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Xu B, Kim S, Blais RK, Nadel M, Cai Q, Tanev KS. Longitudinal changes in the PTSD symptom network following trauma-focused treatment in military populations: Identifying central symptoms and the role of military sexual trauma. J Anxiety Disord 2024; 104:102872. [PMID: 38703664 DOI: 10.1016/j.janxdis.2024.102872] [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: 10/17/2023] [Revised: 03/25/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating condition affecting military populations, with a higher prevalence compared to the general population. Despite the development of first-line trauma-focused treatments such as Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE), a significant proportion of patients continue to experience persistent PTSD symptoms following treatment. This study utilized network analysis to explore the PTSD symptom network's dynamics pre- and post- trauma-focused treatment and investigated the role of military sexual trauma (MST) history in shaping the network. Network analysis is a novel approach that can guide treatment target areas. The sample was comprised of 1648 service members and veterans who participated in a two-week intensive PTSD treatment program, which included completion of evidenced-based individual therapy as well as skill-building focused group therapy. PTSD severity was assessed using the PTSD Checklist for DSM-5 at baseline and post-treatment. Network analyses revealed strong connections within symptom clusters, with negative emotions emerging as one of the most central symptoms. Interestingly, the symptom network's overall structure remained stable following treatment, whereas global strength significantly increased. MST history did not significantly impact the network's structure or its change relative to treatment. Future research should further examine whether targeting negative emotions optimizes PTSD treatment outcomes for military populations.
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Affiliation(s)
- Bingyu Xu
- Psychology Department, Arizona State University, Tempe, AZ, USA.
| | - Soyeong Kim
- Home Base: Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rebecca K Blais
- Psychology Department, Arizona State University, Tempe, AZ, USA
| | - Molly Nadel
- Home Base: Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
| | - Qiyue Cai
- Psychology Department, Arizona State University, Tempe, AZ, USA
| | - Kaloyan S Tanev
- Home Base: Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Tandon T, Piccolo M, Ledermann K, McNally RJ, Gupta R, Morina N, Martin-Soelch C. Mental health markers and protective factors in students with symptoms of physical pain across WEIRD and non-WEIRD samples - a network analysis. BMC Psychiatry 2024; 24:318. [PMID: 38658915 PMCID: PMC11044470 DOI: 10.1186/s12888-024-05767-3] [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: 10/18/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Studies conducted in Western societies have identified variables associated with chronic pain, but few have done so across cultures. Our study aimed to clarify the relationship between specific mental health markers (i.e., depression, anxiety, posttraumatic stress disorder [PTSD], perceived stress) as well as specific protective factors (i.e., social support and self-efficacy) related to physical pain among university students across non-WEIRD and WEIRD samples. METHOD A total of 188 university students (131 women and 57 men) were included in the study. We used network analysis to ascertain mental health markers especially central to the experience of physical pain. RESULTS No statistically significant difference was found between mental health markers (i.e., depression, anxiety, perceived stress, and PTSD) and protective factors (i.e., social support and self-efficacy) associated with physical pain symptoms for Swiss students versus Indian students (M = 0.325, p = .11). In addition, networks for Swiss versus Indian students did not differ in global strength (S = 0.29, p = .803). Anxiety was the most central mental health marker, and social support was the most important protective factor related to physical pain in both countries. However, for Swiss students, perceived stress, and for Indian students, PTSD symptoms were central mental health markers related to physical pain. CONCLUSION Our results identify factors that may serve as important treatment targets for pain interventions among students of both countries before it becomes chronic.
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Affiliation(s)
- Tanya Tandon
- Unit of Clinical and Health Psychology, University of Fribourg, Rue de Faucigny 2, CH-1700, Fribourg, Switzerland.
| | - Mayron Piccolo
- Department of Psychology, Harvard University, Cambridge, USA
| | - Katharina Ledermann
- Unit of Clinical and Health Psychology, University of Fribourg, Rue de Faucigny 2, CH-1700, Fribourg, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Rashmi Gupta
- Cognitive and Behavioural Neuroscience Laboratory, Department of Humanities and Social, Sciences, Indian Institute of Technology Bombay, Mumbai, India
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Chantal Martin-Soelch
- Unit of Clinical and Health Psychology, University of Fribourg, Rue de Faucigny 2, CH-1700, Fribourg, Switzerland
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Shabat N, Bechor U, Yavnai N, Tatsa-Laur L, Shelef L. The Link Between Somatization and Dissociation and PTSD Severity in Veterans Who Sought Help From the IDF Combat Stress Reaction Unit. Mil Med 2024:usae118. [PMID: 38554277 DOI: 10.1093/milmed/usae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION This study aimed to examine the relationships between dissociative and somatic symptoms and how they might contribute to PTSD severity among ex-soldiers who sought help from the IDF Combat Stress Reaction Unit (CSRU). MATERIALS AND METHODS This cross-sectional study included 1,305 former compulsory, career, and reserve soldiers, who filled out self-report questionnaires on admission for evaluation at the CSRU. The study's dependent variables included two posttraumatic stress disorder measures (CAPS and PCL-5). The independent variables were the Dissociative Experience Scale and Brief Symptom Inventory. Background and service-related variables were also examined. RESULTS Spearman correlation revealed that the higher the level of somatization is, the higher the level of PTSD via PCL and CAPS. A significant positive association was found between somatization and dissociation (r = 0.544; P < 0.001). The higher the somatization level, the more severe the dissociation. A multivariate logistic regression analysis to predict severe PTSD revealed that the longer the time elapsed from the traumatic event (OR = 1.019, P = 0.015), the higher the risk for severe PTSD. The most prominent variables were dissociation (OR = 6.420, P < 0.001) and somatization (OR = 4.792, P < 0.001). The entire model reached 40.8% of the shared variance in the regression. CONCLUSIONS While there is direct reference to dissociation in the clinical assessment by PCL or CAPS, there is no such reference to somatization. Highly functioning combatants sometimes express their distress somatically. Our findings suggest regarding severe somatic symptoms as diagnostic criteria for PTSD.
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Affiliation(s)
- Nizan Shabat
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Uzi Bechor
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Nirit Yavnai
- Department of Community Dentistry, Faculty of Dental Medicine, Hebrew University, Hadassah Ein Kerem Campus, Jerusalem 91120, Israel
| | - Lucian Tatsa-Laur
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Leah Shelef
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
- The School of Social Work, Sapir Academic College, D. N. Hof Ashkelon 79165, Israel
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Pathak GA, Singh K, Choi KW, Fang Y, Kouakou MR, Lee YH, Zhou X, Fritsche LG, Wendt FR, Davis LK, Polimanti R. Genetic Liability to Posttraumatic Stress Disorder Symptoms and Its Association With Cardiometabolic and Respiratory Outcomes. JAMA Psychiatry 2024; 81:34-44. [PMID: 37910111 PMCID: PMC10620678 DOI: 10.1001/jamapsychiatry.2023.4127] [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: 04/21/2023] [Accepted: 08/28/2023] [Indexed: 11/03/2023]
Abstract
Importance Posttraumatic stress disorder (PTSD) has been reported to be a risk factor for several physical and somatic symptoms. However, the genetics of PTSD and its potential association with medical outcomes remain unclear. Objective To examine disease categories and laboratory tests from electronic health records (EHRs) that are associated with PTSD polygenic scores. Design, Setting, and Participants This genetic association study was conducted from July 15, 2021, to January 24, 2023, using EHR data from participants across 4 biobanks. The polygenic scores of PTSD symptom severity (PGS-PTSD) were tested with all available phecodes in Vanderbilt University Medical Center's biobank (BioVU), Mass General Brigham (MGB), Michigan Genomics Initiative (MGI), and UK Biobank (UKBB). The significant medical outcomes were tested for overrepresented disease categories and subsequently tested for genetic correlation and 2-sample mendelian randomization (MR) to determine genetically informed associations. Multivariable MR was conducted to assess whether PTSD associations with health outcomes were independent of the genetic effect of body mass index and tobacco smoking. Exposures Polygenic score of PTSD symptom severity. Main Outcomes and Measures A total of 1680 phecodes (ie, International Classification of Diseases, Ninth Revision- and Tenth Revision-based phenotypic definitions of health outcomes) across 4 biobanks and 490 laboratory tests across 2 biobanks (BioVU and MGB). Results In this study including a total of 496 317 individuals (mean [SD] age, 56.8 [8.0] years; 263 048 female [53%]) across the 4 EHR sites, meta-analyzing associations of PGS-PTSD with 1680 phecodes from 496 317 individuals showed significant associations to be overrepresented from mental health disorders (fold enrichment = 3.15; P = 5.81 × 10-6), circulatory system (fold enrichment = 3.32; P = 6.39 × 10-12), digestive (fold enrichment = 2.42; P = 2.16 × 10-7), and respiratory outcomes (fold enrichment = 2.51; P = 8.28 × 10-5). The laboratory measures scan with PGS-PTSD in BioVU and MGB biobanks revealed top associations in metabolic and immune domains. MR identified genetic liability to PTSD symptom severity as an associated risk factor for 12 health outcomes, including alcoholism (β = 0.023; P = 1.49 × 10-4), tachycardia (β = 0.045; P = 8.30 × 10-5), cardiac dysrhythmias (β = 0.016, P = 3.09 × 10-5), and acute pancreatitis (β = 0.049, P = 4.48 × 10-4). Several of these associations were robust to genetic effects of body mass index and smoking. We observed a bidirectional association between PTSD symptoms and nonspecific chest pain and C-reactive protein. Conclusions and Relevance Results of this study suggest the broad health repercussions associated with the genetic liability to PTSD across 4 biobanks. The circulatory and respiratory systems association was observed to be overrepresented in all 4 biobanks.
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Affiliation(s)
- Gita A. Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Veteran Affairs Connecticut Healthcare Center, West Haven
| | - Kritika Singh
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karmel W. Choi
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Yu Fang
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
| | - Manuela R. Kouakou
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Veteran Affairs Connecticut Healthcare Center, West Haven
| | - Younga Heather Lee
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Xiang Zhou
- Department of Biostatistics, School of Public Health, University of Michigan Medicine, Ann Arbor
| | - Lars G. Fritsche
- Department of Biostatistics, School of Public Health, University of Michigan Medicine, Ann Arbor
- Rogel Cancer Center, University of Michigan Medicine, Ann Arbor
- Center for Statistical Genetics, School of Public Health, University of Michigan Medicine, Ann Arbor
| | - Frank R. Wendt
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Veteran Affairs Connecticut Healthcare Center, West Haven
- Department of Anthropology, University of Toronto, Mississauga, Ontario, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lea K. Davis
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Veteran Affairs Connecticut Healthcare Center, West Haven
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Ferrajão P, Tourais B, Elklit A. Attachment Anxiety and Dissociation Mediate Associations Between Polytrauma and Somatization in Kenyan Adolescents. J Trauma Dissociation 2024; 25:83-98. [PMID: 37401367 DOI: 10.1080/15299732.2023.2231958] [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: 11/21/2022] [Accepted: 05/12/2023] [Indexed: 07/05/2023]
Abstract
The experience of several potentially traumatic events (PTE) is a risk factor for higher somatization symptoms severity among adolescents. Attachment orientations and dissociation may influence the link between exposure to PTE and somatization symptoms severity. We analyzed the associations between direct exposure to PTE and somatization symptoms in Kenyan adolescents and explored the mediating role of attachment orientations and dissociation symptoms in the associations between direct exposure to PTE with somatization symptoms severity. A sample of 475 Kenyan adolescents completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modeling employing Preacher and Hayes' procedures (2008). Attachment anxiety and dissociation symptoms mediate the association between direct exposure to traumatic events and somatization symptoms. Higher exposure to traumatic events was significantly associated with higher attachment anxiety levels, which was associated with higher levels of dissociation symptoms, which was then associated with higher somatization symptoms severity. High levels of attachment anxiety and dissociation might aggravate somatization symptoms differently according to sex, which might be seen as a psychological distress mechanism subsequent to exposure to multiple PTE in African adolescents.
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Affiliation(s)
- Paulo Ferrajão
- Faculdade de Ciências Sociais E Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Bárbara Tourais
- Faculdade de Ciências Sociais E Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Ask Elklit
- National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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Mutuyimana C, Maercker A. Elements of cultural scripts of trauma sequelae among trauma victims in East Africa. Front Psychol 2023; 14:1206503. [PMID: 37928575 PMCID: PMC10623154 DOI: 10.3389/fpsyg.2023.1206503] [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: 04/15/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
Background As a new, unifying approach to mapping the cultural expressions of trauma sequelae, cultural scripts of trauma sequelae are empirically investigated here for the first time in a primarily qualitative study. Elements of Cultural Scripts of Trauma (CST) include the typical symptoms and appraisals of changes of those who have experienced traumatic events. These elements refer to the value orientations in the given culture. Aims To identify post-traumatic cultural scripts' elements and their groupings, as expressed by trauma survivors from the East African population, and to explore the cultural values that serve as a reference to such scripts' elements. Methods Semi-structured, in-depth interviews were conducted in nine focus groups of trauma survivors and trauma experts. Grounded theory was the basis for the content analysis, and MAXQDA was used for coding and grouping. Semi-quantitative analyses of the frequency of groupings followed. Results The study extracted 270 elements of the cultural scripts of trauma. Three stages of cultural scripts' elements were identified including unspeakable, heart wounds and painful scars and growth. The reported elements are only those in the three last stages and they are grouped into six categories, such as cognitive appraisals, worldview, interpersonal relationships, body-related, positive changes and changes in family interest and management, while the elements of the first stages are not codable as the survivors do not yet get the words of their expressions. The cultural values that served as a reference consisted of holding the sadness, Christianity, community reputation, solidarity, social connectedness, social cynicism, and reproductiveness, among others. Discussion This comprehensive study with participants from several countries in East Africa collected a large number of elements of cultural scripts of trauma for this regional area. Notably, these elements were based mostly on man-made traumas, such as the genocide against the Tutsis in Rwanda. Further steps in the CST investigation are subject to future studies, such as a more systematic investigation of the relationship with cultural values and the temporal relationships within the scripts.
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Affiliation(s)
- Celestin Mutuyimana
- Division of Psychopathology and Clinical Intervention, Department of Psychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Andreas Maercker
- Division of Psychopathology and Clinical Intervention, Department of Psychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
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Fernandez A, Meurice L, Franke F, Vuillermoz C, Gindt M, Askenazy F, Vandentorren S. Impact of the 7/14/2016 Nice terrorist attack on pediatric emergency department visits thanks to syndromic surveillance: a descriptive study. Front Public Health 2023; 11:1248993. [PMID: 37915811 PMCID: PMC10616791 DOI: 10.3389/fpubh.2023.1248993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
Objective Study the impact of 14th July 2016 Nice terrorist attack on Pediatric Emergency Department (PED) visits by youth under 18 years of age. Methods PED visits diagnoses (ICD10) were clustered and analyzed based on retrospective data from the syndromic surveillance system of the Children's university hospital of Nice (Southern France). The studied period ranges from 2013 to 2019, i.e., 3 years before and after the terrorist attack of 14th July 2016. Results Among 416,191 PED visits, the number of visits for stress in 4-17 years old appeared to increase in the 3 years after the attack compared to the 3 years before, particularly in September 2016 (acute effect) with 11 visits compared to an average of 2.3 visits per month from September 2013 to 2016 (p = 0.001827). In September 2017, we noticed 21 visits compared to an average of 4.8 visits per month during the following period (2013-2019). In 2017, PED visits for stress among 4-17 year olds were higher in comparison to the other years of the study: 107 visits compared to an annual average of 57. Conclusion To our knowledge, this is the first study of the use of the pediatric care system before and after a terrorist attack involving syndromic surveillance. This suggests acute and long-term effects of the terrorist attack on PED use by youth for mental health issues. Further studies of the pediatric care system involving syndromic surveillance are needed in the context of mass violent events, such as terrorist attacks.
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Affiliation(s)
- Arnaud Fernandez
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Laure Meurice
- Santé publique France, French National Public Health Agency, Nouvelle-Aquitaine Regional Office, Bordeaux, France
| | - Florian Franke
- Santé Publique France, French National Public Health Agency, Regional Unit (CIRE, Provence-Alpes-Côte d'Azur and Corsica), Marseille, France
| | - Cecile Vuillermoz
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Social Epidemiology Research Team, Paris, France
| | - Morgane Gindt
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Florence Askenazy
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Stéphanie Vandentorren
- Université Bordeaux, Inserm, UMR1219, Vintage Team, Bordeaux, France
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
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İçin ZN, Koşe Ç, Şar V. Turkish Adaptation of Dissociative Subtype of Post Traumatic Stress Disorder Scale. J Trauma Dissociation 2023; 24:624-639. [PMID: 36994469 DOI: 10.1080/15299732.2023.2195396] [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: 01/20/2022] [Accepted: 02/21/2023] [Indexed: 03/31/2023]
Abstract
After the changes in DSM-5, dissociative subtype was added to post-traumatic stress disorder. That caused a necessity for a scale to measure the mentioned change. A scale named Dissociative Subtype of Post-Traumatic Stress Disorder (DSPS) was developed to measure this subtype and help the diagnosis. The purpose of this study is to adapt the Dissociative Subtype of Post-Traumatic Stress Disorder to Turkish and examine its reliability and validity. The Dissociative Subtype of PTSD (DSPS) was translated into Turkish. DSPS, Turkish forms of The Posttraumatic Diagnostic Scale and Dissociative Experiences Scale were sent to participants via Google Forms and data from 279 people aged 18-45 were analyzed. Reliability tests and factor analysis were conducted. Factor analysis showed that scale has good model fit scores and items were loaded to the factors the same as the original study. Scales internal consistency was examined, and a good score was obtained (α=.84). Fit index values of confirmatory factor analysis were found as χ2/df = 2.51, GFI=.90, RMSEA=.07, RMR=.02. As a result of the high reliability scores and sufficient model fit scores, this scale is considered as a dependable measure to evaluate the dissociative subtype of PTSD.
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Affiliation(s)
- Zühre Neslihan İçin
- Institute of Forensic Sciences and Legal Medicine, Department of Social Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Çiğdem Koşe
- Department of Psychology, Topkapı University, Istanbul, Turkey
| | - Vedat Şar
- Department of Psychiatry, Koc University, Istanbul, Turkey
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Behrendt M, Vervliet M, Rota M, Adeyinka S, Uzureau O, Rasmussen A, Glaesmer H, Lietaert I, Derluyn I. A conceptual study on the relationship between daily stressors, stressful life events, and mental health in refugees using network analysis. Front Psychol 2023; 14:1134667. [PMID: 37599778 PMCID: PMC10438848 DOI: 10.3389/fpsyg.2023.1134667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction There is growing recognition that daily stressors, such as social and material deficiencies, can be highly detrimental to the mental health of refugees. These stressors are in addition to stressful life events, which have been widely studied in the context of migration and forced displacement. Despite increasing evidence for an ecological model, there is still no consensus regarding the conceptualization of these highly influential factors. In particular, the demarcation of daily stressors from stressful life events and the categorization of daily stressors require further examination in order to develop usable and accurate tools for researchers, design effective interventions for practitioners and assist politicians in designing meaningful policies. Methods To address these challenges, we used data from a sample of 392 unaccompanied young refugees from diverse backgrounds and employed network analysis to examine the relationships between daily stressors, stressful life events, and symptoms of depression, anxiety, and post-traumatic stress. Results Our findings highlight the significant relationship between daily stressors and mental health, particularly depression. Meaningful clusters of daily stressors include material stressors, social stressors, and social exclusion stressors. Conclusion Our results demonstrate the importance of considering daily stressors in the mental health of refugees and suggest that using a network approach offers a viable way to study these complex interrelationships. These findings have implications for researchers, practitioners, and policymakers in understanding and addressing the mental health needs of refugees.
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Affiliation(s)
- Malte Behrendt
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Marianne Vervliet
- Department of People and Well-Being, Thomas More University of Applied Sciences, Mechelen, Belgium
| | - Marina Rota
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Sarah Adeyinka
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Océane Uzureau
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Andrew Rasmussen
- Culture, Migration, and Community, Department of Psychology, Fordham University, New York, NY, United States
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, Medical Faculty, The University of Leipzig Medical Center, Leipzig, Germany
| | - Ine Lietaert
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
- Institute on Comparative Regional Integration Studies, United Nations University, Bruges, Belgium
| | - Ilse Derluyn
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
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Åkerblom S, Cervin M, Nordin L, Andersen TE, Thøgersen MH, Perrin S. Relations between PTSD symptom clusters and pain in three trauma-exposed samples with pain. Scand J Pain 2023; 23:483-493. [PMID: 37327349 DOI: 10.1515/sjpain-2022-0142] [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] [Received: 10/05/2022] [Accepted: 05/26/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Little is known about how the individual PTSD symptom clusters relate to intensity and interference of pain and whether these relationships differ across clinical groups. The present study examines relations between PTSD symptom clusters and pain in three trauma-exposed, unique clinical groups: 1) adults seeking treatment for chronic pain with current symptoms of PTSD, 2) trauma affected refugees seeking treatment for PTSD and chronic pain; and 3) individuals identified at admission to the emergency ward after whiplash injury. METHODS Network analysis was used to assess unique relations between pain intensity, pain interference, re-experiencing, avoidance, numbing, hyperarousal, depression, and anxiety separately in each sample. Links between PTSD clusters and pain were then compared within and between samples. RESULTS No within-group differences were identified for the links between pain and any of PTSD clusters in the chronic pain and refugee groups. In the whiplash group, hyperarousal was more strongly related to pain than re-experiencing, avoidance, and numbing. Between group comparisons revealed a more pronounced relationship between hyperarousal and pain in the whiplash group, with no between-group differences between the chronic pain and refugee groups. CONCLUSIONS The findings suggest that when depression and anxiety are accounted for, few unique associations are found between pain and the PTSD symptom clusters in trauma-exposed samples with pain, with the exception of a link between pain and hyperarousal in individuals with whiplash-related PTSD symptoms.
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Affiliation(s)
- Sophia Åkerblom
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Matti Cervin
- Faculty of Medicine, Lund University, Lund, Sweden
| | - Linda Nordin
- Department of Psychology, Lund University, Lund, Sweden
- Department of Rehabilitation, DIGNITY - Danish Institute Against Torture, Copenhagen, Denmark
| | | | - Marie Høgh Thøgersen
- Department of Rehabilitation, DIGNITY - Danish Institute Against Torture, Copenhagen, Denmark
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
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Sejdiu A, Jaka S, Younis H, Kidambi NS, Faruki F, Patel RS, Gunturu S. Psychiatric Comorbidities and Risk of Somatic Symptom Disorders in Posttraumatic Stress Disorder: A Cross-Sectional Inpatient Study. J Nerv Ment Dis 2023; 211:510-513. [PMID: 37040547 DOI: 10.1097/nmd.0000000000001639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
ABSTRACT Nearly 90% of Americans are exposed to a traumatic event at some point in their lives, and over 8% of those individuals will develop posttraumatic stress disorder (PTSD). Our study examined the demographic differences and psychiatric comorbidities in inpatients with PTSD with and without somatic symptom disorders (SSDs), using data from the Nationwide Inpatient Sample for 2018 and 2019. Our sample included 12,760 adult patients with a primary diagnosis of PTSD, which was further subdivided based on a codiagnosis of SSD. We used a logistic regression model to determine the odds ratio (OR) of association for SSD and identify demographic predictors and comorbid risk factors in inpatients with PTSD. The prevalence of SSD in inpatients with PTSD was 0.43%, and it was more commonly seen in women and Caucasians. Personality disorders (OR, 5.55; p < 0.001) and anxiety disorders (OR, 1.93; p = 0.018) were found to increase the likelihood of codiagnoses of SSD in inpatients with PTSD. These findings support the need for a systematic, modular approach that includes evidence-based interventions to treat at-risk populations.
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Affiliation(s)
- Albulena Sejdiu
- Department of Psychiatry, St Cyril and Methodius University, Skopje, North Macedonia
| | | | - Hadia Younis
- Department of Medicine, Peshawar Medical College, Peshawar, Pakistan
| | - Neil S Kidambi
- Shadan Institute of Medical Sciences, Peeramcheru, Telangana, India
| | | | - Rikinkumar S Patel
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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Klasa K, Sobański JA, Dembińska E, Citkowska-Kisielewska A, Mielimąka M, Rutkowski K. Network analysis of body-related complaints in patients with neurotic or personality disorders referred to psychotherapy. Heliyon 2023; 9:e14078. [PMID: 36938406 PMCID: PMC10018473 DOI: 10.1016/j.heliyon.2023.e14078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
Background Psychopathology theory and clinical practice require the most complex knowledge about patients' complaints. In patients seeking for psychotherapy, body-related symptoms often complicate treatment. Aim This study aimed at examining connections between body-related symptoms, and identification of symptoms which may be responsible for emergency and sustaining of anxiety, somatoform and personality disorders with the use of network analysis. Methods In our retrospective research we used data from a sample of 4616 patients of the Department of Psychotherapy, University Hospital in Cracow, diagnosed with anxiety, somatoform or personality disorders. We constructed the Triangulated Maximally Filtered Graph (TMFG) networks of 44 somatoform symptoms endorsed in the symptom checklist "O" (SCL-O) and identified the most central symptoms within the network for all patients and in subgroups of women vs. men, older vs. younger, and diagnosed in 1980-2000 vs. 2000-2015. We used bootstrap to determine the accuracy and stability of five networks' parameters: strength, expected influence, eigenvector, bridge strength and hybrid centrality. Results The most central symptoms within the overall network, and in six subnetworks were dyspnea and migratory pains. We identified some gender-related differences, but no differences were observed for the age and time of diagnosis. Conclusions Self-reported dyspnea and migratory pains are potential important targets for treatment procedures.
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Affiliation(s)
- Katarzyna Klasa
- Faculty of Medicine, Department of Psychotherapy, Jagiellonian University Medical College, Poland
| | - Jerzy A. Sobański
- Faculty of Medicine, Department of Psychotherapy, Jagiellonian University Medical College, Poland
| | - Edyta Dembińska
- Faculty of Medicine, Department of Psychotherapy, Jagiellonian University Medical College, Poland
| | | | - Michał Mielimąka
- Faculty of Medicine, Department of Psychotherapy, Jagiellonian University Medical College, Poland
| | - Krzysztof Rutkowski
- Faculty of Medicine, Department of Psychotherapy, Jagiellonian University Medical College, Poland
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Danböck SK, Hettegger SE, Anders S, Franke LK, Liedlgruber M, Miedl SF, Gashi A, Kurapov A, Weber RC, Ehring T, Wilhelm FH. Psychometric properties of the dissociative subtype of posttraumatic stress disorder scale: replication and extension in two German-speaking samples. Eur J Psychotraumatol 2023; 14:2238492. [PMID: 37593980 PMCID: PMC10443992 DOI: 10.1080/20008066.2023.2238492] [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: 03/14/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 08/19/2023] Open
Abstract
Background: The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced the dissociative subtype of posttraumatic stress disorder (D-PTSD). To assess this subtype, the Dissociative Subtype of PTSD Scale (DSPS), a 15-item self-report measure to identify lifetime and current dissociative symptoms of D-PTSD, was developed. However, so far, the scale has only been validated in war veterans. Moreover, criterion validity and diagnostic utility have not been examined yet.Objective: We aimed to validate the DSPS in two samples of civilian trauma-exposed German-speaking participants.Methods: In Study 1, a pre-registered online study, participants with and without PTSD symptoms (N = 558) answered questionnaires about traumatic experiences, dissociation, PTSD, depression, generalized anxiety disorder, somatic symptom disorder, alcohol use disorder, absorption, and dissociative responding to trauma-related questionnaires. In Study 2, which used secondary data of a pre-registered clinical study, participants with a PTSD diagnosis (N = 71) answered questionnaires about traumatic experiences, dissociation, PTSD, depression, generalized anxiety disorder, somatic symptom disorder, and dissociative responding to standardized trauma exposure. Moreover, PTSD, D-PTSD, and other diagnoses were assessed with structured clinical interviews.Results: Analyses confirmed a three-factor structure as well as high internal consistency, and high convergent, discriminant, and criterion validity of the DSPS. Moreover, the scale was able to identify a latent D-PTSD group and individuals with D-PTSD diagnosis.Conclusions: The DSPS constitutes a reliable and valid tool to assess D-PTSD symptoms in clinical practice and research and thereby may contribute to a better understanding of these debilitating symptoms.
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Affiliation(s)
- Sarah K. Danböck
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Sabrina E. Hettegger
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Sofia Anders
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Laila K. Franke
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Michael Liedlgruber
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Stephan F. Miedl
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Arlinda Gashi
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
- Research Department, Empatia Multidisciplinary Clinic, Prishtina, Kosovo
| | - Anton Kurapov
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
- Faculty of Psychology, Department of Experimental and Applied Psychology, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | | | - Thomas Ehring
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Frank H. Wilhelm
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
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Kratzer L, Schiepek G, Heinz P, Schöller H, Knefel M, Haselgruber A, Karatzias T. What makes inpatient treatment for PTSD effective? Investigating daily therapy process factors. Psychother Res 2022; 32:847-859. [DOI: 10.1080/10503307.2022.2050830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Leonhard Kratzer
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | - Günter Schiepek
- Institute for Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
- University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
- Department of Psychology, Ludwig-Maximilians-University, Munich, Germany
| | - Peter Heinz
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | - Helmut Schöller
- Institute for Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
| | - Matthias Knefel
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
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Using Microbiome-Based Approaches to Deprogram Chronic Disorders and Extend the Healthspan following Adverse Childhood Experiences. Microorganisms 2022; 10:microorganisms10020229. [PMID: 35208684 PMCID: PMC8879770 DOI: 10.3390/microorganisms10020229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/04/2022] [Accepted: 01/19/2022] [Indexed: 12/01/2022] Open
Abstract
Adverse childhood experiences (ACEs), which can include child trafficking, are known to program children for disrupted biological cycles, premature aging, microbiome dysbiosis, immune-inflammatory misregulation, and chronic disease multimorbidity. To date, the microbiome has not been a major focus of deprogramming efforts despite its emerging role in every aspect of ACE-related dysbiosis and dysfunction. This article examines: (1) the utility of incorporating microorganism-based, anti-aging approaches to combat ACE-programmed chronic diseases (also known as noncommunicable diseases and conditions, NCDs) and (2) microbiome regulation of core systems biology cycles that affect NCD comorbid risk. In this review, microbiota influence over three key cyclic rhythms (circadian cycles, the sleep cycle, and the lifespan/longevity cycle) as well as tissue inflammation and oxidative stress are discussed as an opportunity to deprogram ACE-driven chronic disorders. Microbiota, particularly those in the gut, have been shown to affect host–microbe interactions regulating the circadian clock, sleep quality, as well as immune function/senescence, and regulation of tissue inflammation. The microimmunosome is one of several systems biology targets of gut microbiota regulation. Furthermore, correcting misregulated inflammation and increased oxidative stress is key to protecting telomere length and lifespan/longevity and extending what has become known as the healthspan. This review article concludes that to reverse the tragedy of ACE-programmed NCDs and premature aging, managing the human holobiont microbiome should become a routine part of healthcare and preventative medicine across the life course.
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Hashimoto K. Mental health during the COVID-19 pandemic, impact of childhood trauma in psychiatric disorders, and predictable biomarkers for bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2022; 272:753-755. [PMID: 35751656 PMCID: PMC9243931 DOI: 10.1007/s00406-022-01445-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, 1-8-1 Inohana, Chiba, 260-8670, Japan.
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