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There has been a dearth of empirical research examining suicidality in the context of the new diagnosis of the ICD-11 Complex posttraumatic stress disorder (CPTSD). The main aim of the current cross-sectional study was to test the moderating role of trauma-related shame and depression on the relationship between CPTSD symptoms and suicidal ideation. In total, 300 treatment-seeking trauma-exposed adults were included in the study. The mean age was 39.25 (  = 12.77), ranging from 18 to 72 years. The majority of the sample (90.3%) were female and had a university degree (67%). Self-report measures for assessing complex posttraumatic stress disorder and depression symptoms, suicidal ideation and trauma-related shame were used. In the study sample, 22.7% of the participants met the criteria for probable PTSD, 45.7% probable CPTSD, and 45% reported suicidal ideation. The levels of trauma-related shame and CPTSD symptoms were the highest in the high suicidal ideation group. Moderation analysis revealed that the association between CPTSD symptom severity and suicidal ideation intensified with increasing levels of trauma-related shame. The findings of the moderated moderation analysis showed that with increasing levels of shame, the effects of interaction between CPTSD and depression symptoms on suicidal ideation were getting stronger. Results demonstrated that the relationship between CPTSD symptoms and suicidal ideation depends on the levels of trauma-related shame and comorbid depressive symptoms. Such findings provide insights for the assessment and management of suicide risk after trauma exposure and suggest that the relationship between complex posttraumatic stress and suicidal ideation depends on other post-traumatic reactions, comorbid conditions, and on how they interact.

Background The current definitions of resilience can be addressed as a process, an outcome, or a trait. Empirical studies should be carried out to determine the most appropriate definition for it. Therefore, the main aim of the current study was to investigate changes in adolescents’ resilience over two years and explore the links between resilience and different forms of child maltreatment. Methods The three-wave longitudinal study “Stress and resilience in adolescence” (STAR-A) sample was comprised of a general school-based sample of Lithuanian adolescents [baseline N  = 1295, 56.7% females; M ( SD ) age  = 14.24 (1.26)]. Resilience was measured using the 14-item Resilience Scale (RS-14), lifetime exposure to maltreatment was measured at wave 1 using a questionnaire developed by the Norwegian Center for Violence and Traumatic Stress Studies (NKVTS), risk of psychopathology—using the Strengths and Difficulties Questionnaire (SDQ). The changes in resilience scores over the period of two years were investigated using the latent growth modeling approach. Results The analyses revealed two classes of resilience—stable higher and stable lower. We found that experience of at least one form of abuse was significantly more prevalent in the lower resilience group in comparison to the higher resilience group. Also, adolescents with lower resilience had a higher probability of psychopathology. Conclusions This study provided meaningful insights into the stability of resilience over time in adolescence and its relation to various types of child maltreatment. Experiences of maltreatment, as well as risk for psychopathology, were linked to lower resilience in adolescence.

The study aimed to assess the mental health and well-being of Lithuanian healthcare workers by gathering demographic information, identifying common stressors affecting the work environment, evaluating mental health, and exploring directions for psychosocial care. Additionally, the research explored the prevalence of considering a career change among respondents. The study included 1618 responders who completed an online survey in December 2021 - January 2022. Participants included in this study: physicians, nurses, residents and other healthcare workers. It evaluated their demographics, most common stressors affecting their work environment and mental health on the Depression, Anxiety and Stress Scale - 21 (DASS-21) scale. Lastly, all responders asked if they had considered changing their occupation to a non-medical job. Univariate analysis was performed using χ2 and Student's t test, and binary logistic regression evaluated career change predictors. Career change was considered by 1081 (66.8%) responders. The main career change predictors were poor working conditions (OR 1.91, p < 0.001), direct contact with patients (OR 1.84, p < 0.001), lack of career perspectives (OR 1.95, p < 0.001), mobbing (OR 1.67, p = 0.001) and exhaustion (OR 1.51, p = 0.005). After evaluating DASS-21 scores, it was found that 23% of respondents had severe and extremely severe depression symptoms, 27.4% severe and extremely severe anxiety, and 21.4% had severe and extremely severe stress levels. Lithuanian healthcare workers are in high distress and have poor mental health. They are in need psychosocial assistance to avoid burnout and staff loss. Int J Occup Med Environ Health. 2024;37(3):287-99.

A study in Lithuania showed that the International Trauma Interview is a valid tool for assessing and diagnosing ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). The 11 th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). The International Trauma Interview (ITI) is a novel clinician-administered diagnostic interview for the assessment of ICD-11 PTSD and CPTSD. The aim of this study was to evaluate the psychometric properties of the ITI in a Lithuanian sample in relation to interrater agreement, latent structure, internal reliability, as well as convergent and discriminant validity. In total, 103 adults with a history of various traumatic experiences participated in the study. The sample was predominantly female (83.5%), with a mean age of 32.64 years (SD = 9.36). For the assessment of ICD-11 PTSD and CPTSD, the ITI and the self-report International Trauma Questionnaire (ITQ) were used. Mental health indicators, such as depression, anxiety, and dissociation, were measured using self-report questionnaires. The latent structure of the ITI was evaluated using confirmatory factor analysis (CFA). In order to test the convergent and discriminant validity of the ITI we conducted a structural equation model (SEM). Overall, based on the ITI, 18.4% of participants fulfilled diagnostic criteria for PTSD and 21.4% for CPTSD. A second-order two-factor CFA model of the ITI PTSD and disturbances in self-organization (DSO) symptoms demonstrated a good fit. The associations with various mental health indicators supported the convergent and discriminant validity of the ITI. The clinician-administered ITI and self-report ITQ had poor to moderate diagnostic agreement across different symptom clusters. The ITI is a reliable and valid tool for assessing and diagnosing ICD-11 PTSD and CPTSD.

Background Posttraumatic stress disorder (PTSD) is a common mental disorder. However, many cases of PTSD remain untreated because of limited healthcare resources and other treatment-seeking barriers. Effective internet-based interventions could help to improve access to PTSD treatments. Therefore, the main objective of the planned randomized controlled trial is to evaluate the efficacy of the Lithuanian version of the guided internet-based self-help programme (Spring) in reducing ICD-11 PTSD symptoms. Methods The planned sample size is 50 participants exposed to different traumatic experiences. Participants eligible for the study will be randomized into two study groups: the immediate treatment group and the delayed treatment control group. Both groups will receive guided trauma-focused ICBT intervention, but the delayed treatment group will receive access to the programme five months after randomization. The International Trauma Interview (ITI) will be used for the assessment of ICD-11 PTSD symptoms at pre-treatment, post-treatment, and at a 3-month follow-up. Changes in disturbances in self-organization, depression and anxiety levels, as well as posttraumatic cognitions and trauma-related shame, will also be evaluated. In addition, associations between changes in symptoms of PTSD and readiness for treatment, treatment expectations and working alliance will be explored. Changes in treatment outcomes will be evaluated using multiple Latent Change Models. Discussion This study is expected to contribute to valuable knowledge on the efficacy of internet-based interventions for posttraumatic stress disorder. Trial registration ClinicalTrials.gov NCT06475716. Registered on 25 June 2024.

Background:Further developments in trauma care training for mental health staff are needed to ensure that trauma survivors are recognised and get the most effective care. The evaluation of the effects of trauma care training programs would enable the untangling of the most efficient ways of building the competence of clinicians who encounter trauma-exposed patients in their routine clinical practice.Objective:We aimed to analyse longitudinal changes in mental health professionals’ perceived trauma care competencies after a brief online trauma care training, and to examine associations between these changes and specific work-related characteristics.Method:In total, 223 mental health professionals, 96.4% women, 42 years on average, and 51.6% with more than 10 years of clinical practice, participated in a brief online trauma care training programme. The Readiness to Work with Trauma-Exposed Patients Scale (RTEPS) was used to measure perceived trauma care competencies at the pre-training, post-training, and at a 3-month follow-up.Results:Training had a significant effect on all measured perceived trauma care competencies of assessment, treatment and affect tolerance at post-training and 3-month follow-up. We also found that many years of unspecific clinical practice did not contribute to perceived trauma care competencies, and the training was perceived equally beneficial by professionals with more or less clinical practice.Conclusions:Our study indicates that brief training can have lasting effects on clinicians’ self-confidence in trauma care. Further investigation of factors associated with the effects of training might help to increase the effectiveness of the training programs.

There is a need for valid methods to evaluate young children's (4-8 years) psychological difficulties related to traumatic experiences. The Odense Child Trauma Screening (OCTS), developed by Danish researchers, is a play-based story stem assessment tool developed to screen for indicators of traumatization in young children. Just a few studies of the OCTS have been published so far. The current study aimed to test the reliability and convergent validity of the OCTS in the Lithuanian community and risk subsamples of young children aged 4-8 years. The total sample consisted of 209 participants (58.9% girls) from the community (47.4%) and risk (52.6%) subsamples, age = 6.29 ( = 1.48). All children were screened with the OCTS, and caregivers completed self-report questionnaires: demographics, the Child and Adolescent Trauma Screen-Caregiver (CATS-C), and the Strengths and Difficulties Questionnaire (SDQ). The data suggests that the OCTS has good inter-rater reliability. The OCTS, SDQ, and CATS-C scores were significantly higher in the risk subsample, with small to large effect sizes. Boys and younger children (3-4-year-olds) scored higher on the OCTS. Out of all the OCTS stories, the Burnt hand story had significant correlation coefficients with all the CATS-C PTSD symptoms. The study provides initial information about the reliability and the validity of the OCTS and calls for further exploration of this instrument. There were also variations in scores between the Lithuanian data and an earlier study of the Danish sample. Future studies on the OCTS would benefit from further cross-cultural, reliability and the validity examination.

During the current COVID-19 pandemic, the people in Europe are exposed to self-isolation, quarantine, job loss, risk of contracting COVID-19, or grief of loved ones. Such a complex array of stressors may lead to symptoms of adjustment disorder or posttraumatic stress disorder. This research protocol describes a study launched by the European Society of Traumatic Stress Studies (ESTSS) to investigate the impact of the COVID-19 pandemic on symptoms of adjustment disorder across European countries. The longitudinal online cohort study aims (1) to explore psychosocial reactions to the COVID-19 pandemic across ten European countries; (2) to examine the relationships between risk and resilience factors, stressors and symptoms of adjustment disorder during the pandemic; and (3) to investigate whether these relationships are moderated by coping behaviours. In ten countries (Austria, Croatia, Georgia, Germany, Italy, Lithuania, Netherlands, Poland, Portugal, and Sweden), between 1,000 and 2,000 participants will be recruited, depending on the size of the country. Participants will be assessed at two timepoints with a six-month interval. Following a conceptual framework based on the WHO's social framework of health, an assessment of risk and resilience factors, COVID-19 related stressors and pandemic-specific coping behaviours will be measured to estimate their contribution to symptoms of adjustment disorder. The Adjustment Disorder New Module 8 (ADNM-8) will be used to assess symptoms of adjustment disorder. As a secondary measure, symptoms of posttraumatic stress disorder will be measure using the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). The relative contribution of risk factors, resilience factors, and stressors on symptoms of adjustment disorder or symptoms of posttraumatic stress disorder will be estimated using multilevel analysis. To determine the moderating effects of different types of coping behaviours on these relationships, a multilevel mediation analysis will be carried out.

The International Trauma Interview (ITI) is a structured clinician-administered measure developed to assess posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined in the 11th version of the International Classification of Diseases (ICD-11). This study aimed to investigate a psychometric evaluation of the ITI and to finalise the English language version. The latent structure, internal consistency, interrater agreement, and convergent and discriminant validity were evaluated with data from a convenience sample, drawn from an existing research cohort, of 131 trauma exposed participants from the United Kingdom reporting past diagnosis for PTSD or who had screened positively for traumatic stress symptoms. A range of self-report measures evaluating depression, panic, insomnia, dissociation, emotion dysregulation, negative cognitions about self, interpersonal functioning and general wellbeing were completed. Confirmatory factor analysis supported an adjusted second-order two-factor model of PTSD and disturbances in self-organisation (DSO) symptoms, allowing affect dysregulation to also load onto the PTSD factor, over alternative models. The ITI scores showed acceptable internal consistency, and interrater reliability was strong. Findings for convergent and discriminant validity were mostly as predicted for PTSD and DSO domains. Correlations with the ITQ were good but coefficients for the level of agreement of PTSD diagnosis and CPTSD diagnosis between the ITI and the ITQ were weaker, and item level agreement was variable. Results provide support for the reliability and validity of the ITI as a measure of ICD-11 PTSD and CPTSD. Final revisions of the ITI are described.

Prompts offer a promising strategy to promote client engagement in internet-delivered cognitive behavioral therapy (ICBT). However, if the prompts do not meet the needs of clients, they can potentially be more obtrusive rather than helpful. The aim of this study was to test if prompts tailored based on timing and frequency, aligned with preintervention goal setting, can increase usage and the efficacy of a therapist-supported ICBT stress recovery intervention for health care workers. The 2-arm randomized controlled trial included 87 health care workers (99% female, aged 19-68 years: mean 39.61, SD 11.49): 43 in the standard intervention group and 44 in the tailored prompts group. The primary outcome measure was the Recovery Experiences Questionnaire, and the secondary outcomes were the Perceived Stress Scale-4, the Patient Health Questionnaire-4, and the World Health Organization-5 Well-Being Index. The self-report data were collected before the intervention (September 2022), postintervention (October 2022), and 6-month follow-up (May 2023). The results showed that tailored prompts, although appreciated by the majority (39/40, 98%), did not improve intervention usage indicators, such as the number of logins (t =-0.91; P=.36), modules opened (t =-1.47; P=.15), modules completed (t =-0.71; P=.48), exercises completed (t =-1.05; P=.30), or the time spent using the program (χ =1.1; P=.57). Similarly, tailored prompts did not increase the effects of the intervention in terms of stress recovery skills (Cohen d ranging from 0.31 to 0.85), perceived stress (d=-0.08; -0.70), depression (d=-0.11; -0.38), anxiety (d=-0.32; -0.64), or psychological well-being (d=0.26; 0.46). In addition, the standard intervention group showed greater long-term stress recovery effects than the group using the internet-delivered intervention supplemented by tailored prompts (β=-0.24, P=.03). Although the study confirmed the efficacy of the program, the merits of tailored prompts in ICBT for stress recovery were not supported. Future research is needed to test the effects of the stress recovery intervention supplemented by goal setting and tailored prompts. ClinicalTrials.gov NCT05553210; https://clinicaltrials.gov/study/NCT05553210.