Individuals diagnosed with a personality disorder (PD) are often confronted with a low quality of life (QoL) and high health costs, both important outcome variables among cost-effectiveness studies...Show moreIndividuals diagnosed with a personality disorder (PD) are often confronted with a low quality of life (QoL) and high health costs, both important outcome variables among cost-effectiveness studies. Several factors have been identified that are associated with a low QoL and high health costs in individuals diagnosed with a PD. The influence of trauma is unknown. It has been found that PDs are associated with both past trauma experiences and symptoms of posttraumatic stress disorder (PTSD) in their daily life. While several studies suggested that individuals with a Borderline PD (BPD) and comorbid PTSD suffer from a more impaired QoL compared to individuals with a single disorder, less is known about the effect of PTSD on PDs other than BPD and the relation between trauma severity and health costs. The current study investigates the effect of both childhood trauma and current PTSD symptoms on QoL and health costs in individuals diagnosed with a PD and the possible mediating role of QoL on the relationship between trauma and health costs. The sample consisted of 65 individuals, with a mean age of 38 (SD = 12.3), diagnosed with one or more PDs. Data was collected with several questionnaires (Childhood Trauma Questionnaire-Short Form, Posttraumatic Stress Disorder Checklist for DSM-5, Treatment Inventory of Costs in Patients with psychiatric disorders, and the Mental Health Quality of Life questionnaire). The results show that severity of current PTSD symptoms (t(58) = -4.19, p < .001) but not childhood trauma was related to a decreased QoL in individuals diagnosed with a PD. Both current PTSD symptoms and childhood trauma were not significantly related to health costs. QoL did not perform a mediating role on the relationship between trauma and health costs. To conclude, severe PTSD symptoms represent an additional deprivation for QoL among personality-disordered individuals in this sample. This conclusion is based on a relatively small sample, thus should be further investigated with a larger sample.Show less
Abstract Background At this moment, there are more refugees than ever before. Refugees have more chance of developing psychopathology, which can be explained from the (biosocial) ecological models....Show moreAbstract Background At this moment, there are more refugees than ever before. Refugees have more chance of developing psychopathology, which can be explained from the (biosocial) ecological models. Individual and environmental traits influence the development, course and treatment of psychopathology. An unstable environment might cause more stress and mental health issues. The aim of this meta-analysis is to research how effective psychotherapy is for treating PTSD in refugees, and if age as individual factor and language/ cultural adaptation as environmental factor influence the treatment efficacy. Methodology A systematic review with different meta-analyses. Results Systematic researches provided 132 effect sizes within 80 suitable studies. The overall effect size of treating PTSD was significant (Cohen’s d = -0.941, p < 0.001). There were no significant differences between the mean effect sizes of treating PTSD between children, adolescents and adults. There was no difference in treatment efficacy as a function of the level of language or cultural adaptation found. Discussion and conclusion These results show that psychotherapy significantly lowers PTSD symptoms in refugees. However, our results do not find evidence for the proposed (biosocial) ecological models since age and adaptation are not associated with treatment efficacy. Moreover, there is a large difference in treatment efficacy between refugees and non-refugees, this might be caused by the different structural designs between the studies included in this meta-analysis. Future research should consider these different structural designs and should research more environmental factors that can increase treatment efficacy.Show less
Research master thesis | Psychology (research) (MSc)
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Posttraumatic stress disorder (PTSD) and dissociative symptoms often co-occur. Yet, the symptom interrelations between PTSD and dissociation have not been disentangled. The timing and type of...Show morePosttraumatic stress disorder (PTSD) and dissociative symptoms often co-occur. Yet, the symptom interrelations between PTSD and dissociation have not been disentangled. The timing and type of traumatic events have been suggested to play crucial roles in the comorbidity between PTSD and dissociative symptoms. Therefore, partial correlations between PTSD, dissociative symptoms, and adverse childhood maltreatment (ACE) were investigated in two regularized partial correlation networks. Online self-report responses from participants (N = 495) of an overarching study on domestic violence were used. Symptoms and maltreatment types were assessed with the Post-Traumatic Stress Disorder Checklist DSM-5, the Dissociation Experience Scale-II, and the Childhood Trauma Questionnaire-Short Form. The first network analysis included nine nodes (four PTSD symptoms, three dissociation symptoms, two assumed confounders). The second analysis additionally considered five ACE types. The network exploration revealed few and weak connections between PTSD and dissociation. Regardless of the bridge strength, absorption/imagination and hyperarousal showed to be hubs linking PTSD and dissociative symptoms. Adding ACE barely changed the bridges between PTSD and dissociative symptoms. Amnesia appeared to be a hub for connecting dissociative symptoms to ACE. Emotional abuse was the only maltreatment type connected to the PTSD symptoms. These preliminary findings suggest that PTSD and dissociation are largely independent constructs and hint towards separate diagnostic entities. The study was limited by the sample’s subclinical symptoms and maltreatment scores. This limitation may also be partly responsible for the poorly connected network. Prospective studies with clinical samples are needed to further investigate the interplay between PTSD, dissociation, and ACE.Show less
The current coronavirus pandemic is related to psychological problems, such as health fear. Health fear is the anxiety of getting ill and is related to symptoms of posttraumatic stress disorder ...Show moreThe current coronavirus pandemic is related to psychological problems, such as health fear. Health fear is the anxiety of getting ill and is related to symptoms of posttraumatic stress disorder (PTSD) and adjustment disorder. People use coping behavior to manage psychological demands. Positive coping behavior, such as using humor and planning, was related to less symptoms of PTSD and adjustment disorder in nurses during the current pandemic and the SARS epidemic. The aim of this study was to investigate whether positive coping behavior significantly moderated the relationship between health fear and symptoms of PTSD and adjustment disorder during the current coronavirus pandemic. This study was part of an international longitudinal study. A total of 2141 inhabitants of the Netherlands were included. Health fear was measured using a questionnaire that was developed for this study. Furthermore, the “Adjustment Disorder – New Module 8”, the “Primary Care PTSD screen for DSM-5” and the “Pandemic Coping Scale” were used. The results were analyzed using linear regressions. The results showed that more health fear was related to more symptoms of PTSD and adjustment disorder. No significant effect was found for the relation between coping behavior and symptoms of PTSD and adjustment disorder. Positive coping behavior did not significantly moderate the relationship between health fear and symptoms of PTSD and adjustment disorder. Interventions that reduce fear, including yoga and mindfulness, could be helpful to the population. Future studies could investigate whether health fear is a predictive factor for symptoms of PTSD and adjustment disorder.Show less
Background: The number of forced migrants worldwide has been rising for years. Many forced migrants suffer from PTSD, yet demand for mental health care is high and waiting times long. Group-based...Show moreBackground: The number of forced migrants worldwide has been rising for years. Many forced migrants suffer from PTSD, yet demand for mental health care is high and waiting times long. Group-based interventions provide a solution, as they allow for the treatment of more patients. They also provide some unique benefits beyond those of individual therapy. Aims: To evaluate the effectiveness of group-based psychological and psychosocial interventions in reducing symptoms of PTSD in child, adolescent, and adult forced migrants, and to investigate treatment predictors (treatment type, gender, age, and number of sessions). Methods: We conducted systematic searches in PubMed and Web of Science, searched the preprint server Biorxiv.org, and performed a grey literature search (final search date: March 9, 2022). A random-effects model was used for data synthesis, and moderator and subgroup analyses were performed with the predictors. Results: The systematic search yielded 38 eligible studies, including 43 treatment arms. Results showed significant effects of group therapy in reducing PTSD symptoms (Cohen’s d = -0.89, 95% CI = [-1.06, -0.72], SE = 0.085, z = -10.437, p < .001), with substantial heterogeneity. It is likely that publication bias existed. The selected predictors did not affect outcomes. Conclusion: Group therapy effectively reduces PTSD symptoms in forced migrants. Considering its cost and time efficiency and other benefits, practitioners should consider implementing group therapy (more frequently). Future studies will need to consider other predictors, compare group therapy with individual therapy, and evaluate long term effects.Show less
Individuals from communities characterized by high crime rates, violence, poverty, and social disadvantages are of greater risk to develop PTSD. Due to high comorbidity rates between PTSD and...Show moreIndividuals from communities characterized by high crime rates, violence, poverty, and social disadvantages are of greater risk to develop PTSD. Due to high comorbidity rates between PTSD and borderline personality disorder (BPD), recently, complex PTSD was introduced. Complex PTSD contains, next to PTSD symptoms, the additional symptoms as disturbances in self-organization (DSO) and negative alterations in cognitions and mood (NACM). However, it remains unclear how symptoms of complex PTSD, PTSD, and BPD are related in an at-risk, urban sample. The present study explored the relations between PTSD, BPD, DSO symptoms and NACMs using a network approach. The symptoms were assessed using semi-structured clinical interviews. Participants (N = 470; 98.1% female; 97.7% African-American) were recruited by Powers et al. (2022) from medical clinics within urban areas in the USA. Two network analysis were estimated using EBICglasso model to create regularized partial correlation networks. The first to explore the overall structure of PTSD, BPD, and complex PTSD, the second to investigate the relatedness of the NACM and DSO symptoms. The results were in line with previous studies and indicated that the NACM symptoms play a crucial role in the PTSD structure, in connecting PTSD with the DSOs. BPD and DSO symptoms were related via emotional dysregulation. Of the specific NACM symptoms, trauma-related amnesia was more related to BPD than to PTSD, and DSO symptom. This suggests BPD and PTSD to be distinct, complex PTSD to be phenomenologically related to both and the NACM and DSO symptoms to be associated with each other.Show less
A Dutch study indicated that young people who experienced child abuse exhibit significantly more violent delinquent behavior, and that this did not decline over time. This can have harmful...Show moreA Dutch study indicated that young people who experienced child abuse exhibit significantly more violent delinquent behavior, and that this did not decline over time. This can have harmful consequences for both the individual and society. Child abuse has been identified as a cause of risk factors of delinquent behavior, possibly due to the disruption of social, emotional, and cognitive development. Recent literature suggests that post-traumatic stress disorder (PTSD) may play a role in the link between child abuse and delinquent behavior. This study aims to investigate whether PTSD moderates the relationship between the seriousness of delinquent behavior and severity of exposure to child abuse in the same sample as the Dutch study. Surveys were conducted among 127 Dutch youths aged 12 to 20 years who have experienced physical and emotional abuse. The severity of child maltreatment is measured using the Child Parent Conflict Tactics Scale (CPCTS) around the time of the official CPS report. PTSD and delinquent behavior are measured 1,5 years later, using the Trauma Symptom Checklist for Children (TSCC) and the International Self Report Delinquency (ISRD). The results show no significant relationship between the severity of child maltreatment and the seriousness of delinquent behavior, nor identifies any direct or moderating effect of PTSD on delinquent behavior in maltreated youth. However, gender and age are significantly related to the seriousness of delinquent behavior, implying older teenagers and males have a higher likelihood of showing delinquent behavior to a more serious extent. This study finds no relationship between the severity of child maltreatment, PTSD, and the seriousness of juvenile delinquency. Other factors than child maltreatment or PTSD may play a role in predicting delinquent behavior, such as the youth’s social environment. Professionals should focus on identifying and addressing the various factors that influence youth’s behavior.Show less
In dit onderzoek is een meta-analyse uitgevoerd naar de behandeleffecten van cognitieve gedragstherapie (CGT), Eye Movement Desensitization and Reprossing (EMDR) en narratieve exposure therapie ...Show moreIn dit onderzoek is een meta-analyse uitgevoerd naar de behandeleffecten van cognitieve gedragstherapie (CGT), Eye Movement Desensitization and Reprossing (EMDR) en narratieve exposure therapie (NET) op vluchtelingen die gediagnosticeerd zijn met posttraumatische stressstoornis of symptomen van deze stoornis vertonen. Ook is onderzocht of er een verschil in effectiviteit van deze behandelvormen is voor kinderen en volwassen. Aangezien veel vluchtelingen van niet-westerse komaf zijn, is in dit onderzoek ook het moderatoreffect van cultuur- en taalaanpassing op de behandelvorm opgenomen. Een systematische literatuuronderzoek is uitgevoerd en hieruit zijn 34 studies geselecteerd die relevant zijn gebleken voor dit onderzoek volgens de inclusiecriteria. In het programma JASP zijn de analyses uitgevoerd. De meta-analyse heeft aangetoond dat CGT (-1.33, CI [-1.84, -0.82]), EMDR (-1.26, CI [-1.78, -0.74]) en NET –(1.12, CI [-1.56, 0.69]) significante behandeleffecten hebben. Tussen de behandelingen zijn geen significante effect verschillen te zien (p > 0.05). Hieruit kan geconcludeerd worden dat de resultaten van de hoofdeffecten van de behandelingen gelijkwaardig zijn aan elkaar. Dit ondersteunt het dodo bird verdict die stelt dat er geen verschillen waarneembaar zijn tussen psychotherapieën. Verschillen in behandeleffectiviteit bij kinderen en volwassen zijn niet aangetoond door gebrek aan significantie (d = 0.109, p = 0.78). Het toevoegen van de variabele taal- en cultuuradaptatie bleek geen significant effect aan te tonen (d = -0.031, p = 0.926).Show less
Refugees form a population with a high prevalence of psychological disorders relative to non-refugee populations (WHO, 2021). It has been suggested that cultural adaptation of psychological...Show moreRefugees form a population with a high prevalence of psychological disorders relative to non-refugee populations (WHO, 2021). It has been suggested that cultural adaptation of psychological treatments can help to optimise the effectiveness of treatments for refugees, but there is a lack of clear research on this topic. The current work addresses this by investigating the following research question: Are culturally adapted psychological treatments more effective than non-adapted treatments in reducing symptoms of PTSD, depression and anxiety in refugees? It is hypothesized that culturally adapted treatments are more effective than non-adapted treatments. The research question is explored by performing a meta-analysis of treatment effects from a selection of studies. Results from the meta-analysis show significant treatment effects of culturally adapted treatments and non-adapted treatments for PTSD, depression and anxiety. However, no significant differences in treatment effects were found between culturally adapted treatments and non-adapted treatments. Therefore, the conclusion is that culturally adapted treatments for PTSD, depression and anxiety are not more effective for refugees than non-adapted treatments. The main implication of this is that it might not be necessary for clinicians and researchers to invest in cultural adaptation of psychological treatments.Show less
Variants of exposure-based therapy have been found to be effective in ameliorating childhood abuse-related post-traumatic stress disorder (CA-PTSD). This study aims to investigate whether three...Show moreVariants of exposure-based therapy have been found to be effective in ameliorating childhood abuse-related post-traumatic stress disorder (CA-PTSD). This study aims to investigate whether three variants of Prolonged Exposure (PE) improve comorbid depressive symptoms, suicidality and personality disorders amongst patients with CA-PTSD. Data from the IMPACT study was used, which included 149 participants who were randomly assigned to one of three treatment conditions: PE, intensified PE (iPE) or Skills Training in Affective and Interpersonal Regulation followed by PE (STAIR+PE). Participants were assessed at multiple time points ranging from baseline to 12-month follow-up. Linear mixed effect models were utilized to test the effect of treatment on depressive symptoms, suicide risk, personality disorder symptom severity and the prevalence of diagnosed personality disorders. Such models were then extended to test whether the three variants of PE differed in their treatment effects. The findings demonstrated that treatment led to large improvements in depressive symptoms and suicide risk from baseline assessment to 12-month follow-up. Moreover, personality disorder symptom severity and the prevalence of diagnosed personality disorders significantly declined between baseline and 6-month follow-up. It was found that PE, iPE and STAIR+PE did not differ in their treatment effects, implying that deviations from the original PE protocol do not lead to superior treatment outcomes. In conclusion, variants of exposure- based therapy lead to sustained improvements in comorbid psychopathologies amongst patients with CA-PTSD.Show less
One of the difficulties that refugees face is the impact of exposure to traumatic events over long periods of time, which can lead to post-traumatic stress disorder, or PTSD. This study aimed to...Show moreOne of the difficulties that refugees face is the impact of exposure to traumatic events over long periods of time, which can lead to post-traumatic stress disorder, or PTSD. This study aimed to examine the impact of PTSD on cognitive learning potential in refugee adolescents. The 13 participants (mean age = 13.15, 53.85% male) and their parents were recruited through language schools in the Zuid-Holland province in the Netherlands. Cognitive learning potential was measured with a new promising measure, the computerized dynamic test of analogical reasoning. The study was of an experimental pre-test-training-post-test design with two conditions, training and control. The participants completed exercises of analogical reasoning pre-test, then the experimental condition received graduated prompts training. Both groups completed exercises post-test. The effectiveness of the training was examined, but no significant results were found, although both the training and control groups significantly improved from pre-test to post-test. No significant relationship was found between PTSD symptoms and learning potential. Then, anxiety and cognitive empathy were investigated as mediators in the relationship between PTSD symptoms and learning potential. No significant relationships were found. Although the present study has no direct contribution to research, implications for future studies are discussed.Show less
Introduction. Longitudinal prospective studies are needed to identify risk factors for posttraumatic stress disorder (PTSD) symptoms 15 years after trauma, since cross-sectional findings do not...Show moreIntroduction. Longitudinal prospective studies are needed to identify risk factors for posttraumatic stress disorder (PTSD) symptoms 15 years after trauma, since cross-sectional findings do not inform how a possible pattern change as the clinical condition extends. Recently, thyroid hormones were in the top fifteen most relevant biochemical predictors for PTSD symptom trajectory within one year after trauma. Moreover, peritraumatic distress (PD) is highly associated with PTSD symptom severity. Nevertheless, most studies did not investigate the course of PTSD 15 years after a serious injury. This study hypothesized that higher thyroid functioning acutely after trauma, and higher PD predicted higher 15-year PTSD symptom severity, while the thyroid functioning mediated the relation between PD and 15-year PTSD symptom severity. Methods. This longitudinal prospective study examined 452 serious injury survivors. Blood samples were obtained acutely after trauma, and PD 23 days after trauma. PTSD symptom severity was assessed 15 years after trauma (M = 2.77, SD = 4.64), with the Clinician Administered PTSD Scale. Results. Multiple linear regression analyses showed that 15-year PTSD symptom severity was not predicted by the thyroid hormones and PD, and the thyroid hormones did not mediate the relation between PD and 15-year PTSD symptom severity. Discussion. Our study showed the importance of predicting 15-year PTSD symptoms, since understanding how and when these symptoms occur could be crucial for treatment and promising for risk identification at an early stage. More longitudinal studies are needed to understand why some people do, and others do not develop 15-year PTSD symptoms.Show less
Trauma, cognitive flexibility, and empathy are widely studied constructs in psychology. However, inconsistent results are found regarding the aftermath of trauma. In the current study, it was...Show moreTrauma, cognitive flexibility, and empathy are widely studied constructs in psychology. However, inconsistent results are found regarding the aftermath of trauma. In the current study, it was expected that Syrian refugee children with higher severity of trauma symptoms scored significantly higher on cognitive flexibility and empathy tests than children with lower severity of trauma symptoms. To investigate these hypotheses, a quantitative cross-sectional study was conducted with a between-subjects design. The participants were asked to complete three questionnaires and two computer tasks to measure their cognitive flexibility, empathy, and trauma symptoms. Linear regression analyses showed that trauma was not a significant predictor of cognitive flexibility or empathy. If future studies could find this relationship in a larger sample, it possibly has implications for actively using cognitive flexibility and empathy as resilience factors during education for mental health professionals, therapeutic treatments of trauma, and in educational settings.Show less
The quality of early relationships is thought to form the basis of maintaining mental well-being later in life. The aim of this study was to examine the role of parental bonding, loneliness and...Show moreThe quality of early relationships is thought to form the basis of maintaining mental well-being later in life. The aim of this study was to examine the role of parental bonding, loneliness and hopelessness in the development of PTSD symptomatology in a young adult sample. Participants who study at Leiden University was asked to fill-out questionnaires about parental bonding, loneliness, hopelessness and PTSD. According to participants’ scores on parental bonding inventory (PBI), they were assigned either to secure or insecure attachment groups. A mediation analysis was conducted to investigate the relationship between parental bonding and PTSD symptomatology by coding hopelessness and loneliness as potential mediators in this relationship. The results revealed that insecure attachment was associated with higher levels of hopelessness, loneliness and PTSD symptomatology whereas secure attachment was associated with lower levels of hopelessness, loneliness and PTSD symptomatology. Furthermore, loneliness and hopelessness mediated the relationship between parental bonding and PTSD symptomatology. These findings could help in identifying individuals who are more or less vulnerable to develop trauma-related symptoms after a traumatic or an adverse situation.Show less
Domestic violence is a highly prevalent form of violation of human rights. Victims often exhibit trauma symptoms and/or suffer from Post-Traumatic Stress Disorder (PTSD). Identifying individuals at...Show moreDomestic violence is a highly prevalent form of violation of human rights. Victims often exhibit trauma symptoms and/or suffer from Post-Traumatic Stress Disorder (PTSD). Identifying individuals at risk for PTSD can sometimes be difficult, yet it is the key in ensuring prevention of later treatment. The solution might be recognition of early trauma-specific symptoms that are predictors of PTSD and can be detectable through spontaneous narratives. Under extreme stressors individuals experience even more distress, which can amplify pre existing trauma symptoms. This study investigated the linguistic characteristics of trauma specific symptoms over two periods – before Covid-19 and during Covid-19 in a domestic violence (DV) victims’ group and a control group. The sample consisted of a total 4413 Subreddit posts that were analyzed using the software Language Inquiry and Word Count. The following categories were investigated: word count, cognitive processes, 1st person singular pronoun, positive emotions, and death. A MANOVA analysis showed that the linguistic markers of trauma were stronger in the victims group compared to control. Victims had longer narratives that included more 1st person singular pronouns, and fewer cognition words and fewer positive emotion words. However, the markers did not differ over the two time periods. The results indicate that victims exhibit stronger trauma-specific discourse compared to control. Unlike self-reports, linguistic analysis of natural word use is free from response bias, a problem often encountered by clinicians. Analysis of linguistic characteristics of spontaneously written material can contribute to early detection of trauma symptoms and prevention of PTSD.Show less
After decades of widely studying fear habituation as a mechanism of change in exposure therapy, the focus seems to be shifting towards harm expectancy violation through which new non-threat...Show moreAfter decades of widely studying fear habituation as a mechanism of change in exposure therapy, the focus seems to be shifting towards harm expectancy violation through which new non-threat associations are acquired. Expectancy violation has found a more consistent support in modern literature, but it has not yet been sufficiently investigated as a mechanism or a marker of change in exposure, when treating post-traumatic stress disorder (PTSD). Understanding what drives change could facilitate designing effective interventions that would improve exposure outcome, and high dropout or non-response rates, that are often accompanying PTSD treatment. The aim of this master thesis was to explore the relationship between harm expectancy violation, within and between the first two exposure sessions, and change in PTSD symptoms, after these two sessions and post-treatment, as measured by PCL. To put these relationships into perspective, predictive value of fear habituation indices in relation to the outcome was also assessed; and further, it was evaluated whether expectancy violation and habituation act as separate constructs when standing together. Results have shown that early indices of between-session expectancy violation and within-session fear habituation had a significant, though weak, relationship to early treatment outcome, while acting as separate predictors. However, this study has not found any of the early indices of expectancy violation or fear habituation to be indicative of the end-of-treatment outcome. Furthermore, it points to limitations regarding measuring harm expectancies and provides recommendations for future research.Show less
This study investigates the results of a high intensive residential trauma-focussed therapy programme. The main hypotheses were that (1) PTSD patients with a history of CSA report a clinically...Show moreThis study investigates the results of a high intensive residential trauma-focussed therapy programme. The main hypotheses were that (1) PTSD patients with a history of CSA report a clinically significant decrease in their PTSD symptoms after treatment, and (2) PTSD patients with a history of CSA would profit equally from trauma-focused treatment as PTSD patients without a history of CSA. Methods: Patients were 76 individuals who participated in a five-day treatment program consisting of eye movement desensitization and reprocessing (EMDR), prolonged exposure (PE) sessions, and trauma-sensitive yoga. The severity of PTSD symptoms was assessed with the PCL-5 at pre- and post-treatment, at one-week follow-up, and at a one-month follow-up. Pre-post differences were calculated and compared between the two trauma conditions (i.e., patients with a history of CSA, and no CSA). Results: Treatment resulted in a significant short term decrease of PTSD symptoms, which was mostly maintained at follow-up. Although patients with a history of CSA showed significantly higher PTSD symptom severity at pre- and post-treatment compared to those without a history of CSA, no significant pre-post differences were found between the two groups. Longer term decrease in PTSD symptoms was significant for patients without a history of CSA, but was not strong enough to be significant for patients with a history of CSA. Clinical significance of the treatment was demonstrated for half of the participants. Conclusion: Results suggest that intensive treatment for PTSD might be a possible therapeutic option for PTSD patients with a history of CSA.Show less
This thesis discusses the initial mental health care response and subsequent development of postdisaster mental health policies after the 1995 Hanshin-Awaji earthquake and 2011 Great East Japan...Show moreThis thesis discusses the initial mental health care response and subsequent development of postdisaster mental health policies after the 1995 Hanshin-Awaji earthquake and 2011 Great East Japan Earthquake. It seeks to discover which actors had which roles in the progress, and how responsibility and accountability have shifted. To accomplish this goal, a causal process tracing method was used which analyzes the causal mechanisms that shaped the development of post-disaster mental health policies after the 1995 and 2011 disasters. Afterwards, a comparative analysis was used to compare the policy shaping process from both periods. By doing this, we can ascertain if lessons regarding post-disaster mental health care response have been learned, and if so, in what way these lessons have had an effect on the post-disaster mental health care regulation. After the 1995 Hanshin-Awaji earthquake, the Japanese government was heavily criticized for their delayed action, while in contrast the local government, volunteers from the civil society and NPOs immediately came to action. At that time, there was not as much knowledge regarding post-traumatic stress disorder in Japan, and precautions were scarce. After the initial response and the first studies showing many victims battling mental health problems, the government developed post-disaster mental health policies. The 2011 Great East Japan Earthquake triple disaster was unprecedented in scope, and mental health care measures employed since the 1995 disaster were not sufficient. Local governments from across the country, volunteers and NPOs offered their immediate help, while the central government was struggling in Tokyo with inadequate leadership, political power games and inflexible regulations. In the wake of the destruction regulations were again implemented based on the lessons learned, but a real recognition of mental health care still seems far away. A large focus remains on reconstruction of houses, infrastructure and financial revitalization, while the mental health of the victims seems forgotten. The national government should take up more responsibilities to protect not only the physical, but also the mental health of its citizens, and finish large projects such as permanent housing and community building in the affected areas that will provide the victims with a relief of stress and uncertainty.Show less
