PTSD: Past, present and future implications for China

Direct and Indirect Effects of Risk Perception and Risk Information on PTSD in Frontline Healthcare Workers

Background

The COVID-19 Delta variant caused an outbreak in Guangdong in mid-May 2021. The risk information and risk perception of COVID-19 have been considered factors associated with mental health statuses, especially posttraumatic stress disorder (PTSD), in frontline healthcare workers.

Objective

The aim of this study is to investigate the interactive relationship in risk information and risk perception of COVID-19 and PTSD in healthcare personnel from the emergency department.

Design

We conducted a survey one month after the outbreak. A cross-sectional survey design is adopted, and 3078 participants are enrolled. The PTSD checklist for DSM-5 (PCL-5), risk information questionnaire, and risk perception questionnaire are utilized to collect data.

Methods

Bivariate correlation analysis and structural equation modelling are performed to analyze the mediating role of risk perception in the relationship between risk information and PTSD.

Results

The estimated prevalence of PTSD among frontline healthcare workers is 28.2%. The risk information for COVID-19, risk perception, and PTSD symptoms are mutually correlated. The specific paths from risk perception to PTSD show significant effects, in which two had negative effects and one had a positive effect. The risk perception feature in 2020 differed from that in 2019, which is largely due to the risk perception of the virus.

Conclusion

The estimated prevalence of PTSD among frontline healthcare workers remains high. Risk information for COVID-19 has dual effects on PTSD through the mediation of risk perceptions. Unfamiliarity with the SAR-COVID-2 Delta variant increased the risk perception of COVID-19. Effective risk communication regarding COVID-19 can have a positive effect on the mental health of frontline healthcare workers.

Prevalence and associated factors of depression and posttraumatic stress disorder among trauma patients: multi-centered cross-sectional study

Background

Stress-related disorders, such as post-traumatic stress disorder (PTSD), are expected to be the leading cause of global mortality and morbidity by 2030. However, there is limited information on the prevalence of depression and PTSD among trauma patients in Ethiopia. Our study was aimed at determining the prevalence of depression and PTSD and factors affecting it among trauma patients.

Methods

A hospital-based, multi-centered, cross-sectional study was conducted among 621 patients who visited the trauma outpatient clinic from April to June 2023. The stratified random sampling technique was used to select participants. Data were collected using standardized and pretested structured questionnaires and face-to-face interviews. Post-traumatic stress disorder was measured by the posttraumatic stress disorder checklist for DSM-5 (PCL-5), and depression was assessed by the Patient Health Questionnaire (PHQ-9). Data were analyzed using STATA version 14.1. Bivariable and multivariable logistic regression models were used to examine the association between outcome and independent variables. P-values less than 0.05 were considered statistically significant.

Results

In this study, 621 study participants were involved, with a response rate of 100%. More than half (55%) of the participants were male. The participants' median age was 32 years, and the interquartile range (IQR) ranged from 25 to 43 years. The prevalence of depression was 35.4% (95% CI: 31.65-39.2), and the prevalence of PTSD was 14.2% (95% CI: 11.4-16.9). In multivariable analysis, being female (AOR = 1.58, 95% CI: 1.05-2.35), having no formal education (AOR = 1.7, 95% CI: 1.01- 2.85), having a low income (AOR = 4.5, 95% CI: 1.93-10.70), and having poor social Support (AOR=2.04, 95% CI 1.34-3.10) and multiple traumatic events (AOR=7.2, 95% CI: 4.1-12.7) were significant predictors of depression. For post-traumatic stress disorder, being female (AOR=2.7, 95% CI 1.46-5.06), no formal education (AOR=2.61, 95% CI: 1.25-5.46), urban residency (AOR=2.11, 95% CI: 1.14-3.90), having depression (AOR=7.01, 95% CI: 3.65-13.46), and multiple traumatic events (AOR=8.08, 95% CI: 2.83-23.14) were the associated factors identified.

Conclusion and recommendation

The study revealed high levels of depression and post- traumatic stress disorder among trauma patients. Targeted interventions addressing socio-demographic disparities, such as income and education levels, alongside psychosocial support, are imperative.

Post-traumatic stress disorder: evolving conceptualization and evidence, and future research directions

The understanding of responses to traumatic events has been greatly influenced by the introduction of the diagnosis of post-traumatic stress disorder (PTSD). In this paper we review the initial versions of the diagnostic criteria for this condition and the associated epidemiological findings, including sociocultural differences. We consider evidence for post-traumatic reactions occurring in multiple contexts not previously defined as traumatic, and the implications that these observations have for the diagnosis. More recent developments such as the DSM-5 dissociative subtype and the ICD-11 diagnosis of complex PTSD are reviewed, adding to evidence that there are several distinct PTSD phenotypes. We describe the psychological foundations of PTSD, involving disturbances to memory as well as to identity. A broader focus on identity may be able to accommodate group and communal influences on the experience of trauma and PTSD, as well as the impact of resource loss. We then summarize current evidence concerning the biological foundations of PTSD, with a particular focus on genetic and neuroimaging studies. Whereas progress in prevention has been disappointing, there is now an extensive evidence supporting the efficacy of a variety of psychological treatments for established PTSD, including trauma-focused interventions - such as trauma-focused cognitive behavior therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) - and non-trauma-focused therapies, which also include some emerging identity-based approaches such as present-centered and compassion-focused therapies. Additionally, there are promising interventions that are neither psychological nor pharmacological, or that combine a pharmacological and a psychological approach, such as 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. We review advances in the priority areas of adapting interventions in resource-limited settings and across cultural contexts, and of community-based approaches. We conclude by identifying future directions for work on trauma and mental health.

Current Status and Future Directions of Artificial Intelligence in Post-Traumatic Stress Disorder: A Literature Measurement Analysis

This study aims to explore the current state of research and the applicability of artificial intelligence (AI) at various stages of post-traumatic stress disorder (PTSD), including prevention, diagnosis, treatment, patient self-management, and drug development. We conducted a bibliometric analysis using software tools such as Bibliometrix (version 4.1), VOSviewer (version 1.6.19), and CiteSpace (version 6.3.R1) on the relevant literature from the Web of Science Core Collection (WoSCC). The analysis reveals a significant increase in publications since 2017. Kerry J. Ressler has emerged as the most influential author in the field to date. The United States leads in the number of publications, producing seven times more papers than Canada, the second-ranked country, and demonstrating substantial influence. Harvard University and the Veterans Health Administration are also key institutions in this field. The Journal of Affective Disorders has the highest number of publications and impact in this area. In recent years, keywords related to functional connectivity, risk factors, and algorithm development have gained prominence. The field holds immense research potential, with AI poised to revolutionize PTSD management through early symptom detection, personalized treatment plans, and continuous patient monitoring. However, there are numerous challenges, and fully realizing AI's potential will require overcoming hurdles in algorithm design, data integration, and societal ethics. To promote more extensive and in-depth future research, it is crucial to prioritize the development of standardized protocols for AI implementation, foster interdisciplinary collaboration-especially between AI and neuroscience-and address public concerns about AI's role in healthcare to enhance its acceptance and effectiveness.

Impact of social support on PTSD : Chain mediating effects of insomnia and anxiety

Objective

To reveal the chain mediating roles of insomnia and anxiety between social support and PTSD in nursing staff under the stage of COVID-19 regular pandemic prevention and control in China.

Methods

A total of 784 nurses were recruited using the convenience sampling method in Jiangsu Province, China. Demographic questionnaire, Perceived Social Support Scale, Impact of Event Scale-Revised, Generalized Anxiety Disorder-7 and Insomnia Severity Index were applied to collect data.

Results

Social support, PTSD, insomnia and anxiety were significantly correlated with each other. Insomnia and anxiety acted as chain mediators between social support and PTSD.

Conclusion

Insufficient social support may trigger PTSD through the chain mediating effects of insomnia and anxiety in nursing staff under the stage of COVID-19 regular pandemic prevention and control. Measures focusing on social support, insomnia and anxiety should be taken to reduce or even prevent PTSD in nursing staff in Chinese hospitals in similar crises in the future.

Analysis of risk factors and construction of a prediction model for posttraumatic stress disorder among Chinese college students during the COVID-19 pandemic

BACKGROUND

To explore the risk factors of post-traumatic stress disorder (PTSD) among Chinese college students during the COVID-19 pandemic and the construction and validation of risk prediction models.

METHODS

A total of 10,705 university students were selected for the study. The questionnaire included the Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), PTSD Checklist for DSM-5 (PCL-5), and self-designed questionnaire. These assessments were conducted to facilitate the survey, construct the predictive model and validate the model's validity.

RESULTS

Sex, left-behind experience, poverty status, anxiety score, and depression score were identified as independent risk factors influencing psychological trauma among Chinese college students during the COVID-19 pandemic, while COVID-19 infection emerged as a protective factor against psychological trauma. A column chart was constructed to visualize the six independent risk factors derived from logistic regression analysis. The Hosmer-Lemeshow test results (χ2 = 13.021, P = 0.111) indicated that the risk prediction model fitted well. The receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.864 in the model group and 0.855 in the validation group. The calibration curves of the model closely resembled the ideal curve. Decision curve analysis (DCA) revealed that the model provided net benefit and demonstrated good clinical utility.

LIMITATIONS

The validation of the model is currently restricted to internal assessments. However, further confirmation through larger sample sizes, multicenter investigations, and prospective studies is necessary.

CONCLUSIONS

The model effectively predicted PTSD risk among Chinese college students during the COVID-19 pandemic, indicating strong clinical applicability.

Self-construal modulates default mode network connectivity in refugees with PTSD

BACKGROUND

While self-construal and posttraumatic stress disorder (PTSD) are independently associated with altered self-referential processes and underlying default mode network (DMN) functioning, no study has examined how self-construal affects DMN connectivity in PTSD.

METHODS

A final sample of 93 refugee participants (48 with DSM-5 PTSD or sub-syndromal PTSD and 45 matched trauma-exposed controls) completed a 5-minute resting state fMRI scan to enable the observation of connectivity in the DMN and other core networks. A self-construal index was calculated by substracting scores on the collectivistic and individualistic sub-scales of the Self Construal Scale.

RESULTS

Independent components analysis identified 9 active networks-of-interest, and functional network connectivity was determined. A significant interaction effect between PTSD and self-construal index was observed in the anterior ventromedial DMN, with spatial maps localizing this to the left ventromedial prefrontal cortex (vmPFC), extending to the ventral anterior cingulate cortex. This effect revealed that connectivity in the vMPFC showed greater reductions in those with PTSD with higher levels of collectivistic self-construal.

LIMITATIONS

This is an observational study and causality cannot be assumed. The specialized sample of refugees means that the findings may not generalize to other trauma-exposed populations.

CONCLUSIONS

Such a finding indicates that self-construal may shape the core neural architecture of PTSD, given that functional disruptions to the vmPFC underpin the core mechanisms of extinction learning, emotion dysregulation and self-referential processing in PTSD. Results have important implications for understanding the universality of neural disturbances in PTSD, and suggest that self-construal could be an important consideration in the assessment and treatment of post-traumatic stress reactions.

Application of machine learning techniques in the diagnostic approach of PTSD using MRI neuroimaging data: A systematic review

Background

At present, the diagnosis of post-traumatic stress disorder（PTSD） mainly relies on clinical symptoms and psychological scales, and finding objective indicators that are helpful for diagnosis has always been a challenge in clinical practice and academic research. Neuroimaging is a useful and powerful tool for discovering the biomarkers of PTSD,especially functional MRI (fMRI), structural MRI (sMRI) and Diffusion Weighted Imaging（DTI）are the most commonly used technologies, which can provide multiple perspectives on brain function, structure and its connectivity. Machine learning (ML) is an emerging and potentially powerful method, which has aroused people's interest because it is used together with neuroimaging data to define brain structural and functional abnormalities related to diseases, and identify phenotypes, such as helping physicians make early diagnosis.

Objectives

According to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) declaration, a systematic review was conducted to assess its accuracy in distinguishing between PTSD patients, TEHC(Trauma-Exposed Healthy Controls), and HC(healthy controls).

Methods

We searched PubMed, Embase, and Web of Science using common words for ML methods and PTSD until June 2023, with no language or time limits. This review includes 13 studies, with sensitivity, specificity, and accuracy taken from each publication or acquired directly from the authors.

Results

All ML techniques have an diagnostic accuracy rate above 70%，and support vector machine（SVM） are the most commonly used techniques. This series of studies has revealed significant neurobiological differences in key brain regions among individuals with PTSD, TEHC, and HC. The connectivity patterns of regions such as the Insula and Amygdala hold particular significance in distinguishing these groups. TEHC exhibits more normal connectivity patterns compared to PTSD, providing valuable insights for the application of machine learning in PTSD diagnosis.

Conclusion

In contrast to any currently available assessment and clinical diagnosis, ML techniques can be used as an effective and non-invasive support for early identification and detection of patients as well as for early screening of high-risk populations.

The impact of isolation on comorbidity of PTSD symptoms and depression: evidence from PTRP-5-6 in China

BACKGROUND

The Omicron pandemic struck Shanghai, China, resulting in impairments of both physical and psychological health on those patients who were confirmed and transferred to the Fangcang shelters. The way of isolation led to high risk of posttraumatic stress symptoms (PTSS) and depressive symptoms among the patients in Fangcang shelters. We aim to estimate the prevalence and comorbidity of PTSS and depressive symptoms in patients from China's Fangcang shelters during the epidemic.

METHODS

Demographic information questionnaire, the posttraumatic stress disorder checklist for DSM-5 (PCL-5), and Patient Health Questionnaire (PHQ-9) were used in the study. The data were collected online via mobile phones during 10th April to 20th April, 2022, as part of our Psychological Trauma Recover Project-5-6 (PTRP-5-6), a longitudinal study focusing on individuals who have experienced trauma.

RESULTS

A total of 336 subjects were included in the analysis. The results revealed (1) the prevalence of depressive symptoms, and PTSS were 30.1% (cut-off = 10) and 6% (cut-off = 33); (2) Multiple logistic regression showed that female (OR = 3.04, p < 0.05), suffering from dyspnea (OR = 5.83, p < 0.05) or gastrointestinal symptoms (OR = 6.38, p < 0.05) were risk factors for PTSS; higher education level (OR = 3.27, p < 0.05) and suffering from dizziness or headache (OR = 2.46, p < 0.05) were risk factors for depressive symptoms; (3)Respectively, 85% of the patients who reported PTSS also experienced depressive symptoms, 16.8% of the patients who reported depressive symptoms presented PTSS.

CONCLUSION

In the context of COVID-19, the comorbidity rate of PTSS and depressive symptoms among patients in Fangcang shelters increased with the severity of depressive symptoms.

Symptoms of post traumatic stress disorder and their relationship with the fear of COVID-19 and COVID-19 burden among health care workers after the full liberalization of COVID-19 prevention and control policy in China: a cross-sectional study

BACKGROUND

Over the past three years, the COVID-19 pandemic has brought an overwhelming impact on China's hospital system and health care workers, which can lead to post traumatic stress disorder (PTSD) symptoms. Previous research has shown that the COVID-19 pandemic had long-term adverse effects on the mental health of health care workers. Indeed, PTSD symptoms have emerged as one of the significant mental health issues for health care workers arising from the COVID-19 pandemic. Therefore, we conducted this cross-sectional survey to investigate the prevalence of PTSD symptoms in health care workers and its relationship with the fear of COVID-19 and the COVID-19 burden after the full liberalization of COVID-19 prevention and control policy in China.

METHODS

This study was conducted three years after the global COVID-19 pandemic (January 15 to January 16, 2023). This study was conducted via the Wenjuanxing platform and used the Chinese versions of the scales PC-PTSD-5, COVID-19 Anxiety Scale (FCV-19S), Social Support Scale, COVID-19 Stress Scale, GAD-2, and PHQ-2.

RESULTS

The prevalence of PTSD symptoms in health care workers was 24.3% (232/955). depression(P < 0.001), anxiety(P < 0.05), the fear of COVID-19(P < 0.001), and COVID-19 burden(P < 0.001) were highly correlated with PTSD symptoms in health care workers. Social support(P < 0.05) was a protective factor of PTSD symptoms.

CONCLUSIONS

This survey shows that PTSD symptoms were highly prevalent among Chinese health care workers after the COVID-19 pandemic. Governments and leaders of medical institutions should, through psychological interventions, address the current situation of PTSD symptoms among health care workers and develop targeted programs and strategies to reduce their psychological problems.

Post-Traumatic Stress Disorder among Polish Healthcare Staff in the Era of the COVID-19 Pandemic

INTRODUCTION

The COVID-19 pandemic has brought many adverse phenomena, particularly in the area of health for both individuals and society as a whole. Healthcare staff also suffered dire consequences.

AIM

The aim of this study was to assess whether the COVID-19 pandemic increased the risk of post-traumatic stress disorder among healthcare professionals in Poland.

MATERIAL AND METHOD

The survey was conducted between 4 April 2022 and 4 May 2022. The study applied the Computer Assisted Web Interview (CAWI) technique using the standardised Peritraumatic Distress Inventory (PDI) questionnaire.

RESULTS

The average score obtained by the respondents on the PDI was 21.24 ± 8.97. There was a statistically significant difference between the average PDI score obtained based on the gender of the subject (Z = 3.873, p = 0.0001.) The score obtained amongst nurses was statistically significantly higher compared to the paramedic group (H = 6.998, p = 0.030). There was no statistically significant difference between the average PDI score obtained based on the age of the participants (F = 1.282, p = 0.281), nor with their length of service (F = 0.934, p = 0.424). A total of 82.44% of the respondents received 14 PDI points, the cut-off point indicating the risk of PTSD that was adopted in the study. It was concluded that 6.12% of respondents did not require intervention (<7 PDI score); 74.28% of respondents needed further follow-up for PTSD and a reassessment of the PDI approximately 6 weeks after the initial testing; and 19.59% required coverage for PTSD prevention and mitigation (>28 PDI score).

CONCLUSIONS

The study has shown a high risk of post-traumatic stress disorder among healthcare professionals in Poland. This risk is related to the gender of the respondents, with an indication of a higher risk of PTSD among women. The results have also shown a correlation between increased risk of post-traumatic stress disorder and occupation, with nurses being the most affected group. In contrast, no association has been found in terms of age and length of service for an increase in the risk of PTSD, following exposure to trauma in relation to healthcare services during the COVID-19 pandemic.

Effects of acupuncture on regulating the hippocampal inflammatory response in rats exposed to post-traumatic stress disorder

Data from clinical and experimental studies have verified the efficacy and safety of acupuncture in the treatment of post-traumatic stress disorder (PTSD). However, the concrete mechanism has not been well elucidated. The stress-induced activation of inflammatory response is involved in the development and pathogenesis of PTSD. Here, we aimed to investigate the effects of acupuncture on regulating the hippocampal inflammatory response in rats exposed to PTSD. Forty male rats were randomly divided into control, model, acupuncture and sertraline group. Within 1 day after adaptive feeding, all rats were exposed to single prolonged stress (SPS), except for the rats in the control group. Rats in acupuncture group were exposed to acupuncture intervention at the acupoints of Baihui (GV20) and Yintang (GV29), 20 min once per day for 15 days. Rats in sertraline group were exposed to a suspension of sertraline and distilled water (0.2 mg/ml), once per day for 15 days continuously. Body weight and elevated plus maze experiment were detected at different time-points to evaluate the behavioral changes of rats. HE staining method was used to observe the basic pathological morphological changes in hippocampus. Immunofluorescence staining method was used to observe the activation of hippocampal microglia. The content of IL-6 and IL-1β in serum were detected by ELISA method. Compared with the control group, the body weight of rats in model group significantly decreased on 8 days, and the percentage of time in open arms and open arm entries decreased significantly on 15 days after SPS procedures, which indicated that SPS induced PTSD-like behavior in rats. Acupuncture exerted therapeutic effect. Simultaneously, the result of HE staining confirmed that SPS induced hippocampal morphological changes in SPS rats. Notably, acupuncture reversed the reduction and pathological injury to some extent. The results have also shown that acupuncture intervention effectively reversed the activated microglia of the hippocampus in rats. Moreover, the expression of IL-1β in serum was significantly decreased by acupuncture intervention. In summary, the present study demonstrated that the role of acupuncture in eliminating PTSD-like behavior might be connected with reversing the pathological process of the inflammatory response mediated by the activation of microglia induced by SPS.

Neuropharmacological interventions of quercetin and its derivatives in neurological and psychological disorders

Quercetin is a naturally occurring bioactive flavonoid abundant in many plants and fruits. Quercetin and its derivatives have shown an array of pharmacological activities in preclinical tests against various illnesses and ailments. Owing to its protective role against oxidative stress and neuroinflammation, quercetin is a possible therapeutic choice for the treatment of neurological disorders. Quercetin and its derivatives can modulate a variety of signal transductions, including neuroreceptor, neuroinflammatory receptor, and redox signaling events. The research on quercetin and its derivatives in neurology-related illnesses mainly focused on the targets, such as redox stress, neuroinflammation, and signaling pathways; however, the function of quercetin and its derivatives on specific molecular targets, such as nuclear receptors and proinflammatory mediators are yet to be explored. Findings showed that various molecular targets of quercetin and its derivatives have therapeutic potential against psychological and neurodegenerative disorders.

Burdens and psychosocial consequences of the COVID-19 pandemic for Austrian children and adolescents

OBJECTIVES

The negative psychosocial effects of the COVID-19 pandemic are becoming increasingly apparent. Children and adolescents in particular, were affected and torn away from their daily life routines. The aim of our survey is to evaluate the psychosocial burden and impairments of children and adolescents in Austria during the COVID-19 pandemic by using cross-sectional analysis.

SETTING

An Austrian-wide online survey was conducted from 21 February to 19 April 2021 for children and adolescents. The questionnaire was distributed widely using the national press agency and public media.

PARTICIPANTS

Using an online questionnaire, 5,483 children and adolescents between 6 and 18 years of age were sampled.

OUTCOME MEASURE

Quantitative responses to questions regarding the children's feelings, worries, and needs concerning the COVID-19 pandemic were measured. Furthermore, the children were sampled for subjective risk perception as well as their sleep quality.

RESULTS

Most children reported a high degree of fear due to the pandemic, especially female (48.1%) participants being under more emotional strain than their male (35.9%) counterparts. Associated with this, we found a strong overestimation of COVID-19-associated hospitalization likelihood (>100-fold) across all age groups. In addition, an alarming lack of positive perspective during the ongoing pandemic is evident across all age groups, including the youngest participants aged 6-10 years. Feelings of anger and annoyance (58.2%), loneliness (46%), and sadness (42.7%) are reported much more frequently than before the pandemic. On the other hand, only 15.6% reported feeling well (or even better; 2%) since the COVID-19 pandemic. Last but not least, our study shows an alarming 37% of children and adolescents who now report poorer sleep quality than before the pandemic.

CONCLUSION

The results of this survey indicate the high burden and emotional strain for children and adolescents during the pandemic. Personal contact with friends and family is mentioned as the most protective factor for their mental health. The study results underscore the need for immediate action to limit the collateral damage that has already occurred on a psychosocial and developmental level among younger generations worldwide.

An exploration of the antecedents and mechanisms causing athletes' stress and twisties symptom

Research background

Twisties symptoms have attracted the world's attention in the sports field since the 2020 Tokyo Olympics.

Aim

However, studies on the symptoms and causes, inducing mechanisms, and relationships between DP/DR (Depersonalization/Derealization Disorder) and anxiety and depression for athletes have been sparse for both the general population and athletes. The literature on the twisties issue of athletes is quite scarce in the past.

Research method

Adopting the criteria appealing to PRISMA Items to review the subject twisties in a broader mode and combing with the IPO (Input-Process-Output) model for triangulation testing purpose, this study categorized the literature to explore input variables causing athletes' twisties and identified process variables in psychological mechanisms bridging suppression and finally discussed the existing possible ways in helping athletes to solve problems caused by twisties.

Results

The authors formed 6 propositions in summarizing twisties' influential factors and mechanisms and tried to propose solutions to reduce the stress and the relevant twisties symptom of athletes. (1) Promotion of Athletes' Mental Toughness to Resist Stressors. (2) Interventions that correct for cognitive misinterpretations and appropriate relaxation and mindfulness practice in correcting a range of attention might reduce DP/DR. (3) Monitoring the athlete's HRV test results to ensure the Athlete's ability to resist pressure. (4) Avoid organizational stressors. (5) Written Emotional Disclosure method. (6) Improve various support systems for athletes: dual career paths. (7) Athletes' Stressful Awareness about the impact of gender, seniority, and environment.

Conclusion

Through the theoretical dialogue on the symptom of twisties, this study helps promote the development of the research of "twisties" and depersonalization-derealization symptoms (DDS); both have been under-researched.

Tanshinone IIA improves contextual fear- and anxiety-like behaviors in mice via the CREB/BDNF/TrkB signaling pathway

Posttraumatic stress disorder (PTSD) is one of the most common psychiatric diseases, which is characterized by the typical symptoms such as re-experience, avoidance, and hyperarousal. However, there are few drugs for PTSD treatment. In this study, conditioned fear and single-prolonged stress were employed to establish PTSD mouse model, and we investigated the effects of Tanshinone IIA (TanIIA), a natural product isolated from traditional Chinese herbal Salvia miltiorrhiza, as well as the underlying mechanisms in mice. The results showed that the double stress exposure induced obvious PTSD-like symptoms, and TanIIA administration significantly decreased freezing time in contextual fear test and relieved anxiety-like behavior in open field and elevated plus maze tests. Moreover, TanIIA increased the spine density and upregulated synaptic plasticity-related proteins as well as activated CREB/BDNF/TrkB signaling pathway in the hippocampus. Blockage of CREB remarkably abolished the effects of TanIIA in PTSD model mice and reversed the upregulations of p-CREB, BDNF, TrkB, and synaptic plasticity-related protein induced by TanIIA. The molecular docking simulation indicated that TanIIA could interact with the CREB-binding protein. These findings indicate that TanIIA ameliorates PTSD-like behaviors in mice by activating the CREB/BDNF/TrkB pathway, which provides a basis for PTSD treatment.

Stigmatization related COVID-19 and PTSD among Chinese graduates

BACKGROUND

Since COVID-19 broke out worldwide, it had caused extensive public health concerns and psychological distress, including PTSD and stigmatization towards recovered patients and people from high-risk areas. However, the association between PTSD, stigmatization and certain related factors have not been confirmed.

METHODS

Through cluster random sampling, 946 Chinese graduates were investigated from 5 universities in Shanghai at three months after China lifted its coronavirus lockdown. PTSD symptoms were evaluated with PCL-5. Demographic and disease-related characteristics including stigmatization, educational attainment and working position were collected to assess their association with PTSD.

RESULTS

12.4% graduates were reported significant PTSD symptoms in PCL-5 screening with a cut-off of 33. Graduates with a Master's degree (P = 0.02) or working position like "looking for a job" and "planning to go abroad" (P = 0.038) showed severer stigmatization related to COVID-19. Stigmatization towards both patients recovering from COVID-19 and people from high-risk areas had significant association with PTSD symptoms. Multivariate linear regression analysis showed that stigmatization can explain 5% of variation of PCL-5 scores after controlling gender, age, educational attainments and working position.

CONCLUSION

Graduates who were looking for jobs or preparing to go abroad showed more stigmatization related to COVID-19. There was a positive correlation between stigma against COVID-19 and PTSD symptoms. More attention should be paid to the mental health status of graduates who are preparing to go abroad or looking for jobs.

Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention

Post-traumatic stress disorder (PTSD) is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and the International Classification of Diseases 11th Edition (ICD-11) offer the most widely accepted diagnostic guidelines for PTSD. In both diagnostic categories, experiencing a traumatic event (TE) is the necessary criterion for diagnosing PTSD. The TEs described in the DSM-5 include actual or threatened death, serious injury, sexual violence, and other extreme stressors, either directly or indirectly. More than 70% of adults worldwide are exposed to a TE at least once in their lifetime, and approximately 10% of individuals develop PTSD after experiencing a TE. The important features of PTSD are intrusion or re-experiencing fear memories, pervasive sense of threat, active avoidance, hyperarousal symptoms, and negative alterations of cognition and mood. Individuals with PTSD have high comorbidities with other psychiatric diseases, including major depressive disorder, generalized anxiety disorder, and substance use disorder. Multiple lines of evidence suggest that the pathophysiology of PTSD is complex, involving abnormal neural circuits, molecular mechanisms, and genetic mechanisms. A combination of both psychotherapy and pharmacotherapy is used to treat PTSD, but has limited efficacy in patients with refractory PTSD. Because of the high prevalence, heavy burden, and limited treatments, PTSD is a psychiatric disorder that requires urgent attention. In this review, we summarize and discuss the diagnosis, prevalence, TEs, pathophysiology, and treatments of PTSD and draw attention to its prevention.

The Psychological Impact of Quarantine During the COVID-19 Pandemic on Quarantined Non-Healthcare Workers, Quarantined Healthcare Workers, and Medical Staff at the Quarantine Facility in Saudi Arabia

Background

COVID-19 is a viral infectious disease that spreads quickly through droplets. It is highly contagious and could overwhelm the health system. Because of that, many governments established health quarantines for suspected infected people to minimize the spread of this disease.

Objective

This study aimed to assess the prevalence of depression, anxiety, and stress symptoms and to address the associated risk factors among quarantined non-healthcare workers, quarantined healthcare workers, and medical staff in the Ministry of Health quarantine facility.

Patients and Methods

We conducted an analytical cross-sectional study at the health quarantine in Jazan, Saudi Arabia. The total number of participants was 301 individuals. Furthermore, the study questionnaire was composed of three sections, the first two were the background and clinical characteristics, and the last one was DASS 21 scale. Also, we used SPSS software to analyze the data. Lastly, we implemented logistic regression to assess the predictors of depression, anxiety, and stress symptoms.

Results

The prevalence of depression, anxiety, and stress symptoms among quarantined non-healthcare workers were 51.9%, 60.2%, and 40.6%, respectively. These prevalences were 25.0%, 29.8%, and 16.9% among quarantined healthcare workers and 20.5%, 20.5%, and 27.3% among the medical staff. The predictors of depression, anxiety, and stress symptoms among the study participants were female gender, perceived COVID-19 stigma, presence of other relatives in quarantine, comorbidities, and abnormal sleep duration.

Conclusion and Recommendations

Health quarantine is an environment that could negatively affect people's mental health. The quarantined non-healthcare workers were the most affected study participants inside this environment. Therefore, the availability of mental health services there could minimize their depression, anxiety, and stress symptoms. Moreover, a home quarantine would be better to reduce these negative symptoms whenever possible.

Hippocampal Activated Microglia May Contribute to Blood–Brain Barrier Impairment and Cognitive Dysfunction in Post-Traumatic Stress Disorder-Like Rats

Post-traumatic stress disorder (PTSD)-associated cognitive dysfunction significantly disturbs patients’ quality of life and will to live. However, its underlying mechanism is as yet unknown. Recent researches indicate that blood–brain barrier (BBB) breakdown is responsible for early cognitive dysfunction. Microglia might participate in remodeling of BBB-associated tight junction and regulating BBB integrity. Nevertheless, it is unclear whether microglia activation and BBB injury involve in PTSD-associated cognitive dysfunction. Hence, we established an animal model of PTSD, single prolonged stress (SPS), and investigated permeability changes in the hippocampus and further explored the effects of microglia on BBB remodeling. The Y maze was used to assess the changes of cognitive function. The sodium fluorescein (NaFlu) assay and western blotting analysis were employed to detect BBB integrity changes. Minocycline was administered to inhibit microglial activation. Immunofluorescence stains were used to assess the activation states in microglia. The results showed that SPS-exposed rats exhibited poorer cognitive performance, higher passage of NaFlu, and lower expression of tight junction proteins (occludin and claudin 5) in the hippocampus on the day after SPS, but no difference on the 7th day. Inhibition of microglial activation by minocycline attenuated poor cognitive performance and BBB impairment including the extravasation of NaFlu and protein levels of the tight junction. Taken together, the present study indicates that BBB impairment may underlie the shared pathological basis of PTSD and cognitive dysfunction. Microglial activation may involve in BBB remodeling at the early stage of SPS.

The Hidden Factors Affecting Academic Performance Among Chinese Middle School Students: Traumatic Experience and Posttraumatic Stress Symptoms

Background and Purpose

The role of posttraumatic stress disorder (PTSD) in the path from traumatic exposure (TE) to academic performance (AP) is still not explicitly illustrated. The current study aimed to examine the moderator role of PTSD on the relationship between TE and AP, and then to investigate whether this moderator role is influenced by gender.

Participants and Methods

A sample of Chinese students (n=235) who had experienced the major earthquake of Wenchuan was chosen. PTSD and TE were measured by the Impact of Event Scale – Revised (IES-R) and an earthquake-related experience questionnaire, respectively. AP was collected from their up-to-date general examination. Data for 221 participants (53.4% female; mean age=14.03 years, SD=0.824) were finally included in the analysis. Parsimonious latent-variable interaction analysis and hierarchical regression analysis were adopted to examine the moderator role of PTSD.

Results

The average IES-R score was 27.57 (SD=13.265, range 0–67). The average score for earthquake exposure was 5.86 (SD=2.069, range 1–12). The results showed that both TE and the interaction term of PTSD*TE had significant negative correlations with AP, while PTSD was not associated with AP. Subsequent hierarchical regression analysis found that the relationship of the interaction term and AP was only significant in female students, and a simple slope plot showed a distinct pattern of the moderating effect of PTSD in both genders.

Conclusion

This study supported that PTSD moderated the connection between TE and AP in middle school students who had undergone a major earthquake trauma, which was influenced by gender. Students who experienced major trauma with drastic exposure history and manifested PTSD symptoms need specified intervention to avoid further deterioration in performance in school.

Do positive and negative emotional reactions during war predict subsequent symptomatology? A prospective experience sampling study

While peritraumatic negative emotions have been associated with subsequent posttraumatic stress and depression, the predictive role of real-time emotional reactions to specific stressors during prolonged stress exposure is still unclear, particularly that of positive emotions. The current study uses experience sampling methodology to examine individual general levels of negative and positive emotions, and emotional reactivity to specific stressors during war, as prospective predictors of posttraumatic stress and depression. Ninety-six civilians exposed to rocket fire during the 2014 Israel-Gaza war reported exposure to rocket warning sirens and levels of ten negative and six positive emotions twice a day for 30 days. Symptoms of posttraumatic stress and depression were then assessed two months post-war. Participants reported higher negative emotions and lower positive emotions during assessment windows with sirens. Over time, negative emotions decreased and positive emotions increased. Higher levels of overall negative emotions predicted posttraumatic stress symptoms and depression symptoms two months later. Levels of positive emotions, and negative and positive emotional reactivity to sirens, were not associated with subsequent symptomatology. Our results indicate the stronger role of overall negative emotions as predictors of symptomatology compared with momentary emotional reactivity, and the stronger predictive role of negative compared with positive emotions.

Translational relevance of behavioral, neural, and electroencephalographic profiles in a mouse model of post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a severe, long-term psychological disorder triggered by distressing events. The neural basis and underlying mechanisms of PTSD are not completely understood. Therefore, it is important to determine the pathology of PTSD using reliable animal models that mimic the symptoms of patients. However, the lack of evidence on the clinical relevance of PTSD animal models makes it difficult to interpret preclinical studies from a translational perspective. In this study, we performed a comprehensive screening of the behavioral, neuronal, glial, and electroencephalographic (EEG) profiles in the single prolonged stress and electric foot shock (SPS&S) mouse model. Based on the clinical features of PTSD, we observed fearful and excessive responses to trauma-related environments in the SPS&S mouse model that lasted longer than 14 days. The mice exhibited a defective and strong resistance to the extinction of fear memories caused by auditory cues and also showed enhanced innate fear induced by visual stimuli with concomitant phobias and anxiety. Furthermore, neurons, astrocytes, and microglia in PTSD-related brain regions were activated, supporting abnormal brain activation and neuroimmune changes. EEG assessment also revealed decreased power and impaired coupling strength between cortical regions. These results demonstrated that the SPS&S mouse model recapitulates the behavioral symptoms as well as neural and EEG profiles of PTSD patients, justifying the preclinical use of this mouse model.