External Research
External Research
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The Grady Trauma Project is a group of investigators studying civilian trauma based at Grady Memorial Hospital and Emory University School of Medicine in Atlanta, Georgia. The project focuses on Post-Traumatic Stress Disorder and the clinical and physiological implications of trauma exposure.
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The question of whether and how the effects of cultural trauma can be transmitted intergenerationally from parents to offspring, or even to later generations, has evoked interest and controversy in academic and popular forums. Recent methodological advances have spurred investigations of potential epigenetic mechanisms for this inheritance, representing an exciting area of emergent research. Epigenetics has been described as the means through which environmental influences “get under the skin,” directing transcriptional activity and influencing the expression or suppression of genes. Over the past decade, this complex environment–biology interface has shown increasing promise as a potential pathway for the intergenerational transmission of the effects of trauma. This article reviews challenges facing research on cultural trauma, biological findings in trauma and posttraumatic stress disorder, and putative epigenetic mechanisms for transmission of trauma effects, including through social, intrauterine, and gametic pathways. Implications for transmission of cultural trauma effects are discussed, focused on the relevance of cultural narratives and the possibilities of resilience and adaptivity.
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Exposure to psychological trauma is a strong risk factor for several debilitating disorders including post-traumatic stress disorder (PTSD) and depression. Besides the impact on mental well-being and behavior in the exposed individuals, it has been suggested that psychological trauma can affect the biology of the individuals, and even have biological and behavioral consequences on the offspring of exposed individuals. While knowledge of possible epigenetic underpinnings of the association between exposure to trauma and risk of PTSD has been discussed in several reviews, it remains to be established whether trauma-induced epigenetic modifications can be passed from traumatized individuals to subsequent generations of offspring. The aim of this paper is to review the emerging literature on evidence of transgenerational inheritance due to trauma exposure on the epigenetic mechanism of DNA methylation in humans. Our review found an accumulating amount of evidence of an enduring effect of trauma exposure to be passed to offspring transgenerationally via the epigenetic inheritance mechanism of DNA methylation alterations and has the capacity to change the expression of genes and the metabolome. This manuscript summarizes and critically reviews the relevant original human studies in this area. Thus, it provides an overview of where we stand, and a clearer vision of where we should go in terms of future research directions.
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Native American peoples’ health is impacted by structural legacies of settler colonialism, including land dispossession, racism, and poverty. Responding with care to individuals and communities experiencing past and present traumatic stress from genocide and deeply entrenched structural violence means navigating ongoing grief, restoring self-community and human-ecological relationships, and generating cultural vibrancy.
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Our years of research combined with our clinical experience show the value of culturally informed assessments and interventions designed specifically for low-income, urban, African Americans with a history of suicidal behavior and interpersonal trauma.
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Looks at narratives outside of the official Truth and Reconciliation Commission, such as oral histories and Inuit art and film, for aspects of the colonial trauma and the impacts of history.
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American Indians experienced massive losses of lives, land, and culture from European contact and colonization resulting in a long legacy of chronic trauma and unresolved grief across generations. This phenomenon, labeled historical unresolved grief, contributes to the current social pathology of high rates of suicide, homicide, domestic violence, child abuse, alcoholism and other social problems among American Indians
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Brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex. Traumatic stress can be associated with lasting changes in these brain areas. Traumatic stress is associated with increased cortisol and norepinephrine responses to subsequent stressors. Antidepressants have effets on the hippocampus that counteract the effects of stress. Findings from animal studies have been extended to patients with post-traumatic stress disorder (PTSD) showing smaller hippocampal and anterior cingulate volumes, increased amygdala function, and decreased medial prefrontal/anterior cingulate function. In addition, patients with PTSD show increased cortisol and norepinephrine responses to stress. Treatments that are efficacious for PTSD show a promotion of neurogenesis in animal studies, as well as promotion of memory and increased hippocampal volume in PTSD.
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Theories of historical trauma increasingly appear in the literature on individual and community health, especially in relation to racial and ethnic minority populations and groups that experience significant health disparities. As a consequence of this rapid growth, the literature on historical trauma comprises disparate terminology and research approaches. This critical review integrates this literature in order to specify theoretical mechanisms that explain how historical trauma influences the health of individuals and communities. We argue that historical trauma functions as a public narrative for particular groups or communities that connects present-day experiences and circumstances to the trauma so as to influence health. Treating historical trauma as a public narrative shifts the research discourse away from an exclusive search for past causal variables that influence health to identifying how present-day experiences, their corresponding narratives, and their health impacts are connected to public narratives of historical trauma for a particular group or community. We discuss how the connection between historical trauma and present-day experiences, related narratives, and health impacts may function as a source of present-day distress as well as resilience.
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Racial trauma, an ongoing consequence of historical trauma, has deleterious effects on the well-being of Africana communities. The psychological literature primarily reflects individual processes in the relationship between racial trauma and healing. Going beyond individualistic approaches, we present a community healing framework informed by multidisciplinary scholarship: Community Healing and Resistance Through Storytelling (C-HeARTS). Three major components of the framework are delineated: (a) justice as both a condition of and an outcome of community healing; (b) culturally syntonic processes (i.e., storytelling and resistance) that direct the renarrating of trauma and act as conduits for transformation; and (c) psychological dimensions (i.e., connectedness, collective memory, and critical consciousness) that promote justice-informed outcomes. In the C-HeARTS framework, community is advanced as an agent of change while centering justice and the important role of cultural practices to facilitate community healing.
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This paper introduces a new field of study, Reconciliation Systems Design, to guide policymakers and community leaders in conceptualizing, operationalizing, synergizing, and implementing a comprehensive, broad-scale, post-conflict reconciliation system. I elucidate major obstacles to effective reconciliation design and describe twelve strategies to construct and implement a robust approach to societal healing. These twelve interwoven strategies cover all aspects of reconciliation design from establishing the design team and mapping the stakeholders to synergizing various processes and mechanisms and mobilizing public support for reconciliation. The paper concludes with recommendations to advance research and education in the field of Reconciliation Systems Design.
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Human transmission to offspring and future generations of acquired epigenetic modifications has not been definitively established, although there are several environmental exposures with suggestive evidence. This article uses three examples of hazardous substances with greater exposures in vulnerable populations: pesticides, lead, and diesel exhaust. It then considers whether, if there were scientific evidence of transgenerational epigenetic inheritance, there would be greater attention given to concerns about environmental justice in environmental laws, regulations, and policies at all levels of government. To provide a broader perspective on environmental justice the article discusses two of the most commonly cited approaches to environmental justice. John Rawls's theory of justice as fairness, a form of egalitarianism, is frequently invoked for the principle that differential treatment of individuals is justified only if actions are designed to benefit those with the greatest need. Another theory, the capabilities approach of Amartya Sen and Martha Nussbaum, focuses on whether essential capabilities of society, such as life and health, are made available to all individuals. In applying principles of environmental justice the article considers whether there is a heightened societal obligation to protect the most vulnerable individuals from hazardous exposures that could adversely affect their offspring through epigenetic mechanisms. It concludes that unless there were compelling evidence of transgenerational epigenetic harms, it is unlikely that there would be a significant impetus to adopt new policies to prevent epigenetic harms by invoking principles of environmental justice.
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The aim of this report is to support AFSC’s Just Peace and Just Migration work by examining the growing field of trauma and considering its importance within peacebuilding practice.
KEY POINTS
• Trauma describes the impacts of experiences that have overwhelmed the body’s natural capacity to manage distress.
• The impacts of trauma can be especially potent during childhood. Since brains are developing during this time, trauma can alter entire developmental pathways.
As such, its consequences can be much more severe and long-lasting. Since adult resilience to stress is largely established during this period, childhood trauma also influences capacity to cope with adversity as an adult.
• There are innumerable ways that the body and mind can be affected by trauma. Alongside substantially increased health risks, people with trauma can be more sensitive, confrontational, aggressive, have reduced trust and empathy, have tendencies to perceive situations negatively or struggle to have a compassionate perspective.
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USAID has long supported initiatives that increase access to mental health services. The Agency now elevates this commitment with the USAID Mental Health Position Paper, USAID’s first policy document related to the integration of mental health into Agency programs. The Position Paper signals USAID’s commitment to advancing mental health around the world and achieving USAID’s long-term development goals.
The Policy Paper focuses on four principles that will guide the Agency’s approach:
Promote sustainable enabling environments that support mental health.
Apply contextually-appropriate approaches developed in partnership with local communities.
Actively promote the use of ethics, human rights, and Do No Harm practices.
Address key barriers to effective programming, including mental health stigma and the need to diversify and strengthen partnerships.
The Position Paper is the result of careful work spanning over two years. In January of 2022, USAID launched a policy development process and initiated broad stakeholder consultations. Nearly 200 participants, representing geographic, thematic, professional, and experiential diversity provided input. This information and an extensive literature review, summarized in 11 evidence briefs linked below, informed the development of the position paper and the recommended approaches.
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Why are Trauma-Informed Approaches in Global Mental Health Important?
• Reduce the chance of harm by increasing understanding of trauma and improving support for those who have experienced trauma.
• Focus on population and systems-level approaches to address trauma and its impact.
• Promote awareness building which can, in turn, reduce stigma and discrimination.
• Encourage partnerships and collaborations to empower local communities, governments, and policymakers.
A much broader bibliography and additional tools will be updated soon.