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Bauer AG, Williams J, Hambrick E, Rempfer M, Bennett K, Christensen K, Berkley-Patton JY. Mental health attitudes, norms, beliefs, and experiences with care among young Black men: A theory of planned behavior assessment. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2024; 16:653-660. [PMID: 37053405 PMCID: PMC10570394 DOI: 10.1037/tra0001462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVE Young Black/African American men (YBM) are at greater risk for trauma and related mental health concerns compared to young non-Hispanic White men but are less likely to receive mental health care when needed. The current study used a Theory of Planned Behavior (TPB)-guided framework to qualitatively explore beliefs, norms, and intentions related to seeking mental health screening and linkage to care (LTC) among YBM exposed to trauma. METHOD Participants (N = 55, Mage = 23 years) were YBM aged 18-30 recruited from urban community settings in Kansas City, MO, between October 2018 and April 2019 for participation in focus groups. RESULTS Participants discussed lived experiences with trauma and mental health care, plus salient behavioral beliefs-both positive and negative. Key normative referents were significant others and family members, and participants endorsed greater motivation to seek care with their support. Control beliefs ranged from individual and interpersonal facilitators and barriers to more systemic factors (e.g., availability of providers, cost, lack of access, disparities in incarceration). CONCLUSIONS Tailored interventions are needed to promote engagement in mental health services among YBM, with strategies that recognize cultural contexts and ongoing needs for general well-being. Recommendations for providers and systems are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Alexandria G. Bauer
- Center of Alcohol & Substance Use Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States
| | - Joah Williams
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry Street, Kansas City, MO 64110, United States
| | - Erin Hambrick
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry Street, Kansas City, MO 64110, United States
| | - Melisa Rempfer
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry Street, Kansas City, MO 64110, United States
| | - Kymberly Bennett
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry Street, Kansas City, MO 64110, United States
| | - Kelsey Christensen
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, United States
| | - Jannette Y. Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, United States
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Montiel C, Mishara BL. A qualitative study of factors involved in the helping behaviors of suicide prevention gatekeepers. DEATH STUDIES 2024; 48:522-532. [PMID: 37603417 DOI: 10.1080/07481187.2023.2246018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
This study explores the factors involved in the capacity of newly trained suicide prevention gatekeepers to engage in the identification and support of people at risk of suicide. In-depth telephone interviews were conducted with 18 gatekeepers from various settings who had participated in a larger quantitative study of the impact of gatekeeper training. Conventional content analysis was performed on the data collected. Participants said that gatekeeper training provided key information and legitimized their role. Previous experience with suicidal friends and family members motivated their involvement and helped them to engage with at-risk individuals. Support available from the setting, including attitudes toward suicide, resources for referrals and promotion of the gatekeeper activities, were instrumental in gatekeepers' ability to fulfill their role. Gatekeeper programs may benefit from adopting a comprehensive approach to gatekeeper helping behaviors by attending to their contextual influences, and the effects of gatekeepers' personal experiences.
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Affiliation(s)
- Corentin Montiel
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, Canada
| | - Brian L Mishara
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, Canada
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3
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Hinojosa CA, George GC, Ben-Zion Z. Neuroimaging of posttraumatic stress disorder in adults and youth: progress over the last decade on three leading questions of the field. Mol Psychiatry 2024:10.1038/s41380-024-02558-w. [PMID: 38632413 DOI: 10.1038/s41380-024-02558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
Almost three decades have passed since the first posttraumatic stress disorder (PTSD) neuroimaging study was published. Since then, the field of clinical neuroscience has made advancements in understanding the neural correlates of PTSD to create more efficacious treatment strategies. While gold-standard psychotherapy options are available, many patients do not respond to them, prematurely drop out, or never initiate treatment. Therefore, elucidating the neurobiological mechanisms that define the disorder can help guide clinician decision-making and develop individualized mechanisms-based treatment options. To this end, this narrative review highlights progress made in the last decade in adult and youth samples on three outstanding questions in PTSD research: (1) Which neural alterations serve as predisposing (pre-exposure) risk factors for PTSD development, and which are acquired (post-exposure) alterations? (2) Which neural alterations can predict treatment outcomes and define clinical improvement? and (3) Can neuroimaging measures be used to define brain-based biotypes of PTSD? While the studies highlighted in this review have made progress in answering the three questions, the field still has much to do before implementing these findings into clinical practice. Overall, to better answer these questions, we suggest that future neuroimaging studies of PTSD should (A) utilize prospective longitudinal designs, collecting brain measures before experiencing trauma and at multiple follow-up time points post-trauma, taking advantage of multi-site collaborations/consortiums; (B) collect two scans to explore changes in brain alterations from pre-to-post treatment and compare changes in neural activation between treatment groups, including longitudinal follow up assessments; and (C) replicate brain-based biotypes of PTSD. By synthesizing recent findings, this narrative review will pave the way for personalized treatment approaches grounded in neurobiological evidence.
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Affiliation(s)
- Cecilia A Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Grace C George
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Ziv Ben-Zion
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
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Levin RY, Liu RT. Post-traumatic stress disorder in a national sample of preadolescent children 9 to 10 years old: Prevalence, correlates, clinical sequelae, and treatment utilization. Transl Psychiatry 2024; 14:152. [PMID: 38503761 PMCID: PMC10951365 DOI: 10.1038/s41398-024-02868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
Although posttraumatic stress disorder (PTSD) has been well characterized in adults, its epidemiology in children is unclear. The current study provides the first population-based examination of the prevalence of PTSD, sociodemographic and psychiatric correlates, clinical sequelae, and associations with psychiatric treatment in preadolescents 9-10 years old in the United States. Data from the Adolescent Brain and Cognitive Development (ABCD) Study (release 5.0) was analyzed. Participants (unweighted n = 11,875) were recruited from 21 sites across the United States. Current and lifetime PTSD prevalence were estimated, as was treatment use among children with PTSD. Sociodemographic, psychiatric correlates and sequelae of PTSD were analyzed using logistic regression, as was the association between PTSD and psychiatric treatment. After the application of propensity weights, lifetime prevalence of PTSD was 2.17%. Sexual minority status, being multiracial, having unmarried parents, and family economic insecurity were associated with greater odds of PTSD. Among psychiatric disorders, separation anxiety was most strongly associated with PTSD, although general comorbid psychopathology was associated with greater odds of PTSD. Prior history of PTSD predicted a new onset of other psychiatric disorders after PTSD remission. Nearly one in three children with lifetime PTSD did not receive psychiatric treatment, despite negative long-term outcomes of PTSD and significant psychiatric comorbidity. Even among preadolescents who experience full remission of PTSD, a significant risk for future psychiatric illness remains. Further, the current findings underscore the need for improved efforts to reduce unmet treatment needs among those with PTSD at this age.
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Affiliation(s)
- Rachel Y Levin
- University of Rochester, Department of Psychology, Rochester, NY, 14611, USA.
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, 02114, USA.
| | - Richard T Liu
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
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Bragesjö M, Ivanov VZ, Andersson E, Rück C. Exploring the feasibility and acceptance of huddinge online prolonged exposure therapy (HOPE) for severe and complex PTSD. Eur J Psychotraumatol 2024; 15:2320607. [PMID: 38436944 PMCID: PMC10913705 DOI: 10.1080/20008066.2024.2320607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
Background: Trauma-focused cognitive behavioural therapy such as prolonged exposure is considered firsthand choice for treatment of posttraumatic stress disorder (PTSD) but is seldom available in regular care. Digital therapy is proposed to bridge this gap, but its effectiveness for severe and complex PTSD is uncertain. The primary objective of the current study was to examine the feasibility, acceptability, and preliminary effects of digital therapist-guided prolonged exposure (Huddinge Online Prolonged Exposure; HOPE).Method: Thirty participants with moderate to severe PTSD, with the majority self-reporting complex PTSD symptoms, received HOPE over a ten-week period. Eighty percent of participants had been diagnosed with other psychiatric comorbidity by a mental health professional. Primary outcome was the feasibility and acceptability of treatment. Participants were repeatedly assessed using clinician- and self-rated outcome measures at baseline, during the treatment period, post-treatment, and at 1-month and 6-month follow-ups to estimate preliminary treatment effects. The Clinician Administered PTSD Scale version 5 (CAPS-5), administered by independent assessors, evaluated PTSD symptom severity.Results: HOPE proved feasible and effective, delivering evidence-based treatment content in a psychiatric outpatient setting with reduced therapist time. The treatment was well-tolerated, with no severe adverse events and a 17% dropout rate. Sixty-four percent completed the exposure-based portion of the treatment, and overall satisfaction measured by the Client Satisfaction Questionnaire was moderate. Furthermore, significant reductions in PTSD symptoms as assessed with the CAPS-5 (Cohen's d = 1.30 [95% CI -1.79 to -0.82]) at the primary endpoint 1 month which were sustained at the 6-month follow up.Conclusion: Altogether, this study indicate feasibility of treating severe and complex PTSD through a digital PE intervention, thereby building upon and extending previous research findings. Large-scale controlled trials are needed to further validate the specific effect and long-term benefits of HOPE.Trial registration: ClinicalTrials.gov identifier: NCT05560854.
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Affiliation(s)
- Maria Bragesjö
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Volen Z. Ivanov
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
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Bisson JI, Ariti C, Cullen K, Kitchiner N, Lewis C, Roberts NP, Simon N, Smallman K, Addison K, Bell V, Brookes-Howell L, Cosgrove S, Ehlers A, Fitzsimmons D, Foscarini-Craggs P, Harris SRS, Kelson M, Lovell K, McKenna M, McNamara R, Nollett C, Pickles T, Williams-Thomas R. Pragmatic randomised controlled trial of guided self-help versus individual cognitive behavioural therapy with a trauma focus for post-traumatic stress disorder (RAPID). Health Technol Assess 2023; 27:1-141. [PMID: 37982902 PMCID: PMC11017158 DOI: 10.3310/ytqw8336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Background Guided self-help has been shown to be effective for other mental conditions and, if effective for post-traumatic stress disorder, would offer a time-efficient and accessible treatment option, with the potential to reduce waiting times and costs. Objective To determine if trauma-focused guided self-help is non-inferior to individual, face-to-face cognitive-behavioural therapy with a trauma focus for mild to moderate post-traumatic stress disorder to a single traumatic event. Design Multicentre pragmatic randomised controlled non-inferiority trial with economic evaluation to determine cost-effectiveness and nested process evaluation to assess fidelity and adherence, dose and factors that influence outcome (including context, acceptability, facilitators and barriers, measured qualitatively). Participants were randomised in a 1 : 1 ratio. The primary analysis was intention to treat using multilevel analysis of covariance. Setting Primary and secondary mental health settings across the United Kingdom's National Health Service. Participants One hundred and ninety-six adults with a primary diagnosis of mild to moderate post-traumatic stress disorder were randomised with 82% retention at 16 weeks and 71% at 52 weeks. Nineteen participants and ten therapists were interviewed for the process evaluation. Interventions Up to 12 face-to-face, manualised, individual cognitive-behavioural therapy with a trauma focus sessions, each lasting 60-90 minutes, or to guided self-help using Spring, an eight-step online guided self-help programme based on cognitive-behavioural therapy with a trauma focus, with up to five face-to-face meetings of up to 3 hours in total and four brief telephone calls or e-mail contacts between sessions. Main outcome measures Primary outcome: the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, at 16 weeks post-randomisation. Secondary outcomes: included severity of post-traumatic stress disorder symptoms at 52 weeks, and functioning, symptoms of depression, symptoms of anxiety, alcohol use and perceived social support at both 16 and 52 weeks post-randomisation. Those assessing outcomes were blinded to group assignment. Results Non-inferiority was demonstrated at the primary end point of 16 weeks on the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [mean difference 1.01 (one-sided 95% CI -∞ to 3.90, non-inferiority p = 0.012)]. Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, score improvements of over 60% in both groups were maintained at 52 weeks but the non-inferiority results were inconclusive in favour of cognitive-behavioural therapy with a trauma focus at this timepoint [mean difference 3.20 (one-sided 95% confidence interval -∞ to 6.00, non-inferiority p = 0.15)]. Guided self-help using Spring was not shown to be more cost-effective than face-to-face cognitive-behavioural therapy with a trauma focus although there was no significant difference in accruing quality-adjusted life-years, incremental quality-adjusted life-years -0.04 (95% confidence interval -0.10 to 0.01) and guided self-help using Spring was significantly cheaper to deliver [£277 (95% confidence interval £253 to £301) vs. £729 (95% CI £671 to £788)]. Guided self-help using Spring appeared to be acceptable and well tolerated by participants. No important adverse events or side effects were identified. Limitations The results are not generalisable to people with post-traumatic stress disorder to more than one traumatic event. Conclusions Guided self-help using Spring for mild to moderate post-traumatic stress disorder to a single traumatic event appears to be non-inferior to individual face-to-face cognitive-behavioural therapy with a trauma focus and the results suggest it should be considered a first-line treatment for people with this condition. Future work Work is now needed to determine how best to effectively disseminate and implement guided self-help using Spring at scale. Trial registration This trial is registered as ISRCTN13697710. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/192/97) and is published in full in Health Technology Assessment; Vol. 27, No. 26. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Cono Ariti
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Katherine Cullen
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Neil Kitchiner
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Psychology & Psychological Therapies Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Neil P Roberts
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Psychology & Psychological Therapies Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Natalie Simon
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Kim Smallman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Katy Addison
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Vicky Bell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Sarah Cosgrove
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Anke Ehlers
- University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | | | | | - Shaun R S Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Mark Kelson
- Department of Mathematics, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | | | - Claire Nollett
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tim Pickles
- Centre for Trials Research, Cardiff University, Cardiff, UK
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7
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Walker HE, Wamser-Nanney R. Revictimization Risk Factors Following Childhood Maltreatment: A Literature Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:2319-2332. [PMID: 35476548 DOI: 10.1177/15248380221093692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Revictimization research, to date, has primarily focused on sexual revictimization (i.e., child sexual abuse and adult sexual assault), which has resulted in a lack of understanding of trauma revictimization more generally. Specifically, it is unclear what factors are placing individuals with a history of child maltreatment (i.e., sexual abuse, physical abuse, and witnessing intimate partner violence [IPV]) at greater risk for subsequent adult victimization (i.e., sexual assault and IPV). Existing theoretical and empirical work on revictimization suggest that multiple risk factors are likely present within this framework (e.g., posttraumatic stress symptoms [PTSS], emotion dysregulation, and risk-taking behaviors). Prior research has suggested that PTSS are often linked with these other risk factors, and it is possible that the development of PTSS following child maltreatment may be related to the development or maintenance of additional factors that increase the likelihood of revictimization. The purpose of this review was to synthesize findings regarding risk factors that place maltreated individuals at greater risk for adult revictimization. Approximately 228 studies were identified following a thorough search of the peer-reviewed literature using multiple databases (PsycINFO, PILOTS, and Google Scholar). Each study was critically analyzed for relevance. The included studies were used in our review of prevalence, specific risk factors that have been identified, and unanswered questions in this literature. PTSS were noted to be particularly important in the revictimization framework, and thus, a novel model of revictimization was also proposed where PTSS are illustrated as being associated with the development and maintenance of other factors within the revictimization framework.
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Affiliation(s)
- Hannah E Walker
- Department of Psychological Sciences, University of Missouri- St. Louis, St. Louis, MO, USA
| | - Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri- St. Louis, St. Louis, MO, USA
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8
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Cruz-Gonzalez M, Alegría M, Palmieri PA, Spain DA, Barlow MR, Shieh L, Williams M, Srirangam P, Carlson EB. Racial/ethnic differences in acute and longer-term posttraumatic symptoms following traumatic injury or illness. Psychol Med 2023; 53:5099-5108. [PMID: 35903010 PMCID: PMC9884321 DOI: 10.1017/s0033291722002112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Racial/ethnic differences in mental health outcomes after a traumatic event have been reported. Less is known about factors that explain these differences. We examined whether pre-, peri-, and post-trauma risk factors explained racial/ethnic differences in acute and longer-term posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in patients hospitalized following traumatic injury or illness. METHODS PTSD, depression, and anxiety symptoms were assessed during hospitalization and 2 and 6 months later among 1310 adult patients (6.95% Asian, 14.96% Latinx, 23.66% Black, 4.58% multiracial, and 49.85% White). Individual growth curve models examined racial/ethnic differences in PTSD, depression, and anxiety symptoms at each time point and in their rate of change over time, and whether pre-, peri-, and post-trauma risk factors explained these differences. RESULTS Latinx, Black, and multiracial patients had higher acute PTSD symptoms than White patients, which remained higher 2 and 6 months post-hospitalization for Black and multiracial patients. PTSD symptoms were also found to improve faster among Latinx than White patients. Risk factors accounted for most racial/ethnic differences, although Latinx patients showed lower 6-month PTSD symptoms and Black patients lower acute and 2-month depression and anxiety symptoms after accounting for risk factors. Everyday discrimination, financial stress, past mental health problems, and social constraints were related to these differences. CONCLUSION Racial/ethnic differences in risk factors explained most differences in acute and longer-term PTSD, depression, and anxiety symptoms. Understanding how these risk factors relate to posttraumatic symptoms could help reduce disparities by facilitating early identification of patients at risk for mental health problems.
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Affiliation(s)
- Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Patrick A. Palmieri
- Traumatic Stress Center, Department of Psychiatry, Summa Health, Akron, OH, USA
| | - David A. Spain
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - M. Rose Barlow
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, U.S. Department of Veterans Affairs, Menlo Park, CA, USA
| | - Lisa Shieh
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Mallory Williams
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
- Center of Excellence in Trauma and Violence Prevention, Howard University College of Medicine, Washington, DC, USA
| | | | - Eve B. Carlson
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, U.S. Department of Veterans Affairs, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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9
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Harnett NG, Dumornay NM, Delity M, Sanchez LD, Mohiuddin K, Musey PI, Seamon MJ, McLean SA, Kessler RC, Koenen KC, Beaudoin FL, Lebois L, van Rooij SJ, Sampson NA, Michopoulos V, Maples-Keller JL, Haran JP, Storrow AB, Lewandowski C, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Swor RA, McGrath ME, Hudak LA, Pascual JL, House SL, An X, Stevens JS, Neylan TC, Jovanovic T, Linnstaedt SD, Germine LT, Datner EM, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O’Neil BJ, Sergot P, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Luna B, Harte SE, Elliott JM, Ressler KJ. Prior differences in previous trauma exposure primarily drive the observed racial/ethnic differences in posttrauma depression and anxiety following a recent trauma. Psychol Med 2023; 53:2553-2562. [PMID: 35094717 PMCID: PMC9339026 DOI: 10.1017/s0033291721004475] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Racial and ethnic groups in the USA differ in the prevalence of posttraumatic stress disorder (PTSD). Recent research however has not observed consistent racial/ethnic differences in posttraumatic stress in the early aftermath of trauma, suggesting that such differences in chronic PTSD rates may be related to differences in recovery over time. METHODS As part of the multisite, longitudinal AURORA study, we investigated racial/ethnic differences in PTSD and related outcomes within 3 months after trauma. Participants (n = 930) were recruited from emergency departments across the USA and provided periodic (2 weeks, 8 weeks, and 3 months after trauma) self-report assessments of PTSD, depression, dissociation, anxiety, and resilience. Linear models were completed to investigate racial/ethnic differences in posttraumatic dysfunction with subsequent follow-up models assessing potential effects of prior life stressors. RESULTS Racial/ethnic groups did not differ in symptoms over time; however, Black participants showed reduced posttraumatic depression and anxiety symptoms overall compared to Hispanic participants and White participants. Racial/ethnic differences were not attenuated after accounting for differences in sociodemographic factors. However, racial/ethnic differences in depression and anxiety were no longer significant after accounting for greater prior trauma exposure and childhood emotional abuse in White participants. CONCLUSIONS The present findings suggest prior differences in previous trauma exposure partially mediate the observed racial/ethnic differences in posttraumatic depression and anxiety symptoms following a recent trauma. Our findings further demonstrate that racial/ethnic groups show similar rates of symptom recovery over time. Future work utilizing longer time-scale data is needed to elucidate potential racial/ethnic differences in long-term symptom trajectories.
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Affiliation(s)
- N. G. Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - N. M. Dumornay
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - M. Delity
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - L. D. Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - K. Mohiuddin
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, 19141, USA
| | - P. I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - M. J. Seamon
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - S. A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - K. C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - F. L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, 02930, USA
| | - L. Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - S. J. van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30332, USA
| | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - V. Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30332, USA
| | - J. L. Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30332, USA
| | - J. P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - A. B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - C. Lewandowski
- Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
| | - P. L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - S. Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - C. W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - B. E. Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - M. C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, 35294, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, 35294, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - R. A. Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, 48309, USA
| | - M. E. McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - L. A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - J. L. Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - S. L. House
- Department of Emergency Medicine,, Washington University School of Medicine,, St. Louis, MO, 63130, USA
| | - X. An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - J. S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - T. C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - T. Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| | - S. D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - L. T. Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - E. M. Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA, 19141, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA, 19107, USA
| | - A. M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, 19107, USA
| | - C. Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - D. A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - R. C. Merchant
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - R. M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - N. K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - B. J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - P. Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, 77030, USA
| | - S. E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - M. W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - R. H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, 06510, USA
| | - J. Joormann
- Department of Psychology, Yale University, West Haven, CT, 06520, USA
| | - D. M. Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - D. A. Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - J. F. Sheridan
- Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, 43210, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - J. W. Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, USA
| | - B. Luna
- Affiliation Laboratory of Neurocognitive Development, University of Pittsburgh Medical Center- Western Psychiatric Hospital, Pittsburgh, PA, 15213, USA
| | - S. E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - J. M. Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006,, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - K. J. Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
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Kagan R, Pressley J, Espinoza R, Lanktree C, Henry J, Knoverek A, Duffy S, Labruna V, Habib M, Blaustein ME, Spinazzola J. Development of a Differential Assessment Guide to Improve Engagement with Youths & Families Living with Chronic Trauma. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:145-159. [PMID: 36776636 PMCID: PMC9908809 DOI: 10.1007/s40653-022-00479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 06/18/2023]
Abstract
Youths and parents/caregivers who have experienced multiple forms of severe interpersonal trauma may demonstrate severe and persistent symptoms of complex trauma including high-risk behaviors. Engagement, and sustaining engagement, of these youths and parents/caregivers in evidence-supported trauma treatment is a critical challenge, especially when youths or parents/caregivers have experienced chronic traumas that may be expected to continue into the foreseeable future. An extensive literature review was conducted leading to development of an assessment framework that could increase engagement of youths and parents/caregivers in trauma treatment based on research on chronic trauma, complex trauma, Developmental Trauma Disorder (DTD), and factors that promote engagement. A multi-dimensional assessment guide was developed to enable clinicians to differentiate types of chronic trauma based on a continuum of past, current and expected exposure over time and then to use this guide collaboratively with youths and parents/caregivers to develop priorities for treatment and service planning that matches their needs and strengths. The assessment guide incorporates exposure to intra-familial and community forms of interpersonal trauma, attachment disruptions, established symptoms of PTSD, Complex PTSD and DTD, as well as social-emotional development. The assessment and treatment planning guides proposed in this article expand applicability of evidence-supported trauma-informed therapy to youths and families who have not been engaged by programs offering treatments that are focused on past or single incident traumas or do not address disrupted attachments, multi-generational experiences of adversity, discrimination and community violence, life-threatening dangers or the impact of chronic trauma on youth, parent/caregiver and family development.
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Affiliation(s)
- Richard Kagan
- Training Programs on Traumatic Stress, Family Treatment Center Foundation, The Institute for Adolescent Trauma Treatment and Training at Adelphi University, Garden City, USA
| | - Jana Pressley
- The Foundation Trust, Richmont Graduate University, Chattanooga, USA
| | - Rosa Espinoza
- The Foundation Trust, Children’s Hospital Los Angeles/USC UCEDD, Los Angeles, USA
| | - Cheryl Lanktree
- Department of Psychiatry & Behavioral Sciences, Keck Medical School, University of Southern California Adolescent Trauma Training Center, University of Southern California, Los Angeles, USA
| | - Jim Henry
- School of Social Work and Children’s Trauma Assessment Center, Western Michigan University, Kalamazoo, USA
| | - Angel Knoverek
- School of Counselor Education, Culver-Stockton College, Adams State University, Alamosa, USA
| | | | - Victor Labruna
- The Institute for Adolescent Trauma Treatment and Training at Adelphi University, Garden City, USA
| | - Mandy Habib
- The Institute for Adolescent Trauma Treatment and Training at Adelphi University, Garden City, USA
| | | | - Joseph Spinazzola
- The Foundation Trust, Richmont Graduate University, Chattanooga, USA
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11
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Burns CJ, Borah L, Terrell SM, James LN, Erkkinen E, Owens L. Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:401-409. [PMID: 36538661 DOI: 10.1097/acm.0000000000005046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but best practices for TIC education remain unclear. To remedy this, the authors conducted a multidisciplinary scoping literature review to discern best practices for the design, implementation, and evaluation of TIC curricula for health care professionals. METHOD The research team searched Ovid MEDLINE, Cochrane Library, Elsevier's Scopus, Elsevier's Embase, Web of Science, and the PTSDpubs database from the database inception date until May 14, 2021. Worldwide English language studies on previously implemented TIC curricula for trainees or professionals in health care were included in this review. RESULTS Fifty-five studies met the inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma and responding to subsequent disclosures (41 studies [74.5%]), defining trauma (34 studies [61.8%]), and understanding trauma's impact on health (33 studies [60.0%]). Fifty-one of the studies included curricular evaluations, with the most common survey items being confidence in TIC skills (38 studies [74.5%]), training content knowledge assessment (25 studies [49.0%]), participant demographic characteristics (21 studies [41.2%]), and attitudes regarding the importance of TIC (19 studies [37.3%]). CONCLUSIONS Future curricula should be rooted in cultural humility and an understanding of the impacts of marginalization and oppression on individual and collective experiences of trauma. Moreover, curricula are needed for clinicians in more diverse specialties and across different cadres of care teams. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care professionals.
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Affiliation(s)
- Courtney Julia Burns
- C.J. Burns is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3216-5921
| | - Luca Borah
- L. Borah is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8975-1051
| | - Stephanie M Terrell
- S.M. Terrell is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-7776-4621
| | - LaTeesa N James
- L.N. James is a health sciences informationist, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-5955-2876
| | - Elizabeth Erkkinen
- E. Erkkinen is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3522-7286
| | - Lauren Owens
- L. Owens is assistant professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; ORCID https://orcid.org/0000-0002-8277-2826
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12
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Kan E, Riano N, Beardslee J, Frick P, Steinberg L, Cauffman E. Race Differences in the Association Between Binge Drinking and Treatment Among First-Time Justice-System-Impacted Youth. Alcohol Alcohol 2023; 58:23-30. [PMID: 36151735 DOI: 10.1093/alcalc/agac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/15/2022] [Accepted: 08/20/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS We aim to determine whether there are racial/ethnic differences in the association between binge drinking frequency and community-based alcohol treatment among justice-system-impacted adolescents and young adults. METHODS We examined whether race/ethnicity moderated the relation between binge drinking and youths' likelihood of receiving alcohol treatment. The sample included 1216 male, first-time-arrested youth from the Crossroads Study (2011-2018). Participants were recruited from CA, PA and LA. RESULTS Among youth who binge drank occasionally, Black youth were less likely to receive alcohol treatment than White (b = -0.08, 95% confidence interval [CI] [-0.13, -0.04]) and Hispanic/Latino (b = -0.06, 95% CI [-0.09, -0.02]) youth. There were no differences between the White and Hispanic/Latino youth. Black youth who were frequent binge drinkers were as likely to receive alcohol treatment as White youth who binge drank significantly less often. There were no racial/ethnic differences in alcohol treatment at the highest level of binge drinking. CONCLUSION Black youth who binge drink occasionally are less likely than White youth to receive alcohol treatment. The present findings highlight a need for efforts to mitigate racial disparities in access to or motivations to seek community-based treatment.
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Affiliation(s)
- Emily Kan
- Department of Psychiatry, University of California, Los Angeles, 10911 Weyburn Avenue, Ste. 200, Los Angeles, CA 90024, USA
| | - Nicholas Riano
- Department of Psychological Science, University of California, Irvine, 4308 Social and Behavioral Sciences Gateway, Pereira Drive, Irvine, CA 92617, USA
| | - Jordan Beardslee
- Department of Psychological Science, University of California, Irvine, 4308 Social and Behavioral Sciences Gateway, Pereira Drive, Irvine, CA 92617, USA
| | - Paul Frick
- Department of Psychology, Louisiana State University, 208 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Laurence Steinberg
- Department of Psychology, Temple University 1701 N 13th St, Philadelphia, PA 19122, USA
| | - Elizabeth Cauffman
- Department of Psychological Science, University of California, Irvine, 4308 Social and Behavioral Sciences Gateway, Pereira Drive, Irvine, CA 92617, USA
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13
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Parental Criticism and Depressive Symptoms: The Contribution of Active Coping Among African American Adolescents : Prairie View A&M University. Community Ment Health J 2023; 59:85-94. [PMID: 35723767 DOI: 10.1007/s10597-022-00992-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/27/2022] [Indexed: 01/07/2023]
Abstract
The present study examined whether parental criticism, active coping, and peer support associated with depressive symptoms. Then using two mediation models, this study explored whether parental criticism related to depressive symptoms through active coping while controlling for peer support among African American Adolescents (N = 883). Results from a multiple regression analysis revealed that maternal and paternal criticism positively associated with depressive symptoms in contrast to active coping and peer support. In the first mediation analysis, active coping explained the relationship between maternal criticism and depressive symptoms. In the second mediation analysis, active coping did not explain the relationship between paternal criticism and depressive symptoms. These results suggest that mental health practitioners should consider incorporating coping techniques in therapy, specifically while treating African American adolescents. Clinical, family, and community implications are discussed.
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14
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Conceptual Framework for Rape Survivors Diagnosed with PTSD in the North West Province of South Africa. Healthcare (Basel) 2022; 11:healthcare11010127. [PMID: 36611586 PMCID: PMC9819654 DOI: 10.3390/healthcare11010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
The lack of a conceptual framework that can be utilized to manage rape survivors diagnosed with Post-Traumatic Stress Disorders presents a challenge in the North-West province. The study aims to provide a conceptual framework for managing rape survivors with PTSD in the province of the North-West using Practice-Oriented Theory and Donabedian's Structure Process Outcome Model Features. The research was conducted using an explanatory, sequential and mixed-methods approach. Additionally, used was the descriptive and explorative programme evaluation design. The results of the study demonstrated the significance of PTSD assessment before management interventions for rape survivors. The study findings outlined and designed a framework to assess and manage PTSD among rape survivors consulting at Thuthuzela Care Centre and those referred to hospitals for further management. The Practice-Oriented theory by Dickoff, James and Wiedenbach, and the Structure Process Outcome model by Donabedian served as points of reference for the development of the conceptual framework. The study is limited to North-West provincial healthcare facilities and Thuthuzela care centres (TCCs), however, it highlights the lack of a conceptual framework pertaining to the psychological management of PTSD rape survivors in the province and South Africa.
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15
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Hoeft TJ, Hall JD, Solberg LI, Takamine LH, Danna MN, Fortney JC, Shushan S, Cohen DJ. Clinician Experiences With Telepsychiatry Collaborative Care for Posttraumatic Stress Disorder and Bipolar Disorder. Psychiatr Serv 2022:appips202100595. [PMID: 36444528 DOI: 10.1176/appi.ps.202100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) and bipolar disorder are common in primary care. Evidence supports collaborative care in primary care settings to treat depression and anxiety, and recent studies have evaluated its effectiveness in treating complex conditions such as PTSD and bipolar disorder. This study aimed to examine how primary care clinicians experience collaborative care for patients with these more complex psychiatric disorders. METHODS The authors conducted semistructured interviews with 22 primary care clinicians participating in a pragmatic trial that included telepsychiatry collaborative care (TCC) to treat patients with PTSD or bipolar disorder in rural or underserved areas. Analysis utilized a constant comparative method to identify recurring themes. RESULTS Clinicians reported that TCC improved their confidence in managing medications for patients with PTSD or bipolar disorder and supported their ongoing learning and skill development. Clinicians also reported improvements in patient engagement in care. Care managers were crucial to realizing these benefits by fostering communication within the clinical team while engaging patients through regular outreach. Clinicians valued TCC because it included and supported them in improving the care of patients' mental health conditions, which opened opportunities for clinicians to enhance care and address co-occurring general medical conditions. Overall, benefits of the TCC model outweighed its minimal burdens. CONCLUSIONS Clinicians found that TCC supported their care of patients with PTSD or bipolar disorder. This approach has the potential to extend the reach of specialty mental health care and to support primary care clinicians treating patients with these more complex psychiatric disorders.
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Affiliation(s)
- Theresa J Hoeft
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Jennifer D Hall
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Leif I Solberg
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Linda H Takamine
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Maria N Danna
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Stephanie Shushan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Deborah J Cohen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
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16
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Franz MR, Savella GM, Salen N, Contractor AA, Kiser LJ. The Effects of a Multi-Family Group Trauma Intervention on Caregiver Posttraumatic Stress Symptom Clusters. VIOLENCE AND VICTIMS 2022; 37:702-714. [PMID: 36038278 DOI: 10.1891/vv-2021-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Strengthening Family Coping Resources (SFCR), a multi-family group intervention tailored to families experiencing traumatic stress, is associated with improved post-traumatic stress disorder (PTSD) symptoms and family functioning. To further SFCR research, we examined (1) SFCR's effects on caregiver PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity); and (2) whether effects differed by caregiver trauma type (interpersonal versus non-interpersonal; intrafamilial versus extrafamilial). Forty-two caregivers of primarily low socioeconomic status reporting trauma histories completed SFCR treatment. Significant decreases in PTSD intrusion, avoidance, and NACM subscale scores emerged from pre- to post-SFCR; there were no differences in subscale score changes by trauma type categorization. Findings support SFCR as a promising treatment for reducing PTSD severity among caregivers reporting diverse traumas.
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Affiliation(s)
- Molly R Franz
- Department of Psychology, University of Maryland Baltimore County
| | | | - Nicole Salen
- Department of Psychiatry, University of Maryland School of Medicine
| | | | - Laurel J Kiser
- Department of Psychiatry, University of Maryland School of Medicine
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17
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Pincus LE, Brumfield R, Brown LA. Consultation and professional development within the prolonged exposure initiative. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2845-2856. [PMID: 35098546 DOI: 10.1002/jcop.22800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
Previous studies have identified that ongoing consultation and organizational support are key factors in sustaining evidence-based implementation initiatives in community mental health. Clinician-level factors likely influence implementation but are not well delineated. This study assessed clinician-reported professional development incentives for participating in consultation in prolonged exposure (PE) therapy to guide future evidence-based practice (EBP) initiatives. Providers in the PE initiative (N = 22) completed a survey asking about their motivations to participate, the impact of consultation on the implementation of PE and their professional development goals, and the impact of organizational-level support on their goals and on organizational-level clinician turnover. Of the respondents, 10 had decided to pursue additional training to become PE consultants at their agencies. Providers (response rate = 22/35) reported joining the PE Initiative to learn an evidence-based practice in general (not PE specifically) and increase their skill in treating posttraumatic stress disorder. Providers largely found ongoing consultation helpful and reported that consultation provided the feedback and support necessary to achieve their professional goals. Providers who decided to pursue PE consultant training reported that expanding upon supervision and clinical skills were strong motivators. Providers largely attributed clinician turnover within the PE Initiative to organizational-level factors. Ongoing consultation facilitated providers' professional development goals. The survey identified several areas for further exploration, including how consultation can reduce clinician turnover, and how taking on additional responsibility within implementation initiatives can facilitate provider engagement in the EBP.
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Affiliation(s)
- Liza E Pincus
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Bronx, New York, USA
| | - Roz Brumfield
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lily A Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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18
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McBain SA, Stoycos S, Doenges T. Breaking Silos to Address Medical Trauma: The Need for Integration of Trauma and Health Psychology Training. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09897-2. [PMID: 35841442 DOI: 10.1007/s10880-022-09897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) following a traumatic injury is a significant public health concern impacting approximately a third of traumatically injured patients. In 2018, the American College of Surgeons (ACS) Committee on Trauma recommended implementation of PTSD screening and brief intervention in level 1 trauma centers to meet the mental health needs of this underserved population. In March 2022, ACS revised its standards to include a requirement for mental health screening and referral process in level 1 and level 2 trauma centers. However, implementation of these programs has been limited. One barrier to implementation has been the lack of cross-trained trauma and health psychologists to support the development and implementation of trauma-focused programs in acute and critical care settings. This paper is a call to action to bring together experts in the fields of trauma and health psychology to effectively address training gaps in post-injury PTSD and medical traumatic stress. Through development of trauma and health psychology cross-training models, the field of psychology can collaborate to meet the increasing demand for trauma-focused psychologists in acute and critical care settings.
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Affiliation(s)
- Sacha A McBain
- Departments of Psychiatry & Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA.
| | - Sarah Stoycos
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Tim Doenges
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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19
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Lu W, Silverstein SM, Mueser KT, Minsky S, Bullock D, Buchbinder S, Chen Q, Eubanks R, Guillaume-Salvant A. Undocumented PTSD among African American clients with serious mental illness in a statewide mental health system. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2022:2022-79121-001. [PMID: 35797171 PMCID: PMC10229093 DOI: 10.1037/tra0001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES African Americans are at increased risk for trauma exposure and the development of posttraumatic stress disorder (PTSD) relative to other racial groups. Among African Americans with Serious Mental Illness (SMI), PTSD is frequently underdiagnosed and untreated. The primary objective of this study was to investigate trauma exposure, PTSD symptom severity, and the rate of undocumented PTSD in medical records among African Americans diagnosed with SMI. METHODS Screening for trauma exposure and PTSD symptoms was implemented among 404 clients receiving community mental health services. Participants endorsed at least 1 traumatic event, had a score of at least 45 on the DSM-IV PTSD Checklist indicating probable PTSD, and had a chart diagnosis of an Axis I disorder. RESULTS Around 18.3% of participants had PTSD diagnosed in their medical chart. A diagnosis of schizophrenia/schizoaffective disorder was inversely related to the detection of PTSD in the chart. Client age and gender did not adversely affect the detection of PTSD, and detection rates remained low overall. Childhood sexual abuse was the most commonly endorsed index trauma, followed closely by sudden death of a loved one (including violent death). Participants typically experienced an average of 8 types of traumatic events in their lifetime. Cumulative total trauma exposure significantly predicted PTSD severity. Clients with mood disorders reported more severe PTSD. CONCLUSION Findings highlight the low detection rate of PTSD and related symptoms in African American clients with SMI. There is a need for early intervention, grief counseling, culturally sensitive trauma screening, and culturally informed treatment options for this population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Weili Lu
- Department of Psychiatric Rehabilitation and Counseling Professions
| | | | | | - Shula Minsky
- Department of Psychiatric Rehabilitation and Counseling Professions
| | - Deanna Bullock
- Department of Psychiatric Rehabilitation and Counseling Professions
| | | | - Qiang Chen
- Department of Psychiatric Rehabilitation and Counseling Professions
| | - Robin Eubanks
- Department of Psychiatric Rehabilitation and Counseling Professions
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20
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Bisson JI, Ariti C, Cullen K, Kitchiner N, Lewis C, Roberts NP, Simon N, Smallman K, Addison K, Bell V, Brookes-Howell L, Cosgrove S, Ehlers A, Fitzsimmons D, Foscarini-Craggs P, Harris SRS, Kelson M, Lovell K, McKenna M, McNamara R, Nollett C, Pickles T, Williams-Thomas R. Guided, internet based, cognitive behavioural therapy for post-traumatic stress disorder: pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID). BMJ 2022; 377:e069405. [PMID: 35710124 PMCID: PMC9202033 DOI: 10.1136/bmj-2021-069405] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine if guided internet based cognitive behavioural therapy with a trauma focus (CBT-TF) is non-inferior to individual face-to-face CBT-TF for mild to moderate post-traumatic stress disorder (PTSD) to one traumatic event. DESIGN Pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID). SETTING Primary and secondary mental health settings across the UK's NHS. PARTICIPANTS 196 adults with a primary diagnosis of mild to moderate PTSD were randomised in a 1:1 ratio to one of two interventions, with 82% retention at 16 weeks and 71% retention at 52 weeks. 19 participants and 10 therapists were purposively sampled and interviewed for evaluation of the process. INTERVENTIONS Up to 12 face-to-face, manual based, individual CBT-TF sessions, each lasting 60-90 minutes; or guided internet based CBT-TF with an eight step online programme, with up to three hours of contact with a therapist and four brief telephone calls or email contacts between sessions. MAIN OUTCOME MEASURES Primary outcome was the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) at 16 weeks after randomisation (diagnosis of PTSD based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5). Secondary outcomes included severity of PTSD symptoms at 52 weeks, and functioning, symptoms of depression and anxiety, use of alcohol, and perceived social support at 16 and 52 weeks after randomisation. RESULTS Non-inferiority was found at the primary endpoint of 16 weeks on the CAPS-5 (mean difference 1.01, one sided 95% confidence interval -∞ to 3.90, non-inferiority P=0.012). Improvements in CAPS-5 score of more than 60% in the two groups were maintained at 52 weeks, but the non-inferiority results were inconclusive in favour of face-to-face CBT-TF at this time point (3.20, -∞ to 6.00, P=0.15). Guided internet based CBT-TF was significantly (P<0.001) cheaper than face-to-face CBT-TF and seemed to be acceptable and well tolerated by participants. The main themes of the qualitative analysis were facilitators and barriers to engagement with guided internet based CBT-TF, treatment outcomes, and considerations for its future implementation. CONCLUSIONS Guided internet based CBT-TF for mild to moderate PTSD to one traumatic event was non-inferior to individual face-to-face CBT-TF and should be considered a first line treatment for people with this condition. TRIAL REGISTRATION ISRCTN13697710.
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Affiliation(s)
- Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Cono Ariti
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Katherine Cullen
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Neil Kitchiner
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Psychology and Psychological Therapies Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Neil P Roberts
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Psychology and Psychological Therapies Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Natalie Simon
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Kim Smallman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Katy Addison
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Vicky Bell
- Division of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, UK
| | | | - Sarah Cosgrove
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Anke Ehlers
- University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | | | | | - Shaun R S Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Mark Kelson
- Department of Mathematics, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Karina Lovell
- Division of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, UK
| | | | | | - Claire Nollett
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tim Pickles
- Centre for Trials Research, Cardiff University, Cardiff, UK
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21
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Trauma Exposure and PTSD in Philadelphia Community Mental Health. Community Ment Health J 2022; 58:547-552. [PMID: 34052961 DOI: 10.1007/s10597-021-00853-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Based on feedback received during post-training consultation within a Prolonged Exposure (PE) implementation initiative, additional assessment training was added to help community providers identify patients who met criteria for posttraumatic stress disorder (PTSD) symptom severity and were considered appropriate for PTSD treatment. The current study investigated the rates of trauma exposure and PTSD in the community sample, as well as the percentage of individuals deemed "appropriate" for PE by community therapists. METHOD Clinicians involved in the PE Initiative administered the Post-traumatic Diagnostic Scale for DSM-5 (PDS-5) to 10,260 individuals across 13 community agencies. Clinicians were also asked to report whether patients were perceived as appropriate for PE. RESULTS Consistent with our hypothesis, the rates of potential PTSD in Philadelphia community mental health (58.2% of our total sample) far exceeded national averages (8.3%). Contrary to our hypothesis, 100% of patients who scored above the clinical cutoff for PTSD were considered appropriate for PE by their community clinician. CONCLUSIONS The results of this study emphasize the high prevalence of PTSD among individuals presenting for treatment to community mental health centers. Despite common misconceptions that patients are often perceived as ineligible or not appropriate for PE, 100% of patients in the PE Initiative who scored above the clinical cutoff for PTSD were considered good candidates for treatment according to their clinicians. This suggests that with sufficient training and post-training consultation, as provided in this community initiative, community clinicians may be more likely to perceive PE as an appropriate treatment option.
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22
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Meredith LS, Wong E, Osilla KC, Sanders M, Tebeka MG, Han B, Williamson SL, Carton TW. Trauma-informed Collaborative Care for African American Primary Care Patients in Federally Qualified Health Centers: A Pilot Randomized Trial. Med Care 2022; 60:232-239. [PMID: 35157622 PMCID: PMC8867914 DOI: 10.1097/mlr.0000000000001681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND African Americans have nearly double the rate of posttraumatic stress disorder (PTSD) compared with other racial/ethnic groups. OBJECTIVE To understand whether trauma-informed collaborative care (TICC) is effective for improving PTSD among African Americans in New Orleans who receive their care in Federally Qualified Health Centers (FQHCs). DESIGN AND METHOD In this pilot randomized controlled trial, we assigned patients within a single site to either TICC or to enhanced usual care (EUC). We performed intent to treat analysis by nonparametric exact tests for small sample sizes. PARTICIPANTS We enrolled 42 patients from October 12, 2018, through July 2, 2019. Patients were eligible if they considered the clinic their usual source of care, had no obvious physical or cognitive obstacles that would prevent participation, were age 18 or over, self-identified as African American, and had a provisional diagnosis of PTSD. MEASURES Our primary outcome measures were PTSD measured as both a symptom score and a provisional diagnosis based on the PTSD Checklist for DSM-5 (PCL-5). KEY RESULTS Nine months following baseline, both PTSD symptom scores and provisional PTSD diagnosis rates decreased substantially more for patients in TICC than in EUC. The decreases were by 26 points in EUC and 36 points in TICC for symptoms (P=0.08) and 33% in EUC and 57% in TICC for diagnosis rates (P=0.27). We found no effects for mediator variables. CONCLUSIONS TICC shows promise for addressing PTSD in this population. A larger-scale trial is needed to fully assess the effectiveness of this approach in these settings.
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Affiliation(s)
- Lisa S. Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
- VA HSR&D Center for Healthcare Innovation, Implementation & Policy, 16111 Plummer St, North Hills, CA, USA
| | - Eunice Wong
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | | | - Margaret Sanders
- Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, USA
| | | | - Bing Han
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | | | - Thomas W. Carton
- Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, USA
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23
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Maldonado AI, Murphy CM, Davis M, Evans MK, Zonderman AB. Racial discrimination, mental health symptoms, and intimate partner violence perpetration in Black adults. J Consult Clin Psychol 2022; 90:209-220. [PMID: 35201781 PMCID: PMC9470245 DOI: 10.1037/ccp0000712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study had three goals: (a) to examine the association between racial discrimination and intimate partner violence (IPV) perpetration; (b) to determine whether this relationship is explained by mental health (MH) symptoms; and (c) to determine whether these associations vary by poverty status or gender. METHODS During the Wave 4 (2013-2017) visit of the Healthy Aging in Neighborhoods of Diversity Longitudinal Study (HANDLS), Black adults who were in a relationship (N = 433; mean age = 55.26, SD = 9.30; 51% men) provided self-report data on IPV perpetration; frequency of racial discrimination; and levels of anxiety, depression, and posttraumatic stress symptoms. Multigroup mediation models used these cross-sectional data to test whether racial discrimination was associated with MH symptoms, which in turn were associated with IPV perpetration, determining the significance of direct and indirect pathways and whether any pathways varied by poverty status or gender. RESULTS Racial discrimination was associated with more MH symptoms, which in turn was associated with IPV perpetration. The negative effect of discrimination on MH was stronger for Black women than Black men and for Black adults with household incomes below 125% of the Federal poverty line than those with incomes above this cutoff. DISCUSSION Efforts to prevent and treat IPV in the Black community should address the negative effects of racial discrimination experiences on MH and partner aggression, especially among those with multiple marginalized identities. IPV prevention efforts may be enhanced through an overarching commitment to dismantle structural racism and intersectional forms of oppression. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Ana I. Maldonado
- University of Maryland, Baltimore County
- National Institute on Aging, National Institutes of Health
- National Institute on Minority Health and Health Disparities, National Institutes of Health
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24
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Reyes ME, Rossi JS, Thomas ED, C Goldstein S, Weiss NH. Posttraumatic Stress Disorder and Substance Misuse Among Black Emerging Adults: The Influence of Social Support. J Dual Diagn 2022; 18:42-51. [PMID: 34970948 PMCID: PMC9128832 DOI: 10.1080/15504263.2021.2017221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: Black emerging adults are significantly impacted by substance misuse. Posttraumatic stress disorder (PTSD) is associated with heightened substance misuse among Black emerging adults. However, limited research has identified protective factors that may influence the strength of the relation between PTSD and substance misuse in this population. Addressing this important limitation, the present study examined the potential moderating role of perceived social support in the association between PTSD symptoms and substance (i.e., alcohol and drug) misuse. Methods: Participants were 182 trauma-exposed Black emerging adults (M age = 20.50; 71.3% women) who completed self-report measures assessing PTSD symptoms, alcohol and drug misuse, and perceived social support. Results: PTSD symptoms were significantly and positively correlated with both alcohol and drug misuse. Moderation analyses indicated that positive relations between PTSD symptoms and both alcohol and drug misuse were only significant among Black emerging adults with lower (but not higher) levels of perceived social support. Conclusions: These findings suggest the potential utility of addressing social support in the assessment and treatment of substance misuse in trauma-exposed Black emerging adults.
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Affiliation(s)
- Miranda E Reyes
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Joseph S Rossi
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Emmanuel D Thomas
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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25
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Burton MS, Marks EH, Bedard-Gilligan MA, Feeny NC, Zoellner LA. The effect of perceived life stress on posttraumatic stress disorder treatment outcome. J Trauma Stress 2021; 34:1219-1227. [PMID: 34719829 DOI: 10.1002/jts.22744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/08/2022]
Abstract
Life stress following trauma exposure is a consistent predictor of the development of posttraumatic stress disorder (PTSD). However, there is a dearth of research on the effect of life stress on PTSD treatment outcomes. The current study examined the effects of pretreatment levels of perceived life stress on treatment outcome in a sample of 200 individuals with PTSD who were randomized to receive either prolonged exposure (PE) therapy or sertraline as part of a clinical trial. Life stress over the year prior to treatment significantly interacted with treatment type to predict higher residual PTSD symptom severity, as assessed using the PTSD Symptom Scale-Interview, among participants who received sertraline but not those who received PE, β = .24, p = .017, ∆R2 = .03. These findings were similar for self-reported depression severity, β = .27, p = .008, ∆R2 = .04. Adherence to either PE homework or sertraline compliance did not mediate this association nor did life stress predict treatment retention for either treatment arm. Higher levels of perceived life stress may serve as a prescriptive predictor of PTSD treatment outcome, with PE remaining efficacious regardless of heightened pretreatment life stress. These findings encourage clinician confidence when providing PE to individuals with higher levels of life stress. Future researchers should examine the impact of PTSD treatment on perceived and objective measures of life stress to improve treatment for individuals who experience chronic stress.
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Affiliation(s)
- Mark S Burton
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Elizabeth H Marks
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | | | - Norah C Feeny
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lori A Zoellner
- Department of Psychology, University of Washington, Seattle, Washington, USA
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26
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Stavland H, Refvik C, Eid J, Lockhat R, Hammar Å. A brief intervention for PTSD versus treatment as usual: Study protocol for a non-inferiority randomized controlled trial. Trials 2021; 22:737. [PMID: 34696777 PMCID: PMC8547098 DOI: 10.1186/s13063-021-05674-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/30/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although existing treatment methods are effective in alleviating PTSD symptoms, several barriers to care exist, such as waiting times, avoidant tendencies, shame and stigma, potentially leading to fewer people seeking therapy or premature dropouts. A potential solution to battling these barriers is Brain Working Recursive Therapy (BWRT), a single-session exposure-oriented intervention for PTSD. Although not yet subjected to empirical investigation, clinical experiences suggest an often immediate and long-lasting effect following the intervention related to patient's symptomatology and functional abilities. METHODS The current study protocol outlines a plan to conduct the first non-inferiority randomized controlled trial aimed to explore the efficacy of BWRT compared to treatment as usual (TAU), operationalized as any evidence-based trauma treatment method administered in Norwegian out-patient clinics. Eighty-two participants will be allocated at a 1:1 ratio to one of the following treatment conditions: (1) BWRT or (2) treatment as usual. Participants will be compared on several variables, including changes in PTSD symptoms (primary objective), and changes in perceived quality of life, rumination, functional and cognitive ability (secondary objective). Data collection will take place baseline (T1), within three weeks post treatment (T2) and at 6-month follow-up (T3). DISCUSSION Should BWRT prove to be non-inferior to treatment as usual, this brief intervention may be an important contribution to future psychological treatment for PTSD, by making trauma treatment more accessible and battling current barriers to care. TRIAL REGISTRATION 191548, 24.05.2021. ClinicalTrials.gov PRS: Release Confirmation.
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Affiliation(s)
- Halvor Stavland
- Faculty of Psychology, University of Bergen, Bergen, Norway
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Camilla Refvik
- Faculty of Psychology, University of Bergen, Bergen, Norway
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Jarle Eid
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | | | - Åsa Hammar
- Department of Biological and Medical Psychology and Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway.
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27
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Walton QL, Bromley E, Porras-Javier L, Coker TR. Building Bridges: Primary Care and Mental Health Providers’ Perspectives on a Behavioral Health Collaborative Intervention Among Underserved Populations. CHILD & YOUTH CARE FORUM 2021. [DOI: 10.1007/s10566-021-09638-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Kerr WT, Zhang X, Hill CE, Janio EA, Chau AM, Braesch CT, Le JM, Hori JM, Patel AB, Allas CH, Karimi AH, Dubey I, Sreenivasan SS, Gallardo NL, Bauirjan J, Hwang ES, Davis EC, D'Ambrosio SR, Al Banna M, Cho AY, Dewar SR, Engel J, Feusner JD, Stern JM. Epilepsy, dissociative seizures, and mixed: Associations with time to video-EEG. Seizure 2021; 86:116-122. [PMID: 33601302 PMCID: PMC7979505 DOI: 10.1016/j.seizure.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/23/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Video-electroencephalographic monitoring (VEM) is a core component to the diagnosis and evaluation of epilepsy and dissociative seizures (DS)-also known as functional or psychogenic seizures-but VEM evaluation often occurs later than recommended. To understand why delays occur, we compared how patient-reported clinical factors were associated with time from first seizure to VEM (TVEM) in patients with epilepsy, DS or mixed. METHODS We acquired data from 1245 consecutive patients with epilepsy, VEM-documented DS or mixed epilepsy and DS. We used multivariate log-normal regression with recursive feature elimination (RFE) to evaluate which of 76 clinical factors interacting with patients' diagnoses were associated with TVEM. RESULTS The mean and median TVEM were 14.6 years and 10 years, respectively (IQR 3-23 years). In the multivariate RFE model, the factors associated with longer TVEM in all patients included unemployment and not student status, more antiseizure medications (current and past), concussion, and ictal behavior suggestive of temporal lobe epilepsy. Average TVEM was shorter for DS than epilepsy, particularly for patients with depression, anxiety, migraines, and eye closure. Average TVEM was longer specifically for patients with DS taking more medications, more seizure types, non-metastatic cancer, and with other psychiatric comorbidities. CONCLUSIONS In all patients with seizures, trials of numerous antiseizure medications, unemployment and non-student status was associated with longer TVEM. These associations highlight a disconnect between International League Against Epilepsy practice parameters and observed referral patterns in epilepsy. In patients with dissociative seizures, some but not all factors classically associated with DS reduced TVEM.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States.
| | - Xingruo Zhang
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Chloe E Hill
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Emily A Janio
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Andrea M Chau
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Chelsea T Braesch
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Justine M Le
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Jessica M Hori
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Akash B Patel
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Corinne H Allas
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Amir H Karimi
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Ishita Dubey
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Siddhika S Sreenivasan
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Norma L Gallardo
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Janar Bauirjan
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Eric S Hwang
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Emily C Davis
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Shannon R D'Ambrosio
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Mona Al Banna
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Andrew Y Cho
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Sandra R Dewar
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Mekawi Y, Carter S, Brown B, Martinez de Andino A, Fani N, Michopoulos V, Powers A. Interpersonal Trauma and Posttraumatic Stress Disorder among Black Women: Does Racial Discrimination Matter? J Trauma Dissociation 2021; 22:154-169. [PMID: 33460354 PMCID: PMC9082823 DOI: 10.1080/15299732.2020.1869098] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is evidence that the more frequent, severe, and chronic posttraumatic stress disorder (PTSD) symptomatology experienced by Black compared to White individuals cannot be explained by disparities in socioeconomic status or trauma exposure. One factor that may be important to consider is racial discrimination, which is associated with numerous negative mental health outcomes yet has not been studied in the context of interpersonal traumas for Black women. This study aims to fill this gap by examining the independent and interactive roles of racial discrimination and interpersonal trauma in predicting PTSD symptoms in a community sample of trauma-exposed, Black women (n = 292). Consistent with the previous literature, we found that more frequent experiences of racial discrimination were associated with more severe PTSD symptoms overall (r = .34) and by symptom cluster. Furthermore, we found a significant interaction between experiences of racial discrimination and experiences of interpersonal trauma (b = .46, 95%CI[.04, .88], SE = .28; ΔR2 = .01, p = .03) such that the association between PTSD symptoms and interpersonal trauma was stronger at higher (+1 SD above the mean) levels of racial discrimination. This pattern was replicated for most PTSD symptom clusters. These results suggest that racial discrimination experiences exacerbate the association between interpersonal traumatic experiences and PTSD symptoms among Black women.
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Affiliation(s)
- Yara Mekawi
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Brittney Brown
- College of Health Professions, Mercer University, Atlanta, Georgia, USA
| | - Ana Martinez de Andino
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Rudenstine S, McNeal K, Schulder T, Ettman CK, Hernandez M, Gvozdieva K, Galea S. Depression and Anxiety During the COVID-19 Pandemic in an Urban, Low-Income Public University Sample. J Trauma Stress 2021; 34:12-22. [PMID: 33045107 PMCID: PMC7675401 DOI: 10.1002/jts.22600] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
Mental health disparities in the aftermath of national disasters and the protective role of socioeconomic status are both well documented. We assessed the prevalence of depression and anxiety symptoms among underresourced public university students during the COVID-19 pandemic in New York City. Between April 8, 2020, and May 2, 2020, adult students (N = 1,821) across the CUNY system completed an online survey examining COVID-19-related stressors and mental health and sociodemographic factors. Using multivariable logistical regression to assess the association between COVID-19-related stressors and depression and anxiety symptoms, we found a high prevalence and severity of depression and anxiety symptoms. We also observed that more exposure to COVID-19-related stressors was associated with increased depressive (27.0%, 41.4%, and 63.1% for low-, medium-, and high-level stressors, respectively) and anxiety symptoms (19.3%, 34.6%, 52.2%). In addition, the degree of exposure to COVID-19-related stressors served as an important predictor of depression and anxiety symptoms. Compared to high levels of stressors, the odds of depression were 0.2, 95% CI [0.2, 0.3] for low- and 0.4, 95% CI [0.3, 0.5] for medium-level stressors; for anxiety, the odds were 0.2, 95% CI [0.2, 0.3] for low and 0.05, 95% CI [0.4, 0.6] for medium stressors. Finally, household savings of less than $5,000 increased the risk of anxiety but not depression symptoms, OR = 1.3, 95% CI [1.0,1.6]. Together, these findings tell a devastating story of psychological distress among students from lower socioeconomic groups living in the COVID-19 epicenter of the U.S. pandemic.
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Affiliation(s)
- Sasha Rudenstine
- Department of PsychologyCity College of New YorkNew YorkNew YorkUSA
| | - Kat McNeal
- Department of PsychologyCity College of New YorkNew YorkNew YorkUSA
| | - Talia Schulder
- Department of PsychologyCity College of New YorkNew YorkNew YorkUSA
| | | | | | | | - Sandro Galea
- School of Public HealthBoston UniversityBostonMassachusettsUSA
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Czamara D, Tissink E, Tuhkanen J, Martins J, Awaloff Y, Drake AJ, Khulan B, Palotie A, Winter SM, Nemeroff CB, Craighead WE, Dunlop BW, Mayberg HS, Kinkead B, Mathew SJ, Iosifescu DV, Neylan TC, Heim CM, Lahti J, Eriksson JG, Räikkönen K, Ressler KJ, Provençal N, Binder EB. Combined effects of genotype and childhood adversity shape variability of DNA methylation across age. Transl Psychiatry 2021; 11:88. [PMID: 33526782 PMCID: PMC7851167 DOI: 10.1038/s41398-020-01147-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 01/04/2023] Open
Abstract
Lasting effects of adversity, such as exposure to childhood adversity (CA) on disease risk, may be embedded via epigenetic mechanisms but findings from human studies investigating the main effects of such exposure on epigenetic measures, including DNA methylation (DNAm), are inconsistent. Studies in perinatal tissues indicate that variability of DNAm at birth is best explained by the joint effects of genotype and prenatal environment. Here, we extend these analyses to postnatal stressors. We investigated the contribution of CA, cis genotype (G), and their additive (G + CA) and interactive (G × CA) effects to DNAm variability in blood or saliva from five independent cohorts with a total sample size of 1074 ranging in age from childhood to late adulthood. Of these, 541 were exposed to CA, which was assessed retrospectively using self-reports or verified through social services and registries. For the majority of sites (over 50%) in the adult cohorts, variability in DNAm was best explained by G + CA or G × CA but almost never by CA alone. Across ages and tissues, 1672 DNAm sites showed consistency of the best model in all five cohorts, with G × CA interactions explaining most variance. The consistent G × CA sites mapped to genes enriched in brain-specific transcripts and Gene Ontology terms related to development and synaptic function. Interaction of CA with genotypes showed the strongest contribution to DNAm variability, with stable effects across cohorts in functionally relevant genes. This underscores the importance of including genotype in studies investigating the impact of environmental factors on epigenetic marks.
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Affiliation(s)
- Darina Czamara
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804, Munich, Germany.
| | - Elleke Tissink
- grid.12380.380000 0004 1754 9227Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Johanna Tuhkanen
- grid.7737.40000 0004 0410 2071Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014 Helsinki, Finland
| | - Jade Martins
- grid.419548.50000 0000 9497 5095Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany
| | | | - Amanda J. Drake
- grid.4305.20000 0004 1936 7988University/British Heart Foundation Centre for Cardiovascular Science, Queen’s Medical Research Institute, Edinburgh BioQuarter, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Batbayar Khulan
- grid.4305.20000 0004 1936 7988University/British Heart Foundation Centre for Cardiovascular Science, Queen’s Medical Research Institute, Edinburgh BioQuarter, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Aarno Palotie
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland
| | - Sibylle M. Winter
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Charité—Universitätsmedizin Berlin, Campus Virchow, 13353 Berlin, Germany
| | - Charles B. Nemeroff
- grid.89336.370000 0004 1936 9924Department of Psychiatry, Dell Medical School, University of Texas at Austin, 1601 Trinity St, Austin, TX 78712 USA
| | - W. Edward Craighead
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr, Atlanta, GA 30329 USA
| | - Boadie W. Dunlop
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr, Atlanta, GA 30329 USA
| | - Helen S. Mayberg
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr, Atlanta, GA 30329 USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY 10029 USA
| | - Becky Kinkead
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr, Atlanta, GA 30329 USA
| | - Sanjay J. Mathew
- grid.413890.70000 0004 0420 5521Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine Mental Health Care Line, Michael E. Debakey VA Medical Center, Houston, TX USA
| | - Dan V. Iosifescu
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY 10029 USA ,grid.137628.90000 0004 1936 8753NYU School of Medicine and Nathan Kline Institute, New York, NY USA
| | - Thomas C. Neylan
- grid.266102.10000 0001 2297 6811Departments of Psychiatry and Neurology, University of California, San Francisco, CA USA
| | - Christine M. Heim
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Institute of Medical Psychology, Luisenstraße 57, 10117 Berlin, Germany
| | - Jari Lahti
- grid.7737.40000 0004 0410 2071Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014 Helsinki, Finland ,grid.1374.10000 0001 2097 1371Turku Institute for Advanced Studies, University of Turku, 20500 Turku, Finland
| | - Johan G. Eriksson
- grid.7737.40000 0004 0410 2071Department of General Practice and Primary Health Care, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, 00250 Helsinki, Finland ,grid.4280.e0000 0001 2180 6431Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,grid.452264.30000 0004 0530 269XSingapore Institute for Clinical Sciences, Singapore, Singapore
| | - Katri Räikkönen
- grid.7737.40000 0004 0410 2071Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014 Helsinki, Finland
| | - Kerry J. Ressler
- Mailman Research Center, 115 Mill St., Mailstop 339, Belmont, MA 02478 USA
| | - Nadine Provençal
- grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC Canada ,grid.414137.40000 0001 0684 7788BC Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Elisabeth B. Binder
- grid.419548.50000 0000 9497 5095Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany ,grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr, Atlanta, GA 30329 USA
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Stevens NR, Miller ML, Soibatian C, Otwell C, Rufa AK, Meyer DJ, Shalowitz MU. Exposure therapy for PTSD during pregnancy: a feasibility, acceptability, and case series study of Narrative Exposure Therapy (NET). BMC Psychol 2020; 8:130. [PMID: 33298159 PMCID: PMC7727253 DOI: 10.1186/s40359-020-00503-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Prenatal posttraumatic stress disorder (PTSD) is a significant complication of pregnancy linked to increased risk of adverse perinatal outcomes. Although 1 in 5 pregnant trauma-exposed individuals have PTSD, most PTSD treatment trials exclude participants who are pregnant, and none focus on treatment specifically during pregnancy. Moreover, access to mental health treatment is particularly challenging in low-resource settings with high rates of trauma. This study examined implementation of Narrative Exposure Therapy (NET), a short-term evidence-based PTSD treatment, in an urban prenatal care setting. Partial telehealth delivery was used to increase accessibility. Study aims were to examine (a) feasibility, (b) acceptability, and (c) case-based treatment outcomes associated with NET participation. Method Eight pregnant participants (median age = 27, median gestational week in pregnancy = 22.5) received up to six sessions of NET with partial telehealth delivery. PTSD and depression symptoms were assessed at pre-treatment intake (T1), at each session (T2), and 1-week post-treatment (T3). A multiple case study approach was used to examine recruitment and engagement, retention, treatment completion, treatment barriers, use of telehealth, participants’ experiences of treatment, and PTSD and depression symptoms. Results Nine of the 16 participants (56%) who were invited to participate engaged in treatment, and one dropped out after the first session. Eight participants completed the minimum “dose” of 4 NET sessions (N = 8/9, 89%). Seven participants gave the highest ratings of treatment acceptability. The most frequently reported barriers to treatment were competing priorities of work and caring for other children. Pre-post treatment symptom measures revealed clinically meaningful change in PTSD severity for nearly all participants (7/8, 88%). Conclusions Results suggest that a brief exposure therapy PTSD treatment can be successfully implemented during pregnancy, suggesting promising results for conducting a larger-scale investigation. Trial registration ClinicalTrials.gov, NCT04525469. Registered 20 August 2020–Retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=View&listmode=Edit&uid=U00058T2&ts=3&sid=S000A59A&cx=-w1vnvn
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Affiliation(s)
- Natalie R Stevens
- Rush University Medical Center, 1645 West Jackson Blvd, Chicago, IL, 60612, USA.
| | - Michelle L Miller
- Rush University Medical Center, 1645 West Jackson Blvd, Chicago, IL, 60612, USA
| | - Christina Soibatian
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Caitlin Otwell
- Rush University Medical Center, 1645 West Jackson Blvd, Chicago, IL, 60612, USA
| | - Anne K Rufa
- Rush University Medical Center, 1645 West Jackson Blvd, Chicago, IL, 60612, USA
| | - Danie J Meyer
- Vivo International, P.O. Box, 5108D-78430, Konstanz, Germany
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Bounds DT, Winiarski DA, Otwell CH, Tobin V, Glover AC, Melendez A, Karnik NS. Considerations for working with youth with socially complex needs. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:209-220. [PMID: 32691491 PMCID: PMC7970826 DOI: 10.1111/jcap.12288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/26/2020] [Accepted: 07/05/2020] [Indexed: 12/01/2022]
Abstract
TOPIC The presence of adverse childhood experiences offers a glimpse into the social complexity in the lives of youth. Thus far, youth have been categorized as "at-risk" or "vulnerable,"-identifiers which highlight a deficits-based framework and continue to stigmatize youth. To combat this systemic marginalization, we propose using the term youth with socially complex needs. These youth, often minority ethnic/racial and/or sexual/gender minorities, experience repeated adversity and discrimination. PURPOSE The purpose of this paper is to conceptualize the unique considerations of working with youth with socially complex needs-who have an increased vulnerability for social marginalization. SOURCES USED Given the adversity experienced and challenges inherent in working with youth with socially complex needs, ethical principles, and relevant care delivery models were explored. CONCLUSIONS Delivering mental health care and/or conducting research in collaboration with youth with socially complex needs requires thoughtful consideration of ethical principles and models of care. In conclusion, we propose a strengths-based, individualized approach to working with youth with socially complex needs that requires a dynamic, fluid, multisystemic approach to care and research.
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Affiliation(s)
- Dawn T. Bounds
- Rush University College of Nursing, Chicago, IL, USA
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Dominka A. Winiarski
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Caitlin H. Otwell
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Valerie Tobin
- Rush University College of Nursing, Chicago, IL, USA
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Angela C. Glover
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Adrian Melendez
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Niranjan S. Karnik
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
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Brown DG, Flanagan JC, Jarnecke A, Killeen TK, Back SE. Ethnoracial differences in treatment-seeking veterans with substance use disorders and co-occurring PTSD: Presenting characteristics and response to integrated exposure-based treatment. J Ethn Subst Abuse 2020; 21:1141-1164. [PMID: 33111647 DOI: 10.1080/15332640.2020.1836699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Substance use disorders (SUD) and posttraumatic stress disorder (PTSD) frequently co-occur. While previous research has examined ethnoracial differences among individuals with either SUD or PTSD, little research to date has focused on individuals with co-occurring SUD/PTSD. The current study addresses this gap in the literature. METHOD Participants were 79 military veterans (91% male; 38% African American [AA] and 62% White) with current SUD/PTSD who were randomized to receive Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) or Relapse Prevention (RP). Primary outcomes included substance use and self-reported and clinician-rated PTSD symptoms. RESULTS At baseline, AA participants were significantly older, reported greater substance and alcohol use, and tended to report higher PTSD severity than White participants. AA participants evidenced greater decreases in substance and alcohol use during treatment, but greater increases in substance and alcohol use during follow-up as compared to White participants. All participants decreased alcohol consumption during treatment; however, AA participants in the COPE condition and White participants in the RP condition evidenced the steepest decreases in average number of drinks per drinking day (DDD) during treatment. Additionally, White participants receiving RP reported greater increases in DDD during follow-up compared to AA participants. CONCLUSION Overall, integrated treatment for co-occurring SUD/PTSD was effective for both AA and White participants; however, some important differences emerged by ethnoracial group. Findings suggest that greater attention to race and ethnicity is warranted to better understand the needs of diverse patients with SUD/PTSD and to optimize treatment outcomes.
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Affiliation(s)
- Delisa G Brown
- Medical University of South Carolina, Charleston, South Carolina
| | - Julianne C Flanagan
- Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson VAMC, Charleston, South Carolina
| | - Amber Jarnecke
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Sudie E Back
- Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson VAMC, Charleston, South Carolina
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Treating Post-traumatic Stress Disorder with a Prolonged Exposure Protocol Within Primary Care Behavioral Health: A Case Example. J Clin Psychol Med Settings 2020; 28:575-583. [PMID: 33090302 DOI: 10.1007/s10880-020-09747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating condition that impacts anywhere from 2 to 39% of primary care patients. Research suggests overall health, instances of hospitalizations, emergency room visits, and utilization of primary care services are impacted by a diagnosis of PTSD. Evidenced based treatments such as cognitive process therapy and prolonged exposure (PE) are available in specialty mental health but pose many barriers to treatment and implementation into primary care. This case study serves as the first known case example with an ethnic minority civilian, examining the treatment of PTSD within the Primary Care Behavioral Health Model using the brief (5 visits), PE protocol for primary care (PE-PC). PTSD was assessed using the PCL-5. Additional variables were assessed and tracked with the following tools: PHQ-9 (depressive symptoms), GAD-7 (anxiety symptoms), QLES-SF (quality of life), and the AAQ-2 (psychological flexibility) pre/post treatment, 6 months post-treatment and 9 months post-treatment. The patient reported clinically significant decreases in symptoms of PTSD, depression, and anxiety symptoms. Additionally, the patient's scores on quality of life and psychological flexibility improved. Brief, exposure-based treatment for PTSD can be delivered within the PCBH model. This treatment may result in improved quality of life and has the potential to reduce health care costs. This case encourages the treatment of PTSD within primary care, increasing access to care for patients. Future research is needed to further investigate this protocol in primary care with underserved, civilian populations and to explore patient attitudes toward brief treatment for PTSD in a primary care setting.
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Richardson JB, Wical W, Kottage N, Galloway N, Bullock C. Staying Out of the Way: Perceptions of Digital Non-Emergency Medical Transportation Services, Barriers, and Access to Care Among Young Black Male Survivors of Firearm Violence. J Prim Prev 2020; 42:43-58. [PMID: 33025246 DOI: 10.1007/s10935-020-00611-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 11/30/2022]
Abstract
With a reduction in primary barriers to healthcare access as a result of the Affordable Care Act, there is an increased need to address secondary barriers faced by low-income young Black male survivors of violent injury. While transportation is often characterized as a barrier for individuals with chronic disease and disability, it also acts as a significant barrier in accessing cognitive behavioral therapy and mentoring services through hospital-based violence intervention programs (HVIPs). These services address the traumatic stress associated with surviving gun violence. Although there are many challenges associated with the current practices of non-emergency medical transportation, participants in HVIPs face additional risk factors. We highlight the application of a digital transportation intervention to increase the use of psychosocial services among low-income young Black male survivors of violent injury participating in an HVIP. Digital non-emergency medical transportation services (DNEMT) address issues concerning financial barriers, personal safety, program credibility, and program participation. We conducted qualitative interviews and a focus group with this population to assess the impact of Uber Health, a DNEMT service, on their participation in an HVIP located in a suburban Maryland hospital immediately outside of Washington, D.C. Survivors identified the use of Uber Health as essential to addressing the multifaceted and interconnected barriers to treatment. These barriers included reluctance to use alternative forms of transportation services (i.e., bus or subway) due to potential encounters with rivals, increased risk of repeat violent victimization, the need to carry a weapon for protection, stigmatization, and symptoms associated with traumatic stress. We found that integrating digital transportation services into the standard practices of HVIPs, as a part of a patient-centered outcomes framework, contributes to a reduction in violent injury and re-traumatization by addressing the multi-layered risks experienced by survivors of gun violence.
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Affiliation(s)
- Joseph B Richardson
- Department of African-American Studies and the Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, 1141 Taliaferro Building, College Park, MD, 20742, USA.
| | - William Wical
- Department of Anthropology and the Department of African-American Studies, Translational Research and Applied Violence Intervention Lab (TRAVAIL), College of Behavioral and Social Sciences, University of Maryland College Park, 1141 Taliaferro Building, College Park, MD, 20742, USA
| | - Nipun Kottage
- Department of Anthropology and the Department of African-American Studies, Translational Research and Applied Violence Intervention Lab (TRAVAIL), College of Behavioral and Social Sciences, University of Maryland College Park, 1141 Taliaferro Building, College Park, MD, 20742, USA
| | - Nicholas Galloway
- Department of Anthropology and the Department of African-American Studies, Translational Research and Applied Violence Intervention Lab (TRAVAIL), College of Behavioral and Social Sciences, University of Maryland College Park, 1141 Taliaferro Building, College Park, MD, 20742, USA
| | - Che Bullock
- Department of African-American Studies, Translational Research and Applied Violence Intervention Lab (TRAVAIL), College of Behavioral and Social Sciences, University of Maryland College Park, 1141 Taliaferro Building, College Park, MD, 20742, USA
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Kline AC, Feeny NC, Zoellner LA. Race and cultural factors in an RCT of prolonged exposure and sertraline for PTSD. Behav Res Ther 2020; 132:103690. [PMID: 32650231 PMCID: PMC7398839 DOI: 10.1016/j.brat.2020.103690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 03/27/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
The efficacy of treatments for posttraumatic stress disorder (PTSD) among African Americans is less clear given underrepresentation in clinical research. Additionally, intervention research examining race has typically not considered within-group heterogeneity, such as acculturation, ethnic identity, and cultural attitudes. In a randomized controlled trial, African American (n = 43) and Caucasian (n = 130) individuals received prolonged exposure (PE) or sertraline for PTSD, comparing: treatment response, retention, and treatment beliefs and preferences. Indirect effects of cultural variables were also examined. African Americans reported stronger ethnic identity (d = 0.71), less positive attitudes toward other groups (d = 0.36), and less acculturation (d = 0.51) than Caucasians. Noninferiority analyses indicated clinically equivalent PTSD outcomes for African Americans and Caucasians in both treatments. Groups showed comparable improvements in depression and functioning, and similar treatment preferences and beliefs. African Americans attended fewer sessions in PE (d = 0.87) and sertraline (d = 0.53) than Caucasians. Indirect effects analyses indicated positive cultural attitudes toward other ethnoracial groups were consistently associated with better treatment outcome and retention. Despite no differential effectiveness, findings may highlight the need to target retention among African Americans. Within-group cultural aspects of race may be an informative complement to basic, categorical conceptualizations.
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Affiliation(s)
- Alexander C Kline
- PTSD Treatment and Research Program, Case Western Reserve University, Department of Psychological Sciences, 11220 Bellflower Road, Cleveland, OH, 44106-7123, USA.
| | - Norah C Feeny
- PTSD Treatment and Research Program, Case Western Reserve University, Department of Psychological Sciences, 11220 Bellflower Road, Cleveland, OH, 44106-7123, USA
| | - Lori A Zoellner
- Center for Anxiety and Traumatic Stress, University of Washington, Department of Psychology, Guthrie Hall, Box 351525, Seattle, WA, 98195-1525, USA
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Hansen MC, Ghafoori B, Diaz M. Examining attitudes towards mental health treatment and experiences with trauma: Understanding the needs of trauma-exposed middle-aged and older adults. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1452-1468. [PMID: 32176330 PMCID: PMC7316604 DOI: 10.1002/jcop.22339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 06/10/2023]
Abstract
Middle-aged and older adults who have been exposed to traumatic events may have specific developmental needs with respect to engagement in mental health treatment. The current study examined factors that potentially facilitate or inhibit attitudes towards mental health service use (ATMHSU) in a trauma-exposed sample of treatment-seeking adults of age 50 years and older. In this mixed-methods study, quantitative data (N = 165) were analyzed to examine relationships with trauma exposure, posttraumatic stress disorder, quality of life (QOL), and ATMHSU. Semi-structured interviews were conducted assessing similar constructs with a subsample of the data (n = 12). Regression analysis revealed higher QOL-environmental well-being as associated with more positive ATMHSU and higher QOL-social support with more negative ATMHSU. Qualitative themes emerged around perceived distress in managing lifelong traumas due to challenges with functioning, coping, and accessing services. Emphasizing resources to help manage the impact of distress on daily life needs may support aging trauma-exposed populations.
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Affiliation(s)
- Marissa C. Hansen
- California State University, Long Beach, College of Health and Human Services, School of Social Work
| | - Bita Ghafoori
- California State University, Long Beach, Department of Advanced Studies in Education and Counseling
| | - Melanie Diaz
- California State University, Long Beach, College of Health and Human Services, School of Social Work
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Fortney JC, Heagerty PJ, Bauer AM, Cerimele JM, Kaysen D, Pfeiffer PN, Zielinski MJ, Pyne JM, Bowen D, Russo J, Ferro L, Moore D, Nolan JP, Fee FC, Heral T, Freyholtz-London J, McDonald B, Mullins J, Hafer E, Solberg L, Unützer J. Study to promote innovation in rural integrated telepsychiatry (SPIRIT): Rationale and design of a randomized comparative effectiveness trial of managing complex psychiatric disorders in rural primary care clinics. Contemp Clin Trials 2020; 90:105873. [PMID: 31678410 DOI: 10.1016/j.cct.2019.105873] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Managing complex psychiatric disorders like PTSD and bipolar disorder is challenging in Federally Qualified Health Centers (FQHCs) delivering care to U.S residents living in underserved rural areas. This protocol paper describes SPIRIT, a pragmatic comparative effectiveness trial designed to compare two approaches to managing PTSD and bipolar disorder in FQHCs. INTERVENTIONS Treatment comparators are: 1) Telepsychiatry Collaborative Care, which integrates consulting telepsychiatrists into primary care teams, and 2) Telepsychiatry Enhanced Referral, where telepsychiatrists and telepsychologists treat patients directly. METHODS Because Telepsychiatry Enhanced Referral is an adaptive intervention, a Sequential, Multiple Assignment, Randomized Trial design is used. Twenty-four FQHC clinics without on-site psychiatrists or psychologists are participating in the trial. The sample is patients screening positive for PTSD and/or bipolar disorder who are not already engaged in pharmacotherapy with a mental health specialist. Intervention fidelity is measured but not controlled. Patient treatment engagement is measured but not required, and intent-to-treat analysis will be used. Survey questions measure treatment engagement and effectiveness. The Short-Form 12 Mental Health Component Summary (SF-12 MCS) is the primary outcome. RESULTS A third (34%) of those enrolled (n = 1004) are racial/ethnic minorities, 81% are not fully employed, 68% are Medicaid enrollees, 7% are uninsured, and 62% live in poverty. Mental health related quality of life (SF-12 MCS) is 2.5 standard deviations below the national mean. DISCUSSION We hypothesize that patients randomized to Telepsychiatry Collaborative Care will have better outcomes than those randomized to Telepsychiatry Enhanced Referral because a higher proportion will engage in evidence-based treatment.
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Affiliation(s)
- John C Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.
| | - Patrick J Heagerty
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Paul N Pfeiffer
- University of Michigan Medical School, Ann Arbor, MI, USA; Department of Veterans Affairs, Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Melissa J Zielinski
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey M Pyne
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Veterans Affairs, Health Services Research and Development, Center for Mental Healthcare and Outcomes Research, Little Rock, AR, USA
| | - Deb Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Lori Ferro
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Danna Moore
- Social and Economic Sciences Research Center at Washington State University, Pullman, WA, USA
| | | | - Florence C Fee
- NHMH - No Health without Mental Health, San Francisco, CA, Arlington, VA, USA
| | | | | | - Bernadette McDonald
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jeremey Mullins
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erin Hafer
- Community Health Plan of Washington, Seattle, WA, USA
| | | | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Mekawi Y, Murphy L, Munoz A, Briscione M, Tone EB, Norrholm SD, Jovanovic T, Bradley B, Powers A. The role of negative affect in the association between attention bias to threat and posttraumatic stress: An eye-tracking study. Psychiatry Res 2020; 284:112674. [PMID: 31831200 PMCID: PMC7012707 DOI: 10.1016/j.psychres.2019.112674] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 11/25/2022]
Abstract
Biased processing of threatening stimuli, including attention toward and away from threat, has been implicated in the development and maintenance of PTSD symptoms. Research examining theoretically-derived mechanisms through which dysregulated processing of threat may be associated with PTSD is scarce. Negative affect, a transdiagnostic risk factor for many types of psychopathology, is one potential mechanism that has yet to be examined. Thus, the present study (n = 92) tested the indirect effect of attention bias on PTSD via negative affect using rigorous eye-tracking methodology in a sample of urban-dwelling, trauma-exposed African-American women. We found support for the hypothesis that attention bias toward threat was indirectly associated with PTSD symptoms through increased negative affect. These results suggest that negative affect may be an important etiological process through which attention bias patterns could impact PTSD symptom severity. Implications for psychological and pharmacological therapeutic interventions targeting threat-related attention biases and negative affect are discussed.
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Affiliation(s)
- Yara Mekawi
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Georgia, United States of America.
| | | | - Adam Munoz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Maria Briscione
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Erin B. Tone
- Department of Psychology, Georgia State University
| | - Seth D. Norrholm
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine,Atlanta VA Medical Center, Georgia State University
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine,Atlanta VA Medical Center, Georgia State University
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
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Drožđek B, Rodenburg J, Moyene-Jansen A. "Hidden" and Diverse Long-Term Impacts of Exposure to War and Violence. Front Psychiatry 2020; 10:975. [PMID: 32009997 PMCID: PMC6978278 DOI: 10.3389/fpsyt.2019.00975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 12/09/2019] [Indexed: 11/27/2022] Open
Abstract
Nowadays, the PTSD diagnosis is often a prerequisite for the survivor's access to specialized treatment services and for obtaining legal recognition or financial compensation when exposed to violence. However, some survivors do not meet all necessary criteria for the PTSD diagnosis, particularly not in the long term. Therefore, they run the risk of being misdiagnosed, inadequately helped or undertreated, and may remain legally unrecognized and unprotected. In this article the "hidden" long-term impacts of exposure to war and violence, beyond the PTSD diagnosis, are presented, discussed, and illustrated with case presentations. They include dissociative states, attachment problems, personality changes, guilt, shame, rage, identity issues, moral injury, substances abuse, damaged core beliefs, and bodily sensations linked to stress activation. These phenomena are not persistent, but fluctuate over the survivor's life trajectories. Moreover, the "hidden" impacts are framed within theoretical models for understanding long-term impacts of exposure to violence. The models help us grasp the dynamics of interactions between resilience, psychological damage, context and time. These interactions are non linear, and contingently result in development of psychopathological phenomena when reaching a threshold during a process of accumulating potentially traumatic experiences over a survivors' lifetime. Understanding psychological impacts of exposure to violence as a spectrum of interchangeable phenomena over a lifetime, and learning to recognize the "hidden" manifestations of psychological trauma will help to improve mental and legal assistance to the survivors both on a short and long term.
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Affiliation(s)
- Boris Drožđek
- PsyQ Psychotrauma, Parnassia Group, Eindhoven, Netherlands
| | - Jan Rodenburg
- PsyQ Psychotrauma, Parnassia Group, Eindhoven, Netherlands
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42
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Thomas M, Coope A, Falkenberg C, Dunlop BW, Czamara D, Provencal N, Craighead WE, Mayberg HS, Nemeroff CB, Binder EB, Nieratschker V. Investigation of MORC1 DNA methylation as biomarker of early life stress and depressive symptoms. J Psychiatr Res 2020; 120:154-162. [PMID: 31683097 PMCID: PMC6866669 DOI: 10.1016/j.jpsychires.2019.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 12/28/2022]
Abstract
Early life stress (ELS) is associated with an increased risk of depression and this association may be mediated by epigenetic mechanisms. A previous epigenome-wide DNA methylation (DNAm) study investigating human newborns and two animal models of ELS suggested that the epigenetic regulator MORC1 is differentially methylated following ELS. The ELS-induced DNAm alterations were long-lasting in the animal models. However, whether this finding is also transferable to humans experiencing ELS in childhood was not investigated. Further, MORC1 may provide a link between ELS and adult depression, as MORC1 DNAm and genetic variants were found to be associated with depressive symptoms in humans. In the present study, we investigated the validity of MORC1 DNAm as a biomarker of ELS in humans and its role in linking ELS to depression later in life by studying childhood maltreatment. We analyzed whole blood MORC1 DNAm in an adult cohort (N = 151) that was characterized for both the presence of depressive symptoms and childhood maltreatment. Further, we investigated the association between MORC1 DNAm, depressive symptoms and childhood maltreatment in two additional cohorts (N = 299, N = 310). Overall, our data do not indicate an association of MORC1 DNAm with childhood maltreatment. An association of MORC1 DNAm with depressive symptoms was present in all cohorts, but was inconsistent in the specific CpG sites associated and the direction of effect (Tuebingen cohort: standardized β = 0.16, unstandardized β = 0.01, 95% CI [-0.0004, -0.0179], p = 0.061, PReDICT cohort: standardized β = -0.12, unstandardized β = -0.01, 95% CI [-0.0258, -0.0003], p = 0.045), Grady cohort: standardized β = 0.16, unstandardized β = 0.008, 95% CI [0.0019, 0.0143], p = 0.01). Our study thus suggests that peripheral MORC1 DNAm cannot serve as biomarker of childhood maltreatment in adults, but does provide further indication for the association of MORC1 DNAm with depressive symptoms.
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Affiliation(s)
- Mara Thomas
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Calwerstr. 14, 72070, Tübingen, Germany; Graduate Training Centre of Neuroscience, University of Tübingen, Tübingen, Germany.
| | - Andressa Coope
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada,BC Children’s Hospital Research Institute, 938 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada
| | - Carolin Falkenberg
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Calwerstr. 14, 72070 Tübingen, Germany
| | - Boadie W. Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park, Atlanta, Georgia 30329, USA
| | - Darina Czamara
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park, Atlanta, Georgia 30329, USA,Department of Translational Research in Psychiatriy, Max-Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany
| | - Nadine Provencal
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada,BC Children’s Hospital Research Institute, 938 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada
| | - W. Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park, Atlanta, Georgia 30329, USA
| | - Helen S. Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park, Atlanta, Georgia 30329, USA,Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY 10029, USA
| | - Charles B. Nemeroff
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, 1601 Trinity St, Austin, Texas 78712, USA
| | - Elisabeth B. Binder
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park, Atlanta, Georgia 30329, USA,Department of Translational Research in Psychiatriy, Max-Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Calwerstr. 14, 72070 Tübingen, Germany
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Ranjbar N, Erb M, Mohammad O, Moreno FA. Trauma-Informed Care and Cultural Humility in the Mental Health Care of People From Minoritized Communities. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:8-15. [PMID: 32047392 PMCID: PMC7011220 DOI: 10.1176/appi.focus.20190027] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The prevalence and impact of trauma constitute a public health crisis that is complicated by the cultural heterogeneity of contemporary society and a higher rate of trauma among individuals from minoritized communities. A trauma-informed care approach can facilitate improved treatment of those who have experienced trauma, and trauma-informed care is increasingly viewed as potentially beneficial for all patients. This article outlines general principles of trauma-informed care and ways to enact it. Because the situations in which trauma arises, the ways in which it is conceptualized, and how patients respond to it are influenced by both culture and individual factors, a cultural humility approach is also described and recommended. Psychiatrists can navigate the complex terrain of cultures and social backgrounds in the clinical encounter and can promote healing when treating patients who have experienced trauma by adopting a trauma-informed care approach and an attitude of cultural humility.
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Affiliation(s)
- Noshene Ranjbar
- Department of Psychiatry, University of Arizona, Tucson (Ranjbar, Moreno); The Center for Mind-Body Medicine, Washington, D.C. (Erb); Department of Psychiatry, University of Massachusetts-Baystate, Springfield (Mohammad)
| | - Matt Erb
- Department of Psychiatry, University of Arizona, Tucson (Ranjbar, Moreno); The Center for Mind-Body Medicine, Washington, D.C. (Erb); Department of Psychiatry, University of Massachusetts-Baystate, Springfield (Mohammad)
| | - Othman Mohammad
- Department of Psychiatry, University of Arizona, Tucson (Ranjbar, Moreno); The Center for Mind-Body Medicine, Washington, D.C. (Erb); Department of Psychiatry, University of Massachusetts-Baystate, Springfield (Mohammad)
| | - Francisco A Moreno
- Department of Psychiatry, University of Arizona, Tucson (Ranjbar, Moreno); The Center for Mind-Body Medicine, Washington, D.C. (Erb); Department of Psychiatry, University of Massachusetts-Baystate, Springfield (Mohammad)
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44
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Bauer AG, Christensen K, Bowe-Thompson C, Lister S, Aduloju-Ajijola N, Berkley-Patton J. "We Are Our Own Counselor": Resilience, Risk Behaviors, and Mental Health Service Utilization among Young African American Men. Behav Med 2020; 46:278-289. [PMID: 32787722 PMCID: PMC7430196 DOI: 10.1080/08964289.2020.1729087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite risk for trauma, subsequent mental health concerns, and poor health outcomes, young Black/African American men (YBM) are less likely to receive mental health services than other racial/ethnic groups. Despite the growing literature on resilience, there is less information on relationships between resilience, risk behaviors, and use of mental health services. This study sought to examine resilience, trauma-related risk behaviors, and receipt of mental health services among a sample of YBM who experienced trauma. Focus groups and a brief survey were conducted with YBM (N = 55) who had been exposed to at least one traumatic event (e.g., witnessing violence, experienced serious injury or illness) and were recruited from urban community settings (e.g., colleges/universities, barbershops, churches). Participants were an average age of 23 years (SD = 3.9; range 18-30) and experienced an average of 2 to 3 traumatic events (SD = 2.2). Trauma exposure was a significant predictor of risk factors (β = .513, p < .01). However, resilience did not significantly moderate this relationship. Resilience also did not predict receipt of mental health services. Culturally relevant qualitative themes found to be related to resilience included maintaining resilience autonomously, preferred coping methods (e.g., friends, music), and habituating to adversity. This study has potential to inform the development of culturally tailored, relevant interventions to promote engagement in mental health services among YBM who've experienced trauma.
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Affiliation(s)
- Alexandria G. Bauer
- Department of Psychology, University of Missouri-Kansas City, Kansas City, USA,Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, USA
| | - Kelsey Christensen
- Department of Psychology, University of Missouri-Kansas City, Kansas City, USA,Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, USA
| | - Carole Bowe-Thompson
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, USA
| | - Sheila Lister
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, USA
| | - Natasha Aduloju-Ajijola
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, USA
| | - Jannette Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, USA
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45
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Powers A, Woods-Jaeger B, Stevens JS, Bradley B, Patel MB, Joyner A, Smith AK, Jamieson DJ, Kaslow N, Michopoulos V. Trauma, psychiatric disorders, and treatment history among pregnant African American women. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2019; 12:138-146. [PMID: 31464464 DOI: 10.1037/tra0000507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital. METHOD The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother-child dyads. RESULTS Overall, 98% reported trauma exposure, approximately one third met criteria for probable current PTSD, and one third endorsed moderate-or-severe depression based on self-report measures. Similar levels were found based on clinical assessments in the subsample. While 18% endorsed depression treatment, only 6% received treatment for PTSD. In a subsample of women with whom chart reviews were conducted (n = 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider. CONCLUSION Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Stevens N, Lillis T, Wagner L, Tirone V, Hobfoll S. A feasibility study of trauma-sensitive obstetric care for low-income, ethno-racial minority pregnant abuse survivors. J Psychosom Obstet Gynaecol 2019; 40:66-74. [PMID: 29164970 PMCID: PMC6117213 DOI: 10.1080/0167482x.2017.1398727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE This study evaluated the feasibility and acceptability of an integrated (psychological and obstetric) intervention for pregnant abuse survivors with posttraumatic stress symptoms (PTS) from low-income, ethno-racial minority backgrounds. METHODS Trauma-sensitive obstetrics to promote control, anxiety-reduction and empowerment (TO-CARE) offers cognitive-behavioral therapy (CBT) coping skills delivered over six sessions by therapists, coupled with trauma-sensitive obstetric care from specially-trained obstetric physicians. RESULTS Participants were 21 women who completed at least three sessions of CBT, totaling 51.2% of eligible participants. Participants received approximately one-third (M = 2.29; SD = 2.15) of their prenatal visits with obstetric residents trained in trauma-sensitive care. Nearly all participants (95%) reported that they benefited from the intervention. Although most participants demonstrated improvement in PTS, only four demonstrated reliable improvement, and two demonstrated reliable improvement in depression symptoms. These improvements appeared to be maintained at postpartum follow-up for two of the participants. CONCLUSIONS Our findings suggest that TO-CARE was acceptable to pregnant abuse survivors and may be a promising intervention to reduce symptoms of distress. Implications of the low retention rate for the CBT (51.2%) are discussed in the context of interventions for low-income minority pregnant women. Limitations regarding feasibility of the integrated intervention are discussed.
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Affiliation(s)
- N.R. Stevens
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - T.A. Lillis
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - L. Wagner
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - V. Tirone
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - S.E. Hobfoll
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
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Boffa JW, Short NA, Gibby BA, Stentz LA, Schmidt NB. Distress tolerance as a mechanism of PTSD symptom change: Evidence for mediation in a treatment-seeking sample. Psychiatry Res 2018; 267:400-408. [PMID: 29960937 PMCID: PMC6434692 DOI: 10.1016/j.psychres.2018.03.085] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/26/2018] [Accepted: 03/29/2018] [Indexed: 11/30/2022]
Abstract
Low distress tolerance, the perceived or actual inability to tolerate negative emotional states, is a transdiagnostic risk marker associated with greater PTSD symptoms and poorer treatment outcomes. However, the role of distress tolerance in PTSD symptom trajectories has not yet been explored. This study examined the mediating role of distress tolerance in PTSD symptom change among outpatients participating in a trial of computerized interventions for anxiety-related and mood-related risk factors. It was hypothesized that pre- to post-intervention change in distress tolerance would predict PTSD symptoms at three- and six-month follow-up, and mediate the effect of condition on PTSD symptoms above and beyond the effects of a competing mediator, anxiety sensitivity. Although condition differences in distress tolerance change were non-significant, distress tolerance change predicted month-three PTSD symptoms and mediated the direct effect of condition on month-three PTSD symptoms. After accounting for the direct effect of condition on month-six PTSD symptoms, distress tolerance change did not predict month-six PTSD symptoms. Findings suggest distress tolerance does play a longitudinal role in PTSD symptom change, and distress tolerance interventions may benefit certain samples who may otherwise not be able to immediately access, or remain in PTSD treatments.
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Affiliation(s)
| | | | | | | | - Norman B. Schmidt
- Correspondence concerning this article should be addressed to Norman B. Schmidt, Department of Psychology, Florida State University, Tallahassee, FL, 32306. ; Telephone: (850) 644-1707; Fax: (850) 644-1707
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Impact of Veteran Status and Timing of PTSD Diagnosis on Criminal Justice Outcomes. Healthcare (Basel) 2018; 6:healthcare6030080. [PMID: 30002284 PMCID: PMC6164822 DOI: 10.3390/healthcare6030080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022] Open
Abstract
Previous research has demonstrated that jurors show a bias towards treatment for veterans with post-traumatic stress disorder (PTSD). The present research examines this bias when jurors are faced with cases of potential malingering, in which the defendant’s claim of PTSD is a perceived attempt to escape legal punishments. Trial vignettes, in which veteran status and PTSD diagnosis timing were manipulated, were used to explore this phenomenon. It was found that veterans who received their diagnosis after being arrested were found guilty more often, and were diverted to treatment less often, than those who were diagnosed before an arrest. This has critical implications for mental healthcare in that it is crucial to properly diagnose and treat people before they find themselves in court. Further, the negative outcomes in court demonstrate one of the severe social impacts of untreated or late-diagnosed PTSD.
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Meyers JL, Sartor CE, Werner KB, Koenen KC, Grant BF, Hasin D. Childhood interpersonal violence and adult alcohol, cannabis, and tobacco use disorders: variation by race/ethnicity? Psychol Med 2018; 48:1540-1550. [PMID: 29310741 PMCID: PMC6545193 DOI: 10.1017/s0033291717003208] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Exposure to child maltreatment has been shown to increase lifetime risk for substance use disorders (SUD). However, this has not been systematically examined among race/ethnic groups, for whom rates of exposure to assaultive violence and SUD differ. This study examined variation by race/ethnicity and gender in associations of alcohol (AUD), cannabis (CUD), and tobacco (TUD) use disorders with three types of childhood interpersonal violence (cIPV): physical abuse, sexual abuse, and witnessing parental violence. METHOD Data from the National Epidemiologic Survey of Alcohol-Related Conditions-III (N: 36 309), a US nationally representative sample, was utilized to examine associations of DSM-5 AUD, CUD and TUD with cIPV among men and women of five racial/ethnic groups. Models were adjusted for additional risk factors (e.g. parental substance use problems, participant's co-occurring SUD). RESULTS Independent contributions of childhood physical and sexual abuse to AUD, CUD, and TUD, and of witnessing parental violence to AUD and TUD were observed. Associations of cIPV and SUD were relatively similar across race/ethnicity and gender [Odds Ratios (ORs) ranged from 1.1 to 1.9], although associations of physical abuse with AUD and TUD were greater among males, associations of parental violence and AUD were greater among females, and associations of parental violence with AUD were greater among Hispanic women and American Indian men. CONCLUSIONS Given the paucity of research in this area, and the potential identification of modifiable risk factors to reduce the impact of childhood interpersonal violence on SUDs, further research and consideration of tailoring prevention and intervention efforts to different populations are warranted.
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Affiliation(s)
| | - Carolyn E. Sartor
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Alcohol Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Kimberly B. Werner
- George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Deborah Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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Nollett C, Lewis C, Kitchiner N, Roberts N, Addison K, Brookes-Howell L, Cosgrove S, Cullen K, Ehlers A, Heke S, Kelson M, Lovell K, Madden K, McEwan K, McNamara R, Phillips C, Pickles T, Simon N, Bisson J. Pragmatic RAndomised controlled trial of a trauma-focused guided self-help Programme versus InDividual trauma-focused cognitive Behavioural therapy for post-traumatic stress disorder (RAPID): trial protocol. BMC Psychiatry 2018; 18:77. [PMID: 29580220 PMCID: PMC5870753 DOI: 10.1186/s12888-018-1665-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is good evidence that trauma-focused therapies for Post-Traumatic Stress Disorder are effective. However, they are not always feasible to deliver due a shortage of trained therapists and demands on the patient. An online trauma-focused Guided Self-Help (GSH) programme which could overcome these barriers has shown promise in a pilot study. This study will be the first to evaluate GSH against standard face-to-face therapy to assess its suitability for use in the NHS. METHODS The study is a large-scale multi-centre pragmatic randomised controlled non-inferiority trial, with assessors masked to treatment allocation. One hundred and ninety-two participants will be randomly allocated to receive either face-to-face trauma-focused cognitive behaviour therapy (TFCBT) or trauma-focused online guided self-help (GSH). The primary outcome will be the severity of symptoms of PTSD over the previous week as measured by the Clinician Administered PTSD Scale for DSM5 (CAPS-5) at 16 weeks post-randomisation. Secondary outcome measures include PTSD symptoms over the previous month as measured by the CAPS-5 at 52 weeks plus the Impact of Event Scale - revised (IES-R), Work and Social Adjustment Scale (WSAS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Alcohol Use Disorders Test (AUDIT-O), Multidimensional Scale for Perceived Social Support (MSPSS), short Post-Traumatic Cognitions Inventory (PTCI), Insomnia Severity Index (ISI) and General Self Efficacy Scale (GSES) measured at 16 and 52 weeks post-randomisation. Changes in health-related quality of life will be measured by the EQ-5D and the level of healthcare resource utilisation for health economic analysis will be determined by an amended version of the Client Socio-Demographic and Service Receipt Inventory European Version. The Client Satisfaction Questionnaire (CSQ) will be collected at 16 weeks post-randomisation to evaluate treatment satisfaction. DISCUSSION This study will be the first to compare online GSH with usual face-to-face therapy for PTSD. The strengths are that it will test a rigorously developed intervention in a real world setting to inform NHS commissioning. The potential challenges of delivering such a pragmatic study may include participant recruitment, retention and adherence, therapist retention, and fidelity of intervention delivery. TRIAL REGISTRATION ISRCTN13697710 registered on 20/12/2016.
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Affiliation(s)
- Claire Nollett
- Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Catrin Lewis
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Neil Kitchiner
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK ,0000 0001 0807 5670grid.5600.3Cardiff & Vale University Health Board, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Neil Roberts
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK ,0000 0001 0807 5670grid.5600.3Cardiff & Vale University Health Board, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Katy Addison
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Lucy Brookes-Howell
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Sarah Cosgrove
- Independent Public and Patient Involvement (PPI) representative, Cardiff, UK
| | - Katherine Cullen
- 0000 0001 0658 8800grid.4827.9Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Anke Ehlers
- grid.470387.fDepartment of Experimental Psychology, Oxford Centre for Anxiety Disorders and Trauma, Paradise Square, Oxford, OX1 1TW UK
| | - Sarah Heke
- grid.439501.aGrenfell Emotional Health and Wellbeing service, Central and Northwest London (CNWL) NHS Trust, St Charles Hospital, Exmoor Street, London, UK ,0000 0004 0581 2008grid.451052.7Formerly at Institute of Psychotrauma, East London Foundation NHS Trust, 86 Old Montague Street, London, E1 8NN UK
| | - Mark Kelson
- 0000 0004 1936 8024grid.8391.3Department of Mathematics, Laver Building, University of Exeter, Exeter, EX4 4QRE UK
| | - Karina Lovell
- 0000000121662407grid.5379.8Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Room 6.322a, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Kim Madden
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Kirsten McEwan
- 0000 0001 2232 4004grid.57686.3aDepartment of Psychology, University of Derby, Kedleston Road, Derby, DE22 1GB UK
| | - Rachel McNamara
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Ceri Phillips
- 0000 0001 0658 8800grid.4827.9Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Timothy Pickles
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Natalie Simon
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Jonathan Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK.
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