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Melander P, Vang ML, Lindekilde N, Andersen LPS, Elklit A, Pihl-Thingvad J. Social support utilization's effect on post-traumatic stress symptoms: a Danish cross-sectional study of 383 ambulance personnel. Front Psychiatry 2024; 15:1425254. [PMID: 39143962 PMCID: PMC11322131 DOI: 10.3389/fpsyt.2024.1425254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/16/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction Social support is considered an important factor in prevention of mental illness. However, little is known about the association between ambulance personnel's use of multiple types of social support and post-traumatic stress symptoms (PTSS). This study aims to assess if number of used social support types predicts PTSS for ambulance personnel. Apart from assessing the main effect of social support utilization, we were interested in investigating if social support utilization moderated the effect of frequency of critical events on PTSS. Materials and methods A total of 383 ambulance personnel completed a survey consisting of validated questionnaires. Hierarchical multiple linear regression analyses were performed to assess the association between frequency of traumatic exposure and utilization of social support and PTSS as outcome variable. Results Higher number of utilized social support types was associated with higher levels of PTSS (β = 0.15, p <.001). When serving as a moderator of the association between frequency of exposure to critical incidents and PTSS, social support utilization had a significant and positive interaction effect (β = 0.26, p = .049). 307 participants had used 2 or 3 types of informal support during the past year, whereas 81 had used 2 or 3 types of formal support. Conclusion To our knowledge, this is the first study investigating the relationship between utilization of multiple, concurrent social support types and PTSS. This study suggests that to understand the effects of social support among ambulance personnel, it is necessary to assess the utilization of multiple concurrent support types, contributing factors to social support use, and different patterns of social support utilization that constitutes professional life in ambulance work.
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Affiliation(s)
- Pernille Melander
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark
| | - Maria Louison Vang
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- National Centre for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Nanna Lindekilde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark
| | - Lars Peter Sønderbo Andersen
- Danish Ramazzini Centre, Department of Occupational Medicine – University Research Clinic, Goedstrup Hospital, Herning, Denmark
| | - Ask Elklit
- National Centre for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Jesper Pihl-Thingvad
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark
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Kirk MA, Taha B, Dang K, McCague H, Hatzinakos D, Katz J, Ritvo P. A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial. JMIR Ment Health 2022; 9:e26479. [PMID: 34499613 PMCID: PMC8922150 DOI: 10.2196/26479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/16/2021] [Accepted: 07/07/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a debilitating, undertreated condition. The web-based delivery of cognitive behavioral therapy supplemented with mindfulness meditation and yoga is a viable treatment that emphasizes self-directed daily practice. OBJECTIVE This study aims to examine the effectiveness of a web-based cognitive behavioral therapy, mindfulness, and yoga (CBT-MY) program designed for daily use. METHODS We conducted an 8-week, single-arm, experimental, registered clinical trial on adults reporting PTSD symptoms (n=22; aged 18-35 years). Each participant received web-based CBT-MY content and an hour of web-based counseling each week. Pre-post outcomes included self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes included peak pupil dilation (PPD) and heart rate variability (HRV). HRV and PPD were also compared with cross-sectional data from a non-PTSD comparison group without a history of clinical mental health diagnoses and CBT-MY exposure (n=46). RESULTS Pre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d=1.60), depression (d=0.83), anxiety (d=0.99), and mindfulness (d=0.88). Linear multilevel mixed models demonstrated a significant pre-post reduction in PPD (B=-0.06; SE=0.01; P<.001; d=0.90) but no significant pre-post change in HRV (P=.87). Overall, participants spent an average of 11.53 (SD 22.76) min/day on self-directed mindfulness practice. CONCLUSIONS Web-based CBT-MY was associated with clinically significant symptom reductions and significant PPD changes, suggesting healthier autonomic functioning. Future randomized controlled trials are needed to further examine the gains apparent in this single-arm study. TRIAL REGISTRATION ClinicalTrials.gov NCT03684473; https://clinicaltrials.gov/ct2/show/NCT03684473.
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Affiliation(s)
- Megan A Kirk
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada.,Yale Center for Emotional Intelligence, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Bilal Taha
- Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada
| | - Kevin Dang
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
| | - Hugh McCague
- Institute for Social Research, York University, Toronto, ON, Canada
| | - Dimitrios Hatzinakos
- Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
| | - Paul Ritvo
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada.,Department of Psychology, York University, Toronto, ON, Canada
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Rosellini AJ, Szentkúti P, Horváth-Puhó E, Smith ML, Galatzer-Levy I, Lash TL, Galea S, Schnurr PP, Sørensen HT, Gradus JL. Latent classes of posttraumatic psychiatric comorbidity in the general population. J Psychiatr Res 2021; 136:334-342. [PMID: 33636689 PMCID: PMC8485142 DOI: 10.1016/j.jpsychires.2021.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023]
Abstract
Some narrow patterns of posttraumatic psychiatric comorbidity are well-established (e.g., posttraumatic stress disorder and substance use). However, broad multi-diagnosis profiles of posttraumatic comorbidity are poorly characterized. The goal of the current study was to use latent class analysis (LCA) to identify profiles of posttraumatic psychopathology from 11 International Classification of Diseases (ICD-10) diagnostic categories (e.g., stress, substance, depressive, psychosis, personality). Danish national registries were used to identify 166,539 individuals (median age = 41 years, range = <1 to >100) who experienced a traumatic event between 1994 and 2016 and were diagnosed with one or more mental disorders within 5 years. Two through 14-class LCA solutions were evaluated. A 13-class solution (a) provided the best fit, with the Bayes and Akaike Information Criteria reaching a minimum, (b) was broadly consistent with prior LCA studies, and (c) included several novel classes reflecting differential patterns of posttraumatic psychopathology. Three classes were characterized by high comorbidity: broad high comorbidity (M # diagnoses = 4.3), depression with stress/substance use/personality/neurotic disorders (M# diagnoses = 3.8), and substance use with personality/stress/psychotic disorders (M # diagnoses = 3.1). The other 10 classes were characterized by distinct patterns of mild comorbidity or negligible comorbidity. Compared to the mild and negligible comorbidity classes, individuals in high comorbidity classes were younger, had lower income, and had more pre-event psychiatric disorders. Results suggest that several different comorbidity patterns should be assessed when studying and treating posttraumatic psychopathology.
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Affiliation(s)
- Anthony J Rosellini
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Meghan L Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Paula P Schnurr
- National Center for PTSD Executive Division, White River Junction, VT, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jaimie L Gradus
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Dixius A, Möhler E. Feasibility and Effectiveness of a New Short-Term Psychotherapy Concept for Adolescents With Emotional Dysregulation. Front Psychiatry 2021; 11:585250. [PMID: 33551862 PMCID: PMC7858646 DOI: 10.3389/fpsyt.2020.585250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The 'Stress-Trauma-Symptoms-Regulation-Treatment' (START) is an innovative manualized short-term treatment program for stabilization and stress resilience in emotionally dysregulated adolescents, based on an approach of stress and management and emotional regulation. The current pilot trial aims to assess the feasibility and effectiveness of the START intervention program for improvement of emotion regulation. Methods: Sixty-six adolescents between the age of 13-18 years admitted to a psychiatric unit for acute emotional or behavioral dysregulation took part in the START program for 5 weeks in an open group setting with two sessions per week (70 min/session). Before treatment, we assessed a history of adverse experience with the Child and Adolescent Trauma Screen (CATS) and the Child Posttraumatic Cognitions Inventory (CPTCI). Before and after treatment, the participants completed the FEEL-KJ, a self-report screening instrument of emotional regulation and coping strategies. Results: A large proportion of this sample had experienced traumatic events based on the CATS (75%) and the CPTCI (82%). The mean FEEL-KJ score significantly decreased after the intervention (d = -0.248, p = 0.037), while no difference was observed with regard to mean level of adaptive emotion regulation strategies (d = 0.202, p = 0.207). A positive effect of the intervention was observed on three components of the adaptive FEEL-KJ scale: accepting (d = 0.289, p = 0.08), forgetting (d = 0.271, p = 0.049) and dealing with anger (d = 0.309, p = 0.034). Conclusion: START demonstrates preliminary evidence for improvement in emotional dysregulation after a 5-weeks course of treatment. Therefore, this short-term intervention can possibly be regarded as a tool to improve emotional stability in children with a high load of trauma-related psychopathology. The results are promising and warrant future studies, specifically randomized controlled trials on the effectiveness of START for strengthening resilience at-risk-populations.
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Affiliation(s)
- Andrea Dixius
- SHG Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie, Psychosomatik, Saarbruecken, Germany
| | - Eva Möhler
- Saarland University Hospital, Homburg, Germany
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Occupational Violence and PTSD-Symptoms: A Prospective Study on the Indirect Effects of Violence Through Time Pressure and Nontraumatic Strains in the Occupational Context. J Occup Environ Med 2020; 61:572-583. [PMID: 31022098 DOI: 10.1097/jom.0000000000001612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The aim of this study was to assess whether frequency of occupational violence (OV) affects posttraumatic stress disorder (PTSD) symptoms through nontraumatic strains in the occupational context. METHODS Twelve-month prospective survey data on 1763 Social educators were used. Path-analysis measured direct and indirect pathways of frequency of OV on PTSD through change in time pressure, change in burnout, change in sense of safety at work, and change in coping with regret in patient work. RESULTS Forty-two pct. of the variance in PTSD symptoms was predicted; F (20, 1541) = 36.8, P < 0.001, R = 0.42. Frequency of OV indirectly affected level of PTSD through all the mediators; estimated indirect effects = 0.14, 95% confidence interval 0.07 to 0.22. CONCLUSION PTSD resulting from OV is not only a result of the violent acts themselves but is also caused by nontraumatic strains. It is essential to include the broader context of work environment factors in prevention of work-related PTSD.
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Matthews LR, Quinlan MG, Bohle P. Posttraumatic Stress Disorder, Depression, and Prolonged Grief Disorder in Families Bereaved by a Traumatic Workplace Death: The Need for Satisfactory Information and Support. Front Psychiatry 2019; 10:609. [PMID: 31543835 PMCID: PMC6728923 DOI: 10.3389/fpsyt.2019.00609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022] Open
Abstract
The impact of traumatic workplace death on bereaved families, including their mental health and well-being, has rarely been systematically examined. This study aimed to document the rates and key correlates of probable posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and prolonged grief disorder (PGD) in family members following a workplace injury fatality. The hidden nature of the target population necessitated outreach recruitment techniques, including the use of social media, newspaper articles, radio interviews, and contact with major family support organizations. Data were collected using a cross-sectional design and international online survey. The PCL-C (PTSD), the PHQ-8 (MDD), and PG-13 (PGD) were used to measure mental health disorders. All are well-established self-report measures with strong psychometric qualities. Participants were from Australia (62%), Canada (17%), the USA (16%), and the UK (5%). The majority were females (89.9%), reflecting the gender distribution of traumatic workplace deaths (over 90% of fatalities are male). Most were partners/spouses (38.5%) or parents (35%) and over half (64%) were next of kin to the deceased worker. Most deaths occurred in the industries that regularly account for more than 70 percent of all industrial deaths-construction, manufacturing, transport, and agriculture forestry and fishing. At a mean of 6.40 years (SD = 5.78) post-death, 61 percent of participants had probable PTSD, 44 percent had probable MDD, and 43 percent had probable PGD. Logistic regressions indicated that a longer time since the death reduced the risk of having each disorder. Being next of kin and having a self-reported mental health history increased the risk of having MDD. Of the related information and support variables, having satisfactory support from family, support from a person to help navigate the post-death formalities, and satisfactory information about the death were associated with a decreased risk of probable PTSD, MDD, and PGD, respectively. The findings highlight the potential magnitude of the problem and the need for satisfactory information and support for bereaved families.
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Affiliation(s)
- Lynda R. Matthews
- Work and Health Research Team, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Michael G. Quinlan
- School of Management, UNSW Business School, University of New South Wales, Sydney, NSW, Australia
| | - Philip Bohle
- Work and Health Research Team, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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Chronic social defeat induces long-term behavioral depression of aggressive motivation in an invertebrate model system. PLoS One 2017; 12:e0184121. [PMID: 28910319 PMCID: PMC5598953 DOI: 10.1371/journal.pone.0184121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/18/2017] [Indexed: 11/23/2022] Open
Abstract
Losing a fight against a conspecific male (social defeat) induces a period of suppressed aggressiveness and general behaviour, often with symptoms common to human psychiatric disorders. Agonistic experience is also discussed as a potential cause of consistent, behavioral differences between individuals (animal “personality”). In non-mammals, however, the impact of single agonistic encounters typically last only hours, but then again studies of repeated intermittent defeat (chronic social defeat) are seldom. We report the effect of chronic social defeat in adult male crickets (Gryllus bimaculatus), for which all known behavioral effects of defeat last only 3 h. Firstly, after 48 h social isolation, crickets that experienced 5 defeats at 24 h intervals against the same, weight-matched opponent exhibited suppressed aggressiveness lasting >24 h, which was still evident when the animals were matched against an unfamiliar opponent at the last trial. Secondly, this longer-term depression of aggression also occurred in 48 h isolated crickets that lost 6 fights at 1 h intervals against unfamiliar opponents at each trial. Thirdly, crickets isolated as larvae until adult maturity (>16 days) were significantly more aggressive, and less variable in their aggressiveness at their very first fight than 48 h isolates, and also significantly more resilient to the effects of chronic social defeat. We conclude that losing an aggressive encounter in crickets has a residual effect, lasting at least 24 h, that accumulates when repeated defeats are experienced, and leads to a prolonged depression of aggressive motivation in subordinates. Furthermore, our data indicate that social interactions between young adults and possibly larvae can have even longer, possibly lifelong influences on subsequent behavior. Social subjugation is thus likely to be a prime determinant of inter-individual behavioral differences in crickets. Our work also opens new avenues for investigating proximate mechanisms underlying depression-like phenomena.
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