Sexual assault as a public health problem and other developments in psychotraumatology.

A recent scandal in the Netherlands painfully underscored that sexual harassment and abuse are unfortunately still happening around the world, even after decades of advocacy on this issue and five years of #MeToo. To make progress in prevention and treatment we argue that we should address sexual violence from a public health perspective. Fruthermore, looking back on the past year, the COVID-19 pandemic was the dominant and potentially traumatic stressor affecting large populations around the world. Another big topic was that of the impact of climate change, we are only beginning to realize its impact on stress across the globe. The European Journal of Psychotraumatology (EJPT), with its increasing global readership and scientific and social impact, is focusing on the traumatic stress aspects of these and many other events. Relatedly, neurobiological aspects are an important and growing focus of the journal in that they help us better understand the mechanisms behind the development of trauma-related disorders and their treatment. In this editorial, we present recent trends, new Open Science developments, journal metrics, the plans and themes for next year and the ESTSS EJPT award winners for best paper of 2021. Highlights: Next years' research focus should be on sexual violence from a public health lens, climate change, and neurobiologal aspects of trauma-related disorders. The European Journal of Psychotraumatology (EJPT) calls or papers on these issues.

Sexual violence from a public health lens

The day of my writing this editorial a horrific scandal is on the news in the Netherlands. It concerns sexual intimidation, harassment, and assault by popular stars of a famous Dutch talent show, The Voice of Holland (a format that has been sold in 150 countries abroad). It was made public by means of a YouTube documentary with statements from dozens of anonymous women. Millions of people were watching. In the aftermath, many women came forward with similar experience in other settings. It stimulated the broader public awareness of the prevalence and impact of sexual violence as well as a public debate on how to prevent it in the future.

One of the impressive fragments came from a young woman who, although she clearly described a rape situation, found it difficult to use that term – to call it rape. She asked herself, ‘was it not her own fault that things got out of hand?’ Her feelings of shame and guilt were strong, and after all she froze, and was unable to say no. If there is one thing we have learned, it is to support and believe victims. She was not to blame. Shame and guilt are, however, common reactions among those who have experienced sexual violence. Survivors are also not to blame for not reporting these experiences to the authorities, or for not stepping forward. This message, however, is not always clearly communicated by those around them.

It almost seemed to come as a surprise that there also was a major #MeToo scandal in the Netherlands, as if sexual violence only happened abroad, or as if the #MeToo movement had fully addressed this issue. Unfortunately, sexual violence remains an ongoing problem all over the world. A recent systematic review on the global prevalence of sexual assault confirmed this reality: 27–44% of women, 11–25% of men, and 27–47% of transgender individuals experience sexual assault in their lifetime (Breiding et al., 2014; Dworkin, Krahé, & Zinzow, 2021; James et al., 2016; Langenderfer-Magruder, Eugene Walls, Kattari, Whitfield, & Ramos, 2016 Smith et al., 2018; Testa et al., 2012) with often significant mental health impact (e.g. Bach et al., 2021; Louison Vang, Ali, Christiansen, Dokkedahl, & Elklit, 2020; Villalta et al., 2020; Yeh et al., 2021). As the #MeToo movement clearly demonstrated, sexual assault is rarely perpetrated by strangers, by violent men pulling victims into the bushes, but instead most often by close friends, colleagues and family members. It happens not only in artistic scenes, like The Voice of Holland, but in any work environment where there is an unequal power dynamic (professor–student, supervisor–trainee, manager–junior, etc.) and obviously also outside the workplace (in war, sports, in relationships, among teenagers, on college campuses). However, five years after the initial groundswell of #MeToo, it can still be hard for survivors to recognize that what happened to them can be called ‘rape.’

Why does this still happen, after decades of advocacy on this issue and five years of #MeToo? Why is there an increasing need for specialized sexual assault care centres (Baert et al., 2021; Covers et al., 2021)? What are the broader societal-level factors at play, and how do we change them? How can we prevent it (Magruder, McLaughlin, & Elmore Borbon, 2017)? How do we raise our children to be part of the solution rather than part of the problem? How can we reduce shame and guilt in survivors? What are the most effective early interventions or treatments for assault-related disorders? Altogether these questions are reason enough to announce a special issue on the topic of ‘Sexual Violence from a Public Health Lens.’ We have also found an excellent guest editor for this issue: Dr Emily Dworkin. See below for more details on special issues open for calls in 2022.

The past year was further characterized by stress, trauma and grief related to COVID-19 pandemic. This was reflected in the huge number of submissions related to the pandemic. These submissions resulted in a special issue on the topic, part 1 (O'Donnell & Greene, 2021), part 2 is underway. Another worrisome theme of the past year is the discussion on our changing climate, giving rise to a significant increase in natural disasters, uninhabitable environments, increased inequity, poverty, etc. This theme has already been addressed in previous editorials (Olff, 2017, 2019) but I am really pleased that we now have call for papers on this specific theme (see details below).

In this editorial, new Open Science developments, the past year’s performance of the journal and the plans and themes for next year are presented. Finally, we announce the ESTSS EJPT best paper of 2021 award winner!

Open Science developments in the European Journal of Psychotraumatology

While proud to say that the European Journal of Psychotraumatology has been a gold Open Access journal from the start, and it still is the only full Open Access journal in our field, we have introduced several other Open Science principles.

Data sharing – We have made a big step towards sharing of data (see also Kassam-Adams & Olff, 2020; Olff, 2020). FAIR Guiding Principles stating that data should be Findable, Accessible, Interoperable, and Re-usable (FAIR) does not always mean data need to be completely open but knowing where to find traumatic stress data sets is a big first step. For traumatic stress researchers, an interesting database of available FAIR data sets can be found on the website of the Global Collaboration on Traumatic Stress (https://www.global-psychotrauma.net/fair). EJPT now asks authors to provide a brief data availability statement (DAS) when submitting their papers.

Registered Reports – It is interesting to see that registered reports, that we introduced as a new submission format in 2018 (Olff, 2019; Spiller & Olff, 2018), are now coming through. Several study protocols that were submitted for peer review before starting the study (Stage 1) have now passed peer review, and have been provisionally accepted for publication. So as long as the authors follow through with the registered methodology, independent on whether results are negative or positive the publication is guaranteed (Stage 2). It is meant to reduce potentially Questionable Research Practices (QRP), including ‘low statistical power, selective reporting of results, and publication bias, while allowing complete flexibility to report serendipitous findings’ (Center for Open Science). https://www.cos.io/

Protocol papers or Registered Reports or both? A protocol paper is an opportunity to publish the rationale and design of a study. If this is done in combination with a registered report the Stage 1 Registered Report needs to be accepted first and the protocol paper must match the Registered Report.

Preprints – We are receiving a number of questions about whether we allow preprints of an article. We do and we actually encourage the authors to post this early version of the paper on a preprint server. Preprints foster openness and are not considered as a duplicate publication. There are several online repositories, e.g. OSF Preprints (https://osf.io/preprints) with e.g. PsyArXiv, etc. Although preprints are not yet peer reviewed it may be an advantage to get papers out quickly, and also to also have other researchers provide feedback, which may be helpful to improve the article. For further details please see our author information (https://www.tandfonline.com/action/authorSubmission?show=instructions&journalCode=zept20–).

Open Science Badges – Finally, it is good to see more and more Open Science Badges (stemming from the Center for Open Science) as an incentive to share data, materials, or to preregister.

Video abstracts – To share the scientific work with an even wider audience authors now have the option of adding a video abstract. It is an opportunity to be creative and share work in a creative film clip of about two minutes. It can be added after acceptance of the paper. Here is more information on how to reach a wider audience, and what to think about when filming (https://authorservices.taylorandfrancis.com/research-impact/creating-a-video-abstract-for-your-research/).

European Journal of Psychotraumatology in 2021

Metrics of the European Journal of Psychotraumatology show a further increase in the number of papers published, in the number of downloads and citations (impact factor), in global reach, as well as in Altmetrics in 2021.

Content – In the past volume, the journal's content was not unsurprisingly dominated by the pandemic. Of the 214 papers published in Volume 12 (2021), 61 addressed COVID-19 in some way. This is partly due to the call-for-papers we issued shortly after the coronavirus emerged. We published part one of the COVID-19 special issue (O'Donnell & Greene, 2021), part 2 is currently being pulled together and will be published in 2022 (see also the special issues below).

The VOSviewer network of titles and keywords of papers published in 2021 indeed reflects the dominance of COVID-19 related articles, next to the core topic of the journal trauma-related pathology and interventions to prevent or treat them (Figure 1).

Figure 1.

Word co-occurrence network built using words present in titles, abstracts and keywords of articles published in 2021 (VOSviewer).

Notes: Bigger nodes represent more articles being published on the subject. Lines indicate the relations between pair of nodes (citations, co-occurrence of word, co-authorship). Colour of the clusters indicates a set of closely related publications.

For 2022, we aim for a greater inclusion of papers covering the neurobiology of trauma-related disorders and physical diseases. For that reason, we now also have a call-for-papers for a special issue on biological mechanisms underlying adverse mental health outcomes after trauma (see below). In a previous editorial, celebrating the 10 years anniversary year of the journal (see Olff et al., 2019), we described in more detail the priorities for the future directions of the field of psychotraumatology.

Downloads – Figure 2 shows a 40% increase in the number of downloads in 2021. The free availability of all EJPT content is likely instrumental to these high number of downloads compared to other journals in the field.

Figure 2.

Downloads by year* (2015–2021).

From papers published in the last three years, the most downloaded (and cited) paper in 2021 was ‘Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis’ by Lewis, Roberts, Andrew, Starling, and Bisson (2020) (Table 1) with 8943 downloads by the end of 2021. This is remarkable considering that it is a rather recent paper. In this systematic review, the evidence for psychological therapies for PTSD is summarized. The paper is part of a special issue on the evidence base for prevention and treatments for PTSD (Bisson & Olff, 2021).

Table 1.

Most downloaded articles in 2021.

1. Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis (Lewis, Roberts, Andrew, et al., 2020)

2. COVID-19: urgency for distancing from domestic violence (Ertan, El-Hage, Thierree, Javelot, & Hingray, 2020)

3. Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19 (Greene et al., 2021)

4. Age-related effects of the COVID-19 pandemic on mental health of children and adolescents (Schmidt, Barblan, Lory, & Landolt, 2021)

5. Saudi Arabia Mental Health Surveillance System (MHSS): mental health trends amid COVID-19 and comparison with pre-COVID-19 trends (BinDhim et al., 2021)

6. Complex PTSD: assessment and treatment (Cloitre, 2021)

7. Understanding the lived experiences of healthcare professionals during the COVID-19 pandemic: an interpretative phenomenological analysis (McGlinchey et al., 2021)

8. Treating posttraumatic stress disorder remotely with cognitive therapy for PTSD (Wild et al., 2020).

9. Do different traumatic events invoke different kinds of post-traumatic stress symptoms? (Birkeland, Skar, & Jensen, 2021)

10. Psychological distress and state boredom during the COVID-19 outbreak in China: the role of meaning in life and media use (Chao, Chen, Liu, Yang, & Hall, 2020).

In the top 10 downloads, we see the need for information on the traumatic stress impact of COVID-19 in addition to articles on characterization of and interventions for trauma-related problems reflected.

Figure 3 shows a rather even spread of downloads across Europe, North-America and Asia. We are still hoping for further uptake in South-American and African countries, areas with a potentially high burden of trauma (Hoppen & Morina, 2019; Kessler et al., 2017; Olff et al., 2020; Olff et al., 2021; Seedat, Nyamai, Njenga, Vythilingum, & Stein, 2004).

Figure 3.

Downloads by region / country.

Citations – Citations have been increasing again in 2021 and the upcoming impact factors are looking promising again for next year. The 2020 Impact Factor by Clarivate Analytics Web of Science, Journal Citation Reports Social Science Edition was is 4.071.

The most cited paper of 2021 was ‘Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis’ by Lewis, Roberts, Andrew, et al. (2020). There are a number of other very interesting and important review papers that are highly cited as shown in Table 2.

Table 2.

Top cited articles in 2021 from 2019–2020.

Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis (Lewis, Roberts, Andrew, et al., 2020) Secondary traumatization in first responders: a systematic review (Greinacher, Derezza-Greeven, Herzog, & Nikendei, 2019) Virtual reality exposure therapy for posttraumatic stress disorder (PTSD): a meta-analysis (Kothgassner et al., 2019) The effectiveness of narrative exposure therapy: a review, meta-analysis and meta-regression analysis (Lely, Smid, Jongedijk, Knipscheer, & Kleber, 2019) Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: Systematic review and meta-analysis (Lewis, Roberts, Gibson, et al., 2020) The network approach to posttraumatic stress disorder: a systematic review (Birkeland, Greene, & Spiller, 2020) Early psychological intervention following recent trauma: A systematic review and meta-analysis (Roberts et al.,2019) Psychological distress and state boredom during the COVID-19 outbreak in China: the role of meaning in life and media use (Chao et al., 2020). ‘Help for trauma from the app stores?’ A systematic review and standardised rating of apps for Post-Traumatic Stress Disorder (PTSD) (Sander et al., 2020). The prevalence of common and stress-related mental health disorders in healthcare workers based in pandemic-affected hospitals: a rapid systematic review and meta-analysis (Allan et al., 2020)

Almetrics – The 2021 Almetrics scores, i.e. metrics and qualitative data that are complementary to traditional, citation-based metrics including e.g. on news sites or social media, are presented in Figure 4. Altmetrics are seen as a measure of attention, dissemination and as an indicator of influence and impact. It does not come as a surprise that ‘Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19’ (Greene et al., 2021) comes out on top.

Figure 4.

Top Altmetric scores in 2021. (1) Greene et al. (2021), (2) De Jongh et al. (2020), (3) Thoresen, Aakvaag, Wentzel-Larsen, Dyb, and Hjemdal (2012), (4) Monson et al. (2020), (5) Kessler et al. (2017).

We regularly publish special issues or thematic clusters, themed around a topic that is timely or of particular importance. Table 3 provides an overview of special issues that came out last year, are in progress or are currently open for submission.

Table 3.

Special issues.

Special issues published in 2021

The Coronavirus Pandemic and Traumatic Stress Part 1 (O'Donnell & Greene, 2021) Prevention and treatment of PTSD: the current evidence base (Bisson & Olff, 2021) Sleep, Circadian Systems and Traumatic Stress (Agorastos & Olff, 2021) Navigating the who, where, what, when, how and why of trauma exposure and response Frédérique Vallières, Philip Hyland, and Jamie Murphy (2021) Trauma and Mental Health during the Global Pandemic (ESTSS, 2021) Celebrating 10 years of the European Journal of Psychotraumatology.

Issues in progress

The Coronavirus Pandemic and Traumatic Stress – Part 2 (associate editor Soraya Seedat) Integrating and Evaluating Sex and Gender in Psychotrauma Research (Guest Editor: Willemien Langeland) Complementary and integrative interventions for PTSD (guest editors Barbara Niles and Ariel Lang)

Currently open special issues with submission deadlines:

Climate Change, Disasters and Traumatic Stress – 1 June 2022 (guest editors Meaghan O’Donnell & Lawrence Palinkas) Stress, Trauma, and Related Conditions in Military, First Responders, Healthcare professionals and their Families (associate editor Cherie Armour) – 1 June 2022 Biological Mechanisms Underlying Adverse Mental Health Outcome after Trauma – 1 June 2022 (guest editor Mirjam van Zuiden) Sexual Violence from a Public Health Lens – 1 December 2022 (guest editor Emily Dworkin)

Prevention and treatment of PTSD – This is an important issue consisting of a series of meta-analyses on the evidence base for prevention and treatment of PTSD (Bisson & Olff, 2021). The papers address the efficacy of psychological interventions (Lewis, Roberts, Andrew, et al., 2020), the dropout from psychological treatments (Lewis, Roberts, Gibson, & Bisson, 2020), and the efficacy in specific populations active duty and ex-serving military personnel (Kitchiner, Lewis, Roberts, & Bisson, 2019). Another systematic review addressed the efficacy of early interventions (Roberts, Kitchiner, Kenardy, Lewis, & Bisson, 2019). Pharmacological treatment of PTSD (Hoskins, Bridges, et al., 2021) and pharmacologically assisted psychotherapy for adults with PTSD (Hoskins, Sinnerton, et al., 2021) provided information on effective medication for PTSD. And finally non-psychological and non-pharmacological interventions were reviewed and, for instance, yoga, neurofeedback, transcranial magnetic stimulation and acupuncture were considered as promising complementary and alternative approaches (Bisson, Van Gelderen, Roberts, & Lewis, 2020). The papers were based on systematic reviews and meta-analyses that underpinned the development of the International Society for Traumatic Stress Studies Guidelines.

The Coronavirus Pandemic and Traumatic Stress Part 1 – Evidence on how the COVID-19 pandemic has impacted society, specific subgroups like healthcare workers (e.g. Greene et al., 2021), what interventions are needed is gradually being collected. Part one of this series was published in 2021 (O'Donnell & Greene, 2021), part 2 is to be published in 2022.

Sleep and the circadian system – This issue deals with the important impact of sleep disruption and loss of circadian rhythmicity in the development of stress-related disorders including PTSD (Agorastos & Olff, 2020, 2021).

Navigating the who, where, what, when, how and why of trauma exposure and response – This issue targets how the context influences individual differences in the response to trauma such as one’s cultural background, the environment in which trauma occurs, the meanings attached to traumatic experiences, etc. (Vallieres, Hyland, & Murphy, 2021).

Finally, we published two abstract books: one of the ESTSS conference focusing on the pandemic (ESTSS, 2021) and one based on the symposium with all associate editors speaking to celebrate 10 years since launch of the journal (Olff & Seedat, 2021).

Call-for-papers for the special issues can be found here: https://think.taylorandfrancis.com/ejpt/.

ESTSS EJPT best paper of 2021 award

To select the ESTSS EJPT 2021 award we invited associate and guest (ex)editors, members of the editorial board, abstract translators and members of the ESTSS board to nominate papers and indicate why they thought the paper deserved it. Criteria were free and broad, such as sound methodology, relevance for clinical practice, innovation, global reach, outstanding science, theoretically advancing the field, thought provoking, etc. The top five are presented in Table 4 including some of the quotes of the motivations. There is quite a diversity but clinical relevance seems to be an important criterion.

Table 4.

Finalists for the ESTSS EJPT best paper of 2021.

Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR + Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial (Oprel et al., 2021)	Several persons mentioned its clinical relevance and outstanding methodology. Further comments:‘I found this a very useful paper, clinically, with good evidence to support clinical decision making when treating patients with PTSD to childhood abuse.’‘I have read this paper with great pleasure, a very relevant research question, an example of great methodology and importance for clinical practice.’‘I think this paper deserves the award because a lot of work went into this trial and the outcomes were eagerly awaited: is it possible to treat this population with PE without stabilisation? I think this study really shows the way forward for PTSD treatment, especially when it comes to intensified PE.’‘In addition to clinical relevance and sound research methods the adherence to Open Research principles is to be applauded, e.g. preregistering the protocol and statistical analysis plan, and making the data available to other researchers’ (see also https://www.global-psychotrauma.net/data-sets).
Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19 (Greene et al., 2021)	‘Highly topical issue, large sample, state recommendations for effective management practices in outbreak context.’‘This paper has been very instrumental in establishing the psychological burden placed on frontline health and social care workers during the COVID-19 pandemic in the UK. The research was well-conducted and the authors worked very hard to include a wide range of health and social care staff, not just doctors and/or nurses, but also allied health professionals, administrative staff, porters, mortuary workers, cleaners etc. This paper has been cited numerous times in many subsequent papers.’;‘Demonstrated the high levels of clinical distress or frontline workers, and identified some important and modifiable risk factors.’
Pharmacological therapy for post-traumatic stress disorder: a systematic review and meta-analysis of monotherapy, augmentation and head-to-head approaches (Hoskins, Bridges, et al., 2021)Pharmacological-assisted Psychotherapy for Post Traumatic Stress Disorder: a systematic review and meta-analysis (Hoskins, Sinnerton, et al., 2021)	These two papers were often considered together.‘Relevant for clinical practice’‘Exciting developments with MDMA’‘Makes an important contribution in synthesising evidence on medication management of PTSD by thoughtfully synthesising monotherapy, augmentation and head-to-head approaches and has clinical utility’‘Using medications to enhance psychotherapy is very promising for treatment in psychiatry’
Does trauma-focused psychotherapy change the brain? A systematic review of neural correlates of therapeutic gains in PTSD (Manthey, Sierk, Brakemeier, Walter, & Daniels, 2021)	‘This review provides a foundation for linking psychotherapy for PTSD to alterations in brain function.’‘Innovative review’‘Important to understand neurobiology related to treatment in order to improve its effects’
Age-related effects of the COVID-19 pandemic on mental health of children and adolescents (Schmidt et al., 2021)	‘Highly topical issue, large sample of children and adolescents, put the focus on a vulnerable population, promoting good mental health practice.’‘Important COVID-19 paper in times that we it has become clear that we need to take care of the young people in addition to the elderly’‘The lifespan perspective’

Congratulations to Danielle Oprel and Chris Hoeboer, who share first authorship, and colleagues for winning the ESTSS EJPT 2021 award.

Editorial team

It is only with a highly motivated and skilled team that we have been able to create the current high impact journal. I am very grateful to the editorial team. The excellent associate editors (see Box 1), guest editors in charge of special issues, and the larger editorial board have together with external reviewers made all this possible. With the increased submissions we are very pleased to welcome a new associate editor to the team: Dr Matthew Price, George W. Albee & Gold Professor of Psychological Science, University of Vermont, USA so we well prepared to go full speed ahead in the coming years!

Ananda Amstadter, PhD, Associate Professor, Virginia Commonwealth University, USA

Cherie Armour, PhD, Professor of Psychological Trauma and Mental Health, Queens University Belfast, UK

Eric Bui, MD, PhD, Professor of Psychiatry, University of Caen Normandy, Caen, France; Massachusetts General Hospital, Boston, MA, USA

Marylene Cloitre, PhD, Associated Director of Research, National Center for PTSD in Palo Alto, California, USA; New York University Langone Medical Center, New York, USA

Anke Ehlers, PhD, Professor and Wellcome Trust Principal Research Fellow, University of Oxford, UK

Julian D. Ford, PhD, Professor of Psychiatry, University of Connecticut Health Center, USA

Talya Greene, PhD, Head of Department and Senior Lecturer in Department of Community Mental Health, University of Haifa, Israel

Maj Hansen, PhD, Associate Professor in Psychology, University of Southern Denmark, Denmark

Ruth Lanius, MD, PhD, Professor of Psychiatry, Western University of Canada, Canada

Matthew Price, PhD, George W. Albee & Gold Professor of Psychological Science, University of Vermont, USA

Neil Roberts, D. Clin. Psy., Consultant Clinical Psychologist, Cardiff & Vale University Health Board, UK and Honorary Senior Research Fellow, Cardiff University, UK

Soraya Seedat, MD, PhD, Head of Psychiatry, Stellenbosch University, South Africa

Marianne Skogbrott Birkeland, PhD, Research Professor, Norwegian Centre for Violence and Traumatic Stress Studies, Norway

Siri Thoresen, PhD, Research Professor, Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Norway