Post-traumatic stress الصدمة

فَلَمَّا ذَهَبَ عَنۡ إِبۡرَٰهِيمَ ٱلرَّوۡعُ وَجَآءَتۡهُ ٱلۡبُشۡرَىٰ يُجَٰدِلُنَا فِي قَوۡمِ لُوطٍ

Then, when the fear left Abraham and the good news came to him, he pleaded with Us for Lot’s people

وَزُرُوعࣲ وَنَخۡلࣲ طَلۡعُهَا هَضِيمࣱ‏

fields, palm trees laden with fruit

وَزُرُوعࣲ وَمَقَامࣲ كَرِيمࣲ‏

many a cornfield and noble building

وَلَمَّا بَلَغَ أَشُدَّهُۥٓ ءَاتَيۡنَٰهُ حُكۡمࣰ ا وَعِلۡمࣰ اۚ وَكَذَٰلِكَ نَجۡزِي ٱلۡمُحۡسِنِينَ

When he reached maturity, We gave him judgement and knowledge: this is how We reward those who do good

وَلَا تَقۡرَبُواْ مَالَ ٱلۡيَتِيمِ إِلَّا بِٱلَّتِي هِيَ أَحۡسَنُ حَتَّىٰ يَبۡلُغَ أَشُدَّهُۥۚ وَأَوۡفُواْ بِٱلۡعَهۡدِۖ إِنَّ ٱلۡعَهۡدَ كَانَ مَسۡـُٔولࣰ ا

Do not go near the orphan’s property, except with the best [intentions], until he reaches the age of maturity. Honour your pledges: you will be questioned about your pledges

وَلَا تَقۡرَبُواْ مَالَ ٱلۡيَتِيمِ إِلَّا بِٱلَّتِي هِيَ أَحۡسَنُ حَتَّىٰ يَبۡلُغَ أَشُدَّهُۥۚ وَأَوۡفُواْ ٱلۡكَيۡلَ وَٱلۡمِيزَانَ بِٱلۡقِسۡطِۖ لَا نُكَلِّفُ نَفۡسًا إِلَّا وُسۡعَهَاۖ وَإِذَا قُلۡتُمۡ فَٱعۡدِلُواْ وَلَوۡ كَانَ ذَا قُرۡبَىٰۖ وَبِعَهۡدِ ٱللَّهِ أَوۡفُواْۚ ذَٰلِكُمۡ وَصَّىٰكُم بِهِۦ لَعَلَّكُمۡ تَذَكَّرُونَ

Stay well away from the property of orphans, except with the best [intentions], until they come of age; give full measure and weight, according to justice’- We do not burden any soul with more than it can bear- ‘ when you speak, be just, even if it concerns a relative; keep any promises you make in God’s name. This is what He commands you to do, so that you may take heed’

And when the awe the fear departed from Abraham and the good tiding came to him of a child he began to plead with Us pleading with Our messengers concerning the matter of the people of Lot.

Then when the fear had gone away from (the mind of) Ibrahim, and the glad tidings had reached him, he began to plead with Us (Our messengers) for the people of Lut (74)Verily, Ibrahim was, without doubt, forbearing, used to invoke Allah with humility, and was repentant (75)"O Ibrahim! Forsake this. Indeed, the commandment of your Lord has gone forth. Verily, there will come a torment for them which cannot be turned back. (76) The Dispute of Ibrahim over the People of Lut Allah, the Exalted, informs of what happened after the fright of Ibrahim left him and he felt no more fear of the angels when they refused to eat. After this, they gave him the glad tidings of the birth of a son and the destruction of the people of Lut. When they told him of this, he spoke to them as Sa'id bin Jubayr narrated concerning this verse. Sa'id said: When Jibril and the other angels who were with him came to

and farms and date palms with slender delicate and tender spathes?

as well as sown fields and many a glorious residence many a splendid court

"Will you be left secure in that which you have here? (146)"In gardens and springs. (147)"And crops and date palms with soft clusters. (148)"And you hew out in the mountains, houses with great skill. (149)"So, have Taqwa of Allah, and obey me. (150)"And follow not the command of the extravagant, (151)Who make mischief in the land, and reform not. (152) A Reminder to Them of Their Circumstances and the Blessings They Enjoyed Salih preached to them, warning them that the punishment of Allah could overtake them and reminding them of the blessings that Allah had bestowed upon them, by giving them ample provision and making them safe from all kinds of dangers, giving them gardens and flowing springs, and bringing forth for them crops and fruits. وَنَخْلٍ طَلْعُهَا هَضِيمٌ (and date palms with soft clusters.) Al-'Awfi narrated from Ibn 'Abbas, "Ripe and rich." 'Ali bin Abi Talhah narrated

And indeed We tried before them Fir'awn's people, when there came to them a noble Messenger (17)Saying: "Deliver to me the servants of Allah. Verily, I am to you a Messenger worthy of all trust. (18)"And exalt not yourselves against Allah. Truly, I have come to you with a manifest authority. (19)"And truly, I seek refuge with my Lord and your Lord, lest you should stone me. (20)"But if you believe me not, then keep away from me and leave me alone. (21)So he (Musa) called upon his Lord (saying): "These are indeed the people who are criminals. (22)(Allah said): "Depart you with My servants by night. Surely, you will be pursued. (23)"And leave the sea as it is (quiet and divided). Verily, they are a host to be drowned. (24)How many of gardens and springs that they (Fir'awn's people) left behin (25)And green crops (fields) and goodly places (26)And comforts of life wherein they used to take

حَدَّثَنَا عَلِيُّ بْنُ عَبْدِ اللَّهِ، حَدَّثَنَا بِشْرُ بْنُ السَّرِيِّ، حَدَّثَنَا نَافِعُ بْنُ عُمَرَ، عَنِ ابْنِ أَبِي مُلَيْكَةَ، قَالَ قَالَتْ أَسْمَاءُ عَنِ النَّبِيِّ صلى الله عليه وسلم قَالَ ‏ "‏ أَنَا عَلَى، حَوْضِي أَنْتَظِرُ مَنْ يَرِدُ عَلَىَّ، فَيُؤْخَذُ بِنَاسٍ مِنْ دُونِي فَأَقُولُ أُمَّتِي‏.‏ فَيَقُولُ لاَ تَدْرِي، مَشَوْا عَلَى الْقَهْقَرَى ‏"‏‏.‏ قَالَ ابْنُ أَبِي مُلَيْكَةَ اللَّهُمَّ إِنَّا نَعُوذُ بِكَ أَنْ نَرْجِعَ عَلَى أَعْقَابِنَا أَوْ نُفْتَنَ‏.‏

Narrated Asma':The Prophet (ﷺ) said, "I will be at my Lake-Fount (Kauthar) waiting for whoever will come to me. Then some people will be taken away from me whereupon I will say, 'My followers!' It will be said, 'You do not know they turned Apostates as renegades (deserted their religion).'" (Ibn Abi Mulaika said, "Allah, we seek refuge with You from turning on our heels from the (Islamic) religion and from being put to trial

حَدَّثَنَا مُوسَى بْنُ إِسْمَاعِيلَ، حَدَّثَنَا أَبُو عَوَانَةَ، عَنْ مُغِيرَةَ، عَنْ أَبِي وَائِلٍ، قَالَ قَالَ عَبْدُ اللَّهِ قَالَ النَّبِيُّ صلى الله عليه وسلم ‏ "‏ أَنَا فَرَطُكُمْ عَلَى الْحَوْضِ، لَيُرْفَعَنَّ إِلَىَّ رِجَالٌ مِنْكُمْ حَتَّى إِذَا أَهْوَيْتُ لأُنَاوِلَهُمُ اخْتُلِجُوا دُونِي فَأَقُولُ أَىْ رَبِّ أَصْحَابِي‏.‏ يَقُولُ لاَ تَدْرِي مَا أَحْدَثُوا بَعْدَكَ ‏"‏‏.‏

Narrated `Abdullah:The Prophet (ﷺ) said, "I am your predecessor at the Lake-Fount (Kauthar) and some men amongst you will be brought to me, and when I will try to hand them some water, they will be pulled away from me by force whereupon I will say, 'O Lord, my companions!' Then the Almighty will say, 'You do not know what they did after you left, they introduced new things into the religion after you

أَخْبَرَنَا أَبُو عَبْدِ الرَّحْمَنِ، أَحْمَدُ بْنُ شُعَيْبٍ قَالَ أَنْبَأَنَا عَمْرُو بْنُ عَلِيٍّ، قَالَ حَدَّثَنَا أَبُو عَاصِمٍ، قَالَ حَدَّثَنَا ابْنُ أَبِي ذِئْبٍ، قَالَ حَدَّثَنِي أَسِيدُ بْنُ أَبِي أَسِيدٍ، عَنْ مُعَاذِ بْنِ عَبْدِ اللَّهِ، عَنْ أَبِيهِ، قَالَ أَصَابَنَا طَشٌّ وَظُلْمَةٌ فَانْتَظَرْنَا رَسُولَ اللَّهِ صلى الله عليه وسلم لِيُصَلِّيَ بِنَا ثُمَّ ذَكَرَ كَلاَمًا مَعْنَاهُ فَخَرَجَ رَسُولُ اللَّهِ صلى الله عليه وسلم لِيُصَلِّيَ بِنَا فَقَالَ ‏"‏ قُلْ ‏"‏ ‏.‏ فَقُلْتُ مَا أَقُولُ قَالَ ‏"‏ ‏{‏ قُلْ هُوَ اللَّهُ أَحَدٌ ‏}‏ وَالْمُعَوِّذَتَيْنِ حِينَ تُمْسِي وَحِينَ تُصْبِحُ ثَلاَثًا يَكْفِيكَ كُلَّ شَىْءٍ ‏"‏ ‏.‏

It was narrated from Mu'adh bin 'Abdullah that his father said:"It was raining and dark, and we were waiting for the Messenger of Allah [SAW] to lead us in prayer. Then the Messenger of Allah [SAW] came out to lead us in prayer and he said: 'Say.' I said: 'What should I say?' He said: 'Say: He is Allah, (the) One and Al-Mu'awwadhatain in the evening and in the morning, three times, and that will suffice you against everything

أَخْبَرَنَا مُحَمَّدُ بْنُ عَلِيٍّ، قَالَ حَدَّثَنِي الْقَعْنَبِيُّ، عَنْ عَبْدِ الْعَزِيزِ، عَنْ عَبْدِ اللَّهِ بْنِ سُلَيْمَانَ، عَنْ مُعَاذِ بْنِ عَبْدِ اللَّهِ بْنِ خُبَيْبٍ، عَنْ أَبِيهِ، عَنْ عُقْبَةَ بْنِ عَامِرٍ الْجُهَنِيِّ، قَالَ بَيْنَا أَنَا أَقُودُ، بِرَسُولِ اللَّهِ صلى الله عليه وسلم رَاحِلَتَهُ فِي غَزْوَةٍ إِذْ قَالَ ‏"‏ يَا عُقْبَةُ قُلْ ‏"‏ ‏.‏ فَاسْتَمَعْتُ ثُمَّ قَالَ ‏"‏ يَا عُقْبَةُ قُلْ ‏"‏ ‏.‏ فَاسْتَمَعْتُ فَقَالَهَا الثَّالِثَةَ فَقُلْتُ مَا أَقُولُ فَقَالَ ‏"‏ ‏{‏ قُلْ هُوَ اللَّهُ أَحَدٌ ‏}‏ ‏"‏ ‏.‏ فَقَرَأَ السُّورَةَ حَتَّى خَتَمَهَا ثُمَّ قَرَأَ ‏{‏ قُلْ أَعُوذُ بِرَبِّ الْفَلَقِ ‏}‏ وَقَرَأْتُ مَعَهُ حَتَّى خَتَمَهَا ثُمَّ قَرَأَ ‏{‏ قُلْ أَعُوذُ بِرَبِّ النَّاسِ ‏}‏ فَقَرَأْتُ مَعَهُ حَتَّى خَتَمَهَا ثُمَّ قَالَ ‏"‏ مَا تَعَوَّذَ بِمِثْلِهِنَّ أَحَدٌ ‏"‏ ‏.‏

It was narrated that 'Uqbah bin 'Amir Al-Juhani said:"While I was leading the Messenger of Allah [SAW] on his mount on a military campaign, he said: 'O 'Uqbah, say!' I listened, then he said: 'O 'Uqbah, say!' I listened, then he said it a third time. I said: 'What should I say?' He said: 'Say: He is Allah, (the) One...' and he recited the Surah to the end. Then he recited: 'Say: I seek refuge with (Allah) the Lord of the daybreak...' and I recited it with him until the end. Then he recited: 'Say: I seek refuge with (Allah) the Lord of mankind...' and I recited it with him until the end. Then he said: 'No one ever sought refuge (with Allah) by means of anything like them

حَدَّثَنَا أَبُو بَكْرِ بْنُ أَبِي شَيْبَةَ، حَدَّثَنَا أَبُو مُعَاوِيَةَ، وَحَفْصُ بْنُ غِيَاثٍ، عَنِ الأَعْمَشِ، عَنْ أَبِي صَالِحٍ، عَنْ أَبِي هُرَيْرَةَ، قَالَ قَالَ رَسُولُ اللَّهِ ـ صلى الله عليه وسلم ـ ‏ "‏ أُمِرْتُ أَنْ أُقَاتِلَ النَّاسَ حَتَّى يَقُولُوا لاَ إِلَهَ إِلاَّ اللَّهُ فَإِذَا قَالُوهَا عَصَمُوا مِنِّي دِمَاءَهُمْ وَأَمْوَالَهُمْ إِلاَّ بِحَقِّهَا وَحِسَابُهُمْ عَلَى اللَّهِ عَزَّ وَجَلَّ ‏"‏ ‏.‏

It was narrated from Abu Hurairah that the Messenger of Allah (ﷺ) said:“I have been commanded to fight the people until they say: La ilaha illallah. If they say it, then their blood and wealth are protected from me, except for a right that is due from it, and their reckoning will be with Allah.”

حَدَّثَنَا سُوَيْدُ بْنُ سَعِيدٍ، حَدَّثَنَا عَلِيُّ بْنُ مُسْهِرٍ، عَنِ الأَعْمَشِ، عَنْ أَبِي سُفْيَانَ، عَنْ جَابِرٍ، قَالَ قَالَ رَسُولُ اللَّهِ ـ صلى الله عليه وسلم ـ ‏ "‏ أُمِرْتُ أَنْ أُقَاتِلَ النَّاسَ حَتَّى يَقُولُوا لاَ إِلَهَ إِلاَّ اللَّهُ فَإِذَا قَالُوا لاَ إِلَهَ إِلاَّ اللَّهُ عَصَمُوا مِنِّي دِمَاءَهُمْ وَأَمْوَالَهُمْ إِلاَّ بِحَقِّهَا وَحِسَابُهُمْ عَلَى اللَّهِ ‏"‏ ‏.‏

It was narrated from Jabir that the Messenger of Allah (ﷺ) said:“I have been commanded to fight the people until they say: La ilaha illallah. If they say: La ilaha illallah, then their blood and wealth are protected from me, except for a right that is due from it, and their reckoning will be with Allah.”

والمجاهدة بالنفس هي الشجاعة التي ترجع إلى استعمال قوة الغضب على شرط العقل وحد الاعتدال فقد وصف الله تعالى الصحابة فقال أشداء على الكفار رحماء بينهم إشارة إلى أن للشدة موضعا وللرحمة موضعا فليس الكمال في الشدة بكل حال ولا في الرحمة بكل حال فهذا بيان معنى الخلق وحسنه وقبحه وبيان أركانه وثمراته وفروعه

جزى الله يوم الروع خيرا % فإنه أرانا على علاته أم ثابت

والأول يسمى إلهاما ونفثا في الروع

أي لذلك الماء الذي غمر الأرض ومن عليها فصل وأما الوهل فهو بتحريك الهاء وأصله الفزع والروع يقال وهل يوهل وهو وهل ومستوهل قال القطامي يصف إبلا

ومنها البهت والروعة التي تحصل عند مواجهة الحبيب أو عند سماع ذكره ولا سيما إذا رآه فجأة أو طلع عليه بغتة كما قال الشاعر

وإنما كان الوهل من أسماء الحب لما فيه من الروع ومنه يقال جمال رائع فإن قيل ما سبب روعة الجمال ولأي شيء إذا رأى المحب محبوبه فجأة يرتاع لذلك ويصفر لونه ويبهت قال الشاعر

Cognitive Behavioral Treatment for Acute Posttrauma Distress: A Randomized, Controlled Proof-of-Concept Study Among Hospitalized Adults With Burns.: Objective: (1) To evaluate the feasibility of conducting a randomized controlled trial (RCT) of the Safety, Meaning, Activation and Resilience Training (SMART) intervention vs nondirective supportive psychotherapy (NDSP) in an acutely hospitalized adult survivor of burn injury sample; and (2) to assess the preliminary effect of SMART on acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) symptom reduction as secondary prevention. Design: Proof-o

Treatment of acute stress disorder: a randomized controlled trial.: Context: Recent trauma survivors with acute stress disorder (ASD) are likely to subsequently develop chronic posttraumatic stress disorder (PTSD). Cognitive behavioral therapy for ASD may prevent PTSD, but trauma survivors may not tolerate exposure-based therapy in the acute phase. There is a need to compare nonexposure therapy techniques with prolonged exposure for ASD. Objective: To determine the efficacy of exposure therapy or trauma-focused cognitive restructuring in preventing chronic PTSD

Cortisol augmentation of a psychological treatment for warfighters with posttraumatic stress disorder: Randomized trial showing improved treatment retention and outcome.: Background: Prolonged exposure (PE) therapy for post-traumatic stress disorder (PTSD) in military veterans has established efficacy, but is ineffective for a substantial number of patients. PE is also associated with high dropout rates. We hypothesized that hydrocortisone augmentation would enhance symptom improvement and reduce drop-out rates by diminishing the distressing effects of traumatic memories retrieved during imaginal exposure. We also hypothesized that in responders, hydrocortisone a

The culture, mental health and psychosocial wellbeing of Rohingya refugees: a systematic review.: Aims: Despite the magnitude and protracted nature of the Rohingya refugee situation, there is limited information on the culture, mental health and psychosocial wellbeing of this group. This paper, drawing on a report commissioned by the United Nations High Commissioner for Refugees (UNHCR), aims to provide a comprehensive synthesis of the literature on mental health and psychosocial wellbeing of Rohingya refugees, including an examination of associated cultural factors. The ultimate objective i

The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis.: Background: Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time. Methods: PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD

Efficacy of group psychotherapy for posttraumatic stress disorder: Systematic review and meta-analysis of randomized controlled trials.: Objective: The present meta-analysis evaluates the efficacy of group psychotherapy for post-traumatic stress disorder (PTSD) in adults directly compared to no treatment or active treatments examined in randomized controlled trials (RCTs). Method: Electronic databases were searched for eligible studies. Effects on PTSD symptoms, depression, and anxiety were extracted. Between- and within-group effect sizes (Hedges' g) were calculated using a random-effects model. Data were adjusted to account for

Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP.

This study aims to develop and assess the psychometric properties of a measure of moral injury (MI) symptoms for identifying clinically significant MI in health professionals (HPs), one that might be useful in the current COVID-19 pandemic and beyond. A total of 181 HPs (71% physicians) were recruited from Duke University Health Systems in Durham, North Carolina. Internal reliability of the Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP) was examined, along with factor analytic, discriminant, and convergent validity. A cutoff score was identified from a receiver operator curve (ROC) that best identified individuals with significant impairment in social or occupational functioning. The 10-item MISS-HP measures 10 theoretically grounded dimensions of MI assessing betrayal, guilt, shame, moral concerns, religious struggle, loss of religious/spiritual faith, loss of mea…

matched on Stress Disorders, Post-Traumatic (mesh)

Impact of moral injury on the lives of UK military veterans: a pilot study.

Introduction: Research suggests that moral injury (MI) in US veterans is associated with poor psychological outcomes and disruption in functioning. However, little is known about how MI may impact UK Armed Forces (AF) veterans. This study aimed to explore the impact of MI on veteran psychological well-being and functioning. Methods: Six veterans identified as having had exposure to MI and four clinicians who treated veterans with MI were recruited from a UK charitable organisation which provides psychological care for veterans. Data were analysed using thematic analysis. Results: MI was perceived to cause substantial psychological distress in this sample. Our data suggest that some veterans held extremely negative self-appraisals which appeared to contribute towards and maintain their distress. Issues relating to spirituality following MI were thought to be infrequent; however, a loss of…

matched on Stress Disorders, Post-Traumatic (mesh)

Moral distress of undergraduate nursing students in community health nursing.

Background: Nurses exposed to community health nursing commonly encounter situations that can be morally distressing. However, most research on moral distress has focused on acute care settings and very little research has explored moral distress in a community health nursing setting especially among nursing students. Aim: To explore the moral distress experiences encountered by undergraduate baccalaureate nursing students in community health nursing. Research design: A descriptive qualitative design was employed to explore the community health nursing experiences of the nursing students that led them to have moral distress. Participants and research context: The study included 14 senior nursing students who had their course in Community Health Nursing in their sophomore year and stayed in the partner communities in their junior year for 6 and 3 weeks during their senior year. Ethical co…

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Moral Injury and Spiritual Struggles in Military Veterans: A Latent Profile Analysis.

War-related traumas can lead to emotional, relational, and spiritual suffering. Drawing on two community samples of war zone veterans from diverse military eras (Study 1, N = 616 and Study 2, N = 300), the purpose of this study was to examine patterns of constellations between outcomes related to moral injury (MI) and common ways in which veterans may struggle with religion or spirituality, defined as divine, morality, meaning, interpersonal, and doubt. Results from latent profile analyses revealed three distinct classes across the samples, based on psychometrically validated instruments: (a) no MI-related outcomes or spiritual struggles (nondistressed group; Study 1 = 72.7%, Study 2 = 75.0%); (b) MI-related outcomes and equivalent or lower degrees of spiritual struggles relative to MI-related outcomes (psychological MI group; Study 1 = 19.2%, Study 2 = 17.0%); and (c) MI-related outcome…

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Functional impairment as a proxy measure indicating high rates of trauma exposure, post-migration living difficulties, common mental disorders, and poor health amongst Rohingya refugees in Malaysia.

A major challenge in the refugee field is to ensure that scarce mental health resources are directed to those in greatest need. Based on data from an epidemiological survey of 959 adult Rohingya refugees in Malaysia (response rate: 83%), we examine whether a brief screening instrument of functional impairment, the WHO Disability Assessment Schedule (WHODAS), prove useful as a proxy measure to identify refugees who typically attend community mental health services. Based on estimates of mental disorder requiring interventions from analyses of epidemiological studies conducted worldwide, we selected a WHODAS cutoff that identified the top one-fifth of refugees according to severity of functional impairment, the remainder being distributed to moderate and lower impairment groupings, respectively. Compared to the lower impairment grouping, the severe impairment category comprised more boat a…

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Associations Among Exposure to Potentially Morally Injurious Experiences, Spiritual Injury, and Alcohol Use Among Combat Veterans.

Potentially morally injurious experiences (PMIEs) are events that may violate deeply held values or belief systems. Combat engagement places service members at a heightened risk for PMIE exposure. Exposure to PMIEs may elicit internal conflict between moral beliefs and experiences and, if unresolved, conflict may manifest as feelings of guilt, shame, and spiritual or existential crisis. Further, distress caused by these experiences may promote harmful behaviors (e.g., excessive alcohol use), which may serve as attempts to cope with PMIEs veterans have witnessed or participated in. The present study examined a sequential mediation model in which combat exposure was associated with alcohol use (i.e., alcohol consumption, dependence symptoms, and alcohol-related problems) via PMIE exposure and spiritual injury (e.g., alienation from and/or anger towards respective higher power) in a communi…

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Introduction to the Special Issue on Moral Injury: Conceptual Challenges, Methodological Issues, and Clinical Applications.

This article introduces a special issue of the Journal of Traumatic Stress devoted to new directions in the study of moral injury (MI), defined as transgressive harms and the outcomes of those experiences. Although a significant body of research has emerged devoted to the study of the MI construct, a number of conceptual and empirical challenges have arisen; these are summarized and discussed in the present article. In addition, this article proposes ways of overcoming these challenges in order to further research and clinical practice in the field. We then go on to introduce the content and themes of the present collection of articles in this special issue, all of which provide examples of some of the most innovative and forward-looking work on the topic and expand into new conceptual frameworks, new methods of investigation, and new populations and contexts.

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Association of Timing of Adverse Childhood Experiences and Caregiver Support With Regionally Specific Brain Development in Adolescents.

Importance: Few data are available to inform the associations and timing of the associations between adversity, caregiver support, and brain outcomes. Consideration of timing has important public health implications to inform more precise prevention strategies. Objective: To evaluate the timing and regional specificity of the association between adverse childhood experiences (ACEs) and caregiver support to structural development of limbic and striatal brain regions in middle childhood and adolescence. Design, setting, and participants: This 15-year developmental, neuroimaging cohort study included 211 children and their caregivers screened from day care centers and preschools in the St Louis, Missouri, metropolitan area during the preschool period, with an additional 4 waves of neuroimaging at school age through adolescence from November 14, 2007, to August 29, 2017. The cohort was overs…

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Prevalence of prolonged grief disorder in a sample of female refugees.

Background: Prolonged Grief Disorder (PGD) is a distinct syndrome that follows bereavement. It is different from other mental disorders and is characterized by symptoms such as yearning for the bereaved, or intense emotional pain or distress. Violent loss is one major risk factor for the development of PGD. Objectives: PGD has been studied in different populations, mostly in small samples, with only a few of them being representative. Although research highlighted that traumatic experiences paired with challenges related to migration make refugees particularly vulnerable to PGD, PGD has only rarely been studied in refugees. Thus, this article a) examines the prevalence of PGD in female refugees in Germany according to the criteria proposed by Prigerson and colleagues in 2009, and b) associates PGD with other common psychopathology (e.g. anxiety, depression, somatization and trauma). Meth…

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Development and implementation of a group based mental health intervention for unaccompanied minors.

Unaccompanied refugee minors (UMs) are at significant risk to experience severe mental health symptoms (Derluyn, Broekaert & Schuyten). Trauma-focused treatments have been found to be effective for traumatized refugees (Slobodin & de Jong). However, trauma-focused mental health services are seldom available, and treatment fails when UMs lack trust in service providers (Majumder, O'Reilly, Karim & Vostanis). In order to address this gap, a 10-session group based mental health intervention for UMs was developed and then pilot tested in 3 accommodation units for UMs in Finland. The implementation and effectiveness of the intervention was studied by qualitative and quantitative methods. The process was completed by 18 UMs. Symptom measures showed no statistically significant changes on the mental health variables studied. However, staff members and UMs reported increased trust and communicat…

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Moral injury and the four pillars of bioethics.

Healthcare providers experience moral injury when their internal ethics are violated. The routine and direct exposure to ethical violations makes clinicians vulnerable to harm. The fundamental ethics in health care typically fall into the four broad categories of patient autonomy, beneficence, nonmaleficence, and social justice. Patients have a moral right to determine their own goals of medical care, that is, they have autonomy. When this principle is violated, moral injury occurs. Beneficence is the desire to help people, so when the delivery of proper medical care is obstructed for any reason, moral injury is the result. Nonmaleficence, meaning do no harm, has been a primary principle of medical ethics throughout recorded history. Yet today, even the most advanced and safest medical treatments are associated with unavoidable, harmful side effects. When an inevitable side effect occurs…

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Prolonged grief and attachment security: A latent class analysis.

The death of a loved one has been associated with a wide range of mental health outcomes. Attachment theory is one of the primary paradigms for understanding bereavement outcome, yet there is comparatively little examination of the relationship between attachment style and bereavement responses. In this study we use Latent Class Analysis to identify subgroups of bereaved individuals based on patterns of prolonged grief (PG) and major depression symptom co-occurrence in 285 bereaved individuals. We then explored the relationship between these subgroups and attachment anxiety and avoidance. Three new subgroups of individuals were identified: one showing high levels of PGD and depression (PGD/depression), one showing high depression (Depression), and one showing few symptoms (Low). Attachment anxiety significantly differentiated between the three groups; the highest levels of attachment anx…

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Moral injury, suicide ideation, and behavior among combat veterans: The mediating roles of entrapment and depression.

Combat veterans have been identified as a major at-risk group for suicide. Moral injury (MI) experiences have recently been acknowledged as significant stressful combat events that may lead to psychopathology, such as suicidal ideation and behaviors (SIB). In this study, we aimed to examine to what extent potential MI events may comprise risk factors for SIB and to explore the mediating role of the entrapment experience in this relationship. A sample of 191 Israeli combat veterans (Mage = 25.39, SD = 2.37) completed validated self-report questionnaires in a cross-sectional design study. All potential MI experiences were significantly related to SIB levels among veterans. Moreover, self- and betrayal-based MI experiences were significantly associated with sense of entrapment, which subsequently was associated with high levels of SIB. The integrative model indicated that entrapment and dep…

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A Qualitative Examination of VA Chaplains' Understandings and Interventions Related to Moral Injury in Military Veterans.

This study examines VA chaplains' understandings of moral injury (MI) and preferred intervention strategies. Drawing qualitative responses with a nationally-representative sample, content analyses indicated that chaplains' definitions of MI comprised three higher order clusters: (1) MI events, (2) mechanisms in development of MI, and (3) warning signs of MI. Similarly, chaplains' intervention foci could be grouped into three categories: (1) pastoral/therapeutic presence, (2) implementing specific interventions, and (3) therapeutic processes to promote moral repair. Findings are discussed related to emerging conceptualizations of MI, efforts to adapt existing evidence-based interventions to better address MI, and the potential benefits of better integrating chaplains into VA mental health service delivery.

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Discrimination and distress among Afghan refugees in northern California: The moderating role of pre- and post-migration factors.

This study investigates the effect of perceived discrimination on the mental health of Afghan refugees, and secondly, tests the distress moderating effects of pre-migration traumatic experiences and post-resettlement adjustment factors. In a cross-sectional design, 259 Afghans completed surveys assessing perceived discrimination and a number of other factors using scales developed through inductive techniques. Multivariable analyses consisted of a series of hierarchical regressions testing the effect of perceived discrimination on distress, followed by a sequential analysis of moderator variables. Perceived discrimination was significantly associated with higher distress, and this relationship was stronger among those with a strong intra-ethnic identity and high pre-resettlement traumatic experiences. The expected buffering effects of civic engagement, ethnic orientation (e.g. integratio…

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Moral injury in relation to public debates: The role of societal misrecognition in moral conflict-colored trauma among soldiers.

The last decade has witnessed fast-growing scholarly interest in the concept of moral injury, which addresses the link between the ethics of military intervention and deployment-related suffering. However, current research on moral injury, predominantly psychological in nature, tends to approach the phenomenon as an internally contained disorder. Consequently, it medicalizes moral injury and de-contextualizes it from the people who send soldiers to conflict zones and 'welcome' them back. This article addresses the ways in which the experience of moral injury is embedded in and shaped by public debates on military intervention, drawing on relevant literature from the fields of psychology, philosophy, and social sciences, and on in-depth qualitative interviews collected in 2016 and 2017 with 80 Dutch veterans. The article examines the explicit public condemnation experienced by Dutch veter…

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Treatment processes and demographic variables as predictors of dropout from trauma-focused cognitive behavioral therapy (TF-CBT) for youth.

Objective: Premature dropout is a significant concern in trauma-focused psychotherapy for youth. Previous studies have primarily examined pre-treatment demographic and symptom-related predictors of dropout, but few consistent findings have been reported. The current study examined demographic, symptom, and in-session process variables as predictors of dropout from Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth. Method: Participants were a diverse sample of Medicaid-eligible youth (ages 7-17; n = 108) and their nonoffending caregivers (n = 86), who received TF-CBT through an effectiveness study in a community setting. In-session process variables were coded from audio-recorded sessions, and these and pre-treatment demographic variables and symptom levels were examined as predictors of dropout prior to receiving an adequate dose of TF-CBT (<7 sessions). Twenty-nine children…

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Trajectories of prolonged grief one to six years after a natural disaster.

Background: The long-term trajectories of prolonged grief are poorly understood. The aims were to examine the course of grief among bereaved disaster survivors up to six years post loss and factors predicting worse bereavement outcome. A third aim was to explore differences in grief indicators between trajectories. Methods: Bereaved Swedish tourists who survived the 2004 Indian Ocean tsunamis responded to surveys including the Inventory of Complicated Grief 1 to 6 years after the disaster. Latent growth mixture modeling was used to identify longitudinal trajectories of grief. Multinomial logistic regression analysis was used to examine predictors of class membership. Results: Three trajectories were identified: resilient (41% of the sample), recovering (48%), and chronic (11%). The strongest predictor of chronic grief was the loss of one's child. When examining grief indicators, the chro…

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Moral Injury: Contextualized Care.

Amidst the return of military personnel from post-9/11 conflicts, a construct describing the readjustment challenges of some has received increasing attention: moral injury. This term has been variably defined with mental health professionals more recently conceiving of it as a transgression of moral beliefs and expectations that are witnessed, perpetrated, or allowed by the individual. To the extent that morality is a system of conceptualizing right and wrong, individuals' moral systems are in large measure developmentally and socially derived and interpreted. Thus, in seeking to provide care and aid in reintegration for combat veterans, it is necessary to consider communities that have contributed to an individual's formation and that might have participated in the interpretation of his/her suffering. This can take many forms, but given that morality is often complexly intertwined with…

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Collective narrative practice with unaccompanied refugee minors: "The Tree of Life" as a response to hardship.

During the summer of 2016, in the midst of one of the biggest refugee crises in centuries, the author of this article joined the team from a shelter for unaccompanied refugee minors on Samos, Greece, in an effort to provide young boys seeking asylum in Europe with an opportunity to engage in speaking about the difficulties they have encountered in life. The team used a collective narrative methodology called the "Tree of Life", originally developed by Ncube-Mlilo and Denborough. In addition to traditional psychological treatments, collective narrative practice creates a secure foundation for addressing trauma, suffering, and hardship. This approach takes into consideration cultural differences and is easy to access for refugees with perceived stigma of traditional mental health services. The Tree of Life is a minimum of 8-hour workshop involving a strength-based narrative methodology, us…

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Unaccompanied refugee minors in Germany: attitudes of the general population towards a vulnerable group.

Germany saw an increase in numbers of refugees in 2015, with nearly a third being below the age of 18. Unaccompanied refugee minors (URMs) present an especially vulnerable group. In addition to pre-flight and flight stress, the acculturation process can work as potential stressor, and we wanted to explore attitudes towards URM. We conducted a study in a representative sample (n = 2524) of the German population (ages 14 years or older) between January and March 2016. Only 22.8% of participants thought that Germany could accompany more URM. While few participants argued in support of immediate deportation of URM in general (38.6%) or of URM from the Middle East (35.3%), a majority advocated for immediate deportations of URM from the Balkan region (62%) or from Africa (51.1%). Difference in the variance regarding attitudes towards deportation was explained mostly by right-wing political att…

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Senseless Violence Against Central American Unaccompanied Minors: Historical Background and Call for Help.

The southwestern U.S. border has recently seen a significant increase in the number of unaccompanied children from Honduras, Guatemala, and El Salvador illegally crossing the Mexican border into the United States. Many of these children leave home to flee violence, starvation, impoverished living conditions, or other life-threatening situations. The treatment of acute stress, anxiety, and depression associated with traumatic events is crucial in helping these children address these negative psychological events they have experienced so that they can move forward with their lives. Untreated, traumatic events experienced by this population can develop into Post Traumatic Stress Disorder, a potentially life-changing and physically threatening psychological and medical issue. The United States needs to effectively address the serious matter of responding to mental health issues facing refuge…

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Effects of maternal traumatic distress on family functioning and child mental health: An examination of Southeast Asian refugee families in the U.S.

Background: The psychological effects of trauma are well-documented among refugee adults and children alone, yet less research has attended to the intergenerational transmission of trauma within refugee families. Additionally, there is considerable diversity between refugee populations as well as within-group variation in the experiences and effects of refugee trauma. Objective: The current study examines the longitudinal effects of maternal traumatic distress on family functioning and child mental health outcomes among Southeast Asian refugee women and their adolescent children. Given the potential for variation in these effects, we also explore group differences in these relationships by ethnicity and child nativity. Methods: Longitudinal data were collected from a random sample of 327 Southeast Asian refugee mothers and their children in the United States. We employed structural equat…

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The impact of the asylum process on mental health: a longitudinal study of unaccompanied refugee minors in Norway.

Objectives: To examine the mental health of unaccompanied refugee minors prospectively during the asylum-seeking process, with a focus on specific stages in the asylum process, such as age assessment, placement in a supportive or non-supportive facility and final decision on the asylum applications. Design: This was a2½ year follow-up study of unaccompanied minors (UM) seeking asylum in Norway. Data were collected within three weeks (n=138) and at 4 months (n=101), 15 months (n=84) and 26 months (n=69) after arrival. Setting: Initially in an observation and orientation centre for unaccompanied asylum-seeking adolescents, and subsequently wherever the UM were located in other refugee facilities in Norway. Participants: Male UM from Afghanistan, Somalia, Algeria and Iran. Main outcome measures: Mental health symptoms assessed by Hopkins Symptom Checklist-25 and Harvard Trauma Questionnaire…

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The mediating role of resilience in the relationship between social support and posttraumatic growth among colorectal cancer survivors with permanent intestinal ostomies: A structural equation model analysis.

Purpose: Information on posttraumatic growth (PTG) among colorectal cancer (CRC) survivors with permanent intestinal ostomies is limited. The aim of this cross-sectional study was to investigate the occurrence of PTG among CRC survivors with permanent intestinal ostomies and its association with perceived social support and resilience. Methods: This study was conducted with 164 CRC survivors with permanent intestinal ostomies at least one month after surgery. Participants completed questionnaires assessing socio-demographic and clinical characteristics, perceived social support, resilience and PTG. Results: The mean total score on the Post Traumatic Growth Inventory was 66.74 (SD = 13.99). Perceived social support (r = 0.450) and resilience (r = 0.545) were significantly positively correlated with PTG. Structural equation modeling analysis showed that resilience mediated the relationship…

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