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López-Castro T, Sohler N, Riback L, Bravo G, Ohlendorf E, Ghiroli M, Fox AD. Posttraumatic stress disorder in people who use drugs: syringe services program utilization, treatment need, and preferences for onsite mental health care. Harm Reduct J 2024; 21:108. [PMID: 38824597 PMCID: PMC11143655 DOI: 10.1186/s12954-024-01019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/09/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Syringe services programs (SSPs) are critical healthcare access points for people with opioid use disorder (OUD) who face treatment utilization barriers. Co-locating care for common psychiatric comorbidities, like posttraumatic stress disorder (PTSD), at SSPs may reduce harms and enhance the health of individuals with OUD. To guide the development of onsite psychiatric care at SSPs, we collected quantitative survey data on the prevalence of PTSD, drug use patterns, treatment experiences associated with a probable PTSD diagnosis, and attitudes regarding onsite PTSD care in a convenience sample of registered SSP clients in New York City. METHODS Study participants were administered the PTSD Checklist for the DSM-5 (PCL-5) and asked about sociodemographic characteristics, current drug use, OUD and PTSD treatment histories, and desire for future SSP services using a structured interview. Probable PTSD diagnosis was defined as a PCL-5 score ≥ 31. RESULTS Of the 139 participants surveyed, 138 experienced at least one potentially traumatic event and were included in the present analysis. The sample was primarily male (n = 108, 78.3%), of Hispanic or Latinx ethnicity (n = 76, 55.1%), and middle-aged (M = 45.0 years, SD = 10.6). The mean PCL-5 score was 35.2 (SD = 21.0) and 79 participants (57.2%) had a probable PTSD diagnosis. We documented frequent SSP utilization, significant unmet PTSD treatment need, and high interest in onsite PTSD treatment. CONCLUSIONS Study findings point to the ubiquity of PTSD in people with OUD who visit SSPs, large gaps in PTSD care, and the potential for harm reduction settings like SSPs to reach people underserved by the healthcare system who have co-occurring OUD and PTSD.
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Affiliation(s)
- Teresa López-Castro
- Department of Psychology, The City College of New York, City University of New York, 160 Convent Avenue, New York, NY, 10031, USA.
| | - Nancy Sohler
- The City University of New York School of Medicine, 160 Convent Avenue, New York, NY, 10031, USA
| | - Lindsey Riback
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Gina Bravo
- Department of Psychology, The City College of New York, City University of New York, 160 Convent Avenue, New York, NY, 10031, USA
| | - Eric Ohlendorf
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Megan Ghiroli
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Aaron D Fox
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
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Morgan-López AA, Saavedra LM, Prakash K, West SG, Hien DA. The Hidden Psychometric Model Underlying the DSM: What Happens When It Fails to Fit Psychiatric Data. Psychiatr Serv 2024:appips20230370. [PMID: 38769910 DOI: 10.1176/appi.ps.20230370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Antonio A Morgan-López
- RTI International, Research Triangle Park, North Carolina (Morgan-López, Saavedra); Department of Psychology, Eastern Michigan University, Ypsilanti (Prakash); Department of Psychology, Arizona State University, Tempe, and Methods and Evaluation Division, Freie Universität Berlin, Berlin (West); Center of Alcohol and Substance Use Studies, Rutgers University, Piscataway, New Jersey (Hien)
| | - Lissette M Saavedra
- RTI International, Research Triangle Park, North Carolina (Morgan-López, Saavedra); Department of Psychology, Eastern Michigan University, Ypsilanti (Prakash); Department of Psychology, Arizona State University, Tempe, and Methods and Evaluation Division, Freie Universität Berlin, Berlin (West); Center of Alcohol and Substance Use Studies, Rutgers University, Piscataway, New Jersey (Hien)
| | - Krithika Prakash
- RTI International, Research Triangle Park, North Carolina (Morgan-López, Saavedra); Department of Psychology, Eastern Michigan University, Ypsilanti (Prakash); Department of Psychology, Arizona State University, Tempe, and Methods and Evaluation Division, Freie Universität Berlin, Berlin (West); Center of Alcohol and Substance Use Studies, Rutgers University, Piscataway, New Jersey (Hien)
| | - Stephen G West
- RTI International, Research Triangle Park, North Carolina (Morgan-López, Saavedra); Department of Psychology, Eastern Michigan University, Ypsilanti (Prakash); Department of Psychology, Arizona State University, Tempe, and Methods and Evaluation Division, Freie Universität Berlin, Berlin (West); Center of Alcohol and Substance Use Studies, Rutgers University, Piscataway, New Jersey (Hien)
| | - Denise A Hien
- RTI International, Research Triangle Park, North Carolina (Morgan-López, Saavedra); Department of Psychology, Eastern Michigan University, Ypsilanti (Prakash); Department of Psychology, Arizona State University, Tempe, and Methods and Evaluation Division, Freie Universität Berlin, Berlin (West); Center of Alcohol and Substance Use Studies, Rutgers University, Piscataway, New Jersey (Hien)
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3
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Hien DA, Papini S, Saavedra LM, Bauer AG, Ruglass LM, Ebrahimi CT, Fitzpatrick S, López-Castro T, Norman SB, Killeen TK, Back SE, Morgan-López AA. Project harmony: A systematic review and network meta-analysis of psychotherapy and pharmacologic trials for comorbid posttraumatic stress, alcohol, and other drug use disorders. Psychol Bull 2024; 150:319-353. [PMID: 37971855 PMCID: PMC10939977 DOI: 10.1037/bul0000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
We conducted a systematic review and network meta-analyses (NMA) of psychotherapy and pharmacologic treatments for individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol or other drug use disorder (AOD). A comprehensive search spanning 1995-2019 yielded a pool of 39 studies for systematic review, including 24 randomized controlled trials for the NMA. Study interventions were grouped by target of treatment (PTSD + AOD, PTSD-only, and AOD-only) and approach (psychotherapy or medication). Standardized mean differences (SMD) from the NMA yielded evidence that at the end of treatment, integrated, trauma-focused therapy for PTSD + AOD was more effective at reducing PTSD symptoms than integrated, non-trauma-focused therapy (SMD = -0.30), AOD-focused psychotherapy (SMD = -0.29), and other control psychotherapies (SMD = -0.43). End-of-treatment alcohol use severity was less for AOD medication compared to placebo medication (SMD = -0.36) and trauma-focused therapy for PTSD + placebo medication (SMD = -0.67), and less for trauma-focused psychotherapy + AOD medication compared to PTSD medication (SMD = -0.53), placebo medication (SMD = -0.50), and trauma-focused psychotherapy + placebo medication (SMD = -0.81). Key limitations include the small number of studies in the NMA for pharmacologic treatments and the lack of demographic diversity apparent in the existing literature. Findings suggest room for new studies that can address limitations in study sample composition, sample sizes, retention, and apply new techniques for conducting comparative effectiveness in PTSD + AOD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Denise A Hien
- Department of Clinical Psychology, Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick
| | | | | | - Alexandria G Bauer
- Department of Clinical Psychology, Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick
| | | | - Chantel T Ebrahimi
- Department of Clinical Psychology, Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick
| | | | | | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego
| | - Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
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4
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Saavedra LM, Lochman JE, Morgan-López AA, McDaniel HL, Bradshaw CP, Powell NP, Qu L, Budavari A, Yaros AC. Collateral effects of Coping Power on caregiver symptoms of depression and long-term changes in child behavior. Dev Psychopathol 2024:1-13. [PMID: 38179693 DOI: 10.1017/s095457942300144x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
A large body of research demonstrates positive impacts of the Coping Power Program as a preventive intervention for youth behavioral outcomes, but potential collateral effects for caregivers is less known. The current study examined whether the youth-focused Coping Power Program can have a secondary impact on caregiver self-reported symptoms of depression and in turn result in longer-term impacts on child disruptive behavior problems including aggression, conduct problems and hyperactivity. Data from 360 youth/caregiver pairs across 8 waves of data (grades 4 through 10) were analyzed. We used two methodological approaches to (a) assess indirect effects in the presence of potential bidirectionality using timepoint-to-timepoint dynamic effects under Autoregressive Latent Trajectory modeling and (b) estimate scale scores in the presence of measurement non-invariance. Results showed that individually delivered Coping Power (ICP) produced greater direct effects on conduct problems and indirect effects on general externalizing and hyperactivity (through reductions in caregiver self-reported symptoms of depression), compared to group Coping Power (GCP). In comparison to GCP, ICP produced similar direct effects on reductions in caregiver depression. Child-focused prevention interventions can have an indirect impact on caregiver depression, which later shows improvements in longer-term reductions for child disruptive problems.
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Affiliation(s)
- Lissette M Saavedra
- Community Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - John E Lochman
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | | | - Heather L McDaniel
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Catherine P Bradshaw
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Nicole P Powell
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | - Lixin Qu
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | - Alexa Budavari
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Anna C Yaros
- Community Health Research Division, RTI International, Research Triangle Park, NC, USA
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5
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Sawalma AS, Kiefer CM, Boers F, Shah NJ, Khudeish N, Neuner I, Herzallah MM, Dammers J. The effects of trauma on feedback processing: an MEG study. Front Neurosci 2023; 17:1172549. [PMID: 38027493 PMCID: PMC10651751 DOI: 10.3389/fnins.2023.1172549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The cognitive impact of psychological trauma can manifest as a range of post-traumatic stress symptoms that are often attributed to impairments in learning from positive and negative outcomes, aka reinforcement learning. Research on the impact of trauma on reinforcement learning has mainly been inconclusive. This study aimed to circumscribe the impact of psychological trauma on reinforcement learning in the context of neural response in time and frequency domains. Two groups of participants were tested - those who had experienced psychological trauma and a control group who had not - while they performed a probabilistic classification task that dissociates learning from positive and negative feedback during a magnetoencephalography (MEG) examination. While the exposure to trauma did not exhibit any effects on learning accuracy or response time for positive or negative feedback, MEG cortical activity was modulated in response to positive feedback. In particular, the medial and lateral orbitofrontal cortices (mOFC and lOFC) exhibited increased activity, while the insular and supramarginal cortices showed decreased activity during positive feedback presentation. Furthermore, when receiving negative feedback, the trauma group displayed higher activity in the medial portion of the superior frontal cortex. The timing of these activity changes occurred between 160 and 600 ms post feedback presentation. Analysis of the time-frequency domain revealed heightened activity in theta and alpha frequency bands (4-10 Hz) in the lOFC in the trauma group. Moreover, dividing the two groups according to their learning performance, the activity for the non-learner subgroup was found to be lower in lOFC and higher in the supramarginal cortex. These differences were found in the trauma group only. The results highlight the localization and neural dynamics of feedback processing that could be affected by exposure to psychological trauma. This approach and associated findings provide a novel framework for understanding the cognitive correlates of psychological trauma in relation to neural dynamics in the space, time, and frequency domains. Subsequent work will focus on the stratification of cognitive and neural correlates as a function of various symptoms of psychological trauma. Clinically, the study findings and approach open the possibility for neuromodulation interventions that synchronize cognitive and psychological constructs for individualized treatment.
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Affiliation(s)
- Abdulrahman S. Sawalma
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
| | - Christian M. Kiefer
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Mathematics, Computer Science and Natural Sciences, RWTH Aachen University, Aachen, Germany
| | - Frank Boers
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - N. Jon Shah
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Institute of Neuroscience and Medicine (INM-11), Jülich Aachen Research Alliance (JARA), Forschungszentrum Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)-Brain – Translational Medicine, Aachen, Germany
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Nibal Khudeish
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Irene Neuner
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)-Brain – Translational Medicine, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Mohammad M. Herzallah
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, United States
| | - Jürgen Dammers
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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6
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Morgan‐López AA, Saavedra LM, Hien DA, Norman SB, Fitzpatrick SS, Ye A, Killeen TK, Ruglass LM, Blakey SM, Back SE. Differential symptom weighting in estimating empirical thresholds for underlying PTSD severity: Toward a "platinum" standard for diagnosis? Int J Methods Psychiatr Res 2023; 32:e1963. [PMID: 36789653 PMCID: PMC10485310 DOI: 10.1002/mpr.1963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/22/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Symptom counts as the basis for Post-Traumatic Stress Disorder (PTSD) diagnoses in the DSM presume each symptom is equally reflective of underlying disorder severity. However, the "equal weight" assumption fails to fit PTSD symptom data when tested. The present study developed an enhanced PTSD diagnosis based on (a) a conventional PTSD diagnosis from a clinical interview and (b) an empirical classification of full PTSD that reflected the relative clinical weights of each symptom. METHOD Baseline structured interview data from Project Harmony (N = 2658) was used. An enhanced diagnosis for full PTSD was estimated using an empirical threshold from moderated nonlinear factor analysis (MNLFA) latent PTSD scale scores, in combination with a full conventional PTSD diagnosis based on interview data. RESULTS One in 4 patients in the sample had a PTSD diagnosis that was inconsistent with their empirical PTSD grouping, such that the enhanced diagnostic standard reduced the diagnostic discrepancy rate by 20%. Veterans, and in particular female Veterans, were at greatest odds for discrepancy between their underlying PTSD severity and DSM diagnosis. CONCLUSION Psychometric methodologies that differentially weight symptoms can complement DSM criteria and may serve as a platform for symptom prioritization for diagnoses in future editions of DSM.
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Affiliation(s)
| | - Lissette M. Saavedra
- Community Health Research DivisionRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Denise A. Hien
- Center of Alcohol & Substance Use StudiesRutgers University–New BrunswickPiscatawayNew JerseyUSA
| | - Sonya B. Norman
- Department of PsychiatryUniversity of CaliforniaSan DiegoVirginiaUSA
| | | | - Ai Ye
- Department of Psychology & NeuroscienceL.L. Thurstone Psychometric LaboratoryUNC‐Chapel HillChapel HillNorth CarolinaUSA
- Department PsychologieLudwig‐Maximilians‐UniversitätMunichGermany
| | - Therese K. Killeen
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Ralph H. Johnson VA Medical CenterCharlestonSouth CarolinaUSA
| | - Lesia M. Ruglass
- Department of PsychologyCity College of New YorkNew YorkNew YorkUSA
| | - Shannon M. Blakey
- Community Health Research DivisionRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Ralph H. Johnson VA Medical CenterCharlestonSouth CarolinaUSA
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7
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Scheer JR, Helminen EC, Cascalheira CJ, Jaipuriyar V, Shaw TJ, Zabelski S, Behari K, Pirog S, Batchelder AW, Possemato K, Hughes TL, Sullivan TP. Probable PTSD, PTSD symptom severity, and comorbid PTSD and hazardous drinking among sexual minority women compared to heterosexual women: A meta-analysis. Clin Psychol Rev 2023; 102:102283. [PMID: 37150043 PMCID: PMC10205673 DOI: 10.1016/j.cpr.2023.102283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/24/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) is more prevalent among sexual minority women (SMW) than among heterosexual women. PTSD risk varies among SMW, but no meta-analysis has clarified sexual identity-related disparities in probable PTSD among women or SMW's heterogeneity in PTSD risk. SMW are also at pronounced risk of comorbid PTSD and hazardous drinking (HD). However, the difference in comorbid PTSD/HD between SMW and heterosexual women is understudied. This meta-analysis aimed to provide a comprehensive understanding of differences between SMW and heterosexual women and among SMW across demographic characteristics. Peer-reviewed publications that were written in English and reported quantitative data on PTSD specific to SMW were included. Eligible publications (n = 45) were identified through a systematic search of 11 electronic databases, supplemented by a search of reference lists of relevant papers. We found that probable PTSD, PTSD symptom severity, and probable comorbid PTSD/HD are highly prevalent among SMW, with SMW of color, transgender and gender diverse people, and bi+ women (e.g., bisexual, pansexual, queer) being at greatest risk. These results emphasize the need to improve accurate assessment of trauma-related sequelae among SMW and to develop, disseminate, and implement culturally sensitive treatments to reduce PTSD and comorbid PTSD/HD among at-risk SMW.
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Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA.
| | - Emily C Helminen
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; College of Health Science and Technology, Rochester Institute of Technology, USA
| | - Cory J Cascalheira
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; Department of Counseling & Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Virinca Jaipuriyar
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Thomas J Shaw
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Sasha Zabelski
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Sophia Pirog
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Abigail W Batchelder
- Harvard Medical School, Harvard University, Boston, MA, USA; Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY, USA
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, NY, USA; Columbia University School of Nursing Center for Sexual and Gender Minority Research, New York, NY, USA
| | - Tami P Sullivan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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8
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Jongedijk RA, Boelen PA, Knipscheer JW, Kleber RJ. Unity or Anarchy? A Historical Search for the Psychological Consequences of Psychotrauma. REVIEW OF GENERAL PSYCHOLOGY 2023. [DOI: 10.1177/10892680231153096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The field of traumatic stress is often referred to as being in a state of controversy and lack of continuity. Throughout history, disputes repeatedly centered on defining the psychological consequences of severe adverse events and on their causes. Even to this day this is current. To understand these controversies, an extensive historical literature review is presented of how mental consequences of trauma have been described in history, of the circumstances in which this took place, and of the disputes that have influenced the conceptualization of these mental responses. We found psychotrauma always being surrounded by controversy. Significant heterogeneity in symptom expression has been described over the centuries to this day. Some symptoms appeared steadily over many decades, but often each time period showed its own core symptoms. At syndrome level, we found an acute condition, one with longer duration, and a complex condition. Also here, definitions varied over the decades. Finally, causes have always been debated, such as biological, psychological, socio-economic, cultural, political, or legal. To better reflect the described ongoing variation in symptomatology, a more flexible diagnostic approach is proposed with a combination of both staging and subtyping that offers room for a more flexible, symptom-oriented, and personalized perspective.
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Affiliation(s)
- Ruud A. Jongedijk
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- ARQ Centrum’45, Oegstgeest, The Netherlands
| | - Paul A. Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- ARQ Centrum’45, Oegstgeest, The Netherlands
| | - Jeroen W. Knipscheer
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- ARQ Centrum’45, Oegstgeest, The Netherlands
| | - Rolf J. Kleber
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
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9
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Saavedra LM, Morgan-López AA, Back SE, Patel SV, Hien DA, Killeen TK, Norman SB, Fitzpatrick S, Ebrahimi CT, Ruglass LM. Measurement Error-Corrected Estimation of Clinically Significant Change Trajectories for Interventions Targeting Comorbid PTSD and Substance Use Disorders in OEF/OIF Veterans. Behav Ther 2022; 53:1009-1023. [PMID: 35987532 DOI: 10.1016/j.beth.2022.04.007] [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: 11/09/2021] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 11/02/2022]
Abstract
In randomized control trials (RCTs), a focus on average differences between treatment arms often limits our understanding of whether individuals show clinically significant improvement or deterioration. The present study examined differences in individual-level clinical significance trajectories between Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) and Relapse Prevention (RP). Eighty-one treatment-seeking veterans with a comorbid PTSD/SUD diagnosis were randomized to COPE or RP; data from an additional n = 48 patients who did not meet criteria for both disorders was used to establish a normative threshold. A newly developed, modernized approach to the Jacobson and Truax (1991) clinically significant change framework, using (a) moderated nonlinear factor analysis (MNLFA) scale scoring and (b) measurement error-corrected multilevel modeling (MEC-MLM) was used; this approach was compared to other approaches using conventional total scores and/or assuming no measurement error. Using a conventional approach to estimating the Reliable Change Index (RCI) yielded no differences between COPE and RP in the percentage of patients achieving statistically significant improvement (SSI; 88.9% for both groups). However, under MNLFA/MEC-MLM, higher percentages of patients receiving COPE (75.0%) achieved SSI compared to RP (40.7%). Findings suggest that, even though COPE and RP appear to reduce the same number of PTSD symptoms, MNLFA scoring of outcome measures gives greater weight to interventions that target and reduce "hallmark" PTSD symptoms.
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Affiliation(s)
| | | | | | | | - Denise A Hien
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick
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10
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Morgan-López AA, Hien DA, Saraiya TC, Saavedra LM, Norman SB, Killeen TK, Simpson TL, Fitzpatrick S, Mills KL, Ruglass LM, Back SE, López-Castro T. Estimating posttraumatic stress disorder severity in the presence of differential item functioning across populations, comorbidities, and interview measures: Introduction to Project Harmony. J Trauma Stress 2022; 35:926-940. [PMID: 35124864 PMCID: PMC9844237 DOI: 10.1002/jts.22800] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 01/19/2023]
Abstract
Multiple factor analytic and item response theory studies have shown that items/symptoms vary in their relative clinical weights in structured interview measures for posttraumatic stress disorder (PTSD). Despite these findings, the use of total scores, which treat symptoms as though they are equally weighted, predominates in practice, with the consequence of undermining the precision of clinical decision-making. We conducted an integrative data analysis (IDA) study to harmonize PTSD structured interview data (i.e., recoding of items to a common symptom metric) from 25 studies (total N = 2,568). We aimed to identify (a) measurement noninvariance/differential item functioning (MNI/DIF) across multiple populations, psychiatric comorbidities, and interview measures simultaneously and (b) differences in inferences regarding underlying PTSD severity between scale scores estimated using moderated nonlinear factor analysis (MNLFA) and a total score analog model (TSA). Several predictors of MNI/DIF impacted effect size differences in underlying severity across scale scoring methods. Notably, we observed MNI/DIF substantial enough to bias inferences on underlying PTSD severity for two groups: African Americans and incarcerated women. The findings highlight two issues raised elsewhere in the PTSD psychometrics literature: (a) bias in characterizing underlying PTSD severity and individual-level treatment outcomes when the psychometric model underlying total scores fails to fit the data and (b) higher latent severity scores, on average, when using DSM-5 (net of MNI/DIF) criteria, by which multiple factors (e.g., Criterion A discordance across DSM editions, changes to the number/type of symptom clusters, changes to the symptoms themselves) may have impacted severity scoring for some patients.
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Affiliation(s)
| | - Denise A. Hien
- Center for Alcohol Studies, Rutgers University–Piscataway, Piscataway, New Jersey, USA
| | - Tanya C. Saraiya
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Sonya B. Norman
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California–San Diego, San Diego, California, USA
| | - Therese K. Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Tracy L. Simpson
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
| | | | | | - Lesia M. Ruglass
- Department of Psychology, City College of New York, New York, New York, USA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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11
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Bodin E, Peretti V, Rouillay J, Tran PL, Boukerrou M. [Posttraumatic stress disorder and emergency cesarean delivery: Incidence and risk factors]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:240-260. [PMID: 35017128 DOI: 10.1016/j.gofs.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is declared in 3 to 6 % of postpartum women (PP) and up to 18.5 % in cases of complications of pregnancy or childbirth. The objective of this study is to assess the prevalence of PTSD after a red code cesarean section and to identify the risk factors among the prenatal vulnerability factors, the birth alert factors and the maintenance factors in PP. METHOD A phone or computerized questionnaire including an Questionnaire de stress immédiat and the Posttraumatic Stress Disorder Checklist for DSM-5 was offered to patients who had a red code cesarean section between 05/12/2015 and 02/28/2021 at the University South Hospital of Reunion Island. RESULTS Among the 555 cesarean sections selected, 329 parturients responded. The prevalence of PTSD was 20.1 % and was stable over time. The 2 risk factors found were the negative experience of childbirth and the proven traumatic experience. Prenatal vunerability factors were not found to be statistically significant. Almost 3 in 4 women had not been informed of the risk of cesarean section and more than 1 in 2 women did not have an explanation in PP. CONCLUSION Red code cesarean sections cause PTSD in 1 in 5 women. This lasting disorder can last up to 6 years after childbirth. This indicates the seriousness of this disorder and the need to prevent it. The risk of developing it is 4 times greater in the event of a traumatic experience proven in the Questionnaire de stress immédiat. Offering this questionnaire in the maternity could be an important element of secondary prevention. The role of health personnel remains essential.
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Affiliation(s)
- E Bodin
- Service de PMA, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
| | - V Peretti
- Service de gynécologie obstétrique, CHU Sud Réunion, avenue François-Mitterrand, 97410 Saint-Pierre, Réunion.
| | - J Rouillay
- UMPP Ouest, EPSMR Saint-Paul, 11, rue de l'Hôpital, 97460 Saint-Paul, Réunion.
| | - P L Tran
- Service de gynécologie obstétrique, CHU Sud Réunion, avenue François-Mitterrand, 97410 Saint-Pierre, Réunion.
| | - M Boukerrou
- Service de gynécologie obstétrique, CHU Sud Réunion, avenue François-Mitterrand, 97410 Saint-Pierre, Réunion.
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12
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Saavedra LM, Morgan-López AA, Hien DA, López-Castro T, Ruglass LM, Back SE, Fitzpatrick S, Norman SB, Killeen TK, Ebrahimi CT, Hamblen J. Evaluating treatments for posttraumatic stress disorder, alcohol and other drug use disorders using meta-analysis of individual patient data: Design and methodology of a virtual clinical trial. Contemp Clin Trials 2021; 107:106479. [PMID: 34157418 DOI: 10.1016/j.cct.2021.106479] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
This paper describes Project Harmony, a Virtual Clinical Trial (VCT) funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to harmonize and analyze data from over 40 independent psychological, pharmacologic and/or combined pharmacological treatment studies for posttraumatic stress disorder and comorbid alcohol and other drug use disorders (PTSD/AOD). The study attends to three distinct analysis challenges: (1) variation in measurement of PTSD/AOD across studies, time, populations and reporters, (2) cross-study variation in treatment effect sizes and (3) non-randomized, cross-study variation in the classification of treatments (despite within-study randomization of treatment arms). To address these challenges, the study combines meta-analysis of individual patient data (MIPD), integrative data analysis (IDA) and propensity score weighting (PSW) to integrate raw data from these clinical trials. This protocol shows how this VCT analytic framework was used to (1) develop commensurate scale scores of PTSD and AOD severity when measures vary across studies, (2) compare the efficacy of evidence-based treatment models for PTSD/AOD, (3) test for potential mediators of treatment effects on AOD and PTSD across treatment models, and (4) explore individual- and study-level moderators to inform for whom each of the treatment models works best. The advantages of the general VCT approach are juxtaposed against the limitations of single randomized controlled trials and conventional meta-analysis.
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Affiliation(s)
| | | | - Denise A Hien
- Center of Alcohol Studies, Rutgers University-New Brunswick, USA
| | | | | | | | | | - Sonya B Norman
- National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, USA
| | | | | | - Jessica Hamblen
- National Center for PTSD, White River Junction, VT, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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13
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Lebeaut A, Leonard SJ, Healy N, Raines AM, Buser SJ, Vujanovic AA. Associations between Lower-Order Anxiety Sensitivity Facets and PTSD Symptomatology among Trauma-Exposed Firefighters. Behav Modif 2021; 46:294-320. [PMID: 34008431 DOI: 10.1177/01454455211016819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Firefighters are chronically exposed to potentially traumatic events, augmenting their risk of developing posttraumatic stress disorder (PTSD). The current study aimed to examine the incremental associations of lower-order dimensions of anxiety sensitivity (AS), examined concurrently, and PTSD symptom severity among a sample of trauma-exposed firefighters. We hypothesized that AS physical and cognitive concerns would be strongly associated with all PTSD symptom clusters and overall symptom severity, after controlling for theoretically relevant covariates (trauma load; years in fire service; alcohol use severity; depressive symptom severity). Participants were comprised of firefighters (N = 657) who completed an online questionnaire battery and endorsed PTSD Criterion A trauma exposure. Results revealed that the AS cognitive concerns, but not AS physical concerns, was significantly and robustly associated with overall PTSD symptom severity, intrusion symptoms, and negative alterations in cognitions and mood (∆R2's = .028-.042; p's < .01); AS social concerns was incrementally associated with PTSD avoidance (∆R2 = .03, p < .01). Implications for firefighter-informed, evidence-based interventions are discussed.
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Affiliation(s)
| | | | | | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
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14
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Saavedra LM, Morgan-López AA, Hien DA, Killeen TK, Back SE, Ruglass LM, Fitzpatrick S, Lopez-Castro T. Putting the Patient Back in Clinical Significance: Moderated Nonlinear Factor Analysis for Estimating Clinically Significant Change in Treatment for Posttraumatic Stress Disorder. J Trauma Stress 2021; 34:454-466. [PMID: 33175470 DOI: 10.1002/jts.22624] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022]
Abstract
The present study introduced a modernized approach to Jacobson and Truax's (1991) methods of estimating treatment effects on individual-level (a) movement from the clinical to the normative range and (b) reliable change on posttraumatic stress disorder (PTSD) severity. Participants were 450 trauma-exposed women (M age = 39.2 years, SD = 8.9, range: 18-65 years) who presented to seven geographically diverse community mental health and substance use treatment centers. Data from 53 of these women, none of whom met the criteria for full or subthreshold PTSD, were used to establish the normative range. Using moderated nonlinear factor analysis (MNLFA) scale scoring, which weights symptoms by their clinical relevance, a significantly larger proportion of participants moved into the normative range for PTSD severity scores and/or exhibited reliable changes after treatment compared to the same individuals' movement when using symptom counts. Further, approximately 24% of the participants showed discrepant judgments on reliable change indices (RCI) between MNLFA scores and symptom counts, likely due to the false assumption that the standard error of measurement is equal for all levels of underlying PTSD severity when estimating RCIs with symptom counts. An MNLFA approach to estimating underlying PTSD severity can provide clinically meaningful information about individual-level change without the de facto assumption that PTSD symptoms have equivalent weight. Study implications are discussed with regard to a joint emphasis on (a) measurement models that highlight differential symptom weighting and (b) treatment-arm differences in individual-level outcomes rather than the current overemphasis of treatment-arm differences on group-averaged trajectories.
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Affiliation(s)
| | | | - Denise A Hien
- Center of Alcohol Studies, Rutgers University-New Brunswick, New Brunswick, New Jersey, USA
| | - Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lesia M Ruglass
- Department of Psychology, The City College of New York, New York, New York, USA.,Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, New Jersey, USA
| | | | - Teresa Lopez-Castro
- Department of Psychology, The City College of New York, New York, New York, USA
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