This powerpoint describes PTSD and its major causes.

1. Social Determinants
of Health
PRESENTORS:
ALIZA K C BHANDARI
ATCHARAPORN THAMMACHOT
SHINKO SOMA
TOMOKO KOBAYASHI
HARUKO HOSINO

2. Components
of Health
Health
Emotional
Social
Physical
Mental
Environmental
Spiritual

3. Mental Health
Defined as a state of well-being in which
every individual realizes his or her own
potential, can cope with the normal stresses
of life, can work productively and fruitfully,
and is able to make a contribution to her or
his community.
- WHO

4. (When the disequilibrium happens)

5. PTSD

6. PTSD :
Posttraumatic
stress disorder
• “The complex somatic, cognitive, affective, and
behavioral effects of psychological trauma”
• 29 types of traumatic events
• Generally, women are 4 times more likely to
develop PTSD than men
• The incidence of PTSD after rape is higher in
men compared with women (65% vs 46%)

7. Facts And Findings
S.N AUTHOR NAME STUDY FINDINGS
1. Andersen LP, 2018 Association between work-related threats and PTSD.
2. Strohmeier H, 2018 Humanitarian workers and Predicators of mental health illness.
3. Anna Schneider, 2018 Experience of stigmatization and discrimination combined with
trauma load is associated with PTSD.
4. Matthe ß C, 2018 Trauma stabilisation is a treatment effect for PTSD.
5. Jiang C, 2018 PTSD can develop among patients with Trigeminal Neuralgia.

8. Facts and Findings
S.N AUTHOR NAME STUDY FINDINGS
6. Boroughs MS、2018 Higher odds of PTSD among sexual minority men, aged 18-29,
compared with older sexual minority men.
7. Beaglehole B, 2018 Increased rates of psychological distress and
psychiatric disorders follow natural disasters.
8. Magid K, 2018 Post Traumatic Growth may be associated with particular facets
of PTSD symptomatology.
9. Laugharne J 2007 The high degree of psychological resilience demonstrated across
populations affected by terrorism.
10. Zimmerman M, 1999 PTSD is frequently overlooked in routine clinical practice when
symptoms of PTSD are not the presenting complaint.

9. What do you think would happen to
someone who undergoes through
similar harassments like I went
through before by their boss in a
daily basis
???

10. PTSD &
Power harassment

11. Consequences…
Harassment and Discrimination for the Individual
Physical Effects Social & Work Effects Psychological Effects
Sleep Disturbances Stress on Family Depression
Loss of Appetite Strained Relationships Panic & Anxiety
Illness Inability to Concentrate Frustration
Headaches Reduced Productivity Anger
Panic Attacks Increased Turnover PTSD (Post-traumatic stress)
Heart Palpitations Increased Demand on
Management to Deal with
Complications
Loss of Confidence
Risk of Legal Action

13. Whose responsibility is it?
Everyone’s!
Everyone deserves to put in a days work without having to
worry about or deal with harassment, discrimination,
bullying and disrespect.

17. Take action!
Don’t allow anyone to poison your
workplace

18. Domestic Violence
Victims is everyone
Women
Children
Family members
In-house Enemy
“When intimate partner is trying to
control against another”

19. Type of
DV
38% murder
victims are killed by an
intimate partner. 1/3 has experienced
sexual, physical, emotional
1/7 US men are
victims of DV
23.2% of violence
against women in
High-income countries
–WHO–
274 M. children
worldwide are exposed to
violence in the home
92 % :Victims Suffers PTSD
– “Public Health Epidemic” –
Says Expert
Reference: WHO, UNICEF , type of DV

20. Behind Closed Doors;
Impact of domestic violence on Children
 Emotional stress; brains & Impair cognitive
and sensory growth
 Excessive irritability
 Sleep problems
 Fear of being alone
 Immature behavior
 Problems with toilet training
 Language development
Child DV experiences
 Poor concentration and focus
 Reading abilities
 Depression
 Suicidal tendencies
 Bed-wetting
 Substance abuse
 Criminal behavior
 Juvenile pregnancy
School age
“Children who were exposed to violence
in the home were 15 times more
likely to be physically and/or sexually
assaulted than the national average”
-One study in North America-
Reference: UNICEF

21. Healing support for your child:
Safe home environment
Listen to them, Believe them and
Shelter them
Sense of routine and normalcy
Speak out and break the silence
Educate non-violent methods of
resolving conflicts
Policy:
Raise awareness of DV impact
Create public policy/Laws
Enhance social services
Support & Prevention Model
Reference: CDC prevention model

22. "I wasn’t able to take care of
myself without my friend’s help.”
If I heard even the slightest noise, my heart rate would
skyrocket, a stress rash would creep across my cheeks,
neck, and chest, and I started to shake. "I was a wreck"
"The cooling of the air from summer to fall is
also a trigger, reminding me that winter night.
The best way to describe it is that I was a zombie.“
“Last night I had a nightmare about him. It’s all very vivid,”
- “re-experiencing symptoms”-
Breaks the cycle
Speak out!
Reference: Self sharing

23. PTSD after Natural
Disaster
32 - 60% in general
26 – 95% in
children

24. How and why reactions to
natural disasters are differ
to other traumatic event?
Loss of life
Damage of
property
Involve large
population
Outside the
realm of every
day experience
Enormous
stress

25. Biopsychological Response Pattern and Temporal Phases of Disaster
disillusionment
re-stabilization
honeymoon
heroic

26. Disaster Mental Health
Response Strategies
Pre-event stage
• Do you have a disaster
preparedness package at your
home?
• Have you ever taken about a
disaster with your family or
neighbors?
Event stage
• What is our role in community?
Post-event stage
• When can we stop providing
intervention for disaster victims?

27. PTSD & Media

28. Victimized
Cyberbullying
Sexting
Trauma via media
Videos/ImagesSocial Media/SNS

29. Something different happens in our brain when we watch violence we know to be real compared to watching violence in film. With technology now, giving
virtually everyone with a phone to record high-definition video along with the ability to share video with the world instantly, the previous boundaries that
protected people from exposure to real violence are now gone.
From https://www.cbc.ca/news/canada/manitoba/ptsd-online-videos-graphic-1.4091667
Something different happens in our brain
when we watch violence we know to be real compared to
watching violence in film.
With technology now, giving virtually everyone with a
phone to record high-definition video along with the ability
to share video with the world instantly,
the previous boundaries that protected people from
exposure to real violence are now gone.

30. •Secondary Trauma via Media (Occupational Hazard)
Watching Repetitive Violent videos/images
- Lawyers, judges
- Journalists
- Content Moderators (Facebook, Microsoft)
What about the general population?

31. Intervention of Secondary Trauma
MEASURES BY EMPLOYER ORGANIZATION
• Counseling and mental health support
• Special training to recognize trauma
• Spousal wellness program
• Relaxation facilities
PUBLIC HEALTH MEASURES (General Population)
• Education and awareness of secondary trauma
• Family and community involvement
(adolescents and young adults)
• Self-discipline (Stop watching)

32. PTSD & War

33. SYRIAN CIVIL WAR 2011 - 2018
President vs People
Power vs Freedom
• Killed 400,000
• Forced migration hallf of
the population
• Refugees 5 million

34. Affected group of people…

35. War Trauma and Mental Illness
Traumatic Experiences
• Witnessing extreme violence
• Terrorist attacks
• Kidnappings
• Imprisonment
• Torture
• Separation from one’s family
• Rape and sexual humiliation
oamong war-affected populations indicate a
positive association between war trauma
and the presence of various mental health
disorders.
oThe most frequent psychological disorders
among torture survivors were PTSD,
generalized anxiety disorder, depression,
and somatic disorders
oOther psychosocial problems were also
mentioned, such as insomnia, isolation, and
loneliness. (Bolton et al., 2013)
oHigh Levels of Stigma
(Hawkar Ibrahim1,2,3*, Verena Ertl1,3, Claudia Catani1,3, Azad Ali Ismail2 and Frank Neuner1, Ibrahim et al. BMC Medicine (2018) 16:154)
(Shrestha et al., 1998; Van Ommeren et al., 2002; Elklit et al., 2012; Tufan et al., 2013).
(Keller et al., 2006; Schweitzer et al., 2006; Onyut et al., 2009; Badri et al., 2012; Bogic et al., 2012; Aragona et al., 2013).

36. Post-war Mental Health Treatments
TREATMENTS
o Cognitive Behavioural Therapy (CBT)
o Narrative Exposure Therapy (NET)
o Eye Movement Desensitization and
Reprocessing (EDMR)
o Individual-based multimodal interventions for
PTSD
BARRIERS
1. Insufficient mental health care
professionals
2. Language barrier
3. Distance to health care services
(Nickerson, Bryant, Silove, & Steel, 2011; Nose et al., 2017; Slobodin & de Jong, 2015; van Wyk & Schweitzer, 2014)
(Vanessa Milne, Debra Bournes & Michael Nolan One year later: Are Syrian refugees finding the PTSD support they need? December 15, 2016)
o Government supported mental healthcare services
o Health care system reformation for easier access
o Online interventions guided by non-professional
trained personnel
Culturally-sensitive psychoeducation around mental
health, while utilizing “community and family-focused
psychosocial interventions (i.e. vocational, counseling,
supportive trauma-focused help)” (Bahloul et al., 2015).
“Formal mental health services are often seen as the last
resort by refugees. The first line of support tends to be
family, friends, the ethnic community, then religious
leaders, and then primary care”

37. • Community support and social acceptance
• A long-term continuous psychological care
• Victims and peoples awareness about PTSD
• Be an advocate - Open up and start caring
RAISING AWARENESS IS THE KEY…

39. References
• Hsiao, P. (2015). Power Harassment: The Tort of Workplace Bullying in Japan. Pacific Basin Law Journal, 32(2). Retrieved
from https://escholarship.org/uc/item/4wx1206r
• Okechukwu, C. A., Souza, K., Davis, K. D., & de Castro, A. B. (2013). Discrimination, harassment, abuse, and bullying
in the workplace: contribution of workplace injustice to occupational health disparities. American journal of industrial
medicine, 57(5), 573-86.
• Calvete, E., Estévez, A. y Corral, S. (2007). Intimate partner violence and depressive symptoms in women: Cognitive
schemas as moderators and mediators. Behaviour Research and Therapy, 45, 791.
http://dx.doi.org/10.1016/j.brat.2006.07.006
• Andersen LP. Work-related threats and violence and post-traumatic symptoms in four high- risk occupations: short- and
long-term symptoms. Int Arch Occup Environ Health, 2018 Oct 30.
• Strohmeier H, Scholte WF, Ager A (2018) Factors associated with common mental health problems of humanitarian
workers in South Sudan. PLoS ONE 13(10): e0205333. https://doi.org/10.1371/journal.pone.0205333
• Schneider, A., Conrad, D., Pfeiffer, A., Elbert, T., Kolassa, I. T., & Wilker, S. (2018). Stigmatization Is Associated With
Increased PTSD Risk After Traumatic Stress and Diminished Likelihood of Spontaneous Remission-A Study With East-
African Conflict Survivors. Frontiers in psychiatry, 9, 423. doi:10.3389/fpsyt.2018.00423
• Boroughs, M. S., Valentine, S. E., Ironson, G. H., Shipherd, J. C., Safren, S. A., Taylor, S. W., Dale, S. K., Baker, J. S.,
Wilner, J. G., … O'Cleirigh, C. (2015). Complexity of childhood sexual abuse: predictors of current post-traumatic
stress disorder, mood disorders, substance use, and sexual risk behavior among adult men who have sex with
men. Archives of sexual behavior, 44(7), 1891-902.
• Beaglehole, B., Beveridge, J., Campbell-Trotter, W., & Frampton, C. (2017). Unlocking an acute psychiatric ward: the
impact on unauthorised absences, assaults and seclusions. BJPsych bulletin, 41(2), 92-96.
• Laugharne, R., & Laugharne, J. (2002). Psychiatry, postmodernism and postnormal science. Journal of the Royal
Society of Medicine, 95(4), 207-10.
• Zimmerman, M., Morgan, T. A., & Stanton, K. (2018). The severity of psychiatric disorders. World psychiatry : official
journal of the World Psychiatric Association (WPA), 17(3),258-275.