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Hoeboer CM, Karaban I, Karchoud JF, Olff M, van Zuiden M. Validation of the PCL-5 in Dutch trauma-exposed adults. BMC Psychol 2024; 12:456. [PMID: 39198929 PMCID: PMC11351185 DOI: 10.1186/s40359-024-01951-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/14/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND The PTSD Checklist for DSM-5 (PCL-5) is an internationally widely used self-report questionnaire that can be used to screen for probable diagnosis of posttraumatic stress disorder (PTSD). Information on the psychometric properties of the Dutch PCL-5 is currently lacking. OBJECTIVE We aimed to validate the Dutch PCL-5 in a sample of Dutch adults with prior (suspected) serious injury and establish the optimal cut-off for probable PTSD diagnosis herein. METHODS Data for the current study were collected as part of a long-term follow-up measurement of the TraumaTIPS cohort, where adults admitted to an emergency department following (suspected) serious injury completed a follow-up measurement 12-15 years post-trauma. Of N = 333 eligible participants, n = 192 (57.7%) consented and completed the PCL-5 alongside self-report instruments measuring depression (QIDS), PTSD (IES-R), and quality of life (WHO-QOL and EQ-6D). In total, n = 185 participants also completed a clinician administered interview for PTSD (CAPS-5). Most participants were men (66%) and on average 54 years old (SD = 12.41). We evaluated the diagnostic utility of the PCL-5 using Youden index and tested reliability and convergent validity. RESULTS The PCL-5 demonstrated excellent diagnostic accuracy with a cut-off point of 16 resulting in an optimal Youden index (0.90) for screening purposes with a high sensitivity (1.00) and specificity (0.90). A cut-off of 22 yielded a slightly lower Youden index (0.84) but better positive predictive value (0.50 instead of 0.33) than the cut-off of 16. A cut-off of 29 resulted in the most accurate prevalence estimates. The PCL-5 showed a high internal consistency (Cronbach's α = 0.94), excellent inter-item and item-total correlations and good convergent validity (r > .5 for CAPS-5, IES-R and QIDS). CONCLUSIONS The PCL-5 is a reliable and valid measurement for PTSD symptoms and probable diagnosis and shows excellent screening abilities in Dutch adults with prior (suspected) serious injury, with a lower optimal cut-off compared to previously found in clinical populations. We recommend a cut-off of 22 for screening purposes and a cut-off of 29 for prevalence estimates in Dutch trauma-exposed adults.
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Affiliation(s)
- Chris M Hoeboer
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 5, Amsterdam, 1005 AZ, The Netherlands.
- Amsterdam Public Health, Mental Health, Amsterdam, The Netherlands.
| | - Irina Karaban
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 5, Amsterdam, 1005 AZ, The Netherlands
| | - Jeanet F Karchoud
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 5, Amsterdam, 1005 AZ, The Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 5, Amsterdam, 1005 AZ, The Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 5, Amsterdam, 1005 AZ, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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Mutuyimana C, Maercker A. How meaning in life and vitality are associated with posttrauma outcomes: A systematic review. J Trauma Stress 2024; 37:551-562. [PMID: 38580621 DOI: 10.1002/jts.23040] [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] [Received: 09/03/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 04/07/2024]
Abstract
When confronted with a traumatic event, people may suffer from adverse posttraumatic outcomes, such as posttraumatic stress disorder (PTSD) or complex PTSD (CPTSD). Positive psychology research has shown that meaning in life and vitality are potentially correlated protective factors against negative developments following trauma exposure that can lead to PTSD or CPTSD. This systematic review aimed to synthesize global empirical research findings, emphasizing the impact of meaning in life and vitality on both PTSD and CPTSD. A search of empirical studies was performed within the Embase, Scopus, and Web of Science core collection databases, as well as PsycInfo, using the PRISMA checklist. A total of 29 studies were included after a systematic exclusion process. The collective findings from 22 studies examining meaning in life and five studies focusing on vitality revealed a consistent negative association with symptoms of PTSD. No study that explored the associations among meaning in life, vitality, and CPTSD was found. In contrast to vitality, meaning in life has been extensively studied in relation to traumatic stress worldwide, and few discrepancies in results were found. This systematic review identified the need to intensify scientific efforts in capitalizing on meaning in life as a possible target for psychological interventions, especially for trauma survivors globally, and to consider vitality as a protective factor that needs more empirical attention in relation to posttraumatic stress. Furthermore, there is a need for studies that encompass diverse target samples and employ longitudinal study design to examine the associations between protective factors and CPTSD.
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Affiliation(s)
- Celestin Mutuyimana
- Division of Psychopathology and Clinical Intervention, Institute of Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Collegium Helveticum, Switzerland
| | - Andreas Maercker
- Division of Psychopathology and Clinical Intervention, Institute of Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
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Byrow Y, Nickerson A, Specker P, Bryant R, O'Donnell M, McMahon T, Mau V, Liddell B. The impact of age-related differences in emotion dysregulation on refugee mental health and social outcomes. J Trauma Stress 2024. [PMID: 39075844 DOI: 10.1002/jts.23088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/16/2024] [Accepted: 06/20/2024] [Indexed: 07/31/2024]
Abstract
The refugee experience is typically characterized by exposure to numerous premigration traumatic events and postmigration stress in the resettlement environment. Refugees' experiences can lead to elevated rates of psychopathology, including posttraumatic stress disorder (PTSD) and depression. Emotion regulation is a key mechanism contributing to mental health outcomes among refugees. This study examined the impact of age on the association between emotion regulation and critical social outcomes relevant to refugee resettlement, such as social engagement and functional impairment. Participants were 1,081 Arabic-, Farsi-, Tamil- and English-speaking adult refugees. Premigration trauma exposure, postmigration stressors, PTSD symptoms, depressive symptoms, emotion regulation, social engagement, and functional impairment were measured. A series of hierarchical regression and Poisson regression analyses revealed emotion dysregulation as a significant predictor of functional impairment, β = .36, p < .001, and social engagement, Exp B = 0.99, p = .002. A significant interaction between age and emotion dysregulation was associated with both PTSD, β = .05, p = .048 and depressive symptoms, β = .06, p = .010, suggesting a stronger positive association between emotion dysregulation and both PTSD and depressive symptom severity for older individuals. Postmigration stressor exposure, emotion dysregulation, and older age are important factors that may negatively impact social engagement and functional impairment in the resettlement environment. Additionally, higher levels of trauma exposure may negatively impact social engagement. These findings have implications for public health and social services in the context of resettled refugee communities.
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Affiliation(s)
- Yulisha Byrow
- School of Psychology, University of New South Wales Sydney, Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales Sydney, Sydney, Australia
| | - Philippa Specker
- School of Psychology, University of New South Wales Sydney, Sydney, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales Sydney, Sydney, Australia
| | | | - Tadgh McMahon
- Settlement Services International, Ashfield, Australia
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Vicki Mau
- Australian Red Cross, North Melbourne, Australia
| | - Belinda Liddell
- School of Psychology, University of New South Wales Sydney, Sydney, Australia
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Kaur K, Asnaani A, Levy HC, Miller ML, Tolin DF, McLean CP. Moving beyond symptom reduction: A meta-analysis on the effect of exposure therapy for PTSD on quality of life. J Clin Psychol 2024. [PMID: 38875442 DOI: 10.1002/jclp.23727] [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: 06/23/2023] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES Quality of life (QOL) is a multidimensional construct including emotional well-being, life satisfaction, and physical health. Individuals with posttraumatic stress disorder (PTSD) consistently report low QOL, highlighting the importance of assessing the effectiveness of first-line PTSD treatments (e.g., exposure-based therapies) on QOL. This meta-analysis examined the efficacy of exposure therapy for PTSD on QOL compared to control conditions (e.g., waitlist, medication, treatment-as-usual) at posttreatment and follow-up (ranging from 1 month to 2 years). METHODS Building on a previous meta-analysis of exposure-based therapy for PTSD, we searched PsycINFO and Medline in December 2021, July 2022, and March 2023 to include randomized controlled trials of exposure-based treatments for adult PTSD assessing QOL. We screened 295 abstracts for initial eligibility; 20 articles met inclusion criteria and were included (N = 2729 participants). Risk of bias was evaluated using the Cochrane Risk of Bias tool 2.0. RESULTS At posttreatment, exposure-based therapies showed a medium effect on QOL relative to control conditions (k = 25, g = 0.67). This effect was not observed at follow-up for the small subset of studies with follow-up data (k = 8, g = 0.16). At posttreatment, effect size varied significantly as a function of the control condition (p < .0001). There were no differences in QOL effects across exposure therapies at posttreatment or follow-up (p = .09). CONCLUSION Exposure therapy was associated with greater improvement in QOL compared to control conditions at posttreatment. Exposure was not superior to control conditions at follow-up, and the longer-term impact of exposure on QOL is unclear. The implications of these findings are discussed, along with the need for more PTSD treatment studies to examine QOL outcomes at posttreatment and follow-up.
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Affiliation(s)
- Kiran Kaur
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Anu Asnaani
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Hannah C Levy
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, Hartford, Connecticut, USA
| | - Madeleine L Miller
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - David F Tolin
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, Hartford, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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Paiva JM, Dos Santos Melani M, Marques ESN, Arcosy CV, Coutinho ESF, Ventura P, Berger W. The efficacy of internet-delivered cognitive-behavioral therapy for posttraumatic stress disorder according to the mean age of patients: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2024; 29:683-697. [PMID: 38083873 DOI: 10.1080/13548506.2023.2292478] [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: 04/30/2023] [Accepted: 12/04/2023] [Indexed: 03/26/2024]
Abstract
Internet-delivered cognitive-behavioral therapy (I-CBT) is effective in treating post-traumatic stress disorder (PTSD) symptoms, offering enhanced accessibility and cost-effectiveness. However, it's important to note that these technologies may not be suitable for all age groups. Therefore, we conducted a systematic review and meta-analysis to determine if the effectiveness of I-CBT in treating PTSD varies based on the patients' mean age. We conducted a systematic review of the literature, focusing on randomized controlled trials (RCTs) in the ISI Web of Science, PubMed/MEDLINE, and PsycINFO databases. Following this, we performed a meta-analysis and evaluated the risk of bias using the Cochrane risk of bias quality assessment tool. In this study, we examined patient-related factors (civil or military status, age, and gender), clinical characteristics (baseline PTSD severity and type of trauma), and treatment characteristics (type of intervention, synchronous or asynchronous delivery, and the number of sessions) as independent variables. The dependent variable was the reduction in mean PTSD symptoms. Five RCTs out of 1,552 screened studies were included in this review, all of which showed some level of concern regarding potential bias. Our meta-analysis indicates that I-CBT is equally effective regardless of patients' mean age. Since all RCTs included only provide the mean age of the patients, further randomized controlled trials should address the effectiveness of I-CBT among different age groups.
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Affiliation(s)
- Jéssica Meirelles Paiva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marina Dos Santos Melani
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elisa Schoenche Nunes Marques
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cheyenne von Arcosy
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Paula Ventura
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Bouras NN, Mack NR, Gao WJ. Prefrontal modulation of anxiety through a lens of noradrenergic signaling. Front Syst Neurosci 2023; 17:1173326. [PMID: 37139472 PMCID: PMC10149815 DOI: 10.3389/fnsys.2023.1173326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Anxiety disorders are the most common class of mental illness in the U.S., affecting 40 million individuals annually. Anxiety is an adaptive response to a stressful or unpredictable life event. Though evolutionarily thought to aid in survival, excess intensity or duration of anxiogenic response can lead to a plethora of adverse symptoms and cognitive dysfunction. A wealth of data has implicated the medial prefrontal cortex (mPFC) in the regulation of anxiety. Norepinephrine (NE) is a crucial neuromodulator of arousal and vigilance believed to be responsible for many of the symptoms of anxiety disorders. NE is synthesized in the locus coeruleus (LC), which sends major noradrenergic inputs to the mPFC. Given the unique properties of LC-mPFC connections and the heterogeneous subpopulation of prefrontal neurons known to be involved in regulating anxiety-like behaviors, NE likely modulates PFC function in a cell-type and circuit-specific manner. In working memory and stress response, NE follows an inverted-U model, where an overly high or low release of NE is associated with sub-optimal neural functioning. In contrast, based on current literature review of the individual contributions of NE and the PFC in anxiety disorders, we propose a model of NE level- and adrenergic receptor-dependent, circuit-specific NE-PFC modulation of anxiety disorders. Further, the advent of new techniques to measure NE in the PFC with unprecedented spatial and temporal resolution will significantly help us understand how NE modulates PFC function in anxiety disorders.
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Mendlowicz V, Garcia-Rosa ML, Gekker M, Wermelinger L, Berger W, Luz MPD, Pires-Dias PRT, Marques-Portela C, Figueira I, Mendlowicz MV. Post-traumatic stress disorder as a predictor for incident hypertension: a 3-year retrospective cohort study. Psychol Med 2023; 53:132-139. [PMID: 33849680 DOI: 10.1017/s0033291721001227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The goal of the present study was to investigate the association between PTSD and the onset of hypertension in previously normotensive individuals in a population living in the stressful environment of the urban slums while controlling for risk factors for cardiovascular disease (CVD). METHODS Participants were 320 normotensive individuals who lived in slums and were attending a family doctor program. Measurements included a questionnaire covering sociodemographic characteristics, clinical status and life habits, the Posttraumatic Stress Disorder Checklist - Civilian Version, and the Beck Depression Inventory. Incident hypertension was defined as the first occurrence at the follow-up review of the medical records of (1) systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, (2) the participant started taking antihypertensive medication, or (3) a new diagnosis of hypertension made by a physician. Differences in sociodemographic, clinical, and lifestyle characteristics between hypertensive and non-hypertensive individuals were compared using the χ2 and t tests. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Six variables - age, educational level, body mass, smoking, diabetes, and PTSD diagnosis - showed a statistically significant (p ≤ 0.20) association with the hypertensive status. In the Cox regression, only PTSD diagnosis was significantly associated with incident hypertension (multivariate HR = 1.94; 95% CI 1.11-3.40). CONCLUSIONS The present findings highlight the importance of considering a diagnostic hypothesis of PTSD in the prevention and treatment of cardiovascular diseases.
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Affiliation(s)
| | - Maria Luiza Garcia-Rosa
- Department of Epidemiology and Biostatistics, Universidade Federal Fluminense (MEB-UFF), Niteroi, Brazil
| | - Marcio Gekker
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Mariana Pires de Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | - Carla Marques-Portela
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niteroi, Brazil
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Marengo D, Hoeboer CM, Veldkamp BP, Olff M. Text mining to improve screening for trauma-related symptoms in a global sample. Psychiatry Res 2022; 316:114753. [PMID: 35940089 DOI: 10.1016/j.psychres.2022.114753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022]
Abstract
Previous studies showed that textual information could be used to screen respondents for posttraumatic stress disorder (PTSD). In this study, we explored the feasibility of using language features extracted from short text descriptions respondents provided of stressful events to predict trauma-related symptoms assessed using the Global Psychotrauma Screen. Texts were analyzed with both closed- and open-vocabulary methods to extract language features representing the occurrence of words, phrases, or specific topics in the description of stressful events. We also evaluated whether combining language features with self-report information, including respondents' demographics, event characteristics, and risk factors for trauma-related disorders, would improve the prediction performance. Data were collected using an online survey on a cross-national sample of 5048 respondents. Results showed that language data achieved the highest predictive power when both closed- and open-vocabulary features were included as predictors. Combining language data and self-report information resulted in a significant increase in performance and in a model which achieved good accuracy as a screener for probable PTSD diagnosis (.7 < AUC ≤ .8), with similar results regardless of the length of the text description of the event. Overall, results indicated that short texts add to the detection of trauma-related symptoms and probable PTSD diagnosis.
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Affiliation(s)
- D Marengo
- Department of Psychology, University of Turin, Via Verdi 10, Turin 10124, Italy
| | - C M Hoeboer
- Department of Psychiatry, Amsterdam Public Health, University of Amsterdam, Amsterdam UMC location, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands.
| | - B P Veldkamp
- ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | | | - M Olff
- Department of Psychiatry, Amsterdam Public Health, University of Amsterdam, Amsterdam UMC location, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Department of Learning, Data-Analytics, and Technology, Faculty of Behavioral Management and Social Sciences, University of Twente, the Netherlands
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Panisch LS, Rogers RG, Breen MT, Nutt S, Dahud S, Salazar CA. Childhood betrayal trauma, dissociation, and shame impact health-related quality of life among individuals with chronic pelvic pain. CHILD ABUSE & NEGLECT 2022; 131:105744. [PMID: 35749903 DOI: 10.1016/j.chiabu.2022.105744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND High betrayal trauma (HBT), or interpersonal trauma perpetrated by someone close, is linked to dissociation and shame, while trauma perpetrated by someone less close, low betrayal trauma (LBT) is associated with post-traumatic stress disorder (PTSD). OBJECTIVE Child interpersonal trauma is common among women with chronic pelvic pain (CPP) and can negatively impact physical and mental health-related quality of life (HRQOL). Our study investigates unexplored connections between these variables. PARTICIPANTS & SETTING Survey data were analyzed from 96 English-speaking female patients with CPP at a women's health clinic (mean age = 33, 59 % White non-Hispanic, 62 % married or cohabitating, 61.5 % completed post-high school degree); prevalence of HBT and LBT were 65.2 % and 45.6 %, respectively. METHODS Multiple regression analyzed relationships between mental and physical HRQOL and dissociation, shame, and PTSD. Parallel mediation analyses examined indirect relationships between mental and physical HRQOL and exposure to childhood HBT and LBT. RESULTS Dissociation was related to worse physical HRQOL, while shame was related to worse physical and mental HRQOL. Dissociation and shame mediated relationships between childhood HBT and current mental (R2 = 0.08, p = .01) and physical (R2 = 0.11, p = .002) HRQOL. Shame, but not PTSD, mediated relationships between childhood LBT and current mental (R2 = 0.14, p < .001) and physical (R2 = 0.16, p < .001) HRQOL. CONCLUSIONS Our study provides preliminary evidence that dissociation and shame negatively impact HRQOL among individuals with CPP in the context of exposure to different types of childhood betrayal trauma. Replication studies to validate our results with larger samples and longitudinal designs are encouraged.
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Affiliation(s)
- Lisa S Panisch
- Wayne State University School of Social Work, 5447 Woodward Avenue, Detroit, MI 48202, United States of America.
| | - Rebecca G Rogers
- Department of Obstetrics and Gynecology, Albany Medical Center, 391 Myrtle Ave #2, Albany, NY 12208, United States of America
| | - Michael T Breen
- Department of Women's Health, University of Texas at Austin, 1601 Trinity Street, Bldg. A, 9th Floor, Austin, TX 78712, United States of America; Dell Medical School, University of Texas at Austin, 1501 Red River St, Austin, TX 78712, United States of America
| | - Stephanie Nutt
- Department of Women's Health, University of Texas at Austin, 1601 Trinity Street, Bldg. A, 9th Floor, Austin, TX 78712, United States of America
| | - Soraya Dahud
- Department of Women's Health, University of Texas at Austin, 1601 Trinity Street, Bldg. A, 9th Floor, Austin, TX 78712, United States of America
| | - Christina A Salazar
- Department of Women's Health, University of Texas at Austin, 1601 Trinity Street, Bldg. A, 9th Floor, Austin, TX 78712, United States of America; Dell Medical School, University of Texas at Austin, 1501 Red River St, Austin, TX 78712, United States of America
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Rzepka I, Zehetmair C, Roether E, Kindermann D, Cranz A, Junne F, Friederich HC, Nikendei C. Impact of and Coping with Post-Traumatic Symptoms of Refugees in Temporary Accommodations in Germany: A Qualitative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10893. [PMID: 36078608 PMCID: PMC9518066 DOI: 10.3390/ijerph191710893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Due to pre-, peri- and post-migratory stress factors, refugees often experience higher levels of psychological stress than the general population. Post-traumatic stress disorder, in particular, has an increased prevalence in the refugee population. However, living conditions in the early post-migratory phase are characterized by many challenges. In the present qualitative study, 14 refugees with symptoms of PTSD from temporary accommodations in Germany were interviewed in semi-structured interviews about their individual experiences of the impact of their trauma sequelae symptoms on their current living conditions and interactions. Participants reported dealing with post-traumatic symptoms primarily through distraction strategies, such as working or learning the language or social interaction. Many reported a sense of mistrust as a result of traumatic experiences. Current stress factors cited included uncertain asylum status, worry about family members and lack of ability to influence living situations. The interactions between the post-traumatic symptoms and the living conditions of the refugees were highlighted. The effects of the symptomatology of trauma sequelae and the framework conditions under which refugees live can lead to aggravated psychological distress. Therefore, special attention must be paid to refugee mental health care.
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Affiliation(s)
- Irja Rzepka
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Catharina Zehetmair
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Emma Roether
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - David Kindermann
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Anna Cranz
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Magdeburg University Hospital, 39120 Magdeburg, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Christoph Nikendei
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69120 Heidelberg, Germany
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Zhang G, Wang F, Ran Y, Liu D. Applications of the ultrasound-guided nerve block technique for nonanalgesic effects. IBRAIN 2022; 8:389-400. [PMID: 37786735 PMCID: PMC10528970 DOI: 10.1002/ibra.12061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 10/04/2023]
Abstract
The nerve block technique guided by ultrasound has been able to accurately block tiny nerves throughout the body in recent years. It has been increasingly used to treat multisystem diseases or analgesia in surgical patients, but the latter accounted for the vast majority of cases. The nonanalgesic effect of nerve blocks is also in wide demand. After searching ultrasound-guided nerve block works on the PubMed database, we systematically summarized the current clinical application of the nerve block technique and the unique role and related mechanism of nerve block in the prevention and treatment of multi-system diseases or symptoms, including disorders of the circulatory and respiratory systems, postoperative cognitive dysfunction, immune function, posttraumatic stress disorder, and postoperative digestive system, to put forward the potential prospective application in future and serve as a reference for future research of nerve block therapy in these diseases mentioned.
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Affiliation(s)
- Guang‐Ting Zhang
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunYiGuizhouChina
| | - Feng‐Lin Wang
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunYiGuizhouChina
| | - Ying Ran
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunYiGuizhouChina
| | - De‐Xing Liu
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunYiGuizhouChina
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Ching TH, Williams MT, Wang JB, Jerome L, Yazar-Klosinski B, Emerson A, Doblin R. MDMA-assisted therapy for posttraumatic stress disorder: A pooled analysis of ethnoracial differences in efficacy and safety from two Phase 2 open-label lead-in trials and a Phase 3 randomized, blinded placebo-controlled trial. J Psychopharmacol 2022; 36:974-986. [PMID: 35727042 DOI: 10.1177/02698811221104052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited ethnoracial diversity in previous ±3,4-methylenedioxymethamphetamine-assisted therapy (MDMA-AT) trials for posttraumatic stress disorder (PTSD) has prompted questions concerning whether Black, Indigenous, and People of Color (BIPOC) also benefit from this treatment. METHODS Secondary analysis was conducted using a modified intent-to-treat sample pooled from two Phase 2 open-label trials and a Phase 3 randomized, blinded placebo-controlled trial to compare efficacy and safety of MDMA-AT for PTSD between BIPOC and non-Hispanic White participants. Four subgroups were of interest: MDMA-AT, BIPOC (n = 20); MDMA-AT, non-Hispanic White (n = 63); Placebo-assisted therapy (Placebo-AT), BIPOC (n = 17); and Placebo-AT, non-Hispanic White (n = 27). Planned comparisons tested subgroup differences in changes in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores from baseline to primary endpoint, controlling for study type and baseline scores. Adverse events (AEs) on the day of (day 0) to 2 days post-dosing were reported for each subgroup. RESULTS In the MDMA-AT group, no significant ethnoracial difference in CAPS-5 change scores was observed. In the Placebo-AT group, BIPOC participants trended toward greater reductions in CAPS-5 scores than non-Hispanic Whites. Among non-Hispanic Whites, MDMA-AT was accompanied by significantly greater reductions in CAPS-5 scores than Placebo-AT. No treatment difference emerged among BIPOC participants. AEs were mostly rated as mild or moderate across subgroups. CONCLUSIONS These findings provide preliminary support for the efficacy and safety of MDMA-AT for treating PTSD across ethnoracial groups. There was also a trend toward greater efficacy with Placebo-AT among BIPOC participants. There was an imbalance in subgroups, highlighting the need for culturally responsive recruitment strategies to diversify future studies.
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Affiliation(s)
- Terence Hw Ching
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Department of Psychological Sciences, University of Connecticut, Mansfield, CT, USA
| | | | - Julie B Wang
- MAPS Public Benefit Corporation, Santa Cruz, CA, USA
| | - Lisa Jerome
- MAPS Public Benefit Corporation, Santa Cruz, CA, USA
| | | | - Amy Emerson
- MAPS Public Benefit Corporation, Santa Cruz, CA, USA
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, CA, USA
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Zemestani M, Mohammed AF, Ismail AA, Vujanovic AA. A Pilot Randomized Clinical Trial of a Novel, Culturally Adapted, Trauma-Focused Cognitive-Behavioral Intervention for War-Related PTSD in Iraqi Women. Behav Ther 2022; 53:656-672. [PMID: 35697429 DOI: 10.1016/j.beth.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 01/20/2022] [Accepted: 01/29/2022] [Indexed: 12/12/2022]
Abstract
Trauma-focused cognitive-behavioral therapy (TF-CBT), broadly, is one of the leading evidence-based treatments for youth with posttraumatic stress disorder (PTSD). Generally, few culturally adapted TF-CBT interventions have been examined among war trauma-affected populations in low- and middle-income countries. Using a randomized clinical trial design, a total of 48 war trauma-exposed women in Iraq, Mage (SD) = 32.91 (5.33), with PTSD were randomly assigned to either TF-CBT or wait-list control (WLC) conditions. The intervention group received 12 individual weekly sessions of a culturally adapted TF-CBT intervention. Significant reductions in PTSD symptom severity were reported by women in the TF-CBT condition from pre- to posttreatment. Women in the TF-CBT condition reported significantly greater reductions in PTSD symptoms compared to WLC at 1-month follow-up. Additionally, levels of depression, anxiety, stress, and use of maladaptive emotion regulation strategies were significantly lower in the TF-CBT condition at posttreatment and 1-month follow-up, compared to the WLC condition. Women in the TF-CBT condition also reported significant improvements in various domains of quality of life at posttreatment and 1-month follow-up. This clinical trial provides preliminary cross-cultural support for the feasibility and efficacy of TF-CBT for the treatment of PTSD symptoms among women in non-Western cultures. Future directions and study limitations are discussed.
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14
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Panayi P, Berry K, Sellwood W, Campodonico C, Bentall RP, Varese F. The Role and Clinical Correlates of Complex Post-traumatic Stress Disorder in People With Psychosis. Front Psychol 2022; 13:791996. [PMID: 35369153 PMCID: PMC8967251 DOI: 10.3389/fpsyg.2022.791996] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Traumatic experiences and post-traumatic stress are highly prevalent in people with psychosis, increasing symptom burden, decreasing quality of life and moderating treatment response. A range of post-traumatic sequelae have been found to mediate the relationship between trauma and psychotic experiences, including the "traditional" symptoms of post-traumatic stress disorder (PTSD). The International Classification of Diseases-11th Edition recognizes a more complex post-traumatic presentation, complex PTSD (cPTSD), which captures both the characteristic symptoms of PTSD alongside more pervasive post-traumatic sequelae known as 'disturbances in self-organization' (DSOs). The prevalence and impact of cPTSD and DSOs in psychosis remains to be explored. In the first study of this kind, 144 participants with psychosis recruited from North West United Kingdom mental health services completed measures assessing trauma, PTSD and cPTSD symptoms and symptoms of psychosis. Forty-percent of the sample met criteria for cPTSD, compared to 10% who met diagnostic criteria for PTSD. PTSD and DSOs mediated the relationship between trauma and positive symptoms, controlling for dataset membership. Both PTSD and DSOs mediated the relationship between trauma and affective symptoms but did not explain a significant proportion of variance in negative symptoms. Cognitive and excitative symptoms of psychosis did not correlate with trauma, PTSD or DSO scores. These findings indicate the possible value of adjunct therapies to manage cPTSD symptoms in people with psychosis, pending replication in larger epidemiological samples and longitudinal studies.
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Affiliation(s)
- Peter Panayi
- Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Katherine Berry
- Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - William Sellwood
- Faculty of Health & Medicine, Division of Health Research, University of Lancaster, Lancaster, United Kingdom
| | - Carolina Campodonico
- School of Psychology and Computer Science, University of Central Lancashire, Lancashire, United Kingdom
| | - Richard P. Bentall
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Filippo Varese
- Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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15
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Ayotte BJ, Schierberl Scherr AE, Kellogg MB. PTSD Symptoms and Functional Impairment among Nurses Treating COVID-19 Patients. SAGE Open Nurs 2022; 8:23779608221074651. [PMID: 35198734 PMCID: PMC8859481 DOI: 10.1177/23779608221074651] [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: 10/04/2021] [Revised: 12/23/2021] [Accepted: 01/01/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction Nurses providing direct care for patients with COVID-19 may be at particular risk for developing symptoms of post-traumatic stress disorder (PTSD). However, little is known about how these symptoms are related to workplace and non-workplace impairment. Objective We examined if PTSD symptoms mediated the relationship between treating patients with COVID-19 and functional impairment. Methods An online survey collected data regarding demographic and workplace variables, PTSD symptoms, functional impairment, distracted practice, and if the nurse treated patients with confirmed COVID-19. Data collected in November 2020 from 218 primarily White and female nurses were analyzed. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines in reporting the methods and results. Results Analyses involved two steps: (a) calculating descriptive statistics, conducting univariate tests, and examining correlations among study variables; and (b) conducting a path analysis examining the mediating role of PTSD symptoms in the relationship between treating patients with COVID-19 and functional outcomes. Univariate tests found that nurses who had a diploma/associate's/bachelor's and nurses who treated patients with COVID-19 reported more PTSD symptoms, functional impairment, and distracted practice compared to nurses with graduate degrees and those who did not treat patients with COVID-19. Compared to nurses who reported having access to adequate PPE, nurses who reported not having access to adequate PPE reported more PTSD symptoms but lower functional impairment and distracted practice. Men reported lower distracted practice scores than women. In step two of the analyses, the path model suggested that treating patients with COVID-19 was indirectly related to both distracted practice and functional impairment through PTSD symptoms. Conclusion The probable PTSD symptoms and work- and non-work-related functional impairment of nurses working with patients with COVID-19 highlight the importance of developing interventions that help these essential workers address vulnerabilities associated with working during the COVID-19 pandemic.
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Affiliation(s)
- Brian J. Ayotte
- Department of Psychology, University of Massachusetts, Dartmouth, Dartmouth, MA, USA
| | - Anna E. Schierberl Scherr
- Department of Psychology, University of Massachusetts, Dartmouth, Dartmouth, MA, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Marni B. Kellogg
- Department of Community Health Nursing, University of Massachusetts, Dartmouth
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16
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Abu-El-Noor MK, Abu-El-Noor NI, Alswerki M, Naim FN, Elessi KA, Al-Asmar YZ, Afifi T. Post-traumatic stress disorder among victims of great march of return in the Gaza Strip, Palestine: A need for policy intervention. Arch Psychiatr Nurs 2022; 36:48-54. [PMID: 35094825 DOI: 10.1016/j.apnu.2021.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 07/26/2021] [Accepted: 10/29/2021] [Indexed: 11/02/2022]
Abstract
This study aimed to assess the level of Post-Traumatic Stress Disorder (PSTD) and to examine the relationship between exposure to war stress and posttraumatic symptoms among people who were injured during the Great March of Return (GMR) in the Gaza Strip, Palestine. A sample of 264 adults who were injured during participation in the events of GMR completed the Impact Event Scale-Revised (IES-R). IES-R has three sub-scales; intrusion, avoidance, and hyper-arousal. Only 27.3% of the participants had two or more injuries and 38.4% of participants reported having disability due to their injuries. The results showed that 95.4% of the participants had severe posttraumatic symptoms. Total score of IES-R ranged between 29 and 88 (mean = 61.28). The most frequent symptoms of trauma subscales was "Intrusion" (mean = 2.90), followed by "Avoidance" (mean = 2.73), and then "Hyper-arousal" (mean = 2.70). Level of PTSD was affected by working status, need for hospitalization, need for a referral for treatment outside the Gaza Strip, disability and severity of injury. Such high level of PSTD will have negative consequences on participants' physical and mental status. Therefore, a need for special counseling programs is required to help them to survive with least consequences of PTSD on their wellbeing.
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Affiliation(s)
| | | | | | - Fadel N Naim
- Faculty of Medicine, Islamic University of Gaza, P.O. Box 108, Gaza, Gaza Strip, Palestine.
| | - Khamis A Elessi
- Faculty of Medicine, Islamic University of Gaza, P.O. Box 108, Gaza, Gaza Strip, Palestine.
| | | | - Tayseer Afifi
- Faculty of Medicine, Islamic University of Gaza, P.O. Box 108, Gaza, Gaza Strip, Palestine
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17
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Kizilhan JI, Noll-Hussong M, Wenzel T. Transgenerational Transmission of Trauma across Three Generations of Alevi Kurds. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010081. [PMID: 35010342 PMCID: PMC8751140 DOI: 10.3390/ijerph19010081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022]
Abstract
Background: Thus far, most researchers on genocide and transgenerational transmissions have focused on the National Socialist Holocaust as the most abhorrent example of this severe human rights violation. Few data have been published on other ethnic or religious groups affected by genocidal actions in this context. Methodology: Using a mixed-method approach integrating qualitative interviews with standardized instruments (SCID and PDS), this study examines how individual and collective trauma have been handed down across three generations in an Alevi Kurd community whose members (have) suffered genocidal perpetrations over a longer time period (a “genocidal environment”). Qualitative, open-ended interviews with members of three generations answering questions yielded information on (a) how their lives are shaped by the genocidal experiences from the previous generation and related victim experiences, (b) how the genocidal events were communicated in family narratives, and (c) coping strategies used. The first generation is the generation which directly suffered the genocidal actions. The second generation consists of children of those parents who survived the genocidal actions. Together with their family (children, partner, relatives), this generation suffered forced displacement. Members of the third generation were born in the diaspora where they also grew up. Results: Participants reported traumatic memories, presented in examples in this publication. The most severe traumatic memories included the Dersim massacre in 1937–1938 in Turkey, with 70,000–80,000 victims killed, and the enforced resettlement in western Turkey. A content analysis revealed that the transgenerational transmission of trauma continued across three generations. SCID and PDS data indicated high rates of distress in all generations. Conclusions: Genocidal environments such as that of the Kurdish Alevis lead to transgenerational transmission mediated by complex factors.
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Affiliation(s)
- Jan Ilhan Kizilhan
- Institute for Psychotherapy and Psychotraumatology, University of Duhok, Zakho Street, 1006AJ Duhok, Iraq
- Correspondence: ; Tel.: +49-7720-3906-217
| | - Michael Noll-Hussong
- Psychosomatic Medicine and Psychotherapy, Saarland University Medical Centre, Kirrberger Straße 100, D-66421 Homburg, Germany;
| | - Thomas Wenzel
- World Psychiatric Association Scientific Section on Psychological Aspects of Persecution and Torture, CEHRI and OEGBA, 1090 Vienna, Austria;
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Airdrie JN, Lievesley A, Griffith E. Investigating the experience of individuals with comorbid posttraumatic stress disorder and substance misuse attending a Seeking Safety group. ADVANCES IN DUAL DIAGNOSIS 2021. [DOI: 10.1108/add-04-2021-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
There is no specific recommended treatment for the co-morbid presentation of post-traumatic stress disorder (PTSD) and substance use disorder in the United Kingdom (UK). Seeking Safety (SS), a group-based treatment that targets symptoms of both disorder, has emerging evidence in the USA but lacks evidence from UK-based samples. The purpose of this study was to explore UK service users’ experience of attending SS and evaluate its impact on mental health symptomology and substance misuse.
Design/methodology/approach
A mixed method approach was used to evaluate the acceptability of SS for a small sample (n = 7) of adult users of a substance misuse service in the UK. Thematic analysis was used to explore their experiences, derived from individual semi-structured interviews. The authors also calculated the number of participants who achieved reliable and/or clinically significant change in mental health symptomology and substance misuse from data routinely collected by the service.
Findings
Seven overarching themes emerged: strengthening the foundations of the self, the evocation and management of emotions, safety and validation provided relationally, readiness and commitment, content and delivery, Seeking Safety is Not an Island and ending. Most participants with data available both before and after the group made reliable (three out of four) and clinically significant (two out of three) change for depression and anxiety symptomology; however, this was less evident for PTSD symptomology with two out of three making reliable change and one out of three making clinically significant change.
Originality/value
To the best of the authors’ knowledge, this was the first study exploring the experiences of UK attendees of a SS group as an approach to treating comorbid PTSD and substance misuse.
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19
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Hoeboer CM, Oprel DAC, De Kleine RA, Schwartz B, Deisenhofer AK, Schoorl M, Van Der Does WAJ, van Minnen A, Lutz W. Personalization of Treatment for Patients with Childhood-Abuse-Related Posttraumatic Stress Disorder. J Clin Med 2021; 10:4522. [PMID: 34640540 PMCID: PMC8509230 DOI: 10.3390/jcm10194522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Differences in effectiveness among treatments for posttraumatic stress disorder (PTSD) are typically small. Given the variation between patients in treatment response, personalization offers a new way to improve treatment outcomes. The aim of this study was to identify predictors of psychotherapy outcome in PTSD and to combine these into a personalized advantage index (PAI). METHODS We used data from a recent randomized controlled trial comparing prolonged exposure (PE; n = 48), intensified PE (iPE; n = 51), and skills training (STAIR), followed by PE (n = 50) in 149 patients with childhood-abuse-related PTSD (CA-PTSD). Outcome measures were clinician-assessed and self-reported PTSD symptoms. Predictors were identified in the exposure therapies (PE and iPE) and STAIR+PE separately using random forests and subsequent bootstrap procedures. Next, these predictors were used to calculate PAI and to retrospectively determine optimal and suboptimal treatment in a leave-one-out cross-validation approach. RESULTS More depressive symptoms, less social support, more axis-1 diagnoses, and higher severity of childhood sexual abuse were predictors of worse treatment outcomes in PE and iPE. More emotion regulation difficulties, lower general health status, and higher baseline PTSD symptoms were predictors of worse treatment outcomes in STAIR+PE. Randomization to optimal treatment based on these predictors resulted in more improvement than suboptimal treatment in clinician assessed (Cohens' d = 0.55) and self-reported PTSD symptoms (Cohens' d = 0.47). CONCLUSION Personalization based on PAI is a promising tool to improve therapy outcomes in patients with CA-PTSD. Further studies are needed to replicate findings in prospective studies.
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Affiliation(s)
- Chris M. Hoeboer
- Institute of Psychology, Leiden University, Wassenaarsweg 52, 2333 AK Leiden, The Netherlands; (D.A.C.O.); (R.A.D.K.); (M.S.); (W.A.J.V.D.D.)
- Parnassiagroep, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
| | - Danielle A. C. Oprel
- Institute of Psychology, Leiden University, Wassenaarsweg 52, 2333 AK Leiden, The Netherlands; (D.A.C.O.); (R.A.D.K.); (M.S.); (W.A.J.V.D.D.)
- Parnassiagroep, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
| | - Rianne A. De Kleine
- Institute of Psychology, Leiden University, Wassenaarsweg 52, 2333 AK Leiden, The Netherlands; (D.A.C.O.); (R.A.D.K.); (M.S.); (W.A.J.V.D.D.)
- Parnassiagroep, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
| | - Brian Schwartz
- Department of Psychology, University of Trier, 54296 Trier, Germany; (B.S.); (A.-K.D.); (W.L.)
| | | | - Maartje Schoorl
- Institute of Psychology, Leiden University, Wassenaarsweg 52, 2333 AK Leiden, The Netherlands; (D.A.C.O.); (R.A.D.K.); (M.S.); (W.A.J.V.D.D.)
| | - Willem A. J. Van Der Does
- Institute of Psychology, Leiden University, Wassenaarsweg 52, 2333 AK Leiden, The Netherlands; (D.A.C.O.); (R.A.D.K.); (M.S.); (W.A.J.V.D.D.)
- Parnassiagroep, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
- Institute of Psychiatry, Leiden University Medical Center, 2333 AK Leiden, The Netherlands
| | - Agnes van Minnen
- PSYTREC, Bilthoven, Professor Bronkhorstlaan 2, 3723 MB Bilthoven, The Netherlands;
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, The Netherlands
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, 54296 Trier, Germany; (B.S.); (A.-K.D.); (W.L.)
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20
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A Community Survey of Quality of Life and Psychiatric Disorders among Residents Following the Kaohsiung Gas Explosion: a 5-Year Cross-Sectional Follow-Up Study. Psychiatr Q 2021; 92:1-12. [PMID: 33765285 DOI: 10.1007/s11126-021-09911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
To investigate factors associated with quality of life (QoL) and disaster-related psychiatric disorders, including posttraumatic stress disorder (PTSD) and major depressive episode (MDE), in the survivors of a gas explosion in Taiwan 5 years after the event. A community-based cross-sectional study of residents from an area that experienced a gas explosion was conducted 5 years after the event. The Short Form 12v2 (SF-12v2) was used to screen 2511 participants. The Disaster-Related Psychological Screening Test (DRPST) was used to assess probable MDE and PTSD. A total of 2511 participants, including 604 males and 1907 females, completed the QoL survey. The average age was 56.02 ± 16.78 years, and most participants were in the ≧65 age group (39.7%). The males had better QoL in the physical dimensions. Lifestyle was significantly positively associated with QoL. A total of 894 participants completed the DRPST, which showed some individuals with probable MDE (n = 93, 10.4%), probable PTSD (n = 22, 2.5%), or probable MDE and PTSD (n = 49, 5.5%); most people had no MDE or PTSD (n = 730, 81.7%). Those in the probable PTSD or MDE groups were significantly more likely to be female or to be experiencing stressors (p < 0.001). The participants continued to be affected by the disaster based on their QoL, even 5 years later. Females had a higher risk of probable psychiatric disorders and poorer QoL in the physical dimensions. Long-term follow-up, interventions and investigations after a disaster are needed.
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21
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Wooldridge JS, Herbert MS, Dochat C, Afari N. Understanding relationships between posttraumatic stress disorder symptoms, binge-eating symptoms, and obesity-related quality of life: the role of experiential avoidance. Eat Disord 2021; 29:260-275. [PMID: 33459212 PMCID: PMC8285449 DOI: 10.1080/10640266.2020.1868062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obesity, binge-eating symptoms, and PTSD symptoms commonly co-occur. Avoidance, a key feature of PTSD and proposed mechanism of binge-eating, is one potential mechanism for explaining this clinical overlap. The purpose of the current study was to: 1) examine the associations between PTSD symptoms (PTSD Checklist-Civilian; PCL-C) and measures of bingeeating symptoms (Binge Eating Scale; BES) and obesity-related quality of life (Obesity Related Well-Being Questionnaire-97; ORWELL-97) in a sample of veterans with overweight or obesity (N = 89), and 2) determine whether experiential avoidance (The Acceptance and Action Questionnaire-II; AAQ-II) explains the relationship between PTSD symptoms and binge-eating symptoms, and PTSD symptoms and obesity-related quality of life, respectively. Scores on the PCL-C, BES, ORWELL-97, and AAQ-II were all significantly correlated. Linear regression analyses indicated that higher PCL-C scores were related to higher scores on the BES and ORWELL-97 after controlling for potentially confounding factors (BMI and race). Effect sizes were in the medium-large range. Further, AAQ-II mediated the relationship between PCL-C and ORWELL-97, but did not mediate the relationship between PCL-C and BES. These findings suggest that experiential avoidance should be considered in interventions addressing co-occurring PTSD, binge-eating, and poor obesity-related well-being. Longitudinal research is needed to better understand directionality of these relationships and changes over time.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, California, San Diego, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
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22
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Thorvaldsdottir KB, Halldorsdottir S, Johnson RM, Sigurdardottir S, Saint Arnault D. Adaptation of the barriers to help-seeking for trauma (BHS-TR) scale: a cross-cultural cognitive interview study with female intimate partner violence survivors in Iceland. J Patient Rep Outcomes 2021; 5:22. [PMID: 33638750 PMCID: PMC7914310 DOI: 10.1186/s41687-021-00295-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Even though traumatization is linked to substantially reduced health-related quality of life, help-seeking and service utilization among trauma survivors are very low. To date, there has not been available in Iceland a culturally attuned, self-reported measure on help-seeking barriers after trauma. This study aimed to translate and cross-culturally adapt the English version of Barriers to Help-Seeking for Trauma (BHS-TR) scale into the Icelandic language and context. Methods The BHS-TR was culturally adapted following well-established and rigorous guidelines, including forward-backward translation, expert committee review, and pretesting through cognitive interviews. Two rounds of interviews with 17 female survivors of intimate partner violence were conducted using a think-aloud technique and verbal probing. Data were analyzed using qualitative content analysis, a combination of deductive and inductive approaches. Results Issues with the BHS-TR that were uncovered in the study were classified into four categories related to general design, translation, cultural aspects, and post-trauma context. The trauma-specific issues emerged as a new category identified in this study and included concepts specific to trauma experiences. Therefore, modifications were of great importance—resulting in the scale becoming more trauma-informed. Revisions made to address identified issues improved the scale, and the process led to an Icelandic version, which appears to be semantically and conceptually equivalent to the original version; additionally, the results provided evidence of content validity. Conclusions As a cognitive interview study, it adds to the growing cognitive interviewing methodology literature. Furthermore, the results provide essential insights into the self-report response process of trauma survivors, highlighting the significance of making health-related research instruments trauma-informed.
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Affiliation(s)
| | | | - Rhonda M Johnson
- Department of Health Sciences, University of Alaska Anchorage, Anchorage, AK, USA
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23
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Kizilhan JI, Wenzel T. Positive psychotherapy in the treatment of traumatised Yezidi survivors of sexualised violence and genocide. Int Rev Psychiatry 2020; 32:594-605. [PMID: 33016807 DOI: 10.1080/09540261.2020.1809356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
So far, the psychotherapeutic treatment of patients with trauma spectrum disorders has most commonly been based on a disease model in which the normal reaction to trauma results in negative emotions, cognitions and behaviour which, in turn, cause a pathological state of mind or disorder. Here, trauma is associated with distress. This model focuses on identification, classification and treatment of the pathological and maladaptive modulations of the stress response that lead to psychological and social suffering and disability. In contrast to that, recent models in the Psychotherapy of the sequels of extreme life experiences, such as Positive Psychotherapy, have rather focussed on the building of competence, resilience and posttraumatic growth. In this article we summarise our experience in treating Yazidi women for their complex psychological traumata resulting from their experience of ISIS terror. We will use a short summary of published secondary data and reviews and use case examples from our work as primary data to discuss possible individual and collective resources that can help them to recover and to maintain a positive perspective on their person and the world, in spite of their terrible traumatic experiences. Original models of Positive Psychology already paid considerable attention to strength and resilience. The new approach of 'second wave' Positive Psychology expands on this, suggesting that negative emotions as well cultural factors must also be integrated. This approach appears to be particularly helpful in the treatment of this group of Yazidi women. Likewise, it seems to be promising when treating similar groups of people who survived extreme terror and were continuously exposed to genocidal environments.
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Affiliation(s)
- Jan Ilhan Kizilhan
- Institute for Psychotherapy and Psychotraumtology, University of Duhok, Duhok, Iraq.,Institute of Transcultural Health Science Cooperative State University Baden-Württemberg, Villingen-Schwenningen, Germany
| | - Thomas Wenzel
- World Psychiatric Association Scientific Section on Psychological Aspect of Persecution and Torture and OEGBA, University of Vienna, Vienna, Austria
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Arredondo AY, Caparrós B. Posttraumatic Cognitions, Posttraumatic Growth, and Personality in University Students. JOURNAL OF LOSS & TRAUMA 2020. [DOI: 10.1080/15325024.2020.1831812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Beatriz Caparrós
- Psychology Department, University of Girona (Spain), Girona, Spain
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Panisch LS, Hai AH. The Effectiveness of Using Neurofeedback in the Treatment of Post-Traumatic Stress Disorder: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2020; 21:541-550. [PMID: 29890906 DOI: 10.1177/1524838018781103] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Neurofeedback is an innovative treatment for post-traumatic stress disorder (PTSD) that is readily accessible to mental health therapists. As a widespread mental health concern with potentially devastating long-term consequences on psychosocial functioning, PTSD can also adversely impact biophysiological processes, particularly those related to the brain. Neurofeedback has shown promise in alleviating overall PTSD symptoms, including these underlying neurobiological consequences. Successful results have been found among clients with PTSD who have not been responsive to prior treatment modalities. While a strong base of clinical anecdotes and case studies supports its success in treating PTSD, intervention studies on neurofeedback have been critiqued for lack of rigor and poor methodological design. A current systematic review of the literature on the effectiveness of neurofeedback in treating PTSD was conducted. Unlike prior reviews which emphasized neurobiological changes, this study was written for the mental health therapist and focused solely on behavioral outcomes. Ten studies met the criteria for inclusion in this review. Neurofeedback demonstrated salubrious results in at least one outcome measure for the majority of participants across all studies. Interpretations, however, are limited by wide discrepancies in sample sizes, study designs, outcome measures, and the extent of reported results. Future research in this area would benefit from prioritizing randomized controlled trials with larger sample sizes and longitudinal follow-up results.
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Affiliation(s)
- Lisa S Panisch
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Audrey Hang Hai
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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Stevens SM, Gustavson DE, Fang B, Tu X, Logue M, Lyons MJ, Reynolds CA, Kremen WS, Franz CE. Predicting Health-Related Quality of Life in Trauma-Exposed Male Veterans in Late Midlife: A 20 Year Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124554. [PMID: 32599875 PMCID: PMC7345107 DOI: 10.3390/ijerph17124554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/05/2022]
Abstract
Trauma-exposed adults with high levels of posttraumatic stress symptoms (PTSS) report poorer health-related quality of life (HRQOL), but less is known about the persistence of this relationship over time. Participants from the Vietnam Era Twin Study of Aging reported on PTSS, health, and sociodemographic characteristics at average age 38; 775 participants reported having been exposed to trauma. Later, at average ages 56 and 62, mental and physical HRQOL were assessed with the Short-Form 36. Premorbid risk for anxiety/neuroticism was evaluated with a polygenic risk score derived from a large genome-wide association study meta-analysis. In multivariate mixed models, having higher levels of PTSS, poorer self-rated health, lower income, and less education at age 38 were associated with worse physical and mental HRQOL two decades later. Chronic health problems at age 38 predicted midlife physical but not mental HRQOL. Although genetic risk for neuroticism was correlated with HRQOL and PTSS, it was no longer significant in multivariate models. Health-related quality of life (HRQOL) predicts morbidity and mortality independently of objective health measures; early interventions may help to mitigate the ongoing impact of trauma on quality of life.
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Affiliation(s)
- Samantha M. Stevens
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Department of Psychology, The Pennsylvania State University, State College, PA 16801, USA
| | - Daniel E. Gustavson
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Bin Fang
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
| | - Xin Tu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92093, USA;
| | - Mark Logue
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA; (M.L.); (M.J.L.)
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA; (M.L.); (M.J.L.)
| | - Chandra A. Reynolds
- Department of Psychology, University of California Riverside, Riverside, CA 92521, USA;
| | - William S. Kremen
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, University of California San Diego, La Jolla, CA 92093, USA
| | - Carol E. Franz
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Correspondence: ; Tel.: +1-858-822-1793
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Forchuk C, Nazarov A, Hunt R, Davis B, St Cyr K, Richardson JD. The influence of depression-PTSD comorbidity on health-related quality of life in treatment-seeking veterans. Eur J Psychotraumatol 2020; 11:1748460. [PMID: 32922680 PMCID: PMC7448842 DOI: 10.1080/20008198.2020.1748460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) and depression substantially impair health-related quality of life (HRQOL) for many Canadian Armed Forces (CAF) veterans. Although PTSD and depression are highly comorbid, little is known about whether the disorders may interact in their association with HRQOL. We sought to investigate whether depressive symptoms modify the relation between PTSD and HRQOL in treatment-seeking veterans. METHOD We accessed the clinical data of 545 CAF veterans aged 18 to 65 years who were seeking treatment at a specialized clinic in London, Ontario. We used hierarchical linear regression to assess the additive and multiplicative relations between depression and PTSD symptoms on HRQOL, controlling for age and alcohol/substance abuse. Simple slopes were examined to probe significant interactions. RESULTS Probable PTSD and major depression were present in 77.4% and 85.3% of the sample, respectively, and 73.0% of the sample presented with probable PTSD-depression comorbidity. Depression symptoms significantly modified the relation between PTSD symptoms and overall mental HRQOL (β = 0.12, p <0.001, ∆R2 = 0.014), and role impairment due to emotional difficulties (β = 0.20, p <0.001, ∆R2 = 0.035). Simple slope analyses revealed the impact of PTSD was greater among those with lower depression symptoms and became weaker with greater depression symptom severity. In adjusted models, only depression was significantly associated with all mental and physical HRQOL domains; PTSD was not associated with physical HRQOL, role emotional impairment, or vitality. CONCLUSIONS For those with severe comorbid depression, PTSD symptoms were no longer associated with mental HRQOL, particularly in areas related to emotional functioning. Findings suggest the importance of targeting depression in patients presenting with PTSD-depression comorbidity.
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Affiliation(s)
- Callista Forchuk
- The MacDonald Franklin OSI Research Centre, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada
| | - Anthony Nazarov
- The MacDonald Franklin OSI Research Centre, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Renee Hunt
- The MacDonald Franklin OSI Research Centre, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
| | - Brent Davis
- The MacDonald Franklin OSI Research Centre, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada.,Computer Science Department, Western University, London, Ontario, Canada
| | - Kate St Cyr
- The MacDonald Franklin OSI Research Centre, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - J Don Richardson
- The MacDonald Franklin OSI Research Centre, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada.,OSI Clinic, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada
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Sbarski B, Akirav I. Cannabinoids as therapeutics for PTSD. Pharmacol Ther 2020; 211:107551. [PMID: 32311373 DOI: 10.1016/j.pharmthera.2020.107551] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 03/08/2020] [Indexed: 02/09/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a complex disorder that involves dysregulation of multiple neurobiological systems. The traumatic stressor plays a causal role in producing psychological dysfunction and the pattern of findings suggests that the hypothalamic-pituitary-adrenal (HPA) axis, which is instrumental for stress adaptation, is critically dysfunctional in PTSD. Given the lack of understanding of the basic mechanisms and underlying pathways that cause the disorder and its heterogeneity, PTSD poses challenges for treatment. Targeting the endocannabinoid (ECB) system to treat mental disorders, and PTSD in particular, has been the focus of research and interest in recent years. The ECB system modulates multiple functions, and drugs enhancing ECB signaling have shown promise as potential therapeutic agents in stress effects and other psychiatric and medical conditions. In this review, we focus on the interaction between the ECB-HPA systems in animal models for PTSD and in patients with PTSD. We summarize evidence supporting the use of cannabinoids in preventing and treating PTSD in preclinical and clinical studies. As the HPA system plays a key role in the mediation of the stress response and the pathophysiology of PTSD, we describe preclinical studies suggesting that enhancing ECB signaling is consistent with decreasing PTSD symptoms and dysfunction of the HPA axis. Overall, we suggest that a pharmacological treatment targeted at one system (e.g., HPA) may not be very effective because of the heterogeneity of the disorder. There are abnormalities across different neurotransmitter systems in the pathophysiology of PTSD and none of these systems function uniformly among all patients with PTSD. Hence, conceptually, enhancing ECB signaling may be a more effective avenue for pharmacological treatment.
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Affiliation(s)
- Brenda Sbarski
- School of Psychological Sciences, Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
| | - Irit Akirav
- School of Psychological Sciences, Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel.
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29
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Kizilhan JI, Steger F, Noll-Hussong M. Shame, dissociative seizures and their correlation among traumatised female Yazidi with experience of sexual violence. Br J Psychiatry 2020; 216:138-143. [PMID: 32345408 DOI: 10.1192/bjp.2020.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Survivors of Islamic State of Iraq and Syria (ISIS) captivity are at high risk of developing mental disorders such as post-traumatic stress disorder (PTSD). AIMS This study looks at the correlation between sexual abuse, shame, somatoform or bodily distress disorders, and dissociative seizures (psychogenic non-epileptic seizures). METHOD The psychological effects of traumatic events and dissociative seizure were assessed in Yazidi women who were held captive by ISIS in Northern Iraq between 2014 and 2018. These effects were examined comparing 64 women who were held captive and sexually abused by ISIS with 60 women suffering from PTSD who were not held captive and sexually abused by ISIS. Structured clinical-psychological interviews and established psychometric questionnaires were used to assess mental disorders especially dissociative seizures and somatoform disorders, and shame related to trauma. RESULTS Women who were held captive by ISIS showed a significantly higher prevalence of dissociative seizures (43.7%; P = 0.02) and somatisation disorder (38.7%; P = 0.02), as well as depressive (75.0%; P = 0.42) and anxiety disorders (62.5%; P = 0.44), than women who were not held captive and sexually abused by ISIS. Dissociative disorders were identified in 40.6% (P = 0.36) of those female Yazidi who experienced sexual violence while being held captive. CONCLUSIONS Shame in connection with sexual violence seems to play an important role in negative self-perception after rape. Dissociation not only plays an important role in unprocessed childhood trauma with feelings of shame, but also in more recent trauma experiences with shame.
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Affiliation(s)
- Jan Ilhan Kizilhan
- Dean, Institute for Psychotherapy and Psychotraumatology, University of Duhok, Iraq; and Director, Division of the Institute for Transcultural Health Science, State University Baden-Württemberg, Germany
| | - Florian Steger
- Researcher, Division of Institute for Transcultural Health Science, State University Baden-Württemberg, Germany
| | - Michael Noll-Hussong
- Researcher and Lecturer, Clinic for Psychiatry and Psychotherapy, Division of Psychosomatic Medicine and Psychotherapy, Universitaetskliniken des Saarlandes; and Head, Division of Psychosomatic Medicine and Psychotherapy, Universitaetskliniken des Saarlandes, Germany
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Miller ML, Bagley JM, Normand P, Brennan MB, Van Horn R, Pollack MH, Held P. Increasing Mindfulness Skills of Veterans With PTSD Through Daily Mindfulness Training Incorporated Into an Intensive Treatment Program. Mindfulness (N Y) 2020; 11:964-974. [PMID: 34367355 DOI: 10.1007/s12671-020-01326-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives Mindfulness training is frequently included as part of an integrative care approach to treating PTSD in veterans. However, the utility and acceptability of daily group mindfulness training in an intensive treatment program (ITP) for PTSD have not been explored. The study objectives were to determine: (a) whether mindfulness skills significantly increased from pre- to post-treatment and (b) if daily group mindfulness training was acceptable to veterans. Methods Veterans (N = 170 outpatients, age M = 40.7 (SD 9.3), 67.6% male) in this prospective study were consecutively enrolled in a 3-week ITP that included daily mindfulness group sessions. Mindfulness skills were assessed using the Five Facet of Mindfulness Questionnaire (FFMQ) at intake and post-treatment. Acceptability was assessed using an anonymous post-treatment program satisfaction survey. Results Paired t tests demonstrated significant increases in overall mindfulness skills from pre- to post-treatment (t(169) = - 6.33, p < 0.001, d = 0.49). Small to medium effect sizes were observed across subscales: describing, (t(169) = - 5.91, p < 0.001, d = 0.38); acting with awareness, (t(169) = - 3.70, p < 0.001, d = 0.29); nonjudging, (t(169) = - 7.54, p < 0.001, d = 0.58); and nonreactivity, (t(169) = - 4.84, p < 0.001, d = 0.41). Most veterans (n = 125, 74.4%) found daily mindfulness training moderately to very helpful. Conclusions Veterans' mindfulness skills significantly increased over the course of a 3-week ITP, and mindfulness training was found acceptable. Mindfulness training can be delivered daily as part of an ITP for veterans with PTSD, and mindfulness skills can meaningfully increase over the course of 3 weeks. A significant limitation is the lack of control condition.
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Affiliation(s)
- Michelle L Miller
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 400, Chicago, IL 60612, USA
| | - Jenna M Bagley
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 400, Chicago, IL 60612, USA
| | - Patricia Normand
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 400, Chicago, IL 60612, USA
| | - Michael B Brennan
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 400, Chicago, IL 60612, USA
| | - Rebecca Van Horn
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 400, Chicago, IL 60612, USA
| | - Mark H Pollack
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 400, Chicago, IL 60612, USA
| | - Philip Held
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 400, Chicago, IL 60612, USA
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Rae Olmsted KL, Bartoszek M, Mulvaney S, McLean B, Turabi A, Young R, Kim E, Vandermaas-Peeler R, Morgan JK, Constantinescu O, Kane S, Nguyen C, Hirsch S, Munoz B, Wallace D, Croxford J, Lynch JH, White R, Walters BB. Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:130-138. [PMID: 31693083 PMCID: PMC6865253 DOI: 10.1001/jamapsychiatry.2019.3474] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE This is the first multisite, randomized clinical trial of stellate ganglion block (SGB) outcomes on posttraumatic stress disorder (PTSD) symptoms. OBJECTIVE To determine whether paired SGB treatments at 0 and 2 weeks would result in improvement in mean Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total symptom severity scores from baseline to 8 weeks. DESIGN, SETTING, AND PARTICIPANTS This multisite, blinded, sham-procedure, randomized clinical trial used a 2:1 SGB:sham ratio and was conducted from May 2016 through March 2018 in 3 US Army Interdisciplinary Pain Management Centers. Only physicians performing the procedures and the procedure nurses were aware of the intervention (but not the participants or assessors); their interactions with the participants were scripted and limited to the 2 interventions. Active-duty service members on stable psychotropic medication dosages who had a PTSD Checklist-Civilian Version (PCL-C) score of 32 or more at screening were included. Key exclusion criteria included a prior SGB treatment, selected psychiatric disorders or substance use disorders, moderate or severe traumatic brain injury, or suicidal ideation in the prior 2 months. INTERVENTIONS Paired right-sided SGB or sham procedures at weeks 0 and 2. MAIN OUTCOMES AND MEASURES Improvement of 10 or more points on mean CAPS-5 total symptom severity scores from baseline to 8 weeks, adjusted for site and baseline total symptom severity scores (planned a priori). RESULTS Of 190 screened individuals, 113 (59.5%; 100 male and 13 female participants; mean [SD] age, 37.3 [6.7] years) were eligible and randomized (74 to SGB and 39 to sham treatment), and 108 (95.6% of 113) completed the study. Baseline characteristics were similar in the SGB and sham treatment groups, with mean (SD) CAPS-5 scores of 37.6 (11.2) and 39.8 (14.4), respectively (on a scale of 0-80); 91 (80.0%) met CAPS-5 PTSD criteria. In an intent-to-treat analysis, adjusted mean total symptom severity score change was -12.6 points (95% CI, -15.5 to -9.7 points) for the group receiving SGB treatments, compared with -6.1 points (95% CI, -9.8 to -2.3 points) for those receiving sham treatment (P = .01). CONCLUSIONS AND RELEVANCE In this trial of active-duty service members with PTSD symptoms (at a clinical threshold and subthreshold), 2 SGB treatments 2 weeks apart were effective in reducing CAPS-5 total symptom severity scores over 8 weeks. The mild-moderate baseline level of PTSD symptom severity and short follow-up time limit the generalizability of these findings, but the study suggests that SGB merits further trials as a PTSD treatment adjunct. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03077919.
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Affiliation(s)
| | | | - Sean Mulvaney
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Ali Turabi
- Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Ryan Young
- Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Eugene Kim
- Womack Army Medical Center, Fort Bragg, North Carolina
| | | | | | | | - Shawn Kane
- John F. Kennedy Special Warfare Center and School, Fort Bragg, North Carolina
| | | | - Shawn Hirsch
- RTI International, Research Triangle Park, North Carolina
| | - Breda Munoz
- RTI International, Research Triangle Park, North Carolina
| | - Dennis Wallace
- RTI International, Research Triangle Park, North Carolina
| | - Julie Croxford
- RTI International, Research Triangle Park, North Carolina
| | - James H. Lynch
- US Army Special Operations Command, Fort Bragg, North Carolina
| | - Ronald White
- Landstuhl Regional Medical Center, Landstuhl, Germany
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The role of personality in posttraumatic stress disorder, trait resilience, and quality of life in people exposed to the Kiss nightclub fire. PLoS One 2019; 14:e0220472. [PMID: 31356601 PMCID: PMC6663027 DOI: 10.1371/journal.pone.0220472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the relationship among personality (according to Cloninger’s psychobiological model), posttraumatic stress disorder (PTSD) symptoms, trait resilience and quality of life (QoL) in people who were exposed to the Kiss nightclub fire. Methods 188 participants were assessed with the Posttraumatic Checklist–civilian version (PCL-C), the Resilience Scale (RS), the Temperament and Character Inventory (TCI), the World Health Organization Quality of Life–Bref (WHOQOL-Bref), and the WHOQOL-100 Spirituality, religiousness, and personal beliefs (WHOQOL-100-SRPB). Data were analyzed in a dimensional approach, with correlation analysis, multiple linear regression and Structural Equation Modeling (SEM), with PCL-C, RS, and WHOQOL-Bref dimensions as dependent variables. Results Multiple linear regression showed that PTSD symptoms were predicted by harm avoidance (β = .34, p < .001), self-directedness (β = -.28, p < .01), and self-transcendence (β = .24, p < .01). Trait resilience was predicted by harm avoidance (β = -.38, p < .01), self-directedness (β = .20, p < .05), and self-transcendence (β = .18, p < .05). Also, PTSD symptoms had considerable negative effect on all dimensions of QoL. Self-transcendence was a positive predictor of subjective and spiritual QoL. SEM showed that QoL was predicted by PTSD symptoms (β = -.52, p < .001), trait resilience (β = .30, p < .001), cooperativeness (β = .135, p = 0.40), and self-directedness (β = .27, p < .01). The effect of self-directedness on QoL was mediated by PTSD symptoms and trait resilience. PTSD symptoms also mediated the relationship between trait resilience and QoL, and RS mediated the relationship of personality and PTSD symptoms. Conclusion The study gives insights on prediction of PTSD severity, trait resilience and QoL from temperament and character traits, in a sample of people exposed to the Kiss nightclub fire. Harm avoidance was the most influent trait on PTSD symptoms and trait resilience. Self-directedness was the most import trait related to QoL, still that it was more related to PTSD severity than personality traits. Self-transcendence had positive effects on both PTSD symptoms and trait resilience, indicating a coping style that may coexist with psychopathology.
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Do screening and a randomized brief intervention at a Level 1 trauma center impact acute stress reactions to prevent later development of posttraumatic stress disorder? J Trauma Acute Care Surg 2019; 85:466-475. [PMID: 29787532 DOI: 10.1097/ta.0000000000001977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Approximately 20% to 40% of trauma survivors experience posttraumatic stress disorder (PTSD). The American College of Surgeons Committee on Trauma reports that early screening and referral has the potential to improve outcomes and that further study of screening and intervention for PTSD would be beneficial. This prospective randomized study screened hospitalized patients for traumatic stress reactions and assessed the effect of a brief intervention in reducing later development of PTSD. METHODS The Primary Care PTSD (PC-PTSD) screen was administered to admitted patients. Patients with symptoms were randomized to an intervention or control group. The brief intervention focused on symptom education and normalization, coping strategies, and utilizing supports. The control group received a 3-minute educational brochure review. Both groups completed in-hospital interviews, then 45- and 90-day telephone interviews. Follow-up collected the PTSD checklist-civilian (PCL-C) assessment and qualitative data on treatment-seeking barriers. RESULTS The PC-PTSD screen was successful in predicting later PTSD symptoms at both 45 days (β = 0.43, p < 0.001) and 90 days (β = 0.37, p < 0.001) even after accounting for depression. Correlations of the intervention with the PCL-C scores and factor score estimates did not reach statistical significance at either time point (p = 0.827; p = 0.838), indicating that the brief intervention did not decrease PTSD symptoms over time. Of those at or above the PCL-C cutoff at follow-ups, a minority had sought treatment for their symptoms (43.2%). Primary barriers included focusing on their injury or ongoing rehabilitation, financial concerns, or location of residence. CONCLUSION The PC-PTSD screen identified patients who later assess positive for PTSD using the PCL-C. The brief intervention did not reduce 45- and 90-day PTSD development. Follow-up interviews revealed lack of treatment infrastructure in the community. It will be important for trauma centers to align with community resources to address the treatment needs of at-risk patients. LEVEL OF EVIDENCE Prospective randomized controlled trial, level II.
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Joyal M, Wensing T, Levasseur-Moreau J, Leblond J, T. Sack A, Fecteau S. Characterizing emotional Stroop interference in posttraumatic stress disorder, major depression and anxiety disorders: A systematic review and meta-analysis. PLoS One 2019; 14:e0214998. [PMID: 30964902 PMCID: PMC6456228 DOI: 10.1371/journal.pone.0214998] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 03/25/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder is a debilitating psychiatric disorder characterized by symptoms of intrusive re-experiencing of trauma, avoidance and hyper-arousal. Diagnosis and treatment of PTSD is further complicated by concurrently occurring disorders, the most frequent being major depressive disorder and anxiety disorders. Previous research highlights that attentional processing in posttraumatic stress disorder is associated with substantial interference by emotional stimuli, a phenomenon also observed in these concurrently occurring psychiatric disorders. However, the diagnosis-relevance of this interference remains elusive. Here, we investigated the emotional Stroop interference for diagnosis-related stimuli, generally negative stimuli, and generally positive stimuli in posttraumatic stress disorder, major depressive disorder and anxiety disorders. METHODS We performed a systematic database search in PubMed (Medline), Cochrane Library and PsycINFO on emotional Stroop performance in individuals with a diagnosis of posttraumatic stress disorder, major depressive disorder or anxiety disorders separately. Mean effect sizes, standard errors and confidence intervals were estimated for each clinical group and healthy control group comparison using random effect models. RESULTS As compared to healthy control group, the posttraumatic stress disorder group displayed greater interference by diagnosis-related stimuli and positive stimuli but not for generally negative stimuli. The major depressive disorder and anxiety disorders groups showed greater interference by diagnosis-related and negative stimuli, but not by positive stimuli. The age and sex had no significant impact on interference. CONCLUSIONS These findings highlight the importance of diagnosis-relevant information on attentional processing in all three clinical populations, posttraumatic stress disorder, major depressive disorder and anxiety disorders. Further, the impact of generally negative stimuli but not generally positive stimuli in major depressive disorder and anxiety disorders indicate impaired attentional bias for mood-congruent stimuli but not for general stimuli. Finally, it remains to be studied whether the influence of generally positive stimuli in posttraumatic stress disorder indicate that positive stimuli are perceived as PTSD related.
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Affiliation(s)
- Marilyne Joyal
- Medical School, Laval University, Quebec City, QC, Canada
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Tobias Wensing
- Medical School, Laval University, Quebec City, QC, Canada
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Jean Levasseur-Moreau
- Medical School, Laval University, Quebec City, QC, Canada
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Jean Leblond
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Alexander T. Sack
- Faculty of Psychology and Neuroscience, Maastricht Brain Imaging Center, Maastricht University, Maastricht, The Netherlands
| | - Shirley Fecteau
- Medical School, Laval University, Quebec City, QC, Canada
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
- * E-mail:
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Larsen SE, Bellmore A, Gobin RL, Holens P, Lawrence KA, Pacella-LaBarbara ML. An initial review of residual symptoms after empirically supported trauma-focused cognitive behavioral psychological treatment. J Anxiety Disord 2019; 63:26-35. [PMID: 30825720 DOI: 10.1016/j.janxdis.2019.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 01/18/2019] [Accepted: 01/28/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Although residual symptoms remain following clinical treatment for posttraumatic stress disorder (PTSD), little is known about the characteristics of these residual symptoms. We aimed to determine the type, severity, and frequency of symptoms that remain after trauma-focused psychotherapy. METHODS We conducted a systematic review of 51 randomized controlled trials of empirically supported psychosocial interventions for PTSD (68 total treatment arms). Outcomes included: 1) PTSD symptoms and 2) conditions commonly comorbid with PTSD: depression, anxiety, and quality of life impairment. RESULTS In general, the results revealed that participants who completed PTSD treatment continued to report residual PTSD symptoms: 31% reported clinical symptom levels, and 59% reported subthreshold levels at posttreatment, particularly within the hyperarousal cluster. Residual symptoms also emerged for depression (19% clinical), anxiety (55% clinical), and quality of life (36% clinical). Few differences emerged across treatment types, but differential patterns were revealed for sample/trauma types. CONCLUSIONS Results suggest a need for focused research attention to and clinical assessment of individual residual symptoms following empirically supported treatment for PTSD to determine whether further treatment sessions are warranted.
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Affiliation(s)
- Sadie E Larsen
- Clement J. Zablocki, Milwaukee VAMC, Milwaukee, WI, USA; Department of Psychiatry, Medical College of Wisconsin, 1155 North Mayfair Road, Milwaukee, WI, 53226, USA.
| | - Aimee Bellmore
- Pfeiffer University, Department of Social Sciences, 48380 US-52, Misenheimer, NC, 28109, USA
| | - Robyn L Gobin
- University of Illinois at Urbana Champaign, Department of Kinesiology and Community Health, 1206 South Fourth Street MC-588, Champaign, IL, 61874, USA
| | - Pamela Holens
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, c/o OSI Clinic, Deer Lodge Centre, 2109 Portwidage Ave, Winnipeg, MB, RCJ 0L3, Canada
| | - Karen A Lawrence
- University of Kentucky College of Social Work, 669 Patterson Office Tower, Lexington, KY, 40506, USA
| | - Maria L Pacella-LaBarbara
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA, 15261, USA
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Post-traumatic stress disorders in patients with low-grade glioma and its association with survival. J Neurooncol 2019; 142:385-392. [DOI: 10.1007/s11060-019-03112-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/24/2019] [Indexed: 12/13/2022]
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McCallum SM, Batterham PJ, Calear AL, Sunderland M, Carragher N. Reductions in quality of life and increased economic burden associated with mental disorders in an Australian adult sample. AUST HEALTH REV 2019; 43:644-652. [DOI: 10.1071/ah16276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/11/2018] [Indexed: 11/23/2022]
Abstract
Objective
The aim of this study was to determine the effect of a broad range of common mental disorders and their comorbidity on health-related quality of life and functional disability.
Methods
In all, 2734 Australians aged ≥18 years, recruited from the general community via Facebook during August–December 2014, completed an online survey assessing demographic characteristics, nine mental disorders, suicidal ideation and attempt. Outcome measures were health-related quality of life (assessed using the Assessment of Quality of Life (AQoL)-4D measure and functional disability (days out of role).
Results
Overall, 53.1% of the sample met criteria for at least one mental disorder. Participants with each of the 11 mental health problems had significantly lower mean AQoL-4D scores and significantly greater functional disability compared with not having the disorder (P<0.001). A monotonic decrease in quality of life and an increase in functional disability were observed with an increased total number of comorbid disorders (P<0.001). Accounting for disorder prevalence, annual economic burden for each mental disorder was estimated to be in the range of A$870 million–A$17 billion.
Conclusions
Mental disorders negatively affect health-related quality of life and functional disability, exacerbated by increased comorbidity. The economic burden to participants and employers estimated in this study is of concern, and highlights the importance of evidence-based treatment and prevention approaches.
What is known about the topic?
Mental disorders are associated with poorer health-related quality of life, increased functional disability and increased economic costs.
What does this paper add?
This paper furthers our understanding of the associations of nine mental disorders, suicidal ideation and suicide attempts with quality of life in an Australian setting, highlighting the considerable economic implications of these associations. Further, it reveals that comorbidity of mental disorders exacerbates reductions in quality of life and increased functional disability.
What are the implications for practitioners?
The economic burden associated with lost productivity and quality of life for individuals with mental disorders is considerable. Therefore, prioritising funding to prevention and treatment using evidence-based approaches will have significant effect in terms of economic productivity and personal well-being for individuals.
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Araújo AXGD, Fontenelle LF, Berger W, Luz MPD, Pagotto LFADC, Marques-Portella C, Figueira I, Mendlowicz MV. Pre-traumatic vs post-traumatic OCD in PTSD patients: Are differences in comorbidity rates and functional health status related to childhood abuse? Compr Psychiatry 2018; 87:25-31. [PMID: 30195097 DOI: 10.1016/j.comppsych.2018.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/29/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The goal of this study was to compare the clinical and functional status and the trauma-related characteristics of PTSD patients with comorbid OCD whose onset predated the index traumatic event (pre-traumatic OCD) with those of PTSD patient whose comorbid OCD only emerged after the exposure to the traumatic event (post-traumatic OCD). METHODS Sixty-three individuals with PTSD and comorbid OCD were evaluated with the Structured Clinical Interview for DSM-IV AXIS I Disorders and completed the Posttraumatic Stress Disorder Checklist - Civilian Version, the Beck Depression Inventory, the Beck Anxiety Inventory, the Trauma History Questionnaire and the 36-Item Short-Form Health Survey. RESULTS A history of childhood abuse was significantly more frequent among PTSD patients with pre-traumatic OCD (45.2%) than among their counterparts with post-traumatic OCD (16%). PTSD patients with pre-traumatic OCD had higher rates of psychiatric comorbidity in general and showed a lower functional health status in a physical domain (SF-36 Role Limitation due to Physical Health). In contrast, PTSD patients with post-traumatic OCD had a decreased functional health status in a psychological domain (SF-36 Emotional Well Being). The effect sizes were in the medium to large range. CONCLUSIONS A history of child abuse may be an important, but often neglected, factor accounting for clinical, functional, and trauma-related differences between pre-traumatic and posttraumatic OCD in PTSD patients.
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Affiliation(s)
- Alexandre Xavier Gomes de Araújo
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Brazil
| | - Leonardo F Fontenelle
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Brazil; School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Australia; D'Or Institute for Research and Education (IDOR), Brazil.
| | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil
| | - Mariana Pires da Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil
| | | | | | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Brazil
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Gekker M, Coutinho ESF, Berger W, Luz MPD, Araújo AXGD, Pagotto LFADC, Marques-Portella C, Figueira I, Mendlowicz MV. Early scars are forever: Childhood abuse in patients with adult-onset PTSD is associated with increased prevalence and severity of psychiatric comorbidity. Psychiatry Res 2018; 267:1-6. [PMID: 29879599 DOI: 10.1016/j.psychres.2018.05.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
Childhood abuse and PTSD are independently associated with severe psychiatric comorbidity. We hypothesized that among patients with adult-onset PTSD, a history of child abuse was associated with increased prevalence and severity of comorbid mental disorders. Participants were 109 adult treatment-seeking patients, 23.9% of whom had a history of childhood sexual, physical or emotional abuse. The socio-demographic characteristics and comorbidity profile of PTSD patients with and without history of child abuse were compared using the two-tailed t-test and the chi-square test. PTSD patients with a history of child abuse had significantly higher average PCL-C hyperarousal [21.8 (SD = 3.6) vs 19.8 (SD = 3.5)] and BDI [35.7 (SD = 9.2) vs 29.1 (SD = 13.9)] scores, a significantly increased average number of lifetime [4.85 (SD = 1.43) vs 3.93 (SD = 1.33)] and current [4.46 (SD = 1.24) vs 3.75 (SD = 1.32)] comorbid disorders, and a greater prevalence of lifetime (73.1% vs 44.6%) and current (79.2% vs 46.7%) panic disorder/agoraphobia and of psychotic symptoms (73.1% vs 30.1%). All effect sizes were in the medium to large range. Adult-onset PTSD patients with a history of child abuse may represent a subgroup with a more severe form of the disorder that is associated with a more serious clinical course, treatment resistance and poorer outcome.
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Affiliation(s)
- Márcio Gekker
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil
| | - Evandro Silva Freire Coutinho
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil; Department of Epidemiology and Quantitative Methods in Health, Escola Nacional de Saúde Pública (ENSP-FIOCRUZ), Rio de Janeiro, Brazil
| | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil
| | - Mariana Pires da Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil
| | - Alexandre Xavier Gomes de Araújo
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niterói, Rio de Janeiro, Brazil
| | | | - Carla Marques-Portella
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niterói, Rio de Janeiro, Brazil.
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Kizilhan JI, Noll-Hussong M. Post-traumatic stress disorder among former Islamic State child soldiers in northern Iraq. Br J Psychiatry 2018; 213:425-429. [PMID: 29852882 DOI: 10.1192/bjp.2018.88] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Former child soldiers are at high risk of developing mental disorders such as post-traumatic stress disorder (PTSD); however, their comprehensive mental health has yet to be examined.AimsThis study looks at the prevalence of PTSD, depression and associated risk factors such as disturbed self-esteem among former child soldiers of the so-called 'Islamic State'. METHOD The psychological effect of traumatic events was assessed in 81 Yazidi children who had been child soldiers for the Islamic State in northern Iraq between 2014 and 2017 for at least 6 months. The children were between 8 and 14 years of age. Thirty-two Yazidi boys and 31 Muslim boys who were not child soldiers in Iraq served as control groups. A structured psychological interview and established psychometric questionnaires were used to assess traumatisation and mental disorders. RESULTS The child soldiers showed a significantly higher prevalence of PTSD (48.3%), depressive disorders (45.6%), anxiety disorders (45.8%) and somatic disturbances (50.6%) than the boys who had not been child soldiers. Developmentally crucial self-esteem was significantly reduced in former child soldiers. No significant differences between the two control groups could be found. CONCLUSIONS PTSD and other mental disorders are highly present among former child soldiers in northern Iraq. The study highlights the huge and as yet unmet need for psychological services among former child soldiers.Declaration of interestNone.
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Affiliation(s)
- Jan Ilhan Kizilhan
- Institute for Psychotherapy and Psychotraumatology,University of Duhok, Iraq and State University Baden-Württemberg,Germany
| | - Michael Noll-Hussong
- Clinic for Psychiatry and Psychotherapy,Division of Psychosomatic Medicine and Psychotherapy,Universitaetskliniken des Saarlandes,Germany
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Lu J, Dong H, Zheng X. Strengthened functional connectivity among LFPs in rat medial prefrontal cortex during anxiety. Behav Brain Res 2018; 349:130-136. [PMID: 29680786 DOI: 10.1016/j.bbr.2018.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/29/2018] [Accepted: 04/11/2018] [Indexed: 01/01/2023]
Abstract
Theta oscillations in medial prefrontal cortex (mPFC) have been consistently implicated in the regulation of anxiety-related behaviors. However, the theta-band functional connectivity in mPFC is less well characterized. Therefore, we simultaneously recorded local filed potentials (LFPs) from mPFC in freely behaving rats in the elevated plus maze (EPM). Functional connectivity among LFPs was measured by directed transfer function (DTF) via spectral Granger causal connectivity analysis. Causal network was then identified based on DTF. Global efficiency (Eglob) was selected to quantitatively describe the characteristic of the network. Our results showed that a significant difference in theta-band functional connectivity between safe and aversive location in the maze anxiety test. Strikingly, DTF and Eglob were higher specifically in the closed arms and decreased sharply prior to entrying into the open arms. These results indicate strengthened theta-band functional connectivity may be related to anxiety.
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Affiliation(s)
- Jun Lu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, 300070, China
| | - Haoran Dong
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, 300070, China
| | - Xuyuan Zheng
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, 300070, China.
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Harned MS, Wilks CR, Schmidt SC, Coyle TN. Improving functional outcomes in women with borderline personality disorder and PTSD by changing PTSD severity and post-traumatic cognitions. Behav Res Ther 2018; 103:53-61. [PMID: 29448136 PMCID: PMC5837954 DOI: 10.1016/j.brat.2018.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/27/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
Although functional impairment typically improves during evidence-based psychotherapies (EBPs) for borderline personality disorder (BPD), functional levels often remain suboptimal after treatment. The present pilot study evaluated whether and how integrating PTSD treatment into an EBP for BPD would improve functional outcomes. Participants were 26 women with BPD, PTSD, and recent suicidal and/or self-injurious behavior who were randomized to receive one year of Dialectical Behavior Therapy (DBT) or DBT with the DBT Prolonged Exposure (DBT PE) protocol for PTSD. Five domains of functioning were assessed at 4-month intervals during treatment and at 3-months post-treatment. DBT + DBT PE was superior to DBT in improving global social adjustment, health-related quality of life, and achieving good global functioning, but not interpersonal problems or quality of life. Results of time-lagged mixed effects models indicated that, across both treatments, reductions in PTSD severity significantly predicted subsequent improvement in global social adjustment, global functioning, and health-related quality of life, whereas reductions in post-traumatic cognitions significantly predicted later improvement in all functional outcomes except global social adjustment. These findings provide preliminary evidence supporting the role of change in PTSD severity and trauma-related cognitions as active mechanisms in improving functional outcomes among individuals with BPD and PTSD.
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Trauma and Pain in Family-Orientated Societies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 15:ijerph15010044. [PMID: 29283370 PMCID: PMC5800143 DOI: 10.3390/ijerph15010044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 11/16/2022]
Abstract
People from family-oriented societies in particular, in addition to having a post-traumatic stress disorder (PTSD) suffer from chronic pain and physical complaints. Such people have a different understanding of physical illness and pain and, compared to patients from western societies, have different ideas on healing, even when confronted with the therapist. Hitherto, these factors have not been sufficiently taken into account in modern, multi-module therapy approaches. Trauma can be perceived via pain and physical complaints, whereby the pain is not restricted to one part of the body but is seen as covering the body as a whole. Therefore, in the treatment and above all in the patient-therapist relationship, it is necessary to understand what importance is attached to the perceived pain in relation to the trauma. The afflicted body expresses the trauma in the shape of its further-reaching consequences such as the patient's social, collective, economic and cultural sensitivity. Therefore, for the effective treatment of trauma and chronic pain, it is necessary to use a multi-modal, interdisciplinary, and culture-sensitive approach when treating patients from traditional cultural backgrounds.
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Harris JI, Strom TQ, Ferrier-Auerbach AG, Kaler ME, Hansen LP, Erbes CR. Workplace social support in job satisfaction among veterans with posttraumatic stress symptoms: A preliminary correlational study. PLoS One 2017; 12:e0181344. [PMID: 28777812 PMCID: PMC5544179 DOI: 10.1371/journal.pone.0181344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 06/29/2017] [Indexed: 11/18/2022] Open
Abstract
For Veterans managing PTSD symptoms, returning to vocational functioning is often challenging; identifying modifiable variables that can contribute to positive vocational adjustment is critical to improved vocational rehabilitation services. Workplace social support has proven to be important in vocational adjustment in both general population and vocational rehabilitation samples, but this area of inquiry has received little attention among Veterans with PTSD symptoms. In this small correlational study, employed Veterans (N = 63) presenting for outpatient PTSD treatment at a VA Health Care System completed surveys assessing demographic variables, PTSD symptoms, workplace social support, and job satisfaction. Workplace social support contributed to the prediction of job satisfaction. It is of note that workplace social support predicted a larger proportion of the variance in employment satisfaction than PTSD symptoms. Further research on workplace social support as a vocational rehabilitation resource for Veterans with PTSD is indicated.
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Affiliation(s)
- J. I. Harris
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
- University of Minnesota Department of Psychiatry, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Thad Q. Strom
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
- University of Minnesota Department of Psychiatry, Minneapolis, Minnesota, United States of America
| | | | - Matthew E. Kaler
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Lucas P. Hansen
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Christopher R. Erbes
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
- University of Minnesota Department of Psychiatry, Minneapolis, Minnesota, United States of America
- Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, United States of America
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Gerdau I, Kizilhan JI, Noll-Hussong M. Posttraumatic Stress Disorder and Related Disorders among Female Yazidi Refugees following Islamic State of Iraq and Syria Attacks-A Case Series and Mini-Review. Front Psychiatry 2017; 8:282. [PMID: 29326610 PMCID: PMC5733480 DOI: 10.3389/fpsyt.2017.00282] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/29/2017] [Indexed: 12/20/2022] Open
Abstract
Following the severe attacks by the so-called "Islamic State of Iraq and Syria" on the Yazidi population, which started in summer 2014, the state government of Baden-Württemberg, Germany, funded a Special-Quota Project to bring 1,000 very ill or left-behind women and children who were being held hostage to 22 cities and towns in Baden-Württemberg to receive integrated care. Here, we report for the first time on the cases of four Yazidi women living in Ulm, Germany, focusing on the clinically observed and psychometrically assessed mental phenomena or disorders. Our primary aim was to explore what International Classification of Diseases, 10th Revision diagnoses are present in this population. Although highly traumatized, these women were suffering primarily from adjustment disorder rather than posttraumatic stress disorder according to official classification systems. Despite their symptoms of depression and anxiety, the women's responses to self-assessment questionnaires provided no evidence of compulsion, somatization, or eating disorders. The results suggest that further investigation of the individual-level effects of rape and torture, as well the historic, systemic, and collective effects, e.g., on families and societies, is required.
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Affiliation(s)
- Inga Gerdau
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | - Jan Ilhan Kizilhan
- Duale Hochschule Baden-Württemberg Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Michael Noll-Hussong
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
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Quality of Life and Functioning in Comorbid Posttraumatic Stress Disorder and Major Depressive Disorder After Treatment With Citalopram Monotherapy. Clin Neuropharmacol 2017; 40:16-23. [DOI: 10.1097/wnf.0000000000000190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Martínez L, Prada E, Satler C, Tavares MCH, Tomaz C. Executive Dysfunctions: The Role in Attention Deficit Hyperactivity and Post-traumatic Stress Neuropsychiatric Disorders. Front Psychol 2016; 7:1230. [PMID: 27602003 PMCID: PMC4993788 DOI: 10.3389/fpsyg.2016.01230] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/02/2016] [Indexed: 11/13/2022] Open
Abstract
Executive functions (EFs) is an umbrella term for various cognitive processes controlled by a complex neural activity, which allow the production of different types of behaviors seeking to achieve specific objectives, one of them being inhibitory control. There is a wide consensus that clinical and behavioral alterations associated with EF, such as inhibitory control, are present in various neuropsychiatric disorders. This paper reviews the research literature on the relationship between executive dysfunction, frontal-subcortical neural circuit changes, and the psychopathological processes associated with attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD). A revision on the role of frontal-subcortical neural circuits and their presumable abnormal functioning and the high frequency of neuropsychiatric symptoms could explain the difficulties with putting effector mechanisms into action, giving individuals the necessary tools to act efficiently in their environment. Although, neuronal substrate data about ADHD and PTSD has been reported in the literature, it is isolated. Therefore, this review highlights the overlapping of neural substrates in the symptomatology of ADHD and PTSD disorders concerning EFs, especially in the inhibitory component. Thus, the changes related to impaired EF that accompany disorders like ADHD and PTSD could be explained by disturbances that have a direct or indirect impact on the functioning of these loops. Initially, the theoretical model of EF according to current neuropsychology will be presented, focusing on the inhibitory component. In a second stage, this component will be analyzed for each of the disorders of interest, considering the clinical aspects, the etiology and the neurobiological basis. Additionally, commonalities between the two neuropsychiatric conditions will be taken into consideration from the perspectives of cognitive and emotional inhibition. Finally, the implications and future prospects for research and interventions in the area will be outlined, with the intention of contributing scientific reference information that encompasses the knowledge and understanding of executive dysfunction and its relationship with these treated disorders.
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Affiliation(s)
- Lía Martínez
- Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, University of Brasilia Brasilia, Brazil
| | - Edward Prada
- Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, University of BrasiliaBrasilia, Brazil; Faculty of Psychology, Social Sciences Department, Universidad Pontificia Bolivariana Seccional BucaramangaBucaramanga, Colombia
| | - Corina Satler
- Faculty of Ceilandia, University of Brasilia Brasilia, Brazil
| | - Maria C H Tavares
- Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, University of Brasilia Brasilia, Brazil
| | - Carlos Tomaz
- Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, University of BrasiliaBrasilia, Brazil; Neuroscience Research Program, University CEUMASão Luis, Brazil
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Price M, Szafranski DD, van Stolk-Cooke K, Gros DF. Investigation of abbreviated 4 and 8 item versions of the PTSD Checklist 5. Psychiatry Res 2016; 239:124-30. [PMID: 27137973 DOI: 10.1016/j.psychres.2016.03.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 03/05/2016] [Accepted: 03/05/2016] [Indexed: 11/25/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a significant public health concern associated with marked impairment across the lifespan. Exposure to traumatic events alone, however, is insufficient to determine if an individual has PTSD. PTSD is a heterogeneous diagnosis such that assessment of all 20 symptoms is problematic in time-limited treatment settings. Brief assessment tools that identify those at risk for PTSD and measure symptom severity are needed to improve access to care and assess treatment response. The present study evaluated abbreviated measures of PTSD symptoms derived from the PTSD Checklist for DSM-5 (PCL-5) - a 20-item validated measure of PTSD symptoms - across two studies. In the first, using a community sample of adults exposed to a traumatic event, 4-and 8-item versions of the PCL-5 were identified that were highly correlated with the full PCL-5. In the second, using a sample of combat veterans, the 4-and 8-item measures had comparable diagnostic utility to the total-scale PCL-5. These results provide support for an abbreviated measure of the PCL-5 as an alternative to the 20-item total scale.
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Affiliation(s)
- Matthew Price
- Department of Psychological Science, University of Vermont, Burlington, VT, USA.
| | - Derek D Szafranski
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Daniel F Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Painter JM, Gray K, McGinn MM, Mostoufi S, Hoerster KD. The relationships of posttraumatic stress disorder and depression symptoms with health-related quality of life and the role of social support among Veterans. Qual Life Res 2016; 25:2657-2667. [DOI: 10.1007/s11136-016-1295-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2016] [Indexed: 10/21/2022]
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50
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Sofko CA, Currier JM, Drescher KD. Prospective associations between changes in mental health symptoms and health-related quality of life in veterans seeking posttraumatic stress disorder residential treatment. ANXIETY STRESS AND COPING 2016; 29:630-43. [PMID: 26902309 DOI: 10.1080/10615806.2016.1157171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES This study examined prospective associations between changes in mental health symptoms (posttraumatic stress disorder [PTSD], depression) and health-related quality of life (physical health, psychological well-being) for veterans with PTSD. DESIGN This study focused on 139 patients who completed a residential treatment program for PTSD in the Veterans Health Administration. METHODS Patients completed the veteran-specific, 12-item Medical Outcomes Study Short Form, PTSD Checklist - Military version, and Beck Depression Inventory at pre-treatment, discharge, and a four-month follow-up. When accounting for demographic factors, combat exposure, and baseline scores on the respective outcome variables (e.g. mental health, physical health, PTSD, and depressive symptoms), a series of multivariate analyses were conducted for treatment-related changes in mental and physical health on the outcome measures. RESULTS Reductions in PTSD symptomatology during the treatment period were prospectively linked with better health-related outcomes at the four-month follow-up. In addition, improved physical health and psychological well-being during treatment were each similarly associated with better PTSD and depression outcomes in the months following treatment. CONCLUSIONS Addressing concerns in mental and physical health might have synergistic effects across both domains, supporting the need for holistic models and integrated health care strategies for treating veterans with PTSD.
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Affiliation(s)
- Channing A Sofko
- a Psychology Department , University of South Alabama , Mobile , AL , USA
| | - Joseph M Currier
- a Psychology Department , University of South Alabama , Mobile , AL , USA
| | - Kent D Drescher
- b National Center for PTSD , Dissemination and Training Division , Menlo Park , CA , USA
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