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      Basic safety first: trauma-informed care in a hostile environment

      editorial
      Author(s): 1 , 2
      Publication date (Electronic, pub):
      Journal: BJPsych Bulletin
      Publisher: Cambridge University Press
      Keywords: Trauma, post-traumatic stress disorder, asylum seeker, refugees

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          Summary

          This editorial introduces and reflects on a Praxis article in the trainees' section of this issue. The article, 'Assessing asylum seekers, refugees and undocumented migrants' by Waterman et al, begins with a clinical scenario describing an emergency presentation at a ‘place of safety’. The authors are to be congratulated for navigating a compassionate path through the complexities of law, health and new diagnostic categories. The resources found in the article, drawing on the principles of trauma-informed care and the work of Judith Herman, can help trainees to be more confident in promoting the basic rights of survivors of trauma, which might form a first step in the re-establishment of trust and empowerment.

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          National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviors in England

          Mark Bellis, Karen Hughes, Nicola Leckenby … (2014)
          Background Epidemiological and biomedical evidence link adverse childhood experiences (ACEs) with health-harming behaviors and the development of non-communicable disease in adults. Investment in interventions to improve early life experiences requires empirical evidence on levels of childhood adversity and the proportion of HHBs potentially avoided should such adversity be addressed. Methods A nationally representative survey of English residents aged 18 to 69 (n = 3,885) was undertaken during the period April to July 2013. Individuals were categorized according to the number of ACEs experienced. Modeling identified the proportions of HHBs (early sexual initiation, unintended teenage pregnancy, smoking, binge drinking, drug use, violence victimization, violence perpetration, incarceration, poor diet, low levels of physical exercise) independently associated with ACEs at national population levels. Results Almost half (47%) of individuals experienced at least one of the nine ACEs. Prevalence of childhood sexual, physical, and verbal abuse was 6.3%, 14.8%, and 18.2% respectively (population-adjusted). After correcting for sociodemographics, ACE counts predicted all HHBs, e.g. (0 versus 4+ ACEs, adjusted odds ratios (95% confidence intervals)): smoking 3.29 (2.54 to 4.27); violence perpetration 7.71 (4.90 to 12.14); unintended teenage pregnancy 5.86 (3.93 to 8.74). Modeling suggested that 11.9% of binge drinking, 13.6% of poor diet, 22.7% of smoking, 52.0% of violence perpetration, 58.7% of heroin/crack cocaine use, and 37.6% of unintended teenage pregnancy prevalence nationally could be attributed to ACEs. Conclusions Stable and protective childhoods are critical factors in the development of resilience to health-harming behaviors in England. Interventions to reduce ACEs are available and sustainable, with nurturing childhoods supporting the adoption of health-benefiting behaviors and ultimately the provision of positive childhood environments for future generations.
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            PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania

            Thanos Karatzias, Marylene Cloitre, Andreas Maercker … (2018)
            ABSTRACT The 11th revision to the World Health Organization’s International Classification of Diseases (ICD-11) proposes two distinct sibling conditions: Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). In this paper, we aim to provide an update on the latest research regarding the conceptual structure and measurement of PTSD and CPTSD using the International Trauma Questionnaire (ITQ) as per ICD-11 proposals in the USA, UK, Germany and Lithuania. Preliminary findings suggest that CPTSD is common in clinical and population samples, although there may be variations across countries in prevalence rates. In clinical samples, preliminary evidence suggests that CPTSD is a more commonly observed condition than PTSD. Preliminary evidence also suggests that the ITQ scores are reliable and valid and can adequately distinguish between PTSD and CPTSD. Further cross-cultural work is proposed to explore differences in PTSD and CPTSD across different countries with regard to prevalence, incidence, and predictors of PTSD and CPTSD.
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              Maternal PTSD associates with greater glucocorticoid sensitivity in offspring of Holocaust survivors.

              Vincent Passarelli, Zoey Harris, A Bedi … (2014)
              Intergenerational effects of trauma have been observed clinically in a wide range of populations, and parental PTSD has been associated with an increased risk for psychopathology in offspring. In studies of Holocaust survivor offspring, parental PTSD, and particularly maternal PTSD, has been associated with increased risk for PTSD, low basal urinary cortisol excretion and enhanced cortisol suppression in response to dexamethasone. Such findings implicate maternally derived glucocorticoid programming in the intergenerational transmission of trauma-related consequences, potentially resulting from in utero influences or early life experiences. This study investigated the relative influence of Holocaust exposure and PTSD in mothers and fathers on glucocorticoid sensitivity in offspring. Eighty Holocaust offspring and 15 offspring of non-exposed Jewish parents completed evaluations and provided blood and urine samples. Glucocorticoid sensitivity was evaluated using the lysozyme suppression test (LST), an in vitro measure of glucocorticoid receptor sensitivity in a peripheral tissue, the dexamethasone suppression test (DST), and 24-h urinary cortisol excretion. Maternal PTSD was associated with greater glucocorticoid sensitivity in offspring across all three measures of glucocorticoid function. An interaction of maternal and paternal PTSD on the DST and 24-h urinary cortisol showed an effect of decreased glucocorticoid sensitivity in offspring with paternal, but not maternal, PTSD. Although indirect, these findings are consistent with the hypothesis that epigenetic programming may be involved in the intergenerational transmission of trauma-related effects on glucocorticoid regulation. Published by Elsevier Ltd.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BJPsych Bull
                Journal ID (iso-abbrev): BJPsych Bull
                Journal ID (publisher-id): BJB
                Title: BJPsych Bulletin
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Print): 2056-4694
                ISSN (Electronic): 2056-4708
                Publication date (Print, pub): April 2020
                Publication date (Electronic, pub): 30 March 2020
                Volume: 44
                Issue: 2
                Pages: 41-43
                Affiliations
                [1 ]East London NHS Foundation Trust , UK
                [2 ]Barts and the London School of Medicine , UK
                Author notes

                Declaration of interest None.

                Correspondence to Dr Cate Bailey ( cate.bailey@ 123456nhs.net )

                See this issue.

                Author information
                https://orcid.org/0000-0003-2719-8558
                Article
                Publisher Item ID: S2056469419000913
                DOI: 10.1192/bjb.2019.91
                PMC ID: 7283123
                PubMed ID: 32223785
                SO-VID: 149bb038-406c-48f8-a3b5-b149074cbcc1
                Copyright © © The Author 2020
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 December 2019
                Date accepted : 18 December 2019
                Page count
                References: 20, Pages: 3
                Categories
                Subject: Editorial

                Keywords: trauma,post-traumatic stress disorder,asylum seeker,refugees
                Data availability:
                Keywords: trauma, post-traumatic stress disorder, asylum seeker, refugees

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