Older Adults with PTSD: Brief State of Research and Evidence-Based Psychotherapy Case Illustration

Making meaning of one's own life story in words and images: A narrative case report of personal recovery from personality disorder through the interventions "An Empowering Story" and art therapy

Understanding and processing life experiences are essential in the treatment of personality disorders to promote personal recovery and psychological wellbeing. In this qualitative case report, drafted in co-creation between the client, clinical psychologist, and art therapist, individual treatment consisted of two psychotherapeutic interventions, "An Empowering Story" and life-story-focused art therapy, in 12 parallel sessions for 24 weeks. Hilda, 68 years of age, had been diagnosed with an unspecified personality disorder and various traits of borderline personality disorder. She experienced emotional exhaustion following long-term mental health problems rooted in a traumatic early childhood. This affected her ability to manage her emotions and social relations, resulting in the sense that her life had no meaning. Hilda was invited to reconstruct her life experiences, divided into the past, turning point, and present/future, in a written and a painted life story. This allowed for the integration of traumatic as well as positive memories, enhanced self-compassion, and meaning making. She developed self-reflection and integration of internal conflicts leading to a better emotional balance and self-understanding. Art therapy emphasizes bottom-up regulatory processes, while narrative psychology supports top-down regulatory processes. The combined approach effectively integrated bottom-up, experiential, sensory experiences with top-down, cognitive emotion-regulation processes. The results suggest that psychotherapeutic interventions involving a multi-pronged, complementary, and thus more holistic approach can support personal recovery in personality disorders.

Reciprocal associations of posttraumatic stress symptoms and cognitive decline in community-dwelling older adults: The mediating role of depression

BACKGROUND

People with posttraumatic stress disorder (PTSD) may have cognitive decline, a risk which can be particularly threatening at old age. However, it is yet unclear whether initial cognitive decline renders one more susceptible to subsequent PTSD following exposure to traumatic events, whether initial PTSD precedes cognitive decline or whether the effects are reciprocal.

OBJECTIVE

This study examined the bidirectional longitudinal associations between cognitive function and PTSD symptoms and whether this association is mediated by depressive symptoms.

METHOD

The study used data from two waves of the Israeli component of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in 2013 and 2015. This study focused on adults aged 50 years and above (N = 567, mean age = 65.9 years). Each wave used three measures of cognition (recall, fluency, and numeracy) and PTSD symptoms following exposure to war-related events. Data were analyzed using mediation analysis with path analysis.

RESULTS

Initial PTSD symptoms predicted cognitive decline in recall and fluency two years later, while baseline cognitive function did not impact subsequent PTSD symptoms. Partial mediation showed that older adults with more PTSD symptoms had higher depressive symptoms, which in turn were linked to subsequent cognitive decline across all three measures.

CONCLUSIONS

This study reveals that PTSD symptoms are linked with subsequent cognitive decline, supporting approaches addressing this direction. It further indicates that part of this effect can be explained by increased depressive symptoms. Thus, treatment for depressive symptoms may help reduce cognitive decline due to PTSD.

Employment of trauma informed principles in the Palabras Fuertes project: Implications for narrative research with older Latinx communities

In the US, there is a growing number of older Latinx communities. Qualitative approaches such as narrative inquiry may be fruitful endeavors to elucidate their lived experiences. However, older Latinx communities, including sexual minorities, are disproportionately exposed to social, health, and historical challenges that may result in exposure to potentially traumatic events (e.g. discrimination, illness, grief, etc.). The recognition of high rates of exposure to potentially traumatic events among participants has led to the recommended adoption of Trauma Informed (TI) principles for use in non-trauma specific research. At present, there are limited examples and discussions about the implementation of TI principles in qualitative research and our literature review yielded no discussion of the use of TI principles in narrative inquiry or with older Latinx communities. In this manuscript, we advocate for the adoption of TI principles when engaging in narrative inquiry with older Latinx adults. Second, we discuss examples of TI guided practices we employed while conducting the Palabras Fuertes study of life history narratives with older Latino immigrant gay men living in New York City. Finally, based on these experiences, we provide recommendations for incorporating TI into future narrative research with older Latinx communities.

Exploring Distress and Occupational Participation Among Older Canadians During the COVID-19 Pandemic

Background. The coronavirus disease 2019 (COVID-19) pandemic disrupted daily life with corresponding implications on levels of distress. Purpose. To describe factors associated with high distress among community-dwelling older adults during the first lockdown and explore how occupational participation was managed. Methods. A mixed methods design whereby multivariate regression analysis of a survey (N = 263) identified factors associated with high distress, as per the Impact of Events of Scale-Revised (IES-R). Follow-up interviews with a sub-sample of those surveyed who reflected a range of IES-R scores were conducted (N = 32). Findings. Those with lower resilience and anxiety/depression had 6.84 and 4.09 greater odds respectively of high distress. From the interviews, the main theme, "Lost and Found," and subthemes (Interruption and Disruption; Surving, not Thriving; Moving Forward, Finding Meaning) highlighted the process and corresponding stages, including adaptive strategies, by which participants navigated changes in their occupational participation. Implications. While the results suggest that many older adults, including those with high distress, were able to manage daily life under lockdown, some experienced ongoing challenges in doing so. Future studies should focus on those who experienced or who are at-higher risk for such challenges to identify supports that mitigate adverse consequences if another event of this magnitude occurs again.

Activity system, schizotypal personality, and mentalization: A study between halted activity and COVID-19 conducted in Henan, China

The pandemic-related lifestyle has potentially imposed crucial disturbances on daily and long-term activities, which, in turn, were associated with thought disturbance. This study investigates how the characteristics of the activity system during pandemic-related restrictions are associated with other psychomental aspects. By focusing on PTSD, mentalization, and schizotypal personality, and by inquiring about the main components of the activity system of 852 college students (Zhengzhou, Henan, China)- including the goals orienting their activity, goals' terms and types, the motivation levels and sources, the activity type and engagement time, the flow of the activity, and how due to pandemic lifestyle-results revealed that the activity system's components have significant associations with PTSD, reflective function, and schizotypal traits. Additionally, some of the activity system's elements have a significant predictive role regarding schizotypal traits. The study considered that the life narrative during the pandemic has been disturbed; hence, this may have a crucial effect on mind coherence. Additionally, the outcomes from the pandemic context will support mental health interventions in other similar contexts where the life narrative is severely affected.

Posttraumatic Stress Disorder Risk and Benzodiazepine Dependence in Older Veterans with Insomnia Symptoms

OBJECTIVES

To measure the rate of benzodiazepine receptor agonist (BZA) dependence in older veterans with insomnia symptoms chronically using BZAs and to assess for associations between high posttraumatic stress disorder (PTSD) risk and BZA dependence.

METHODS

A cross-sectional study was conducted among veterans aged 55 years and older with insomnia symptoms (current or historical) and chronic use of BZAs (≥3 months). Measurements included the Primary Care-PTSD screen (score >2 indicates high PTSD risk) and Benzodiazepine Dependence Questionnaire. Logistic regression was used to test for associations between PTSD risk and BZA dependence.

RESULTS

A high PTSD risk was observed in 40% of the participants (N = 33). One-fifth (21.7%, N = 18) of participants met the criteria for benzodiazepine dependence (score ≥23 on Benzodiazepine Dependence Questionnaire). Veterans with high PTSD risk were significantly more likely to have BZA dependence (odds ratio 10.09, 95% CI [2.39, 42.54], p = .002).

CONCLUSIONS

In older veterans with insomnia symptoms and chronic use of BZAs, high PTSD risk is associated with elevated risk for BZA dependence, which may make discontinuation of these medications difficult.

CLINICAL IMPLICATIONS

Clinicians should consider the strong association between PTSD symptoms and benzodiazepine dependence when developing plans to taper a BZA in veterans with these symptoms.

From Pathology to Intervention and Beyond. Reviewing Current Evidence for Treating Trauma-Related Disorders in Later Life

Background

An emerging body of empirical research on trauma-focused interventions for older adults experiencing symptoms of posttraumatic stress disorder or PTSD has yielded encouraging results. Nevertheless, up to date, the evidence remains scattered and is developed within rather specific groups, while studies have focused mostly on individual psychopathology, overlooking the relevance of resilience and recovering in one's social environment.

Objective

This study aims at summarizing the emerging evidence on treating trauma-related disorders in older adults, followed by implications for clinical practice and future research. Specifically, the following research questions are addressed: Which factors may optimize access to intervention, what treatment benefits can be realized, and how to improve resilience by using individual as well as community-oriented approaches?

Methods

A systematic literature research of intervention studies on PTSD among older adults, published between 1980 and December 2021, was expanded by cross-referencing, summarized in a narrative synthesis and supplemented with a clinical vignette reflecting qualitative outcomes.

Results

Five RCTs compared varying types of trauma-focused Cognitive Behavioral Therapy with non-trauma-focused control conditions. From one of them, qualitative results were reported as well. The most recent studies reported encouraging results, confirming the suggestion that evidence-based psychotherapy for PTSD can be safely and effectively used with older adults.

Conclusions

Since evidence-based psychotherapy for PTSD can be safely and effectively used with older adults, new avenues for practice and research may be found in a resilience perspective and a public mental health framework.

What Factors are Associated with Posttraumatic Growth in Older Adults? A Systematic Review

OBJECTIVES

Posttraumatic growth (PTG) is of increased theoretical and clinical interest. However, less is known about PTG in older adults specifically. This systematic review aimed to identify domains where PTG is studied for older adults; investigate factors associated with PTG in older adults; consider how these might differ between historical and later life traumas.

METHODS

Online databases were searched for quantitative studies examining PTG outcomes in adults aged ≥ 60 years.

RESULTS

15 studies were subject to a narrative synthesis.

CONCLUSIONS

Older adults can experience substantial levels of PTG, from traumas during later life or across the lifespan, and historical wartime traumas. Traumas can be diverse, some studies found equivalent levels of PTG from different traumas across the lifespan. Social processes may be a key variable for older adults. Additional psychosocial factors are found; however, diverse findings reflect no overall model, and this may be consistent with variations found in other PTG literature.

CLINICAL IMPLICATIONS

Clinical considerations are discussed. As diverse studies, findings may not be widely generalizable and directions for further research are highlighted. PROSPERO: CRD42020169318.

Posttraumatic stress disorder, complex PTSD and subtypes of loneliness among older adults

OBJECTIVES

Research examining the relationship between loneliness and Complex Posttraumatic Stress Disorder (CPTSD) is scarce, particularly among older adults. CPTSD includes the core symptoms of PTSD along with additional symptoms reflecting "disturbances in self-organisation" (DSO). This study examined the cross-sectional relationships between loneliness (emotional and social loneliness) and CPTSD symptoms (i.e., PTSD and DSO symptoms) in older adults.

METHODS

Structural equation modelling was used to examine these relationships in a nationally representative sample of US adults aged 60-70 years (n = 456).

RESULTS

Controlling for covariates, emotional loneliness was associated with PTSD (β = 0.31) and DSO (β = 0.57) symptoms whereas social loneliness was only associated with DSO symptoms (β = 0.25). The model explained 35.0% of the variance in PTSD symptoms and 71.3% in DSO symptoms.

CONCLUSION

These findings have important implications for treating and understanding PTSD/CPTSD and their correlates among older adults.

Social support, neurocognition, and posttraumatic stress disorder: Findings from the Canadian Longitudinal Study on Aging

OBJECTIVE

Most research investigating neurocognitive changes in participants with PTSD has focused on young adults. Numerous studies have recognized the crucial role of social support in diminishing the likelihood of developing PTSD. The current study evaluates the cognitive performance of middle-aged and older adults with symptoms of PTSD, and examines if perceived social support can act as a cognitive reserve factor.

METHOD

The study was conducted using data from the Canadian Longitudinal Study on Aging, a nationwide study on health and aging. The current study included 1,096 participants in the PTSD group and 22,158 participants in the comparison group, all between the ages of 45 and 85. Participants completed the MOS (Medical Outcomes Study) Social Support Survey as well as neuropsychological tests in the domains of executive functioning, declarative memory, and prospective memory.

RESULTS

The PTSD group had worse performance in the domains of executive functioning and prospective memory than the comparison group. Furthermore, when examining global cognitive impairments (impairment was defined as scoring 1.5 or more standard deviations below age and education adjusted comparison group), the PTSD group demonstrated greater impairment rates than the comparison group on two or more tests. Moderation analyses revealed that greater social support was associated with better executive functioning for the comparison group, although this was not found to be true for the PTSD group.

CONCLUSION

The PTSD group experienced greater cognitive deficits compared to the comparison group. Higher levels of perceived social support were associated with better performance on neurocognitive measures for the comparison group. However, social support did not appear to moderate this relationship for the PTSD group.

The Association Between Post-Traumatic Stress and Depressive Symptoms Among Older Puerto Ricans in Boston: How Does Loneliness Matter?

OBJECTIVES

To examine the association between post-traumatic stress and depression and whether such an association differs by level of loneliness among older Puerto Ricans.

METHODS

Data were collected from 304 Puerto Ricans aged 60 and above living in the Greater Boston area who responded to questionnaires. We used ordinary least squares regression to examine the association between post-traumatic stress, loneliness, and depressive symptoms.

RESULTS

Post-traumatic stress was significantly associated with higher levels of depression. The association between post-traumatic stress and depression was stronger for those experiencing a higher degree of loneliness.

DISCUSSION

In working with older Puerto Ricans experiencing post-traumatic stress, it is important for mental health professionals to incorporate the assessment of loneliness and to prevent and reduce comorbid depression by addressing loneliness through improving social skills, enhancing social support, and reducing maladaptive social cognition.

Policymakers' perspectives on responding to the elderly's mental health needs in post-disaster situations

Background: Mental health issues following the occurrence of disaster remain neglected area especially for older people group. The purpose of this study was to explore stakeholders’ perspectives on post-disaster management related to the elderly’s mental health needs.

Design and methods: This qualitative case study was conducted between June and October 2020. The investigators conducted in-depth interviews with policymakers who were in charge of disaster management at national, provincial, and regional levels. The policymakers were selected through purposive sampling. A policy analysis was conducted by the investigators to answer the research question.

Results: The results were presented based on actor, content, context, and process. The actors engage in intersectoral collaboration between disaster agencies, health agencies, and social agencies. The content is largely comprehensive; however, the disaster management policy should not neglect to address mental health conditions after a disaster event. The context is the vulnerability and risk of the elderly in terms of experiencing physical and mental issues after a disaster, which should be considered by policymakers in Indonesia. The process is the development of disaster management policies, which are influenced by cultural, economic, political, and international factors.

Conclusions: This study reveals that stakeholders need to pay attention to the mental health issue of elderly in national and regional policy, particularly during post-disaster situations. In addition, posttraumatic stress in post-disaster situations should be highlighted in order to formulate a better aged care policy.

Sex and age differences in ICD-11 PTSD and complex PTSD: An analysis of four general population samples

BACKGROUND

Posttraumatic stress disorder (PTSD) is traditionally understood as a disorder that occurs more commonly in women than in men, and in younger age groups than in older age groups. The objective of this study was to determine if these patterns are also observed in relation to International Classification of Diseases (ICD-11) PTSD and complex PTSD (CPTSD).

METHODS

Secondary data analysis was performed using data collected from three nationally representative samples from the Republic of Ireland (N = 1,020), the United States (N = 1,839), and Israel (N = 1,003), and one community sample from the United Kingdom (N = 1,051).

RESULTS

Estimated prevalence rates of ICD-11 PTSD were higher in women than in men in each sample, and at a level consistent with existing data derived from Diagnostic and Statistics Manual of Mental Disorders (DSM)-based models of PTSD. Furthermore, rates of ICD-11 PTSD were generally lower in older age groups for men and women. For CPTSD, there was inconsistent evidence of sex and age differences, and some indication of a possible interaction between these two demographic variables.

CONCLUSIONS

Despite considerable revisions to PTSD in ICD-11, the same sex and age profile was observed to previous DSM-based models of PTSD. CPTSD, however, does not appear to show the same sex and age differences as PTSD. Theoretical models that seek to explain sex and age differences in trauma-related psychopathology may need to be reconsidered given the distinct effects for ICD-11 PTSD and CPTSD.

Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia, 2020: A multi-centered cross-sectional study

OBJECTIVE

This study aimed to assess the prevalence and associated factors of post-traumatic stress disorder among health professionals working in South Gondar Zone hospitals in the era of the COVID-19 pandemic, Amhara Ethiopia 2020.

METHODS

Institutional based cross-sectional study design was conducted. A total of 396 respondents completed the questionnaire and were included in the analysis. A previously adapted self-administered pretested standard questionnaire, Impact of Event Scale-Revised (IES-R-22) was used to measure post-traumatic stress disorder. Data was entered into Epi data version 4.4.2 then exported to SPSS version 24 for analysis. Descriptive and analytical statistical procedures, bivariate, and multivariate binary logistic regressions with odds ratios and 95% confidence interval were employed. The level of significance of association was determined at a p-value < 0.05.

RESULTS

The prevalence of post-traumatic stress disorder among health care providers in this study was 55.1% (95% CI: 50.3, 59.6). Lack of standardized PPE supply (AOR = 2.5 7,95CI;1.37,4.85), respondents age > 40 years (AOR = 3.95, 95CI; 1.74, 8.98), having medical illness (AOR = 4.65, 95CI;1.65,13.12), perceived stigma (AOR = 1.97, 95CI;1.01, 3.85), history of mental illness(AOR = 8.08,95IC;2.18,29.98) and having poor social support (AOR = 4.41,95CI;2.65,7.3) were significantly associated with post-traumatic stress disorder at p-value < 0.05. Conversely, being a physician (AOR = 0.15, 95CI; 0.04, 0.56) was less affected by PTSD.

CONCLUSIONS

The prevalence of post-traumatic stress disorder among health care providers in this study was high. Adequate and standardized PPE supply, giving especial emphasis to those care providers with medical illness, history of mental illness, and having poor social support, creating awareness in the community to avoid the stigma faced by health care providers who treat COVID patients is recommended.

Post-traumatic Stress Disorder in Middle Age and Beyond

OBJECTIVE

To review the clinical manifestations and treatment of post-traumatic stress disorder (PTSD) in adults and older people.

DATA SOURCES

Articles indexed in PubMed, Embase, psychology databases, and the Cochrane library over the past 10 years using the key words "post-traumatic stress disorder," "stress disorders," and "post-traumatic stress disorder and treatment."

STUDY SELECTION AND DATA EXTRACTION

Sixty-seven publications were reviewed and criteria supporting the primary objective were used to identify useful resources.

DATA SYNTHESIS

The literature included practice guidelines; review articles; original research articles; and product prescribing information for the clinical manifestations, diagnosis, and treatment of PTSD.

CONCLUSION

Psychotherapy is the first-line therapy for PTSD. Pharmacologic therapy is recommended, as second-line therapy, for adults living with PTSD who do not have access to psychotherapy or refuse psychotherapy. Pharmacologic therapy may also be considered in cases of partial, or no, response to psychotherapy. Current guidelines recommend prescribing one of 3 selective serotonin-reuptake inhibitors, either fluoxetine, paroxetine, or sertraline, or prescribing the serotonin norepinephrine reuptake inhibitor venlafaxine, for adult patients who do not have access to psychotherapy or prefer not to use psychotherapy. Unfortunately, these recommended medications have additional cautions for use in older people so may not be appropriate for many older people living with PTSD. Therapy for older people should be tailored to patient-specific symptoms, with careful consideration of the potential benefits and risks of the therapy and coexisting medical conditions of each patient.

A Review of PTSD Augmentation Strategies for Older Adults and Case of rTMS-Augmented Prolonged Exposure

Evidence-based psychotherapies such as prolonged exposure therapy (PE) are recommended by clinical practice guidelines as first-line treatments for post-traumatic stress disorder (PTSD) and are safe and acceptable for use with older adults. One third to one half of all patients do not achieve a clinically meaningful response to standard outpatient PE and recent research suggests that older adults in particular may experience barriers to full engagement and response. Standard treatment may be challenging in older adults due to cognitive, medical, and psychosocial barriers. This article reviews the current state of the evidence on adjunctive and second-tier interventions that show promise for increasing response and/or engagement in evidence-based psychotherapy for PTSD, including medications such as d-cycloserine and 3,4-methylenedioxy-methamphetamine, neuromodulation techniques such as repetitive transcranial magnetic stimulation, and augmentations to the structure and content of psychotherapy, such as intensive outpatient formats. A case illustration of successful application of multiple augmentations to PE with an initially nonresponsive older adult patient is presented. A creative interdisciplinary approach based in available research may be beneficial for older adults who do not respond to first-line treatments.

Cognitive treatment of post-traumatic stress disorder in the elderly. A longitudinal study

OBJECTIVE

This article aims to verify whether a cognitive treatment of post-traumatic stress disorder (PTSD) by cognitive behavioural therapy (CBT) adapted to elderly subjects can lead to long-term improvement in symptomatology and quality of life.

METHOD

We present a longitudinal study of 32 subjects over the age of 65 years, with no cognitive impairment or mild impairment, residing in two nursing homes. We compare a target group (n=16) with PTSD treated with 20 CBT sessions and a control group (n=16) with PTSD without symptom treatment. The two groups are compared in four stages: (T1) before treatment of the target group's PTSD, (T2) after treatment of PTSD, (T3) after six months of follow-up and (T4) after 18 months of follow-up. The absence of cognitive impairment is verified with the MMSE. The evolution of PTSD is monitored with the CAPS. The evolution of the quality of life of the subjects in the target group is verified with the ADRQL.

RESULTS

If both groups show elevated PTSD symptoms at the beginning of the study (T1), the signs of PTSD disappear for the target group at the end of treatment (T2) at the same time as quality of life improves (scores more than doubled). These improvements continue for more than 18 months (T4). Conversely, the control group retains high PTSD symptoms, without significant decrease over time.

CONCLUSION

The treatment of PTSD by cognitive-behavioural therapy adapted to elderly people without cognitive impairment, or with mild cognitive or memory disorders, allows for a lasting disappearance of symptoms and an improvement in quality of life.

Development and evaluation of a social inclusion framework for a comprehensive hospital-based elder abuse intervention

A framework of social inclusion can promote equity and aid in preventing and addressing the abuse of older adults. Our objective was to build a social inclusion framework for a comprehensive hospital-based elder abuse intervention being developed. Potential components of such a framework, namely, health determinants and guiding principles, were extracted from a systematic scoping review of existing responses (e.g., interventions, protocols) to elder abuse and collated. These were subsequently rated for their importance to the elder abuse intervention by a panel of violence experts and further evaluated by a panel of elder abuse experts. The final social inclusion framework comprised 12 health determinants each representing factors underpinning susceptibility for abuse in aging populations: history of trauma/abuse, communication needs, disability, health status, mental capacity, social support, culture, language, sexuality, religion, gender identity, and socioeconomic status. The framework also comprised 19 guiding principles each encompassing considerations for equitable engagement with older adults (e.g., All older adults have the right to self-determination, All older adults have the right to be safe, All older adults are assumed competent unless determined otherwise). Integrating this social inclusion framework into the design and delivery of an elder abuse intervention could empower older adults, while at the same time ensuring that practices and policies are tailored to meet their unique and varying needs.

The Influence of Social Exclusion on Posttraumatic Stress Reactions in Older Adult Veterans

The relationship between social exclusion and posttraumatic stress reactions in aging veterans is a particularly timely issue, warranting greater attention in the social work literature. Research with military veterans indicates that the social marginalization resulting from racial and ethnic discrimination can exacerbate posttraumatic stress symptoms. This marginalization suggests an increased potential for emergent or recurrent trauma reactions in aging military veterans, as previous research has documented older adults' unique risk for social exclusion. The issue takes on greater relevance as increased numbers of Vietnam veterans enter older adulthood. Professionals working with military veterans should be aware of the social and cultural factors that play a critical role in posttrauma response and recovery.

Risk factors for PTSD of Shidu parents who lost the only child in a rapid aging process: a cross-sectional study

BACKGROUND

The elderly population is rising globally, especially in China where a large population base causes the largest number of older adults in the world. Notably, Shidu people who are over the age of 60 and have lost their only child have drawn great public attentions as they become more elderly, medically unstable and worse mentally unhealthy. Posttraumatic stress disorder (PTSD) is one of the most common consequences resulted from the loss of the only child. However, few previous studies have examined PTSD in Shidu older aldults, and the risk factors are a relatively understudied area. Our study aims to estimate the prevalence and potential risk factors of PTSD and improve the possibility of early identifying the high-risk Shidu parents with PTSD, and successively provide timely and effective interventions.

METHOD

Based on the register of population statistic information provided by the health family planning commission, 149 participants were enrolled randomly. Data was collected by interviews and questionnaires. Socio-demographic and bereavement-related information and physical health outcomes were obtained. PTSD Checklist-Civilian Version was used to screen for bereavement-related PTSD.

RESULT

The morbidity of PTSD reached 30.9%, while in the group of age over 60 the morbidity reached 31.6%. Stratified by potential demographic risk factors, SDPs have significant between-group differences of PTSD. Specially, being women, higher income, losing the single child at older age, more serious medical conditions and being Shidu for a shorter period indicated higher severity of PTSD in SDPs. The single child dying at a older age and from accidence were also significant indicators. Regression analysis showed the gender of SDPs, hospital visits, and the cause of child death significantly predicted the severity of PTSD.

CONCLUSION

With the accelerate process of aging, especially in China, Shidu older adults become a group deserved more attentions. PTSD is clearly a possible reaction to the loss of the only child. The gender and hospital visits of the Shidu older adults and the causes of their child's death significantly related to the prevalence of PTSD, which could help to improve the possibility of early intervening.

Examining military population and trauma type as moderators of treatment outcome for first-line psychotherapies for PTSD: A meta-analysis

There is conflicting evidence as to whether military populations (i.e., veteran and active-duty military service members) demonstrate a poorer response to psychotherapy for posttraumatic stress disorder (PTSD) compared to civilians. Existing research may be complicated by the fact that treatment outcomes differences could be due to the type of trauma exposure (e.g., combat) or population differences (e.g., military culture). This meta-analysis evaluated PTSD treatment outcomes as a function of trauma type (combat v. assault v. mixed) and population (military v. civilian). Unlike previous meta-analyses, we focused exclusively on manualized, first-line psychotherapies for PTSD as defined by expert treatment guidelines. Treatment outcomes were large across trauma types and population; yet differences were observed between trauma and population subgroups. Military populations demonstrated poorer treatment outcomes compared to civilians. The combat and assault trauma subgroups had worse treatment outcomes compared to the mixed trauma subgroup, but differences were not observed between assault and combat subgroups. Higher attrition rates predicted poorer treatment outcomes, but did not vary between military populations and civilians. Overall, manualized, first-line psychotherapies for PTSD should continue to be used for civilians and military populations with various trauma types. However, greater emphasis should be placed on enhancing PTSD psychotherapies for military populations and on treatment retention across populations based on findings from this meta-analysis.

Psychological burden of PTSD, depression, and their comorbidity in the U.S. veteran population: Suicidality, functioning, and service utilization

BACKGROUND

Emerging evidence suggests that comorbid posttraumatic stress disorder (PTSD) and major depressive disorder (PTSD/MDD) may impose an even greater burden than either disorder alone. However, nearly all previous studies examining these associations have relied on treatment-seeking samples. This study examined the mental health burden associated with co-occurring PTSD/MDD compared to PTSD and MDD alone using a nationally representative sample of U.S. veterans.

METHODS

Data were analyzed from National Health and Resilience in Veterans Study, a nationally representative survey of U.S. veterans (n = 2,732). Analyses (a) estimated the current prevalence of PTSD only, MDD only, and comorbid PTSD/MDD; (b) compared demographic/military variables by PTSD/MDD status; and (c) examined associations between PTSD/MDD status and suicidality, functioning, psychiatric comorbidities, and service utilization.

RESULTS

The current prevalences of probable PTSD only, probable MDD only, and probable comorbid PTSD/MDD were 1.7%, 4.8%, and 3.4%. Compared to all other groups, the PTSD/MDD group was more likely to screen positive for current suicidal ideation, lifetime suicide attempts, probable generalized anxiety and social anxiety disorders, and ever utilize mental health services. They also scored lower on measures of mental health functioning (d = 1.49), cognitive functioning (d = 1.03), and quality of life (d = 0.84). Veterans with comorbid PTSD/MDD were more than twice as likely as those with PTSD only to have attempted suicide.

LIMITATIONS

The cross-sectional design of this study precludes causal inference.

CONCLUSIONS

Results provide a population-based characterization of the psychological burden of PTSD/MDD comorbidity in U.S. veterans. Findings further underscore the importance of screening, monitoring, and treatment of the comorbid manifestation of these disorders.

Posttraumatic Stress Disorder in Older Adults: A Conceptual Review

Objectives: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life. Methods: We performed a search using PubMed and Academic Search Premier (EBSCO) databases and reviewed reference sections of selected papers. We also drew on our own clinical perspectives and reflections of seven expert mental health practitioners. Results: Rates of PTSD are lower in older compared with younger adults. The presence of sub-syndromal/partial PTSD is important and may impact patient functioning. Assessment requires awareness and adaptation for potential differences in PTSD experience and expression in older adults. Psychotherapies for late-life PTSD appear safe, acceptable and efficacious with cognitively intact older adults, although there are relatively few controlled studies. Treatment adaptations are likely warranted for older adults with PTSD and co-morbidities (e.g., chronic illness, pain, sensory, or cognitive changes). Conclusions: PTSD is an important clinical consideration in older adults, although the empirical database, particularly regarding psychotherapy, is limited. Clinical Implications: Assessment for trauma history and PTSD symptoms in older adults is essential, and may lead to increased recognition and treatment.

Using Prolonged Exposure With an Older Male U.S. Veteran With Childhood Sexual Abuse-Related PTSD

Older adults have generally not been included in randomized clinical trials of psychotherapy for posttraumatic stress disorder (PTSD). Of the case reports and treatment outcome studies that have included those aged 55 and older, most did not include men with sexual abuse-related PTSD. This case report presents the successful application of Prolonged Exposure (PE) to a 58-year-old single, Caucasian noncombat U.S. Army veteran with severe, chronic PTSD related to several sexual assaults, including childhood sexual abuse. PE is a manualized, short-term, evidence-based psychotherapy for the treatment of PTSD which involves psychoeducation, breathing retraining, in vivo exposure, and imaginal exposure. PTSD and depressive symptoms demonstrated clinically meaningful improvement during the course of treatment. In addition, he experienced significant improvement in quality of life as well as meaning and purpose from baseline to posttreatment. Implications for clinically working with older men with untreated childhood sexual abuse-related PTSD later in life are presented. Future research directions are discussed.

Trauma and Aging

PURPOSE OF REVIEW

The aim of this paper is to present a succinct summary of the major scientific findings on trauma, posttraumatic stress disorder (PTSD), and aging over the past few years.

RECENT FINDINGS

There have been several reports from longitudinal investigations using representative samples of veterans regarding traumatic exposure and subsequent effects on health and functioning. There has also been further documentation of the significant association between PTSD and dementia as well as accelerated aging in late life. Several studies indicate that older adults with PTSD are at risk of not receiving timely and appropriate mental health treatment, indicating that targeted outreach could be helpful in increasing service use and improving care. The current knowledge base would benefit from more research on traumatized older adults from non-industrialized countries, as well as those in North America from diverse backgrounds, including ethnic and racial minorities, women, and those with cognitive impairments. Studies limited to adults aged 65 and over as well as those addressing disparities in the availability of mental health-related services within this population are warranted.

EMDR in Older Adults With Posttraumatic Stress Disorder

Recognition of posttraumatic stress disorder (PTSD) in older adults is often difficult due to its complicated presentation. Once recognized, trauma symptoms can, in accordance with (inter)national guidelines, be successfully treated with eye movement desensitization and reprocessing (EMDR) therapy. However, limited empirical research has been done on the expression and treatment of PTSD in older adults. This article explains trauma and age in the context of psychotherapy. It discusses the interaction between age and pathology and summarizes the cognitive issues related to age, PTSD, and anxiety. It provides practical suggestions for how these can be addressed in treatment. Age-related challenges related to motivation are identified with practical suggestions for addressing them. The case illustrates the necessary additions and subtractions for older adults, with clear explanations and instructions. This article points the way for future research.

Assessment and Treatment Considerations for Post Traumatic Stress Disorder at End of Life

Post traumatic stress disorder (PTSD) may first emerge, reemerge, or worsen as individuals approach end of life and may complicate the dying process. Unfortunately, lack of awareness of the occurrence and/or manifestation of PTSD at end of life can lead to PTSD going unaddressed. Even if PTSD is properly diagnosed, traditional evidence-based trauma-focused treatments may not be feasible or advisable with this group as many patients at end of life often lack the physical and mental stamina to participate in traditional psychotherapy. This article reviews the clinical and empirical literature on PTSD at end of life, as well as discusses assessment and psychotherapy treatment issues with this neglected population. In addition, it expands on the current reviews of this literature1-3 by extrapolating results from nontraditional treatment approaches with other patient populations. Elements of these approaches with patients sharing similar characteristics and/or comorbidities with patients with PTSD at end of life may provide additional benefits for the latter population. Clinical implications and suggestions for interdisciplinary care providers are provided.