A multivariate categorization scheme for classifying clients' presenting problems wa... more A multivariate categorization scheme for classifying clients' presenting problems was empirically developed. Six hundred and eleven clients who sought services at a university counseling center completed the Computerized Assessment System for Psychotherapy Evaluation and Research (L. McCullough & A. D. Farrell, 1983). Descriptive statistics, cluster analysis, cluster differentiation by external variables, and stability of cluster solutions across subsamples are presented. Nine clusters of clients with different types of presenting problems that were stable across subsamples were identified. This multivariate approach provides a more complex assessment of clients' presenting problems that may have implications for case disposition, therapeutic interventions, prevention interventions, and research pertaining to coping, help seeking, and therapeutic outcomes.
Journal of the American Psychiatric Nurses Association, Jan 3, 2014
Understanding the dynamics of mental health stigma through existing frameworks, especially in min... more Understanding the dynamics of mental health stigma through existing frameworks, especially in minorities with higher stigma, is problematic. There is a need to reconceptualize stigma, particularly in highly traumatized groups. The current study examines the validity of a new development-based trauma framework that conceptualizes stigma as a type III chronic trauma that contributes to negative mental health effects. This framework proposes that public stigma is a unique chronic traumatic stress that mediates the effects of similar trauma types in mental health patients. To test this proposition, this study explores the relationships between internalized stigma of mental illness (ISMI), different trauma types, and posttrauma spectrum disorders. ISMI, posttraumatic stress disorder, other posttrauma spectrum disorders, and cumulative trauma measures were administered to a sample of 399 mental health patients that included Arab (82%), Muslim (84%), and refugee (31%), as well as American ...
This study explored the effects of bullying victimization (BV), as a Type II traumatic stressor, ... more This study explored the effects of bullying victimization (BV), as a Type II traumatic stressor, on intelligence quotient (IQ), posttraumatic stress disorder (PTSD), and complex PTSD symptoms. Participants were 390 African American and Iraqi refugee adolescents. Measures of BV, cumulative life trauma, PTSD, discrimination, and IQ were administered. Correlational, multilevel regression, and path analyses were conducted. BV, independent of cumulative trauma, and discrimination were found to have 432 I. A. Kira et al.
A Palestinian sample was used to explore the dynamics of posttraumatic growth (PTG) across differ... more A Palestinian sample was used to explore the dynamics of posttraumatic growth (PTG) across different trauma types. Cumulative trauma, posttraumatic stress disorder, depression, anxiety, PTG, and stress-related growth (SRG) measures were administered. As predicted, only type I traumas were associated with PTG. Type II traumas were not associated with PTG, while type III collective identity traumas were negatively associated with PTG. Results indicated that PTG was not a significant predictor of any mental health symptoms and that PTG is different from SRG, which seems to describe growth in non-traumatic situations. The results suggest that it is important to analyze trauma profiles rather than single trauma.
To clarify the effects of torture trauma and its components on PTSD and other mental health condi... more To clarify the effects of torture trauma and its components on PTSD and other mental health conditions, we investigated the relationship between measures for PTSD, Cumulative trauma disorders CTD, cumulative life trauma, torture and torture severity in a sample of 326 torture survivors. Hierarchical multiple regressions found no significant association between torture and PTSD. However, when we examined the effects of different types of torture we found witnessing and sexual tortures were significant predictors of PTSD and CTD. Path analysis results found that torture trauma and its severity may not be predicative of PTSD; but it is highly predictive of the more complex syndromes of CTD. The implications of the results for treating torture survivors were discussed. One of the important findings is the potential effects of torture on decreased re-experiencing and emotional numbness. Torture trauma may be too emotionally and physically painful experience that tends to be suppressed decreasing re-experiencing and increasing dissociation.
ABSTRACT The current research utilized a new integrative traumatology framework to measure and st... more ABSTRACT The current research utilized a new integrative traumatology framework to measure and study chronic stress and trauma profiles, cumulative trauma (CT) appraisal, and coping in 2 multiply traumatized communities: Palestinians in Gaza (N = 132) and American Indians in the United States (N = 302). The first study with Palestinians was conducted by using the CT scale and other mental and physical health variables. The second study with American Indians used the same trauma measure with different measures of physical and mental health and coping. Trauma profiles of the 2 groups were compared. American Indians had a higher trauma load with different trauma profiles than Palestinians. Using path analysis in both studies, CT, mediated by appraisal and coping, indirectly predicted mental disorders and directly predicted comorbidity and negative health. Cumulative positive and negative appraisals, rather than CT, predicted positive or negative outcomes in coping and posttraumatic growth. These results may help to clarify the dynamics of the cognitive–behavioral approaches’ success using reappraisal and coping. The implications of the study for trauma theory and clinical psychology are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
The goal of this paper is to advance the theory of chronic and traumatic stressors that have been... more The goal of this paper is to advance the theory of chronic and traumatic stressors that have been identified as type III traumas in the trauma developmentally-based framework (DBTF) and use it to investigate the mental and physical health effects of such traumas on impacted individuals and groups. Participants were 438 Palestinian adolescents from the West Bank who had been exposed to a number of types of trauma including chronic intergroup violence. The age of participants in the sample ranged from 12 to 19 with a mean of 15.66 and SD of 1.43. The sample included 54.6% males, 52.3% resided in cities, 44.4% resided in villages, while 3.2% resided in refugee camps. The study utilized a measure for cumulative traumas that is based on the DBTF and measures of post-traumatic stress disorder (PTSD), cumulative trauma related disorders (CTD), depression, anxiety, collective annihilation anxiety (AA), identity salience, and fear of death. The results of partial correlation and path analyses indicated that continuous traumatic stress was a significant predictor of mental health. The analyses also indicated that poverty predicted identity salience and AA that mediated their negative effects on physical and mental health of Palestinian adolescents. The relevance of these results to peace, social and clinical psychology was discussed.
Measures that screen for mental health in multiple traumatized populations (e.g., refugees, minor... more Measures that screen for mental health in multiple traumatized populations (e.g., refugees, minorities, mental health patients, prison inmates) lack theoretical clarity that makes it difficult to develop a measure that has robust psychometrics. The paper proposes cumulative trauma disorders (CTD) model and develops a scale that measures the concept and can be used as a general mental health screening tool in such populations. The measure has been tested on two studies: on representative community sample of Iraqi refugees in Michigan and on a clinic sample of refugees. Further, the measure was used on samples of Iraqi refugee and African American adolescents, West Bank and Gaza in Palestinian territories, as well as a mental health screening tool in some centers that screen refugees and torture survivors in US. The measure has been found to have high alpha and test-retest reliability, good construct, concurrent, discriminative and predictive validity in the two main samples and on all the studies and centers that utilized it. The measure can be used as a general mental health screening tool for adult and adolescent in public health settings in different cultures, as well as for refugees, torture survivors, and highly traumatized populations.
The study explores the effects of gender discrimination GD as type III trauma in 359, (160 female... more The study explores the effects of gender discrimination GD as type III trauma in 359, (160 females and 199 males) torture survivors. Data includes measures of GD and other traumas, PTSD and cumulative trauma disorders CTD. GD found to decrease PTSD symptoms in males favoring mental health status of males, and increase CTD symptoms in females. GD mediated the effects of personal identity traumas on PTSD and CTD symptoms of psychosis/dissociation; executive function deficits, and suicidality. The results highlight GD as type III trauma that contributes to the mental health differences between males and females.
A multivariate categorization scheme for classifying clients' presenting problems wa... more A multivariate categorization scheme for classifying clients' presenting problems was empirically developed. Six hundred and eleven clients who sought services at a university counseling center completed the Computerized Assessment System for Psychotherapy Evaluation and Research (L. McCullough & A. D. Farrell, 1983). Descriptive statistics, cluster analysis, cluster differentiation by external variables, and stability of cluster solutions across subsamples are presented. Nine clusters of clients with different types of presenting problems that were stable across subsamples were identified. This multivariate approach provides a more complex assessment of clients' presenting problems that may have implications for case disposition, therapeutic interventions, prevention interventions, and research pertaining to coping, help seeking, and therapeutic outcomes.
Journal of the American Psychiatric Nurses Association, Jan 3, 2014
Understanding the dynamics of mental health stigma through existing frameworks, especially in min... more Understanding the dynamics of mental health stigma through existing frameworks, especially in minorities with higher stigma, is problematic. There is a need to reconceptualize stigma, particularly in highly traumatized groups. The current study examines the validity of a new development-based trauma framework that conceptualizes stigma as a type III chronic trauma that contributes to negative mental health effects. This framework proposes that public stigma is a unique chronic traumatic stress that mediates the effects of similar trauma types in mental health patients. To test this proposition, this study explores the relationships between internalized stigma of mental illness (ISMI), different trauma types, and posttrauma spectrum disorders. ISMI, posttraumatic stress disorder, other posttrauma spectrum disorders, and cumulative trauma measures were administered to a sample of 399 mental health patients that included Arab (82%), Muslim (84%), and refugee (31%), as well as American ...
This study explored the effects of bullying victimization (BV), as a Type II traumatic stressor, ... more This study explored the effects of bullying victimization (BV), as a Type II traumatic stressor, on intelligence quotient (IQ), posttraumatic stress disorder (PTSD), and complex PTSD symptoms. Participants were 390 African American and Iraqi refugee adolescents. Measures of BV, cumulative life trauma, PTSD, discrimination, and IQ were administered. Correlational, multilevel regression, and path analyses were conducted. BV, independent of cumulative trauma, and discrimination were found to have 432 I. A. Kira et al.
A Palestinian sample was used to explore the dynamics of posttraumatic growth (PTG) across differ... more A Palestinian sample was used to explore the dynamics of posttraumatic growth (PTG) across different trauma types. Cumulative trauma, posttraumatic stress disorder, depression, anxiety, PTG, and stress-related growth (SRG) measures were administered. As predicted, only type I traumas were associated with PTG. Type II traumas were not associated with PTG, while type III collective identity traumas were negatively associated with PTG. Results indicated that PTG was not a significant predictor of any mental health symptoms and that PTG is different from SRG, which seems to describe growth in non-traumatic situations. The results suggest that it is important to analyze trauma profiles rather than single trauma.
To clarify the effects of torture trauma and its components on PTSD and other mental health condi... more To clarify the effects of torture trauma and its components on PTSD and other mental health conditions, we investigated the relationship between measures for PTSD, Cumulative trauma disorders CTD, cumulative life trauma, torture and torture severity in a sample of 326 torture survivors. Hierarchical multiple regressions found no significant association between torture and PTSD. However, when we examined the effects of different types of torture we found witnessing and sexual tortures were significant predictors of PTSD and CTD. Path analysis results found that torture trauma and its severity may not be predicative of PTSD; but it is highly predictive of the more complex syndromes of CTD. The implications of the results for treating torture survivors were discussed. One of the important findings is the potential effects of torture on decreased re-experiencing and emotional numbness. Torture trauma may be too emotionally and physically painful experience that tends to be suppressed decreasing re-experiencing and increasing dissociation.
ABSTRACT The current research utilized a new integrative traumatology framework to measure and st... more ABSTRACT The current research utilized a new integrative traumatology framework to measure and study chronic stress and trauma profiles, cumulative trauma (CT) appraisal, and coping in 2 multiply traumatized communities: Palestinians in Gaza (N = 132) and American Indians in the United States (N = 302). The first study with Palestinians was conducted by using the CT scale and other mental and physical health variables. The second study with American Indians used the same trauma measure with different measures of physical and mental health and coping. Trauma profiles of the 2 groups were compared. American Indians had a higher trauma load with different trauma profiles than Palestinians. Using path analysis in both studies, CT, mediated by appraisal and coping, indirectly predicted mental disorders and directly predicted comorbidity and negative health. Cumulative positive and negative appraisals, rather than CT, predicted positive or negative outcomes in coping and posttraumatic growth. These results may help to clarify the dynamics of the cognitive–behavioral approaches’ success using reappraisal and coping. The implications of the study for trauma theory and clinical psychology are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
The goal of this paper is to advance the theory of chronic and traumatic stressors that have been... more The goal of this paper is to advance the theory of chronic and traumatic stressors that have been identified as type III traumas in the trauma developmentally-based framework (DBTF) and use it to investigate the mental and physical health effects of such traumas on impacted individuals and groups. Participants were 438 Palestinian adolescents from the West Bank who had been exposed to a number of types of trauma including chronic intergroup violence. The age of participants in the sample ranged from 12 to 19 with a mean of 15.66 and SD of 1.43. The sample included 54.6% males, 52.3% resided in cities, 44.4% resided in villages, while 3.2% resided in refugee camps. The study utilized a measure for cumulative traumas that is based on the DBTF and measures of post-traumatic stress disorder (PTSD), cumulative trauma related disorders (CTD), depression, anxiety, collective annihilation anxiety (AA), identity salience, and fear of death. The results of partial correlation and path analyses indicated that continuous traumatic stress was a significant predictor of mental health. The analyses also indicated that poverty predicted identity salience and AA that mediated their negative effects on physical and mental health of Palestinian adolescents. The relevance of these results to peace, social and clinical psychology was discussed.
Measures that screen for mental health in multiple traumatized populations (e.g., refugees, minor... more Measures that screen for mental health in multiple traumatized populations (e.g., refugees, minorities, mental health patients, prison inmates) lack theoretical clarity that makes it difficult to develop a measure that has robust psychometrics. The paper proposes cumulative trauma disorders (CTD) model and develops a scale that measures the concept and can be used as a general mental health screening tool in such populations. The measure has been tested on two studies: on representative community sample of Iraqi refugees in Michigan and on a clinic sample of refugees. Further, the measure was used on samples of Iraqi refugee and African American adolescents, West Bank and Gaza in Palestinian territories, as well as a mental health screening tool in some centers that screen refugees and torture survivors in US. The measure has been found to have high alpha and test-retest reliability, good construct, concurrent, discriminative and predictive validity in the two main samples and on all the studies and centers that utilized it. The measure can be used as a general mental health screening tool for adult and adolescent in public health settings in different cultures, as well as for refugees, torture survivors, and highly traumatized populations.
The study explores the effects of gender discrimination GD as type III trauma in 359, (160 female... more The study explores the effects of gender discrimination GD as type III trauma in 359, (160 females and 199 males) torture survivors. Data includes measures of GD and other traumas, PTSD and cumulative trauma disorders CTD. GD found to decrease PTSD symptoms in males favoring mental health status of males, and increase CTD symptoms in females. GD mediated the effects of personal identity traumas on PTSD and CTD symptoms of psychosis/dissociation; executive function deficits, and suicidality. The results highlight GD as type III trauma that contributes to the mental health differences between males and females.
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