduate students (2 Black and 2 

  White) and 4 male graduate students (2 Black and 2 White) to interview and 

  request secrets from 128 children aged 6-11 yrs who varied in race (51 Black, 

  43 Caucasian, and 34 Biracial, Hispanic or Asian children). Results show that 

  race of the interviewer requesting the secret strongly affected disclosure, 

  with Black children particularly showing an unwillingness to disclose a 

  negative secret to a different race interviewer. Children at high risk for 

  sexual abuse (as assessed by the D. Finkelhor checklist) also were more likely 

  to keep the secret. 

========================================

Title: A risk profile of emergency room adult trauma victims: Intentional versus 

  unintentional trauma injuries.

Author(s)/Editor(s): Brown, Karin A. Elliott; Brown, James R.; Kennedy, Frank; Fleming, 

Arthur W.

Source/Citation: Social Work in Health Care; Vol 27(2) 1998, US: Haworth Press 

  Inc; 1998, 69-86

Abstract/Review/Citation: Presents a prospective study of 285 adult trauma 

  victims admitted to a Los Angeles inner-city level 1 trauma center, from 

  November 1991 to February 1992. The purpose of this study was to determine the 

  magnitude of intentional and unintentional trauma injuries and to identify 

  sociodemographic, lifestyle, and medical risk factors predisposing patients to 

  intentional vs unintentional trauma injury. Chi-square analysis revealed that 

  intentional trauma victims and unintentional trauma victims significantly 

  differed in 8 of 13 risk factors. The resulting risk profile indicated that 

  intentional trauma victims were more likely to be between the ages of 16-29 

  yrs old; African American males; and more likely to present to the emergency 

  room with injury severity scores higher than 15 (indicating severe injuries) 

  than unintentional trauma victims. Strategies for prevention and medical 

  social work intervention are discussed. 

Risk Prevention and Trauma II

Title: Appraisal, coping, social support, and posttraumatic stress of trauma 

  patients one week following accidental injury.

Author(s)/Editor(s): Tsay, Shiow-Luan

Source/Citation: Dissertation Abstracts International: Section B: The Sciences 

  & Engineering; Vol 58(8-B) Feb 1998, US: Univ. Microfilms International; 

  1998, 4149

Abstract/Review/Citation: The purposes of the study are to test relationships 

  among injury appraisals, coping, social support and outcomes of coping 

  efficacy, mood states, and post-traumatic stress; and to test the interaction 

  effects of coping and social support on the relationship of stress and 

  outcomes in the traumatically injured individual one week following accidental 

  injury. The conceptual model for the study is primary derived from the stress 

  and coping theory which includes major components of stress appraisals, 

  coping, social support, and outcomes. A sample of 152 hospitalized trauma 

  patients a week following accidental injury were recruited from two trauma 

  centers. The measures included the injury appraisal of perceived stressor, 

  perceived stressfulness, perceived controllability, and perceived injury 

  severity; the modified Ways of Coping Scale (WCS); the brief Social Support 

  Questionnaire (SSQ); the brief Profile of Mood State (POMS); the Impact of 

  Event Scale (IES); and selected demographic and injury related variables. Data 

  were analyzed by multivariate statistics. The results indicated that perceived 

  controllability (beta=.17, p<.01), satisfaction with social support 

  (beta=.27, p<.01), wishful thinking (beta=-.33, p<.01), and 

  problem-focused coping (beta=.23, p<.01), were the significant predictors 

  for coping efficacy; perceived stressfulness (beta=.33, p<.01), 

  problem-focused coping (beta=-.19, p<.01), and wishful thinking (beta=.47, 

  p<.01), explained a significant amount of variance in mood states; and 

  avoidance coping (beta=.42, p<.01), and wishful thinking (beta=.23, 

  p<.01), were the significant predictors for post-traumatic stress. The 

  moderating effects of emotion-focused coping at high and medium levels were 

  identified as the underlying mechanism that affects coping efficacy by 

  enhancing negative effect of stress on outcome. No buffering effects of social 

  support were identified in the study. These findings can be used to identify 

  traumatically injured patients who are at risk for mood disturbance and 

  post-traumatic stress in the trauma center. Nursing interventions to address 

  these factors can be developed and tested. Longitudinal studies are needed for 

  understanding the mechanism of relationships among appraisals, coping, social 

  support and outcomes of coping efficacy, mood states, and post-traumatic 

  stress. 

========================================

Title: Resourceful partners: Patterns of attachment and depression among breast 

  cancer patients and their partners.

Author(s)/Editor(s): Cohen, Marie Seren

Source/Citation: Dissertation Abstracts International: Section B: The Sciences 

  & Engineering; Vol 59(1-B) Jul 1998, US: Univ. Microfilms International; 

  1998, 0413

Abstract/Review/Citation: Research indicates high levels of marital resources 

  support recovery from individual depression and 'buffer' partners at risk of 

  depression following negative life events. Marital treatments of depression 

  provide greater efficacy than individual therapies when marital factors are 

  relevant. This body of research is useful for treatment of individual 

  depression following the medical trauma of breast cancer diagnosis and 

  treatment. Research historically emphasized the patient but spousal and 

  marital variables are now considered critical factors in recovery among breast 

  cancer patients. The present study tests a model called 'The Resourceful 

  Partner' (RP), a construct which specifies marital factors (i.e., mastery, 

  attachment, resilience) hypothesized to reduce vulnerability to depression 

  following medical trauma. The RP model was operationalized in a clinical 

  assessment scale and tested among a sample of 37 couples (N = 74) coping with 

  breast cancer diagnosis and treatment. Findings indicate the RP scale predicts 

  psychological distress more effectively than a general marital satisfaction 

  scale. Higher levels of marital resources, as defined by the RP model, were 

  associated with lower levels of psychological distress and higher levels of 

  patient rehabilitation when measured by a disease-specific, behavioral measure 

  designed for breast cancer patients (CARES). Results also supported hypotheses 

  based on attachment theory. Subjects reporting 'secure' attachment styles 

  reported higher levels of rehabilitation and lower levels of psychological 

  distress than subjects reporting 'insecure' attachment styles. Findings 

  indicate that the RP model could improve clinical assessment and treatment of 

  psychological needs among breast cancer patients and their spouses during 

  periods following diagnosis and treatment. 

========================================

Title: Children's reactions to hurricane andrew: A forty-four month follow-up 

  study.

Author(s)/Editor(s): Vincent, Nicole Renee

Source/Citation: Dissertation Abstracts International: Section B: The Sciences 

  & Engineering; Vol 59(2-B) Aug 1998, US: Univ. Microfilms International; 

  1998, 0891

Abstract/Review/Citation: Little is known about children's long-term adjustment 

  following a disaster. Thus, the current study was conducted as a 44-month 

  follow-up investigation, examining children's reactions to Hurricane Andrew 

  over time. Previous data collection was conducted at 3, 7, and 10 months 

  post-hurricane with a sample of 442 children. Subjects at follow-up were a 

  subset of the original sample, consisting of 43 children who had continued to 

  report high levels of PTSD symptomatology 10 months post-hurricane. At 

  follow-up, children were in grades six through eight at various South Florida 

  schools. The first objective was to examine the persistence of children's PTSD 

  symptomatology (total symptoms, symptom cluster scores, full PTSD diagnosis) 

  utilizing multi-method (questionnaire and structured interview), 

  multi-informant (both child- and parent-report) assessment. The second 

  objective was to utilize an established conceptual model to examine factors 

  related to the persistence of children's symptomatology. Factors in the model 

  include exposure to disaster-related traumatic experiences, pre-existing child 

  characteristics (age, gender, ethnicity), aspects of the post-disaster 

  recovery environment (social support, intervening life events, parents' PTSD 

  symptomatology), and the child's coping strategies. Results indicated that a 

  surprising number of children continued to report severe symptomatology 44 

  months after Hurricane Andrew; sixteen children (40%) continued to qualify for 

  a full PTSD diagnosis. Re-experiencing symptoms were most frequently endorsed 

  (92.5%), followed by hyperarousal (80%) and avoidance/psychic numbing symptoms 

  (45%). Child questionnaire and child structured interview responses 

  corresponded highly. However, significant differences were found between 

  parent- and child-report of children's symptomatology (children reported 

  considerably more symptoms). With regard to the conceptual model, ethnic 

  minority children, as well as children who had greater hurricane-related 

  exposure, more recent life events, and/or lower levels of social support at 44 

  months post-hurricane were less likely to evidence decreases in symptomatology 

  over time. Parents' PTSD symptomatology was not significantly related to 

  children's continuing symptomatology. Findings illustrate that a substantial 

  number of children may continue to experience significant long-term 

  disaster-related symptomatology. Further, findings indicated the utility of 

  the conceptual model in predicting children's long-term PTSD symptomatology, 

  and suggested some risk factors for persistence of symptomatology. Potential 

  implications for intervention and future research are discussed. 

========================================

Title: Risk factors associated with posttraumatic stress indicators among middle 

  and senior high school students in Oklahoma City.

Author(s)/Editor(s): Christiansen, Elaine H.

Source/Citation: Dissertation Abstracts International: Section B: The Sciences 

  & Engineering; Vol 59(4-B) Oct 1998, US: Univ. Microfilms International; 

  1998, 1844

Abstract/Review/Citation: The impact of violence on children and adolescents is 

  of growing concern. Increased occurrences of violence as well as the media's 

  increasingly graphic, 'real time' images of traumatic events, have both 

  short-term and long-term, cumulative psychological effects on children and 

  adolescents. The focus of the current investigation was the psychological 

  reactions of students in the middle and senior high schools of the Oklahoma 

  City Public Schools following the April 19, 1995 bombing of the Murrah Federal 

  Building. Self-reported data were collected seven weeks after the bombing from 

  all students in grades 6-12 who chose to participate. A total of 3,218 

  students returned completed questionnaires which included the questions from 

  the Horowitz Impact of Event Scale (IES). Questionnaires were completed during 

  a school class period. Multivariate analysis revealed a number of 

  statistically significant, nonredundant predictors of variability in total 

  posttraumatic stress scores (PTS), as well as its component symptom clusters, 

  arousal, intrusion, and avoidance. Direct exposure, defined as injury or 

  knowing someone injured or killed, accounted for approximately 7% of variance 

  in total PTS. The addition of amount of bombing-related television coverage 

  watched doubled the model's prediction of PTS. Grade level, gender, and 

  retrospective accounts of initial psychological responses were also 

  significant predictors of PTS and the symptom subgroups. Finally, subjects' 

  perceptions of their own personal safety and security seven weeks after the 

  bombing accounted for additional nonredundant variability in PTS and the 

  symptom clusters. The final model accounted for more than one-third of 

  variability in total PTS $(R)m (Rp2badj. = .38),$ arousal $(R)m Rp2badj. = 

  .32),$ and intrusion $(R)m (Rp2badj. = .36).$ The amount of variability in the 

  avoidance symptom cluster was somewhat lower $(R)m (Rp2badj = .20).$ Restoring 

  or improving children and adolescents' perceptions of their personal safety, 

  stability of social support and systems, and personal control are critical 

  elements which must be addressed by post-trauma interventions. The results of 

  this investigation suggest that additional research is warranted to better 

  understand ways in how best to mitigate the psychological impact of trauma on 

  children and adolescents. 

========================================

Title: Posttraumatic Stress Disorder among firearm assault survivors: Risk and 

  resiliency factors in recovery from violent victimization.

Author(s)/Editor(s): Burnette, Sherry

Source/Citation: Dissertation Abstracts International: Section B: The Sciences 

  & Engineering; Vol 59(6-B) Dec 1998, US: Univ. Microfilms International; 

  1998, 3049

Abstract/Review/Citation: Firearm violence in the United States has reached 

  epidemic proportions, and yet little is known about the psychosocial impact of 

  firearm assault on its survivors. This study set out to: (1) determine the 

  rate of chronic Posttraumatic Stress Disorder (PTSD), and (2) to identify 

  pre-assault factors, assault characteristics, and factors in the post-assault 

  recovery environment that serve as risk or protective factors for the 

  development of PTSD in a sample of firearm assault survivors. In addition, a 

  qualitative analysis drew upon in-depth interviews with six firearm assault 

  survivors about their recovery experience. Fifty-five firearm assault 

  survivors recruited from an urban trauma center completed a number of measures 

  assessing pre-assault factors, assault characteristics, factors in the 

  post-assault recovery environment, and PTSD symptomatology. Fifty-eight 

  percent of the sample met full diagnostic criteria for PTSD 3 to 36 months 

  post-assault. Hierarchical multiple regression analysis supported a model in 

  which negative change of outlook, assault severity, and adopting safeguarding 

  behaviors served as risk factors for the presence of PTSD after firearm 

  assault; while social support operated as a resiliency factor protecting 

  individuals from development of PTSD after severe violent victimization. 

  Qualitative analysis revealed a number of commonalities in the recovery 

  experience for both impaired and resilient survivors. The findings suggest 

  that firearm assault survivors are at high risk for the development of chronic 

  PTSD. Further, the use of a high-risk screening tool that assesses risk and 

  protective factors for the development of chronic PTSD may have important 

  clinical applications in identifying victims most in need of clinical intervention. 

========================================

Title: Evaluation design for a community prevention trial: An environmental 

  approach to reduce alcohol-involved trauma.

Author(s)/Editor(s): Holder, Harold D.; Saltz, Robert F.; Treno, Andrew J.; Grube, 

Joel W.; Voas, Robert B.

Source/Citation: Evaluation Review: Special Issue: Evaluation design for a 

  community trial to reduce alcohol-involved trauma: An environmental approach 

  to prevention.; Vol 21(2) Apr 1997, US: Sage Publications Inc; 1997, 140-165

Abstract/Review/Citation: Describes the evaluation approach used in the 

  Community Prevention Trial, a 5-yr effort to reduce alcohol-involved injuries 

  and death through a comprehensive program of community awareness and policy 

  activities. Three experimental communities and matched comparison communities 

  of approximately 100,000 in population were studied. The project implemented 

  and evaluated community based activities in 5 areas: community knowledge, 

  values, and mobilization; responsible beverage service, underage drinking; 

  risk of drinking and driving; access to alcohol. This evaluation approach 

  demanded unique procedures for determining overall community aggregate 

  effects, that is, distal outcomes, as well as changes in key mediating 

  variables, that is, process effects. The problem of trending and lagged 

  effects of community prevention programs are discussed. 

========================================

Title: Documenting community-level outcomes: Lessons from drinking and driving.

Author(s)/Editor(s): Voas, Robert B.; Lange, James; Treno, Andrew J.

Source/Citation: Evaluation Review: Special Issue: Evaluation design for a 

  community trial to reduce alcohol-involved trauma: An environmental approach 

  to prevention.; Vol 21(2) Apr 1997, US: Sage Publications Inc; 1997, 191-208

Abstract/Review/Citation: Contrasts the demographic characteristics of 

  automobile operators who drive on Friday and Saturday evenings with those who 

  do not, through the comparison of data from 2 of the most widely used methods 

  for gathering information on drinking and driving: Random Digit Dialing 

  Telephone Surveys and Roadside Voluntary Breath Test Surveys. Roadside surveys 

  set up at locations where alcohol-related crashes occur provide a better 

  sample of those drivers most at risk of crash involvement. Telephone surveys, 

  because they do not generally measure the exposure of drivers both in the 

  location of driving and the number of miles driven, are less suited to 

  identifying the drivers at risk. However, they highlight the large number of 

  individuals who drive during high-risk times but avoid high-risk locations. 

========================================

Title: Sexual, physical, and emotional abuse in out-of-home care: Prevention 

  skills for at-risk children.

Author(s)/Editor(s): Johnson, Toni Cavanagh

Source/Citation: Binghamton, NY, US: Haworth Maltreatment and Trauma Press/The 

  Haworth Press, Inc; 1997, (xii, 118)

Abstract/Review/Citation: This book hopes to bring into the open current or past 

  sexually, physically, or emotionally abusive behaviors between children or 

  between children and their caregivers in out-of-home care and to help prevent 

  future victimization. The exercises contained here assist children and 

  caregivers in understanding their rights and others' rights in residential 

  treatment centers and group or foster homes. It presents 20 exercises that 

  focus on: communication on a continuum; a touch continuum; differentiating 

  sexual play from problematic sexual contact between children; personal space 

  and boundaries; sexual knowledge and discovering what a sex offender does to 

  trick children into situations that end up in sexual abuse. It is intended for 

  use by clinicians. 

Notes/Comments:  Associates Acknowledgments Introduction Exploring communication 

  Exploring touch Differentiating between sexual play and sexual abuse Personal 

  space Sexual knowledge Prevention of sexual misuse or abuse References 

  Appendix A: Children's sexual behaviors Appendix B: How to use the behavior 

  chart Appendix C: Worksheets Index sexual & physical & emotional abuse 

  & prevention, at risk children in out of home care

========================================

Title: Women who survived childhood sexual abuse: Do their coping strategies 

  vary by personality type as measured by the Myers-Briggs Type Indicator?

Author(s)/Editor(s): Jahn, Linda

Source/Citation: Dissertation Abstracts International Section A: Humanities 

  & Social Sciences; Vol 57(11-A) May 1997, US: University Microfilms 

  International; 1997, 4659

Abstract/Review/Citation: Through a phenomenological qualitative approach, this 

  study examined possible differences of introverted versus extraverted adult 

  female survivors of childhood sexual abuse with regard to the coping 

  mechanisms they chose. Preference modalities of introversion and extraversion 

  were measured by the Myers-Briggs Type Indicator and data was collected 

  through a semi-structured interview designed by the researcher. The interview 

  contained questions about the 21 subjects' perceptions of their abuse and the 

  ways in which they coped. Specific coping mechanisms included but were not 

  limited to eating disorders, alcohol and/or drug abuse, high risk behavior, 

  depression, anxiety, and somatic complaints. Results indicated that for both 

  groups, the degree to which each of the individual coping mechanisms was used 

  congregated at the level of 'a driven pattern of behavior lasting for at least 

  7 days' or 'on-going use resulting in severe problems'. Extraverts showed 

  higher percentages of severe use of the six coping mechanisms than did 

  introverts. Depression was the most frequently used coping mechanism of both 

  the introverts and the extraverts. Introverts showed higher percentages of 

  stopping the use of eating disorders, alcohol/drug abuse, high risk behavior, 

  and depression. Extraverts had higher percentages of discontinued use of 

  anxiety and somatic problems. Introverts reported more somatic complaints, 

  while extraverts reported more severe somatic problems. The most often 

  reported somatic complaints of both groups were arthritis, migraines, sleep 

  difficulty, nightmares, and gastrointestinal problems. The majority of each 

  group used most of the coping mechanisms at some time, suggesting a need for 

  therapeutic intervention that considers the possibility of difficulties 

  stemming from combined use of many of these coping mechanisms in addition to 

  focusing on the trauma of the sexual abuse itself. 

========================================

Title: Violence prevention through victim assistance: Helping people escape the 

  web of violence.

Author(s)/Editor(s): Friedman, Lucy N.; Tucker, Susan B.

Source/Citation: Victims of crime (2nd ed.)., Thousand Oaks, CA, US: Sage 

  Publications, Inc; 1997, (viii, 294), 183-193

Abstract/Review/Citation: contend that victim services are an important 

  mechanism for freeing people from a "web of violence" / recognizing 

  that victims are at increased risk of experiencing future violence (as either 

  victims or offenders), [the authors] advocate the use of victim services to 

  break the cycle of violence the role of victim assistance [safety and shelter, 

  recovering from trauma, connection to others, economic viability] / helping 

  victims through other social services / working with offenders / victims in 

  violence prevention.

========================================

Title: Adolescent homicide: Towards assessment of risk.

Author(s)/Editor(s): Hardwick, Peter J.; Rowton-Lee, Martyn A.

Source/Citation: Journal of Adolescence; Vol 19(3) Jun 1996, United Kingdom: 

  Academic Press Ltd; 1996, 263-276

Abstract/Review/Citation: Recent murders committed by children and adolescents 

  have raised concern over the detection and management of dangerous youngsters 

  in our society. Yet in the training of child and adolescent mental health 

  professionals the assessment and management of dangerousness to others is 

  frequently given little attention. This paper attempts to begin to redress the 

  balance by reviewing the mental health literature relevant to homicidal 

  children and adolescents. Background and situational factors relevant to risk 

  are described. Background factors include the witnessing of serious violence, 

  both live and on the screen, as well as abuse through neglect and deprivation. 

  Such trauma can assist in the creation of a morbid identity and a cognitive 

  set that make murder possible in certain situations. Other background factors 

  include learning difficulties and problems with impulse control. However even 

  if a youngster is assessed as highly dangerous it is frequently difficult in 

  the current climate to offer adequate intervention. Issues in the prevention 

  of violence are considered. 

========================================

Title: Wounded spirits, ailing hearts: PTSD and related disorders among American 

  Indians.

Author(s)/Editor(s): Manson, Spero; Beals, Janette; O'Nell, Theresa; Piasecki, Joan; 

Bechtold, Donald; Keane, Ellen; Jones, Monica

Source/Citation: Ethnocultural aspects of posttraumatic stress disorder:  

  Issues, research, and clinical applications., Washington, DC, US: American 

  Psychological Association; 1996, (xxii, 576), 255-283

Abstract/Review/Citation: describes ongoing work of the National Center for 

  American Indian and Alaska Native Mental Health Research . . . , which 

  promises to shed light on the nature and extent of trauma among Indian and 

  Native people, from latency-age children to middle-age adults / [describe] 

  the purpose, design, instrumentation, and samples of each of these 4 studies / 

  [highlight] the importance of convergent investigative methods and the need to 

  firmly ground the diagnosis, epidemiology, treatment, and prevention of 

  trauma-related illnesses within the sociocultural contexts that give them 

  meaning / frequency of traumatic events / elicitation of DSM-III-R 

  diagnostic criteria for posttraumatic stress disorder (PTSD) / performance 

  characteristics of screeners and diagnostic interviews / symptomatological 

  patterns / prevalence of PTSD / comorbidity with other disorders / 

  developmental precursors / mediators of risk / functioning and domains of 

  impairment / treatment / prevention / collective representations of and 

  responses to traumatic stress.

========================================

Title: Acute treatments.

Author(s)/Editor(s): Turnbull, Gordon J.; McFarlane, Alexander C.

Source/Citation: Traumatic stress:  The effects of overwhelming experience on 

  mind, body, and society., New York, NY, US: The Guilford Press; 1996, (xxv, 

  596), 480-490

Abstract/Review/Citation: highlights some of the key strategies and principles 

  that can assist clinicians in an approach to patients who have recently been 

  exposed to a traumatic event and require more than a preventive intervention / 

  the assessment and containment of distress are major components of early 

  treatment / the presence of severe dissociative reactions is probably the most 

  common challenge for the clinician dealing with victims of acute trauma / 

  treatments that are effective in the latter stages of posttraumatic stress 

  disorder (PTSD) may not be effective in the immediate postdisaster period, and 

  vice versa / our knowledge of the neurobiology of the acute disorder vs 

  chronic PTSD is in a state of evolution.

========================================

Title: The prevention of posttraumatic stress.

Author(s)/Editor(s): Creamer, Mark

Source/Citation: Early intervention & prevention in mental health., Carlton 

  South VIC, Australia: Australian Psychological Society Ltd; 1996, (xii, 287), 

  229-246

Abstract/Review/Citation: Discusses early-intervention strategies for survivors 

  of traumatic incidents, with the aim of reducing the severity and prevalence 

  of any subsequent psychopathology, specifically posttraumatic stress disorder 

  (PTSD). The unpredictable nature of trauma is such that little time is 

  available for planning intervention; it is hoped that the chapter contains 

  sufficient detail to assist mental health professionals in the provision of 

  early interventions following a range of traumatic incidents and disasters. 

  Additional topics include: the nature of posttraumatic reactions; rationale 

  and conceptualisation; identifying high-risk survivors; and implications for 

  planning interventions. 

========================================

Title: Helping victims of military trauma.

Author(s)/Editor(s): Solomon, Zahava; Shalev, Arieh Y.

Source/Citation: Traumatic stress:  From theory to practice., New York, NY, US: 

  Plenum Press; 1995, (xvii, 402), 241-261 Plenum series on stress and coping.

Abstract/Review/Citation: surveys the available treatment approaches for CSR 

  [combat stress reaction] and posttraumatic stress disorder (PTSD) / reviews. 

  . . 2 approaches taken by the military itself within, or shortly following, 

  the combat situation: (1) debriefing, a preventive approach used to reduce the 

  risk of long-term psychological injury; and (2) frontline treatment, the 

  prevalent mode of dealing with acute CSR in most western armies / present 4 

  major models of PTSD: the biological, the behavioral, the psychodynamic, and 

  the cognitive / discuss the basic theory and assumptions of the treatment 

  modes that follow from [the 4 models], as well as the research that has 

  examined the effectiveness of the therapies / concludes with the observation 

  that treatment results have been partial at best, sometimes alleviating the 

  symptoms but rarely ever effecting a cure / suggest that pharmacotherapy, 

  based on the biological model of PTSD, may be used to facilitate the patient's 

  participation in psychotherapy point out that treatment must address the needs 

  of family members, who suffer along with the combat survivor 

Title: Helping the victims of disasters.

Author(s)/Editor(s): McFarlane, Alexander C.

Source/Citation: Traumatic stress:  From theory to practice., New York, NY, US: 

  Plenum Press; 1995, (xvii, 402), 287-314 Plenum series on stress and coping.

Abstract/Review/Citation: examines the various ways in which mental health 

  professionals can assist in the psychological care and rehabilitation of 

  disaster victims [discusses] the impact of trauma upon clinical judgment and 

  personal well-being of the professional / emphasizes the complex and evolving 

  nature of disasters by recommending that interventions can occur at 5 phases 

  in time ranging from before to following the disaster (planning, threat, 

  inventory and rescue, remedy, recovery) / states that the nature of 

  intervention will change in each time phase / discusses a biopsychosocial 

  model for individual mental health risk or resiliency that can be considered 

  in light of the 5 stages of intervention / appropriate assessment (interview 

  and self-report) and treatment strategies are considered / emphasizes both 

  prevention and treatment / [discusses] the common elements in successful 

  mental health treatment, emphasizing a flexible clinical approach that 

  integrates biological and psychosocial approaches / ends with a series of . 

  . . case examples that illustrate a range of clinical concerns (e.g., brief 

  interventions, control issues, death, family issues, depression, emergency 

  service personnel, and dissociative symptoms) 

Title: Suicide in patients with traumatic brain injury: Risk and prevention.

Author(s)/Editor(s): Klonoff, Pamela S.; Lage, Gustavo A.

Source/Citation: Journal of Head Trauma Rehabilitation; Vol 10(6) Dec 1995, US: 

  Aspen Publishers Inc; 1995, 16-24

Abstract/Review/Citation: Many patients sustaining traumatic brain injury (TBI) 

  experience multiple deficits affecting cognition, personality, and physical 

  independence. Often there is a dramatic and permanent change in work status, 

  income, family life, support network, and quality of life. Clinical experience 

  indicates that this can predispose patients to significant depressive 

  reactions and increased risk of suicide. This article describes clinical 

  evaluation and treatment techniques that attempt to address suicide in TBI 

  patients participating in an outpatient milieu-oriented rehabilitation 

  program. Historical theories and research on suicide are reviewed, and risk 

  factors for TBI and their similarity to suicide are explored. Preliminary 

  clinical findings from a retrospective study of 111 TBI program participants 

  are also provided. 

========================================

Title: The treatment of acute trauma: Post-traumatic stress disorder prevention.

Author(s)/Editor(s): Lundin, Tom

Source/Citation: Psychiatric Clinics of North America; Vol 17(2) Jun 1994, US: 

  W.B. Saunders & Co.; 1994, 385-391

Abstract/Review/Citation: Examines the various treatment strategies for persons 

  experiencing acute trauma. Psychological support, crisis intervention, 

  defusing, debriefing, and other psychotherapeutic methods as well as 

  psychopharmacologic treatment are often needed for victims of disasters or 

  traumatic stress. The 2 most important factors for a proper assessment of the 

  adequate treatment methods are the degree of psychological overdetermination 

  and the degree of traumatization. One of the most important tasks for the 

  psychiatrist in the aftermath of a traumatic stress situation is to identify 

  those victims who are at risk for developing PTSD or other types of 

  stress-related psychic or psychosomatic disorders. 

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