may 2017 issue no.17 october 2019 newsletter issue 19 · 01 asian traumatic stress points may 2017...

ASIAN TRAUMATIC STRESS POINTS01

May 2017 Issue No.17

October 2019 NEWSLETTER Issue 19

President’s MessageKitty WU, Ph.D.

CONTENTS

CONTACTS

EXECUTIVECOMMITTEE

President's Message

Knowledge Gateway• Policies, public health and trauma:

prevention and resilience

Past Events• Two-day Workshop on Cogn i t i ve

Processing Therapy for PTSD (28 & 29 November 2018)

• Student Research Grant

Membership Application Form

Message from AsianSTSS

Unit 915, 9th Floor, China Merchants Tower, Shun Tak Centre, 168-200 Connaught Road, Central, Sheung WanHome Page :http://www.asianstss.orgEmail :[email protected]

President : Dr. Kitty Wu, J. P.Vice President : Dr. Eugenie LeungSecretary : Ms. Esther NgTreasurer : Dr. Karen ShumMembership Officer : Ms. Betty LukPublicity Officer : Mr. Neo NganPublication Officer : Ms. Rose WongScientific Officer : Mr. Stanley ChanMember : Mr. Darren Chan

: Dr. Chung-sing Kan: Ms. Corine Wong

Reading is good hobby. It can help me to relax, reduce stress level, gain knowledge and reflect on what has happened and is happening in life. Recently, I came across a few readings that may interest professionals and public who would like to know about how to keep well in times of unrest and provide care for people with traumatic experience(s).

The first reading is a booklet first printed in 1943, “How to Keep Well in Wartime”. “Issued for the Ministry of Health by the Ministry of Information” was printed next to the nostalgic design and drawing of this green booklet cover printed by the British government during World War II. The replica of this 54-page booklet reminds me of the atmosphere and stories I have watched in films about lives of people during one of the most difficult time in modern world history. The content of the book suggests that common sense and good habits were the most important part of everyday lives that could help people to keep well in times of uncertainty and unrest even in wartime. It offers advice on various aspects of life including eating, drinking, engaging in exercise and relaxing activities, family relationship, keeping good hygiene and infection control, coping with sleep and sex issues, help seeking etc. Though the content is brief, it is worthwhile to take reference even from the subject index of this small booklet so that we can fill in details in the context of today’s life for subjects that are relevant for ourselves, our clients, or people around us (Clegg, 1943).

The second reading is a recent ly pub l i shed paper, “The Hong Kong Survey on the Epidemiology of Traumatic Experience and Posttraumatic Stress Disorder” (Wu et al., 2019). This paper documents the largest epidemiology study on traumatic experience (TE) and posttraumatic stress disorder (PTSD) in Hong Kong conducted from 2010 to 2013. The results support the findings of World Mental Health Survey (WMHS) that trauma is common globally (Kessler et al., 2017; Koenen et al., 2017). The

rate of direct exposure to TE (64.8%) in this Hong Kong study was comparable to the average found in the WMHS (69.7%). The overall prevalence estimates of PTSD found (3.0%) was also comparable to the WMHS (3.9%). The association of PTSD with mental difficulties (e.g., suicidal attempts, substance abuse and common mental disorders, such as, depression) and health service utilization reported in this Hong Kong study underscores that TE and PTSD should be treated as a public health concern.

The third reading that I would l ike to share is information freely available on the web regarding the concept of trauma-informed care (TIC). TIC can be implemented not only in mental health services, but also in the community and various settings, such as schools and hospitals. Becoming trauma-informed means recognizing TE could be common and members in the community often have many different types of traumatic experiences in their lives. Traumatized people need support and understanding from those around them. TIC involves an organizational structure and service framework that provides stepped-care support, need-based service and outcome-based evaluation / implementation. It advocates understanding, recognizing and responding to the effects of different types of trauma and helping people with traumatic exposure and their involved community to rebuild a sense of control and empowerment through measures that give emphasis to physical and psychological safety.

The article in Knowledge Gateway written by Dr. Isaac Yip of this issue is a good pairing for reading that helps us to consider public health measures that give emphasis to trauma psychology and related mental health service.

I do wish everyone can find food for thoughts and oasis for thinking in these readings.

References:Elliott D, Bjelajac P, Fallot R, Markoff L, Reed BG. Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women.

Journal of Community Psychology 2005;33(4):461-477.Clegg, H.A. (1943). How to keep well in wartime. London: Ministry of Information. Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, F., . . . On behalf of the WHO World Mental Health Survey Collaborators. (2017).

Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology. https://doi.org/10.1080/20008198.2017.1353383 Koenen, K. C., Ratanatharathorn, A., Ng, L., McLaughlin, K. A., Bromet, E. J., Stein, D. J., . . . Kessler, R. C. (2017). Posttraumatic stress disorder in the World

Mental Health Surveys. Psychological Medicine, 47, 2260–2274. https://doi.org/10.1017/s0033291717000708 National Child Traumatic Stress Network, Schools Committee. (2017). Creating, supporting, and sustaining trauma-informed schools: A system framework.

Los Angeles, CA, and Durham, NC: National Center for Child Traumatic Stress. https://www.nctsn.org/sites/default/files/resources//creating_supporting_sustaining_trauma_informed_schools_a_systems_framework.pdf. Accessed 22 September, 2019.

SAMHSA. Trauma-Informed Approach and Trauma-Specific Interventions. 27 April 2018. https://www.samhsa.gov/nctic. Accessed 8 September, 2018.Wu, K. K., Leung, P. W., Wong, C. S., Yu, P. M., Luk, B. T., Cheng, J. P., Wong, R. M., Wong, P. P., Lui, J. C., Ngan, J. C., Leung, F. L. and Lam, L. C. (2019),

The Hong Kong Survey on the Epidemiology of Trauma Exposure and Posttraumatic Stress Disorder. Journal of Traumatic Stress. doi:10.1002/jts.22430

ASIAN TRAUMATIC STRESS POINTS 02

Knowledge GatewayPolicies, public health and trauma: prevention and resilience

Author: Dr Yip Pui LamMBBS(HK), MRes(Med)(HK), FHKCPsych, FHKAM(Psychiatry), Specialist in Psychiatry

For various chronic medical conditions such as hypertension and diabetes, the current local public health practices place strong emphasis on prevention (such as healthy diet, regular exercise, early detection and treatment) and relevant government policies (such as food labels and tobacco control). However, for mental health, including trauma-related conditions, the relevant preventive strategies appear much less adequate.

Trauma is highly prevalent throughout the world. The World Health Organization World Mental Health Surveys showed that 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita (Kessler et al., 2017). Lifetime prevalence of Post-traumatic Stress Disorder is estimated to be 7.8% (Kessler et al. 1995). Trauma could lead to a wide range of mental illness, such as major depression, anxiety disorders, substance abuse and other behavioural problems.

Possible types of trauma include child abuse, school bullying, traffic accidents, workplace injury, domestic violence, physical assaults, natural disaster, war etc. The commonly adopted prevention framework includes Primary prevention (preventing the actual occurrence of illness), Secondary prevention (early disease intervention) and Tertiary prevention from preventing disability from an illness). In addition, the US Centers for Disease Control and Prevention have adopted a social-ecological model for prevention (Dalberg & Krug, 2002), consisting of the individual level, relationship level, community level and societal level. Applying the prevention framework with the different levels of the social-ecological model across the common types of trauma would yield a number of preventive strategies.

Of these, policies have a significant role in the prevention of traumatic events. Child trauma is very common and has significant health implications, such as elevated risk of alcoholism, drug abuse, depression, suicidal attempts, smoking, obesity, ischemic heart disease etc. (Anda et al., 2008; Felitti et al., 1998). Prevention is better than cure. A systematic review of child maltreatment prevention found that home-visiting and parent education could prevent actual child maltreatment (Mikton & Butchart, 2009). Impaired emotional regulation and psychiatric problems (such as depression, substance abuse and personality disorder) are known risk factors for child maltreatment. However, in Hong Kong, resources and services for such prevention are far from adequate. For example, common parenting support or skills training programs are often brief and generic, lacking the continuity and specificity that enables parents to handle their continuous challenges. After-school child care services could help to alleviate the parenting stress but such services are not easily available or affordable. For parents who developed psychiatric problems, the public Mental Health Service had a long waiting queue (sometime more than a year) and a very limited consultation time due to the unreasonably high caseloads.


These issues which have direct implications in trauma prevention, clearly need to be addressed by the government.

Another social issue of growing concern is school bullying. Victims are at higher risk of developing various psychiatric problems in future. The government needs to work closely with the education sector, social welfare sector and healthcare sector to formulate policies for the prevention, early identification and proper management of school bullying.

On a wider context, numerous studies have shown that social adversities such as unemployment, poverty, accommodation problem etc. had been associated with domestic violence and child abuse. Each of the above issues was related to a wide range of social policies, including labour, social welfare, housing etc. As such, a broad range of social policies is in fact implicated in the prevention of domestic violence and child trauma.

The identification of high-risk families was also often regarded as inadequate. As victims of domestic violence (including children) may not always seek help, the early identification by personnel whom they have regular contact, including healthcare professionals, social workers and teachers, is essential. However, with the very tight resources, caseloads of Integrated Family Services Centre, medical social workers, school social workers and doctors are all very high, and their capacity to establish sufficient rapport to enable the victims to disclose such information may be affected. In addition, regular training should be provided to frontline personnel of various disciplines to help them maintain a high index of suspicion and be competent in the management of suspected cases.

Besides prevention and early identification, another dimension is social support and resilience. Resilience is defined as the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of stress (APA 2013). Research suggested that high social support could improve stress-regulation by increasing self-confidence, decreasing the likelihood of engaging in risky behaviours, and fostering more effective coping strategies; possibly through mechanisms related to the Hypothalamus-Pituitary-Adrenal axis, serotonin-transporter and brain-derived neurotrophic factor polymorphisms (Sippel et al., 2015). It was opined that political and societal policies that address issues such as poverty, housing and food instability, poor education and income inequality could have substantial impact on the resilience of individuals affected by these policies (Shim et al., 2014). In Hong Kong, there has been growing income inequality over the years. In addition, with the rising property price and rental expenses, families with low income could only afford to reside in very small subdivided flats with poor hygiene, poor ventilation, and which may also be unsafe. There are also concerns about cross-generation poverty, as children from deprived families are likely to have less resources for personal development and thus less opportunities to rise up the social ladder in the future. Government policies need to address these issues which have significant implications on resilience.

In summary, social policies have a strong role in the prevention of trauma, early identification of cases, and provision of social support to enhance resilience. Given the potential long-term impact trauma could have on an individual, the government should always keep this in mind when formulating and reviewing the social policies.

References:

American Psychological Association. 2013. The road to resilience: what is resilience? American Psychological Association, Washington, D.C., USA.Anda R.F. , Brown D.W. , Dube S.R. , Bremner D. , Felitti V.J. , Giles W.H . Adverse childhood experiences and chornic obstructive pulmonary disease

in adults. American Journal of Preventive Medicine. 2008; 34(5): 396–403.Christopher Mikton & Alexander Butchart. Child maltreatment prevention: a systematic review of reviews. Bull World Health Organ 2009; 87: 353 – 361. Dahlberg L.L. , Krug E.G . Krug E. , Dahlberg L.L. , Mercy J.A. , Lozano R . Violence: A global public health problem. World report on violence and health.

2002; Geneva, Switzerland: World Health Organization. 1–56.Felitti V.J. , Anda R.F. , Nordenberg D. , Williamson D.F. , Spitz A.M. , Edwards V. , Marks J. S . Relationship of childhood abuse and household dystunction

to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine. 1998; 14(4): 245–258.

Kessler RC, Sonnega A, Bromet E, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry. 1995; 52: 1048-60.Kessler RC, Aguilar-Gaxiola S, Alonso J, et al. Trauma and PTSD in the WHO World Mental Health Surveys. Eur J Psychotraumatol.

2017; 8(sup5): 1353383.Shim, R., C. Koplan, F. J. P. Langheim, M. W. Manseau, R. A. Powers and M. T. Compton 2014. The social determinants of mental health: an overview and

call to action. Psychiatric Annals 44:22-26.Sippel, L. M., R. H. Pietrzak, D. S. Charney, L. C. Mayes, and S. M. Southwick. 2015. How does social support enhance resilience in the trauma-exposed

individual? Ecology and Society 20(4):10.


Past EventsTWO-DAY WORKSHOP ON COGNITIVE PROCESSING THERAPY FOR PTSD(28 & 29 November 2018)

After the very successful workshop conducted by Professor Patricia Resick in 2010, it is our honour to have invited her to Hong Kong again in 2018 to conduct another 2-day workshop on Cognitive Processing Therapy (CPT) for PTSD. During the workshop, Professor Resick has guided the audience through the process of using CPT to treat PTSD clients. She has highlighted how to encounter the difficulties commonly faced by PTSD clients. Treatment tools to facil itate treatment effectiveness were also taught. We thanked Professor Resick and the audiences for participating in an interactive and fruitful two-day training.

Past Events



Membership Application Form(Membership does not imply qualification or expertise)

AsianSTSS will treat the data provided by you strictly confidential. AsianSTSS may provide such data for its administrative and service planning purposes. In order to facilitate networking among members who are interested in the trauma field, your personal information may be placed on the AsianSTSS website, in the Members’ Directory which is only accessible to members of this Society. AsianSTSS will not disclose any personal information provided by you to any bodies or organizations unless you have been informed or it is required to do so by law.

Please put an X in the red square boxes if you do not want any of such information to be included in the Members’ Directory on the AsianSTSS website.

Office Use

Form received on: Amt: Cash / Cheque (no: )

Confirmation sent on: Ref no:

Please check the categories that identify your main areas of interest:

Populations Children Emergency Personnel

Adolescents Health Care Workers

Adults Minorities

Elderly Perpetrators

Disciplinary / Military Personnel Others, please specify:

Areas of Interest Research Grief

Teaching / Training Legal / Forensic

Assessment Policy development

Treatment Human rights

Others, please specify:

Work Settings University Teaching institute

Private practice Community

Disciplinary Public health

Social Welfare Others, please specify:

The Society’s financial year runs from 1st October through 30th September, membership fees are not pro-rated.

I hereby enclose my cheque for Life membership: HKD 1000 Full membership: HKD 200 Student membership: HKD 100

(Student member applicants are requested to send a copy of current and valid proof of full-time student status together with this form)

Membership: New Renewal: Membership No:

Title: Family Name: Given Name:

Correspondence Address:

Phone: ( ) Fax: ( ) E-mail: (AsianSTSS encourages electronic communication with members. Please provide your email address to facilitate communication between AsianSTSS and you.)

Office Address (if different from correspondence address):

Profession: Relevant Academic Qualifications:

http://www.asianstss.org.

* II hereby agree to provide the above information for AsianSTSS and support the objectives of the AsianSTSS as expressed in the Constitution.

Signature: Date:

7

Student Research AwardAsianSTSS is a multi-disciplinary organization aiming at advancement of knowledge about

the nature and consequences of highly stressful events, and provision of a forum for the sharing

of research, clinical strategies, public policy concerns and theoretical formulations on trauma

around the Asian region.

To encourage exploration of different paradigms and promote standards of excellence

in trauma research, AsianSTSS now provides two $5,000 Student Research Award (SRA) to

members who submit proposals judged to have the greatest potential to contribute to the field of

traumatic stress studies. The AsianSTSS SRA is now open for application until 30 June 2020.

Eligibility:

1. Applicants must be students who are currently enrolled and in good standing in an

undergraduate or postgraduate program in Hong Kong. The program has to be in a field with

relevance to the study of traumatic stress. Such programs include but are not limited to those in

Psychology, Social Work, Public Health, Nursing and Medicine.

2. Applicants must provide documents that their research has been approved by their

academic advisor or other suitable research mentor, and / or by all review committees of

respective institution if necessary.

3. Applicants who have previously received an AsianSTSS SRA may apply again, but new

applicants will receive priority consideration in the process.



Membership Application Form(Membership does not imply qualification or expertise)

AsianSTSS will treat the data provided by you strictly confidential. AsianSTSS may provide such data for its administrative and service planning purposes. In order to facilitate networking among members who are interested in the trauma field, your personal information may be placed on the AsianSTSS website, in the Members’ Directory which is only accessible to members of this Society. AsianSTSS will not disclose any personal information provided by you to any bodies or organizations unless you have been informed or it is required to do so by law.

Please put an X in the red square boxes if you do not want any of such information to be included in the Members’ Directory on the AsianSTSS website.

Office Use

Form received on: Amt: Cash / Cheque (no: )

Confirmation sent on: Ref no:

Please check the categories that identify your main areas of interest:

Populations Children Emergency Personnel

Adolescents Health Care Workers

Adults Minorities

Elderly Perpetrators

Disciplinary / Military Personnel Others, please specify:

Areas of Interest Research Grief

Teaching / Training Legal / Forensic

Assessment Policy development

Treatment Human rights

Others, please specify:

Work Settings University Teaching institute

Private practice Community

Disciplinary Public health

Social Welfare Others, please specify:

The Society’s financial year runs from 1st October through 30th September, membership fees are not pro-rated.

I hereby enclose my cheque for Life membership: HKD 1000 Full membership: HKD 200 Student membership: HKD 100

(Student member applicants are requested to send a copy of current and valid proof of full-time student status together with this form)

Membership: New Renewal: Membership No:

Title: Family Name: Given Name:

Correspondence Address:

Phone: ( ) Fax: ( ) E-mail: (AsianSTSS encourages electronic communication with members. Please provide your email address to facilitate communication between AsianSTSS and you.)

Office Address (if different from correspondence address):

Profession: Relevant Academic Qualifications:

http://www.asianstss.org.

* II hereby agree to provide the above information for AsianSTSS and support the objectives of the AsianSTSS as expressed in the Constitution.

Signature: Date:

7

Message from AsianSTSS

What is AsianSTSS ? The Asian Society for Traumatic Stress Studies (AsianSTSS) was founded in 2005 as a fully

incorporated limited company registered in Hong Kong for professionals to share information about

the effects of trauma. AsianSTSS is a multi-disciplinary organisation that provides a forum for

exchange of knowledge about severe stress and trauma within the Asian region. This knowledge

includes preventing traumatic events, understanding the scope and consequences of traumatic

exposure, and ameliorating their consequences.

Our Mission • To advance knowledge about the nature and consequences of highly stressful events

• To provide a forum for the sharing of research, clinical strategies, public policy concerns and

theoretical formulations on trauma around the Asian region

• To promote high standards and ethical practice in the trauma field

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may 2017 issue no.17 october 2019 newsletter issue 19 · 01 asian traumatic stress points may 2017...

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