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Suchanecki L, Goutaudier N. Childbirth as an anticipated trauma during pregnancy: pretraumatic stress symptoms in primiparous women. J Reprod Infant Psychol 2024; 42:668-680. [PMID: 36266766 DOI: 10.1080/02646838.2022.2137118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/09/2022] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Women can develop anticipated traumatic reactions related to the forthcoming delivery through "pretraumatic stress" symptoms. The present study aims at: a) exploring the frequency of probable pretraumatic stress disorder in primiparous pregnant women, b) evidencing associated features of pretraumatic stress symptoms and c) exploring which specific components of antenatal anxiety are associated with pretraumatic stress symptoms. METHODS A sample of 100 primiparous pregnant women completed an online questionnaire assessing pretraumatic stress, fear of childbirth, depressive and anxiety symptoms. Socio-demographic and pregnancy-related data were also gathered. RESULTS 8 % of women met all criteria for probable pretraumatic stress disorder. Increased depressive symptoms (ß = 0.48, p< .05), childbirth concerns (ß = 0.47, p< .05) and worry about self (ß = 0.74; p< .05) were associated with the intensity of pretraumatic stress disorder symptoms. CONCLUSION This study contributes to the very limited literature on pretraumatic stress symptoms. Thus, it is noteworthy that pretraumatic stress is not a reactivation of a former postpartum PTSD or associated with a prior negative experience of childbirth. Future studies conducted on primiparous women with no history of traumatic exposure could allow to provide additional evidences of the existence of anticipated traumatic reactions of childbirth.
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Affiliation(s)
- Lara Suchanecki
- Department of Psychology, Centre de Recherches sur la Cognition et l'Apprentissage -UMR CNRS 7295, Université de Poitiers, Poitiers, France
| | - Nelly Goutaudier
- Department of Psychology, Centre de Recherches sur la Cognition et l'Apprentissage -UMR CNRS 7295, Université de Poitiers, Poitiers, France
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Vega-Sanz M, Berastegui A, Sanchez-Lopez A. Perinatal posttraumatic stress disorder as a predictor of mother-child bonding quality 8 months after childbirth: a longitudinal study. BMC Pregnancy Childbirth 2024; 24:389. [PMID: 38796417 PMCID: PMC11128109 DOI: 10.1186/s12884-024-06570-4] [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: 06/23/2023] [Accepted: 05/07/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Negative childbirth experiences can be related to the onset of perinatal post-traumatic stress symptomatology (P-PTSS), which significantly impacts the mother and the infant. As a response in the face of the discomfort caused by P-PTSS, maladaptive emotion regulation strategies such as brooding can emerge, contributing to the consolidation of post-partum depressive symptoms. Ultimately, both types of symptomatology, P-PTSS and post-partum depression, can act as risk factors for developing mother-child bonding difficulties. Still, this full set of temporal paths has to date remained untested. The present longitudinal study aimed to analyze the risk factors associated with the appearance of P-PTSS after post-partum and to test a path model considering the role of P-PTSS as an indirect predictor of bonding difficulties at eight months of postpartum. METHODS An initial sample of pregnant women in the third trimester of gestation (N = 594) participated in a longitudinal study comprising two follow-ups at two and eight months of postpartum. The mothers completed online evaluations that included socio-demographic data and measures of psychological variables. A two-step linear regression model was performed to assess the predictive role of the variables proposed as risk factors for P-PTSS, and a path model was formulated to test the pathways of influence of P-PTSS on bonding difficulties. RESULTS A history of psychopathology of the mother, the presence of depression during pregnancy, the presence of medical complications in the mother, and the occurrence of traumatic birth experiences all acted as significant predictors of P-PTSS, explaining 29.5% of its variance. Furthermore, the path model tested further confirmed an indirect effect of P-PTSS, triggered by a negative childbirth experience, on subsequent bonding difficulties eight months after labor through its association with higher levels of brooding and, ultimately, postpartum depression levels. A further path showed that bonding difficulties at two months postpartum can persist at eight months postpartum due to the onset of brooding and postpartum depression symptoms. CONCLUSION We identified a set of robust predictors of P-PTSS: the mother's previous history of depression, perinatal depression during pregnancy, the presence of medical complications in the mother and the occurrence of traumatic birth experiences, which has important implications for prevention. This is particularly relevant, as P-PTSS, when triggered by a negative childbirth experience, further indirectly predicted the development of mother-child bonding difficulties through the mediation of higher use of brooding and symptoms of postpartum depression. These findings can serve as a basis for developing new longitudinal studies to further advance the understanding of perinatal mechanisms of mental health.
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Affiliation(s)
- Maria Vega-Sanz
- University Institute of Family Studies, Pontifical Comillas University, Madrid, Spain.
| | - Ana Berastegui
- University Institute of Family Studies, Pontifical Comillas University, Madrid, Spain
| | - Alvaro Sanchez-Lopez
- Department of Personality, Evaluation and Psychological Treatments, Complutense University of Madrid, Madrid, Spain
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Pettrich A, Friedrich M, Nesterko Y, Glaesmer H. The German PCL-5: evaluating structural validity in a large-scale sample of the general German population. Eur J Psychotraumatol 2024; 15:2317055. [PMID: 38379510 PMCID: PMC10883083 DOI: 10.1080/20008066.2024.2317055] [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: 07/13/2023] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
Background: In attempts to elucidate PTSD, recent factor analytic studies resulted in complex models with a proliferating number of factors that lack psychometrical and clinical utility. Recently, suggestions have been made to optimize factor analytic practices to meet a refined set of statistical and psychometric criteria.Objective: This study aims to assess the factorial structure of the German version of the PCL-5, implementing recent methodological advancements to address the risk of overfitting models. In doing so we diverge from traditional factor analytical research on PTSD.Method: On a large-scale sample of the German general population (n = 1625), exploratory factor analyses were run to investigate the dimensionality found within the data. Subsequently, we validated and compared all model suggestions from our preliminary analyses plus all standard and common alternative PTSD factor models (including the ICD-11 model) from previous literature with confirmatory factor analyses. We not only consider model fit indices based on WLSMV estimation but also deploy criteria such as favouring less complex models with a parsimonious number of factors, sufficient items per factor, low inter-factor correlations and number of model misspecifications.Results: All tested models showed adequate to excellent fit in respect to traditional model fit indices; however, models with two or more factors increasingly failed to meet other statistical and psychometric criteria.Conclusion: Based on the results we favour a two-factor bifactor model with a strong general PTSD factor and two less dominant specific factors - one factor with trauma-related symptoms (re-experiencing and avoidance) and one factor with global psychological symptoms (describing the trauma's higher-order impact on mood, cognition, behaviour and arousal).From the perspective of clinical utility, we recommend the cut-off scoring method for the German version of the PCL-5. Basic psychometric properties and scale characteristics are provided.
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Affiliation(s)
- Amelie Pettrich
- Department of Medical Psychology and Medical Sociology, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Yuriy Nesterko
- Department of Medical Psychology and Medical Sociology, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, Medical Faculty, Leipzig University, Leipzig, Germany
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Messman BA, Compton SE, Majeed I, Weiss NH, Contractor AA. Beyond the mean: examining associations between intraindividual variability in posttraumatic stress disorder symptoms and posttrauma reckless behaviors. ANXIETY, STRESS, AND COPING 2024:1-17. [PMID: 38268223 DOI: 10.1080/10615806.2024.2307465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND/OBJECTIVES Posttrauma reckless behaviors have been linked to the onset and exacerbation of posttraumatic stress disorder (PTSD) symptoms. However, PTSD symptoms fluctuate across time, triggered by environmental stimuli in daily life, referred to as (intraindividual) variability in PTSD symptoms. DESIGN We utilized experience sampling methods to investigate associations between engagement in posttrauma reckless behaviors and variability in PTSD symptoms and the moderating role of emotion dysregulation in this association. METHODS Data from 166 trauma-exposed university students (Mage = 21.43 ± 5.07, 85.4% women) were collected between January 2019 to August 2020. Participants completed baseline and follow-up surveys to assess engagement in posttrauma reckless behaviors and daily surveys (10-days) to assess variability in PTSD symptoms. Results. Analyzes indicated greater baseline engagement in posttrauma reckless behaviors was associated with greater 10-day variability in PTSD symptoms (β = 0.23, p = .031), and baseline emotion dysregulation moderated this association (β = -0.33, p = .003). Additionally, greater 10-day variability in PTSD symptoms was associated with greater follow-up engagement in posttrauma reckless behaviors (β = 0.14, p = .045). CONCLUSIONS Findings substantiate the interplay between engagement in posttrauma reckless behaviors and daily fluctuations in PTSD symptoms and support therapeutically targeting both engagement in posttrauma reckless behaviors and emotion dysregulation to impact PTSD symptoms.
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Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Sidonia E Compton
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Ifrah Majeed
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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Yan W, Shang Z, Wu L, Lv H, Jia Y, Zhan J, Wang J, Ouyang H, Liu W, Chen W. The impact of isolation on comorbidity of PTSD symptoms and depression: evidence from PTRP-5-6 in China. BMC Public Health 2024; 24:21. [PMID: 38166952 PMCID: PMC10762958 DOI: 10.1186/s12889-023-17450-5] [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: 05/30/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The Omicron pandemic struck Shanghai, China, resulting in impairments of both physical and psychological health on those patients who were confirmed and transferred to the Fangcang shelters. The way of isolation led to high risk of posttraumatic stress symptoms (PTSS) and depressive symptoms among the patients in Fangcang shelters. We aim to estimate the prevalence and comorbidity of PTSS and depressive symptoms in patients from China's Fangcang shelters during the epidemic. METHODS Demographic information questionnaire, the posttraumatic stress disorder checklist for DSM-5 (PCL-5), and Patient Health Questionnaire (PHQ-9) were used in the study. The data were collected online via mobile phones during 10th April to 20th April, 2022, as part of our Psychological Trauma Recover Project-5-6 (PTRP-5-6), a longitudinal study focusing on individuals who have experienced trauma. RESULTS A total of 336 subjects were included in the analysis. The results revealed (1) the prevalence of depressive symptoms, and PTSS were 30.1% (cut-off = 10) and 6% (cut-off = 33); (2) Multiple logistic regression showed that female (OR = 3.04, p < 0.05), suffering from dyspnea (OR = 5.83, p < 0.05) or gastrointestinal symptoms (OR = 6.38, p < 0.05) were risk factors for PTSS; higher education level (OR = 3.27, p < 0.05) and suffering from dizziness or headache (OR = 2.46, p < 0.05) were risk factors for depressive symptoms; (3)Respectively, 85% of the patients who reported PTSS also experienced depressive symptoms, 16.8% of the patients who reported depressive symptoms presented PTSS. CONCLUSION In the context of COVID-19, the comorbidity rate of PTSS and depressive symptoms among patients in Fangcang shelters increased with the severity of depressive symptoms.
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Affiliation(s)
- Wenjie Yan
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Zhilei Shang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Lili Wu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Hongli Lv
- Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, 210000, P. R. China
| | - Yanpu Jia
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Jingye Zhan
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Jing Wang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Hui Ouyang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China.
| | - Weizhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China.
| | - Wenfang Chen
- Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 East Zhongshan Road, Nanjing, 210000, P. R. China.
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Haws JK, Laifer LM, Acosta LM, Ralston AL, Ruggiero KJ, Davidson TM, Andrews AR. A Distinction Without a Difference? A Multi-Method Approach to Understanding PTSD and Depression Symptom Overlap Among Disaster-Exposed Adolescents. Res Child Adolesc Psychopathol 2023; 51:1021-1035. [PMID: 36881210 DOI: 10.1007/s10802-023-01042-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
Among adolescents exposed to trauma, posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) commonly co-occur. Despite the prevalence of comorbidity, the question of how PTSD and MDD are related and appropriate conceptual models for understanding their linkage in adolescence remains unclear. This study applies a multi-methodological approach to advance conceptual and theoretical understanding of the overlap between PTSD and MDD diagnoses/symptoms. We tested three methodological approaches with three distinct theoretical underpinnings on the structure of each disorder proposed in the literature: confirmatory factor analysis (CFA) with dimensional constructs, latent class analysis (LCA) with person-based categorical constructs, and network analysis with symptom-to-symptom associations. Across the three different analytical approaches, there was a significant overlap between PTSD and MDD. Overall, there was no compelling evidence for distinct boundaries between disorders among trauma-exposed adolescents. Instead, we found considerable evidence that the typical latent-construct-based conceptualizations, whether categorical or dimensional, may need revision.
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Affiliation(s)
- James Kyle Haws
- Department of Family Medicine, and the Adult and Child Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, 13199 E. Montview Blvd, Suite 300, Aurora, CO, 80045, USA.
| | - Lauren M Laifer
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Laura M Acosta
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Allura L Ralston
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Tatiana M Davidson
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Arthur R Andrews
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
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7
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Bryant RA. Is Fear Extinction Impairment Central to Psychopathology? Curr Top Behav Neurosci 2023; 64:195-212. [PMID: 37668874 DOI: 10.1007/7854_2023_439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
As discussed in this chapter, there have been enormous advances in our understanding of how anxiety disorders develop, are maintained, and can be treated. Many of these advances have been the result of translational studies using fear conditioning and extinction models. Despite these successes, we recognize, as a field, that there are important limitations in the extent to which extinction can explain how anxiety disorders and behaviors remit. Clinically speaking, the outstanding challenge for treatment of anxiety disorders is to improve the current suboptimal success rates. Over the past 30 years, we have not improved our treatment success rates despite employing many pharmacological and pharmacological strategies. While extinction and related fear circuitry mechanisms most certainly appear to play a role in treatment of anxiety disorders, they are also apparently insufficient to fully accommodate the varied responses individuals exhibit with this treatment approach. Increasingly diverse and innovative approaches are needed that accommodate the multitude of change mechanisms involved in treating anxiety. However, this is not to suggest ignoring the key role that extinction and memory updating processes play in overcoming anxiety.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
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8
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Franz MR, Savella GM, Salen N, Contractor AA, Kiser LJ. The Effects of a Multi-Family Group Trauma Intervention on Caregiver Posttraumatic Stress Symptom Clusters. VIOLENCE AND VICTIMS 2022; 37:702-714. [PMID: 36038278 DOI: 10.1891/vv-2021-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Strengthening Family Coping Resources (SFCR), a multi-family group intervention tailored to families experiencing traumatic stress, is associated with improved post-traumatic stress disorder (PTSD) symptoms and family functioning. To further SFCR research, we examined (1) SFCR's effects on caregiver PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity); and (2) whether effects differed by caregiver trauma type (interpersonal versus non-interpersonal; intrafamilial versus extrafamilial). Forty-two caregivers of primarily low socioeconomic status reporting trauma histories completed SFCR treatment. Significant decreases in PTSD intrusion, avoidance, and NACM subscale scores emerged from pre- to post-SFCR; there were no differences in subscale score changes by trauma type categorization. Findings support SFCR as a promising treatment for reducing PTSD severity among caregivers reporting diverse traumas.
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Affiliation(s)
- Molly R Franz
- Department of Psychology, University of Maryland Baltimore County
| | | | - Nicole Salen
- Department of Psychiatry, University of Maryland School of Medicine
| | | | - Laurel J Kiser
- Department of Psychiatry, University of Maryland School of Medicine
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9
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Kovacevic M, Haney AM, Sullivan CP, Kramer LB, Chard KM. Four profiles of symptom change in residential Cognitive Processing Therapy. J Anxiety Disord 2022; 90:102585. [PMID: 35797805 DOI: 10.1016/j.janxdis.2022.102585] [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: 08/17/2021] [Revised: 02/26/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
Abstract
A significant portion of veterans do not respond to evidence-based treatments for PTSD. Therefore, researchers have sought to predict who will respond well to trauma-focused treatment. The present study examined pre- and posttreatment symptom profiles, session-by-session change, as well as demographic and additional diagnostic information to better understand PTSD treatment response. Participants included 332 veterans undergoing residential Cognitive Processing Therapy. Latent profile analyses were computed, and four meaningful profiles emerged: Fast Responders, Steady Responders, Partial Responders, and Minimal Responders. Each profile demonstrated symptom reduction at approximately the same rate in the first half of treatment. Two specific profiles, Steady Responders and Minimal Responders, showed key clinically important differences. Both profiles demonstrated severe pretreatment PTSD symptom severity; however, in the second half of treatment, Steady Responders saw the steepest decrease in symptoms of any of the profiles while Minimal Responders saw less symptom reduction compared to all other profiles. Via a thorough examination, membership in Steady Responders compared to Minimal Responders was not associated with demographic or health variables. Results suggest that pretreatment symptom severity does not necessarily determine a client's posttreatment symptom severity. Pretreatment symptom severity did not determine outcome, though some veterans (Minimal Responders) did not experience the same symptom change and treatment effectiveness. Further identifying the factors that lead to the separation of these groups will add important information for determining treatment selection and potential obstacles to effectiveness.
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Affiliation(s)
- Merdijana Kovacevic
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio USA.
| | - Alison M Haney
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio USA
| | - Connor P Sullivan
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio USA
| | - Lindsay B Kramer
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio USA
| | - Kathleen M Chard
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio USA
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10
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Grekin R, Thomas EBK, Miller ML, O’Hara MW. The role of prenatal posttraumatic stress symptoms among trauma exposed women in predicting postpartum depression. Stress Health 2022; 38:610-614. [PMID: 34617661 PMCID: PMC8986883 DOI: 10.1002/smi.3100] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/24/2021] [Accepted: 10/05/2021] [Indexed: 01/10/2023]
Abstract
Research suggests that a history of trauma and prenatal posttraumatic stress symptoms (PTSS) are predictive of postpartum depression (PPD). Pregnant women at risk for PPD are often identified through depression symptom measures, while PTSS also may help to identify those at increased risk. Women who do not endorse depressive symptoms, though experience PTSS, may be missed when screening is exclusively based on depressive symptoms. The current study aimed to determine if prenatal PTSS were associated with PPD at 4- and 12-week postpartum in trauma-exposed women. Pregnant women (N = 230) in their third trimester were assessed for depression and PTSS at pregnancy, 4 and 12 weeks postpartum. Traumatic life events were assessed during pregnancy. Hierarchical regression analyses examined predictors of PPD, including history of depression, number of past traumas, and symptoms from the posttraumatic stress disorder (PTSD) Checklist short-form (PCL-6). At 4 and 12 weeks postpartum, history of trauma and depression did not predict depressive symptoms, however, irritability and unwanted intrusive memories of trauma were predictive of increased depressive symptoms. Prenatal irritability and unwanted memories may be predictive of elevated PPD symptoms. Future research should examine whether these symptoms represent increased risk of postpartum depressive symptoms to improve screening, prevention, and treatment efforts.
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Affiliation(s)
- Rebecca Grekin
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Emily B. K. Thomas
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Michelle L. Miller
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael W. O’Hara
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
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11
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Du J, Diao H, Zhou X, Zhang C, Chen Y, Gao Y, Wang Y. Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:219-243. [PMID: 37724188 PMCID: PMC10388753 DOI: 10.1515/mr-2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/21/2022] [Indexed: 09/20/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and the International Classification of Diseases 11th Edition (ICD-11) offer the most widely accepted diagnostic guidelines for PTSD. In both diagnostic categories, experiencing a traumatic event (TE) is the necessary criterion for diagnosing PTSD. The TEs described in the DSM-5 include actual or threatened death, serious injury, sexual violence, and other extreme stressors, either directly or indirectly. More than 70% of adults worldwide are exposed to a TE at least once in their lifetime, and approximately 10% of individuals develop PTSD after experiencing a TE. The important features of PTSD are intrusion or re-experiencing fear memories, pervasive sense of threat, active avoidance, hyperarousal symptoms, and negative alterations of cognition and mood. Individuals with PTSD have high comorbidities with other psychiatric diseases, including major depressive disorder, generalized anxiety disorder, and substance use disorder. Multiple lines of evidence suggest that the pathophysiology of PTSD is complex, involving abnormal neural circuits, molecular mechanisms, and genetic mechanisms. A combination of both psychotherapy and pharmacotherapy is used to treat PTSD, but has limited efficacy in patients with refractory PTSD. Because of the high prevalence, heavy burden, and limited treatments, PTSD is a psychiatric disorder that requires urgent attention. In this review, we summarize and discuss the diagnosis, prevalence, TEs, pathophysiology, and treatments of PTSD and draw attention to its prevention.
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Affiliation(s)
- Jun Du
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Huapeng Diao
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Xiaojuan Zhou
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Chunkui Zhang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yifei Chen
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yan Gao
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yizheng Wang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
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12
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Tanev KS, Lynch EA, Blackburn AM, Terry D, Goetter EM, Wright EC, Gupta C, Stasko CE, Spencer T. Associations between residual hyperarousal and insomnia symptoms in veterans following a 2-week intensive outpatient program for posttraumatic stress disorder. J Trauma Stress 2022; 35:461-472. [PMID: 34811818 DOI: 10.1002/jts.22758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 11/09/2022]
Abstract
Many returning military service members and veterans who were deployed following the September 11, 2001, terrorist attacks (9/11) suffer from posttraumatic stress disorder (PTSD) and insomnia. Although intensive treatment programs for PTSD have shown promise in the treatment of PTSD symptoms, recent research has demonstrated that sleep disturbance shows little improvement following intensive trauma-focused treatment. The aim of the present study was to evaluate changes in self-reported insomnia symptoms among veterans and service members following participation in a 2-week intensive program for PTSD. We further aimed to investigate if residual PTSD symptoms, specifically hyperarousal, were associated with residual insomnia symptoms. Participants (N = 326) completed self-report assessments of insomnia, PTSD symptoms, and depressive symptoms at pre- and posttreatment. At pretreatment, 73.9% of participants (n = 241) met the criteria for moderate or severe insomnia, whereas at posttreatment 67.7% of participants (n = 203) met the criteria. Results of paired t tests demonstrated statistically significant differences between pre- and posttreatment Insomnia Severity Index scores; however, the effect size was small, d = 0.34. Analyses revealed that posttreatment hyperarousal symptoms were associated with posttreatment insomnia. These findings suggest that although an intensive program for service members and veterans with PTSD may significantly reduce insomnia symptoms, clinically meaningful residual insomnia symptoms remain. Further research is warranted to elucidate the association between residual hyperarousal and insomnia symptoms following intensive trauma-focused treatment.
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Affiliation(s)
- Kaloyan S Tanev
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse A Lynch
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Allyson M Blackburn
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychology, University of Illinois in Urbana-Champaign, Champaign, Illinois, USA
| | - Douglas Terry
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth M Goetter
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward C Wright
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carina Gupta
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Cory E Stasko
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Tom Spencer
- Home Base: A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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13
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One Year after the Flood: Prevalence and Correlates of Post-Traumatic Stress Disorder among Residents in Fort McMurray. Behav Sci (Basel) 2022; 12:bs12030069. [PMID: 35323388 PMCID: PMC8944971 DOI: 10.3390/bs12030069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background: The 2020 Fort McMurray (FMM) and area flood caused more than $228 million in insured damage, affected over 1200 structures, and more than 13,000 people were evacuated. Objective: This study sought to determine the prevalence of post-traumatic stress disorder (PTSD)-like symptoms and the risk predictors among the population of FMM one year after the 2020 flooding. Methods: An online quantitative cross-sectional survey was distributed to residents of FMM via REDCap between 24 April to 2 June 2021 to collect sociodemographic, clinical, and flood-related information. The PTSD checklist for DSM-5 (PCL-C) was used to assess likely PTSD among respondents. Results: 186 of 249 respondents completed all essential self-assessment questionnaires in the analysis, yielding a response rate of 74.7%. The prevalence of likely PTSD was 39.6% (65). Respondents with a history of depression were more likely to develop PTSD symptoms (OR = 5.71; 95% CI: 1.68–19.36). Similarly, responders with limited and no family support after the disaster were more prone to report PTSD symptoms ((OR = 2.87; 95% CI: 1.02–8.05) and (OR = 2.87; 95% CI: 1.06–7.74), respectively). Conclusions: Our research indicated that history of depression and the need for mental health counseling significantly increased the risk of developing PTSD symptoms following flooding; family support is protective. Further studies are needed to explore the relations between the need to receive counseling and presenting with likely PTSD symptoms.
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14
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Transdiagnostic Symptom Subtypes to Predict Response to Therapeutic Transcranial Magnetic Stimulation in Major Depressive Disorder and Posttraumatic Stress Disorder. J Pers Med 2022; 12:jpm12020224. [PMID: 35207712 PMCID: PMC8874724 DOI: 10.3390/jpm12020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/07/2022] [Accepted: 01/27/2022] [Indexed: 01/09/2023] Open
Abstract
The diagnostic categories in psychiatry often encompass heterogeneous symptom profiles associated with differences in the underlying etiology, pathogenesis and prognosis. Prior work demonstrated that some of this heterogeneity can be quantified though dimensional analysis of the Depression Anxiety Stress Scale (DASS), yielding unique transdiagnostic symptom subtypes. This study investigated whether classifying patients according to these symptom profiles would have prognostic value for the treatment response to therapeutic transcranial magnetic stimulation (TMS) in comorbid major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). A linear discriminant model was constructed using a simulation dataset to classify 35 participants into one of the following six pre-defined symptom profiles: Normative Mood, Tension, Anxious Arousal, Generalized Anxiety, Anhedonia and Melancholia. Clinical outcomes with TMS across MDD and PTSD were assessed. All six symptom profiles were present. After TMS, participants with anxious arousal were less likely to achieve MDD remission compared to other subtypes (FET, odds ratio 0.16, p = 0.034), exhibited poorer PTSD symptom reduction (21% vs. 46%; t (33) = 2.025, p = 0.051) and were less likely to complete TMS (FET, odds ratio 0.066, p = 0.011). These results offer preliminary evidence that classifying individuals according to these transdiagnostic symptom profiles may offer a simple method to inform TMS treatment decisions.
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15
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Yrondi A, Colineaux H, Claudet I, Sales de Gauzy J, Huo S, Taib S, Bui E, Birmes P. Prevalence and prediction of PTSD and depression in mothers of children surviving a motor vehicle crash. Eur J Psychotraumatol 2022; 13:2121014. [PMID: 36212115 PMCID: PMC9543172 DOI: 10.1080/20008066.2022.2121014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Few studies have examined the psychopathological consequences for parents of children who were survivors of a motor vehicle crash (MVC). This study assessed the impact of dissociation and peritraumatic distress on the severity of PTSD and post-traumatic major depressive episode (MDE) symptoms in mothers during the first years after the MVC and the role that cortisol response might play in this association. Methods: 125 mothers were included. Peritraumatic distress and dissociation were assessed. Morning salivary cortisol was tested at the baseline. Participants were assessed for a probable diagnosis of PTSD and MDE at 5 weeks, 6 months and 12 months. Results: At 5 weeks, 12 (13.6%) mothers exhibited probable PTSD. During the first year, the PCL score was higher when the (i) Peritraumatic Distress Inventory (PDI) score increased and (ii) the Peritraumatic Dissociation Experience Questionnaire (PDEQ) score increased. Cortisol levels were lower when the PDI score increased. Conclusion: This is the first study to assess the mothers of MVC survivors for one year following the trauma. We confirm that peritraumatic responses are useful for predicting the severity of PTSD symptoms. These results could encourage the implementation of follow-up programmes not only for survivors but also for their mothers. HIGHLIGHTS Mothers of children involved in motor vehicle accident are at risk for developing PTSD.Peritraumatic responses (distress and dissociation) are associated to the severity of PTSD symptoms.Low salivary cortisol levels were associated with high peritraumatic distress.
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Affiliation(s)
- Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hopital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Hélène Colineaux
- UMR1027, Université Toulouse III, Inserm, Toulouse, France.,Département d'Epidemiologie, CHU Toulouse, Toulouse, France
| | - Isabelle Claudet
- Département des Urgences Pédiatriques, CHU Toulouse, Toulouse, France
| | - Jérome Sales de Gauzy
- Département de chirurgie orthopédique, Hopital des enfants, CHU Toulouse, Toulouse, France
| | - Samantha Huo
- Département d'Epidemiologie, CHU Toulouse, Toulouse, France
| | - Simon Taib
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Eric Bui
- Université de Caen Normandie et CHU Caen, Caen, France.,Massachusetts General Hospital, Boston
| | - Philippe Birmes
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
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16
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Greene T, Sznitman S, Contractor AA, Prakash K, Fried EI, Gelkopf M. The memory-experience gap for PTSD symptoms: The correspondence between experience sampling and past month retrospective reports of traumatic stress symptoms. Psychiatry Res 2022; 307:114315. [PMID: 34896842 DOI: 10.1016/j.psychres.2021.114315] [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: 07/12/2021] [Revised: 11/14/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022]
Abstract
Posttraumatic stress disorder assessments typically require individuals to provide an aggregate report on the frequency or severity of symptoms they have experienced over a particular time period. Yet retrospective aggregate assessments are susceptible to memory recall and retrieval difficulties. This study examined the correspondence between a month of real-time experience sampling methodology (ESM) reports of traumatic stress symptoms and a retrospective assessment of past-month traumatic stress symptoms for that same period. Participants were a convenience community sample (n=96) from Southern and Central Israel exposed to rocket fire during the Israel-Gaza July-Aug 2014 conflict. Participants provided ESM reports on traumatic stress symptoms twice a day for 30 days via smartphone. Average ESM scores, rather than peak or most recent reports, were most highly correlated with retrospective assessments. For individual symptoms, concentration difficulties had the highest correspondence between ESM and retrospective reports, while amnesia had the lowest correspondence. Regression analysis found that average ESM scores and younger age significantly predicted past-month retrospective assessments of PTSD symptoms. Additionally, previously experiencing more types of trauma predicted PTSD symptoms, but did not moderate the relationship between ESM and retrospective assessments. These findings have implications for assessment.
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Affiliation(s)
- Talya Greene
- Department of Community Mental Health, University of Haifa, Israel; Division of Psychiatry, University College London, UK.
| | | | | | | | - Eiko I Fried
- Department of Clinical Psychology, Leiden University, The Netherlands
| | - Marc Gelkopf
- Department of Community Mental Health, University of Haifa, Israel
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17
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Lapid Pickman L, Gelkopf M, Greene T. Do positive and negative emotional reactions during war predict subsequent symptomatology? A prospective experience sampling study. J Anxiety Disord 2021; 84:102492. [PMID: 34749217 DOI: 10.1016/j.janxdis.2021.102492] [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] [Received: 03/18/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
While peritraumatic negative emotions have been associated with subsequent posttraumatic stress and depression, the predictive role of real-time emotional reactions to specific stressors during prolonged stress exposure is still unclear, particularly that of positive emotions. The current study uses experience sampling methodology to examine individual general levels of negative and positive emotions, and emotional reactivity to specific stressors during war, as prospective predictors of posttraumatic stress and depression. Ninety-six civilians exposed to rocket fire during the 2014 Israel-Gaza war reported exposure to rocket warning sirens and levels of ten negative and six positive emotions twice a day for 30 days. Symptoms of posttraumatic stress and depression were then assessed two months post-war. Participants reported higher negative emotions and lower positive emotions during assessment windows with sirens. Over time, negative emotions decreased and positive emotions increased. Higher levels of overall negative emotions predicted posttraumatic stress symptoms and depression symptoms two months later. Levels of positive emotions, and negative and positive emotional reactivity to sirens, were not associated with subsequent symptomatology. Our results indicate the stronger role of overall negative emotions as predictors of symptomatology compared with momentary emotional reactivity, and the stronger predictive role of negative compared with positive emotions.
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Affiliation(s)
- Liron Lapid Pickman
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; NATAL - Israel Trauma and Resiliency Center, Tel Aviv, Israel.
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; NATAL - Israel Trauma and Resiliency Center, Tel Aviv, Israel
| | - Talya Greene
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Division of Psychiatry, University College London, London, UK
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18
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Disentangling the association between PTSD symptom heterogeneity and alcohol use disorder: Results from the 2019-2020 National Health and Resilience in Veterans Study. J Psychiatr Res 2021; 142:179-187. [PMID: 34359013 DOI: 10.1016/j.jpsychires.2021.07.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/06/2021] [Accepted: 07/31/2021] [Indexed: 12/25/2022]
Abstract
Veterans are at increased risk of comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) relative to civilians. Few studies have explored the association between distinct PTSD symptoms and AUD in veterans, and existing findings are highly discrepant. This study aimed to address this gap and equivocal association by evaluating which PTSD symptom clusters are most associated with AUD in a veteran sample using the 7-factor 'hybrid' model of PTSD. Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), a nationally representative survey of 4069 U.S. veterans. Veterans completed self-report measures to assess current PTSD symptoms and AUD. Multivariable logistic regression and relative importance analyses were conducted to examine associations between the 7-factor model of PTSD symptoms and AUD. Adjusting for sociodemographic, military, trauma factors, and depressive symptoms, scores on the dysphoric arousal (20.7% relative variance explained [RVE]) and externalizing behaviors (19.0% RVE) symptom clusters were most strongly associated with AUD in the full sample, while externalizing behaviors (47.7% RVE), anxious arousal (23.9% RVE), and dysphoric arousal (12.4%) accounted for the majority of explained variance in veterans who screened positive for PTSD. Results of this nationally representative study of U.S. veterans highlight the importance of externalizing behaviors and arousal symptoms of PTSD as potential drivers of AUD in this population. The 7-factor hybrid model of PTSD provides a more nuanced understanding of PTSD-AUD associations, and may help inform risk assessment and more personalized treatment approaches for veterans with and at-risk for AUD.
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19
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Radell ML, Hamza EA, Moustafa AA. Depression in post-traumatic stress disorder. Rev Neurosci 2021; 31:703-722. [PMID: 32866132 DOI: 10.1515/revneuro-2020-0006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/31/2020] [Indexed: 12/12/2022]
Abstract
Major depressive disorder (MDD) symptoms commonly occur after trauma-exposure, both alone and in combination with post-traumatic stress disorder (PTSD). This article reviews recent research on comorbidity between these disorders, including its implications for symptom severity and response to treatment. Despite considerable symptom overlap, the two disorders represent distinct constructs and depend, at least in part, on separate biological mechanisms. Both, however, are also clearly related to stress psychopathology. We recommend that more research focus specifically on the study of individual differences in symptom expression in order to identify distinct subgroups of individuals and develop targeted treatments. However, a barrier to this line of inquiry is the trend of excluding particular patients from clinical trials of new interventions based on symptom severity or comorbidity. Another obstacle is the overreliance on self-report measures in human research. We argue that developing computer-based behavioral measures in order to supplement self-report can help address this challenge. Furthermore, we propose that these measures can help tie findings from human and non-human animal research. A number of paradigms have been used to model MDD-and PTSD-like behavior in animals. These models remain valuable for understanding the biological basis of these disorders in humans and for identifying potential interventions, but they have been underused for the study of comorbidity. Although the interpretation of animal behavior remains a concern, we propose that this can also be overcome through the development of close human analogs to animal paradigms.
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Affiliation(s)
- Milen L Radell
- Department of Psychology, Niagara University, Lewiston, NY, USA
| | - Eid Abo Hamza
- Department of Mental Health, Faculty of Education, Tanta University, Tanta, Egypt
| | - Ahmed A Moustafa
- School of Psychology, Western Sydney University, Sydney, NSW, Australia.,Marcs Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia.,Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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20
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Yuan Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, Cheung T, Jackson T, Jiang GQ, Xiang YT. Prevalence of Post-traumatic Stress Symptoms and Its Associations With Quality of Life, Demographic and Clinical Characteristics in COVID-19 Survivors During the Post-COVID-19 Era. Front Psychiatry 2021; 12:665507. [PMID: 34093279 PMCID: PMC8176302 DOI: 10.3389/fpsyt.2021.665507] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The prevalence of post-traumatic stress symptoms (PTSS) in COVID-19 survivors is unclear. This study examined the prevalence of PTSS and its association with quality of life (QOL) among COVID-19 survivors during the post-COVID-19 era in China. Methods: This was a comparative, cross-sectional study. PTSS, depressive symptoms, and QOL were assessed with standardized instruments. Results: A total of 134 COVID-19 survivors and 214 non-infected controls (healthy controls hereafter) were recruited. Among COVID-19 survivors, the PTSS prevalence was 18.66% (95%CI: 11.98-25.34%), which was significantly higher than that (5.61%, 95%CI: 2.50-8.71%) of healthy controls (P < 0.001). After controlling for covariates, an analysis of covariance (ANCOVA) showed that COVID-19 survivors had a higher PTSS total score than did healthy controls [F (1,348) = 4.664, P = 0.032]. A separate ANCOVA revealed there were no significant differences in overall QOL between COVID-19 survivors with and without PTSS [F (1,348) = 1.067, P = 0.304]. A multiple logistic regression analysis showed that more severe depressive symptoms were significantly associated with PTSS in COVID-19 survivors (OR = 1.425, P < 0.001). Conclusions: PTSS were more severe in COVID-19 survivors compared to healthy controls in the post-COVID-19 era. Considering their negative impact on daily life and functional outcomes, regular assessment and appropriate treatments of PTSS should be conducted in COVID-19 survivors.
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Affiliation(s)
- Yuan Yuan
- Chongqing Mental Health Center, Chongqing, China
| | - Zi-Han Liu
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
| | - Yan-Jie Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders, School of Mental Health, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China.,The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders, School of Mental Health, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China.,The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Macau, China
| | | | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
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21
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Herts KL, Evans S. Schema Therapy for Chronic Depression Associated with Childhood Trauma: A Case Study. Clin Case Stud 2020. [DOI: 10.1177/1534650120954275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic depression lasting longer than 2 years is often undertreated. Research suggests that maladaptive cognitive schemas mediate the association between childhood trauma and later depression. Schema Therapy (ST) is an integrative treatment approach that targets maladaptive cognitive schemas through cognitive, behavioral, interpersonal, and experiential interventions. ST has been studied in patients with chronic depression with good results. The purpose of this case study is to detail how an ST treatment was used to treat chronic depression in a woman, “Amy,” with a childhood trauma history. Amy presented with a persistent depressive disorder that had lasted over 40 years. An ST approach was chosen in light of the chronicity of Amy’s symptoms and her childhood trauma history. Standardized measures including the Beck Depression Inventory were used to assess progress throughout treatment. We provide a comprehensive summary of the 22-session ST case conceptualization and treatment, through which Amy’s depressive symptoms evidenced a 73 percent reduction. Amy qualitatively reported reduced depressive rumination and avoidance behaviors as well as increased frequency of positive mood.
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Affiliation(s)
- Kate L. Herts
- Weill Cornell Medicine, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Susan Evans
- Weill Cornell Medicine, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
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22
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Jin L, Dolan M, Contractor A, Weiss NH, Dranger P. Relations between Emotional Expressivity Dimensions and DSM-5 PTSD Symptom Clusters in a Trauma-Exposed Community Sample. BEHAVIOUR CHANGE 2020; 37:116-129. [PMID: 33776199 PMCID: PMC7995860 DOI: 10.1017/bec.2020.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground and Objective. A growing body of literature indicates a significant contribution and role of positive and negative emotions (specifically expressivity) in post-traumatic stress disorder's (PTSD) symptomatology. The current study examined the facet-level relationships between emotional expressivity and PTSD. Specifically, we investigated which emotional expressivity dimension (impulse strength, negative emotional expressivity, and positive emotional expressivity) most strongly related to DSM-5 PTSD symptom clusters severity (intrusions, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity). Methods. The sample of 123 trauma-exposed participants seeking mental health treatment completed the PTSD Checklist for DSM-5 (PCL-5) and the Berkeley Expressivity Questionnaire (BEQ). Results. Results of multivariate multiple regression analysis indicated that only intensity of emotion and difficulty in controlling such emotions (i.e., impulse strength) was strongly related to all four PTSD symptom clusters. The valence of emotional expressivity (positive or negative) was not related to any of the PTSD symptom clusters. Conclusions. Study findings highlight the role of emotional expressivity, specifically impulse strength, in PTSD's symptomatology and may inform guidelines for emotion-focused clinical work for trauma-exposed individuals with PTSD symptoms.
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Affiliation(s)
- Ling Jin
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Megan Dolan
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Ateka Contractor
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Paula Dranger
- Counseling Services, Valparaiso University, Valparaiso, IN, USA
- Choices Counseling Services, Valparaiso, IN
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23
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Brown LA, Chen S, Narine K, Contractor AA, Oslin D. DSM-5 PTSD symptom clusters and suicidal ideation in veterans. Psychiatry Res 2020; 288:112942. [PMID: 32315877 DOI: 10.1016/j.psychres.2020.112942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 12/23/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with significantly greater risk for suicidal ideation (SI). In civilians, the negative alterations in cognitions and mood (NACM) and alterations in arousal and reactivity (AAR) clusters are most strongly associated with SI. This study sought to examine the association between PTSD symptom clusters and SI in a large sample of veterans. Veterans (n = 1,789) completed the PTSD Checklist for DSM-5 and the Patient Health Questionnaire (PHQ) during primary care visits. Wald chi-square tests of parameter constraints were computed to test hypothesized relations between PTSD factors and the PHQ-9 suicidal ideation item. Each of the PTSD symptom clusters were significantly associated with SI. The NACM cluster was more strongly associated with SI than AAR and marginally more strongly associated with SI than the avoidance symptom clusters. In a restricted sample of only veterans with PTSD, NACM remained more strongly associated with SI than avoidance. Each of the NACM symptoms were significantly associated with SI. Changes in cognitions and mood were most strongly associated with SI in this large sample of veterans. These findings suggest that directly targeting the NACM symptom cluster may be an important goal for suicide prevention efforts among veterans with PTSD.
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Affiliation(s)
- Lily A Brown
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA.
| | - Shirley Chen
- Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center and Center of Excellence for Substance Abuse Treatment and Evaluation Corporal Michael J. Crescenz VA Medical Center, 21 S University Ave, Philadelphia, PA 19104, Philadelphia, PA, USA
| | - Kevin Narine
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
| | - Ateka A Contractor
- University of North Texas, 1155 Union Cir, Denton, TX 76203, Denton, TX, USA
| | - David Oslin
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA; Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center and Center of Excellence for Substance Abuse Treatment and Evaluation Corporal Michael J. Crescenz VA Medical Center, 21 S University Ave, Philadelphia, PA 19104, Philadelphia, PA, USA
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24
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Sommer JL, El-Gabalawy R, Contractor AA, Weiss NH, Mota N. PTSD's risky behavior criterion: Associated risky and unhealthy behaviors and psychiatric correlates in a nationally representative sample. J Anxiety Disord 2020; 73:102247. [PMID: 32502805 DOI: 10.1016/j.janxdis.2020.102247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 02/06/2023]
Abstract
Criterion E2 ("reckless or self-destructive behavior") was added to the DSM-5 posttraumatic stress disorder (PTSD) criteria to reflect the established association between PTSD and risky and unhealthy behaviors (RUBs); however, previous research has questioned its clinical significance. To determine whether criterion E2 adequately captures reckless/self-destructive behavior, we examined the prevalence and associations of RUBs (e.g., substance misuse, risky sexual behaviors) with criterion E2 endorsement. Further, we examined associations between criterion E2 and psychiatric conditions (e.g., depressive disorders, anxiety disorders) in a population-based sample of trauma-exposed adults. We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed lifetime DSM-5 psychiatric conditions and self-reported RUBs. Among trauma-exposed adults (n = 23,936), multiple logistic regressions examined criterion E2's associations with RUBs and psychiatric conditions. After adjusting for covariates, all RUBs were associated with E2 endorsement (AOR range: 1.58-3.97; most prevalent RUB among those who endorsed E2: greater substance use than intended [57.0 %]) except binge eating, and E2 endorsement was associated with increased odds of PTSD, bipolar disorder, substance use disorders, and schizotypal, borderline, and antisocial personality disorders (AOR range: 1.65-2.75), and decreased odds of major depressive disorder (AOR = 0.76). Results support the clinical significance of criterion E2 through identifying associated RUBs and distinct correlates. These results may inform screening and intervention strategies for at-risk populations.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2, Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2, Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2, Canada; Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada; Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX, 76203, United States
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, United States
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada; Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada.
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Double Trouble: Treatment Considerations for Patients with Comorbid PTSD and Depression. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00213-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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26
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Öğülmüş S, Boysan M, Fidan-Acar Ö, Koca H. The underlying dimensions of DSM-5 posttraumatic stress disorder (PTSD) and their relationships with mental and somatoform dissociation, depression and anxiety among jail inmates. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2020. [DOI: 10.1080/03069885.2020.1738338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Selahiddin Öğülmüş
- Department of Guidance and Psychological Counseling, Faculty of Educational Sciences, Ankara University, Ankara, Turkey
| | - Murat Boysan
- Department of Psychology, Faculty of Social Sciences and Humanities, Ankara Social Sciences University, Ankara, Turkey
| | - Özlem Fidan-Acar
- Van M Type Correctional Institution, Department of Penalty and Arresting Houses, Turkish Republic Ministry of Justice, Van, Turkey
| | - Hanife Koca
- Van M Type Correctional Institution, Department of Penalty and Arresting Houses, Turkish Republic Ministry of Justice, Van, Turkey
- Çanakkale Correctional Institution, Department of Penalty and Arresting Houses, Turkish Republic Ministry of Justice, Çanakkale, Turkey
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27
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Factor Structure and Multi-Group Measurement Invariance of Posttraumatic Stress Disorder Symptoms Assessed by the PCL-5. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09800-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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28
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Extending our understanding of the association between posttraumatic stress disorder and positive emotion dysregulation: A network analysis approach. J Anxiety Disord 2020; 71:102198. [PMID: 32109828 PMCID: PMC7196007 DOI: 10.1016/j.janxdis.2020.102198] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/24/2019] [Accepted: 02/10/2020] [Indexed: 12/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) has empirically-established associations with positive emotion dysregulation. Extending existing research, we utilized a network approach to examine relations between PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive emotion dysregulation dimensions (nonacceptance, impulse control, goal-directed behavior). We identified (1) differential relations of PTSD symptom clusters with positive emotion dysregulation, and (2) central symptoms accounting for the PTSD and positive emotion dysregulation inter-group interconnections. Participants were 371 trauma-exposed community individuals (Mage = 43.68; 70.9 % females; 34.5 % white). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD symptom clusters and three nodes representing positive emotion dysregulation dimensions. Study results indicated the key role of AAR and intrusions clusters in the PTSD group and impulse control difficulties in the positive emotion dysregulation group. Regarding cross-group connectivity patterns, findings indicate the pivotal role of (1) AAR in its link with positive emotion dysregulation dimensions, and (2) nonacceptance of positive emotions and impairment in goal-directed behavior in the context of positive emotions in their link to PTSD symptom clusters. Thus, the current study indicates the potentially central role of particular PTSD symptom clusters and positive emotion dysregulation dimensions, informing assessment and treatment targets.
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29
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Vidaña AG, Forbes CN, Gratz KL, Tull MT. The influence of posttraumatic stress disorder and recurrent major depression on risk-taking propensity following trauma script exposure among patients with substance use disorders. Addict Behav 2020; 102:106181. [PMID: 31775063 DOI: 10.1016/j.addbeh.2019.106181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 11/29/2022]
Abstract
Although evidence suggests that risk-taking among individuals with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) may be precipitated by trauma-related emotional distress, studies have yet to examine moderators of this effect. One moderator worth investigating is recurrent major depressive disorder (MDD), given its influence on emotional responding and subsequent behavior. This study examined the moderating role of recurrent MDD in the relation of PTSD to risk-taking propensity following neutral and trauma scripts among SUD patients. Participants were 193 patients with and without current PTSD and/or recurrent MDD in residential SUD treatment. Risk-taking propensity, as assessed through the Balloon Analogue Risk Task (BART), was evaluated following a neutral script and a personalized trauma script. A significant script by PTSD by recurrent MDD interaction was found. Participants with PTSD and recurrent MDD exhibited significantly lower risk-taking following the trauma script relative to participants with PTSD but no recurrent MDD. Moreover, participants with PTSD and recurrent MDD exhibited a significantly smaller increase in risk-taking following the trauma script (relative to the neutral script) than participants with PTSD but no recurrent MDD. Participants with PTSD and recurrent MDD did not differ significantly from participants without PTSD. Results provide support for the context-dependent nature of risk-taking among PTSD-SUD patients without (vs. with) recurrent MDD. Results also highlight the importance of considering the presence of recurrent MDD in research and/or clinical work with SUD patients with PTSD.
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Affiliation(s)
- Ariana G Vidaña
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | | | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA.
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30
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Egberts MR, Engelhard IM, Schoot RVD, Bakker A, Geenen R, van der Heijden PGM, Van Loey NEE. Mothers' emotions after pediatric burn injury: Longitudinal associations with posttraumatic stress and depressive symptoms 18 months postburn. J Affect Disord 2020; 263:463-471. [PMID: 31969279 DOI: 10.1016/j.jad.2019.11.140] [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] [Received: 07/01/2019] [Revised: 10/30/2019] [Accepted: 11/29/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Various emotions are implicated in posttraumatic stress disorder (PTSD). Longitudinal studies examining temporal associations between emotions and posttraumatic stress may reveal who is at risk of chronic psychological problems. This study examined the longitudinal relationships of mothers' trauma-related emotions with posttraumatic stress and depressive symptoms after pediatric burn injury. METHODS Data from two cohort studies were used (n = 296). Mothers reported the intensity of burn-related emotions within the first month (T1) and 12 months postburn (T2). The Impact of Event Scale (IES) and the Hospital and Anxiety Depression Scale (HADS-D; depression subscale) were administered at T1 and 18 months postburn (T3). RESULTS Based on two exploratory factor analyses, emotion variables were combined into acute and long-term basic emotions (fear, sadness, horror, anger) and self-conscious emotions (guilt, shame). The path model showed a positive relationship between acute and long-term basic emotions. Higher long-term basic emotions were related to persistence of posttraumatic stress and depressive symptoms. Acute self-conscious emotions showed associations with posttraumatic stress and depressive symptoms at T1 and were longitudinally related to depressive, but not posttraumatic stress, symptoms. LIMITATIONS The posttraumatic stress measure was not based on DSM-5 PTSD criteria and results require replication using these criteria. CONCLUSIONS This study suggests that mothers' acute self-conscious and long-term basic emotions in relation to their child's burn injury are involved in the development of posttraumatic stress and depressive symptoms. Clinically, assessing and monitoring parents' early posttraumatic stress, depressive symptoms and burn-related emotions may be useful to identify parents at risk.
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Affiliation(s)
- Marthe R Egberts
- Association of Dutch Burn Centres, Beverwijk, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands; Department of Methods and Statistics, Utrecht University, Utrecht, the Netherlands.
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Rens van de Schoot
- Department of Methods and Statistics, Utrecht University, Utrecht, the Netherlands; Optentia Research Program, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
| | - Anne Bakker
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, research institute(s), Amsterdam, the Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
| | - Peter G M van der Heijden
- Department of Methods and Statistics, Utrecht University, Utrecht, the Netherlands; S3RI, University of Southampton, Southampton, United Kingdom
| | - Nancy E E Van Loey
- Association of Dutch Burn Centres, Beverwijk, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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31
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Contractor AA, Weiss NH, Dolan M, Mota N. Examination of the Structural Relations Between Posttraumatic Stress Disorder Symptoms and Reckless/Self-Destructive Behaviors. INTERNATIONAL JOURNAL OF STRESS MANAGEMENT 2020; 27:35-44. [PMID: 33776397 PMCID: PMC7993008 DOI: 10.1037/str0000133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Megan Dolan
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, MB, CANADA
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32
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Armour C, Greene T, Contractor AA, Weiss N, Dixon-Gordon K, Ross J. Posttraumatic Stress Disorder Symptoms and Reckless Behaviors: A Network Analysis Approach. J Trauma Stress 2020; 33:29-40. [PMID: 32086982 DOI: 10.1002/jts.22487] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 10/21/2019] [Accepted: 12/10/2019] [Indexed: 12/17/2022]
Abstract
Existing literature indicates a theoretical and empirical relation between engagement in reckless behaviors and posttraumatic stress disorder (PTSD). Thus, the DSM-5 revision of the PTSD nosology added a new "reckless or self-destructive behavior" (RSDB) symptom (Criterion E2). The current study applied a network analytic approach to examine the item-level relations among a range of reckless behaviors and PTSD symptom clusters. Participants were recruited from Amazon's Mechanical Turk (N = 417), and network analysis was conducted with 20 variables: six PTSD symptom clusters, corresponding to the hybrid model of PTSD (Armour et al., 2015) and excluding the externalizing behavior cluster (Community 1), and 14 items related to reckless behavior (Community 2). The results showed that the network associations were strongest within each construct (i.e., within PTSD and within reckless behaviors), although several bridge connections (i.e., between PTSD clusters and reckless behaviors) were identified. Most reckless behavior items had direct associations with one or more PTSD symptom clusters. The present findings support the existence of close relations between a variety of reckless behaviors and PTSD symptom clusters beyond their relations with DSM Criterion E2. The results provide testable hypotheses about the associations between specific reckless behaviors and PTSD symptom clusters, which may inform future research.
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Affiliation(s)
- Cherie Armour
- School of Psychology, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | - Nicole Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Katherine Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Jana Ross
- School of Psychology, Queen's University Belfast, Northern Ireland, United Kingdom
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33
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Contractor AA, Greene T, Dolan M, Weiss NH, Armour C. Relation between PTSD symptom clusters and positive memory characteristics: A network perspective. J Anxiety Disord 2020; 69:102157. [PMID: 31751918 PMCID: PMC6960352 DOI: 10.1016/j.janxdis.2019.102157] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/02/2019] [Accepted: 11/02/2019] [Indexed: 01/03/2023]
Abstract
Positive memory characteristics relate to posttraumatic stress disorder (PTSD) severity. We utilized a network approach to examine relations between PTSD clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive memory characteristics (count, accessibility, valence, vividness, coherence, time perspective, sensory details). We identified differential relations between PTSD clusters and positive memory characteristics, and central/bridging symptoms. Participants were an Amazon Mechanical Turk-recruited sample of 206 individuals (Mage = 35.36; 61.20% females). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD clusters and six nodes representing positive memory characteristics. Regarding cross-community relations, AAR (highest node strength) was negatively associated with positive memory count, valence, coherence, and accessibility; avoidance was positively and negatively associated with positive memory vividness and count respectively. The NACM-AAR and intrusion-avoidance edges were significantly stronger than most edges. From the PTSD community, AAR and avoidance had the highest bridge strength and bridge expected influence respectively; from the positive memory community, coherence and vividness had the highest bridge strength and bridge expected influence respectively. Results indicate the potential pivotal role of AAR, avoidance, coherence, and vividness in the PTSD-positive memory relation, which renders them assessment/treatment targets pending further investigation.
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Affiliation(s)
| | - Talya Greene
- Department of Community Mental Health, University of Haifa, Israel
| | - Megan Dolan
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Nicole H. Weiss
- Department of Psychology, University of Rhode Island, RI, TX, USA
| | - Cherie Armour
- School of Psychology, Queens University Belfast, Northern Ireland, UK
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Garabiles MR, Lao CK, Wang S, Hall BJ. The network structure of posttraumatic stress disorder among Filipina migrant domestic workers: comorbidity with depression. Eur J Psychotraumatol 2020; 11:1765544. [PMID: 34630933 PMCID: PMC8500701 DOI: 10.1080/20008198.2020.1765544] [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: 12/18/2022] Open
Abstract
BACKGROUND Labour migrants are exposed to potentially traumatic events throughout the migration cycle, making them susceptible to developing mental disorders. Posttraumatic stress disorder (PTSD) is often comorbid with depression. Comorbidity worsens the course of illness, prognosis, treatment response, and increases suicidal risk. Using network analysis, this study examined the structure of PTSD and depression in a sample of migrant domestic workers, an especially vulnerable community of labour migrants. This study sought to derive the central or most important symptoms, strongest edges or relationships among symptoms, and bridge symptoms between PTSD and depression. METHODS Data were obtained from 1,375 Filipina domestic workers in Macao SAR, China. Data from a subsample of 1,258 trauma-exposed participants were analysed using R software. RESULTS Most of the strongest edges were within the same disorder and, for PTSD, within the same symptom cluster. Highest node centrality were PCL-5's 'avoid thoughts', 'lose interest', 'negative emotions', and 'not concentrate', and PHQ-9's 'sleep difficulties'. The bridge symptoms were PHQ-9's 'sleep difficulties,' 'psychomotor agitation/retardation,' and 'fatigue,' PCL-5's 'not concentrate', and PHQ-9's 'worthlessness' and 'anhedonia'. LIMITATIONS Results may not generalize to Filipino migrant workers in other occupations and to male migrant workers. Potentially relevant symptoms like somatic symptoms and fear of somatic and mental symptoms were not included. CONCLUSIONS Central and bridge symptoms are the most important nodes in the network. Developing interventions targeting these symptoms, particularly depression symptoms, is a promising alternative to PTSD treatment given substantial barriers to specialist care for this population.
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Affiliation(s)
- Melissa R Garabiles
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, The University of Macau, Macao (SAR), People's Republic of China.,Department of Psychology, Ateneo de Manila University, Quezon City, Philippines
| | - Chao K Lao
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, The University of Macau, Macao (SAR), People's Republic of China
| | - Siyuan Wang
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, The University of Macau, Macao (SAR), People's Republic of China
| | - Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, The University of Macau, Macao (SAR), People's Republic of China
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Contractor AA, Banducci AN, Dolan M, Keegan F, Weiss NH. Relation of positive memory recall count and accessibility with post-trauma mental health. Memory 2019; 27:1130-1143. [PMID: 31189410 PMCID: PMC6643998 DOI: 10.1080/09658211.2019.1628994] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
Positive memory encoding and retrieval deficits have an empirical relation with several post-trauma outcomes. Drawing from the Contractor et al. model, we examined relations between positive memory characteristics and post-trauma mental health indicators. A trauma-exposed community sample of 203 participants (Mage = 35.40 years; 61.10% female) was recruited via Amazon's Mechanical Turk. Participants completed measures of posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5), depression (Patient Health Questionnaire-9), posttraumatic cognitions (Posttraumatic Cognitions Inventory), affect (Positive and Negative Affect Schedule), count/number of recalled specific positive memories (Autobiographical Memory Test) and accessibility of a specific positive memory (i.e., subjective ease of recalling details of a memory; Memory Experiences Questionnaire-Short Form). Linear regression results indicated that PTSD intrusion severity, PTSD negative alterations in cognitions and mood (NACM) severity, PTSD alterations in arousal and reactivity (AAR) severity, self-blame, and positive affect significantly and negatively predicted the count of specific positive memories. Further, PTSD NACM severity, PTSD AAR severity, negative cognitions about the self, and negative affect significantly and negatively predicted accessibility of a specific positive memory. Thus, count/accessibility of specific positive memories was associated with several post-trauma mental health indicators; this highlights the relevance and potential impact of integrating positive memories into trauma treatment.
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Affiliation(s)
- Ateka A Contractor
- a Department of Psychology , University of North Texas , Denton , TX , USA
| | - Anne N Banducci
- b The National Center for PTSD at VA Boston Healthcare System , Boston , MA , USA
- c Boston University School of Medicine , Boston , MA , USA
| | - Megan Dolan
- a Department of Psychology , University of North Texas , Denton , TX , USA
| | - Fallon Keegan
- a Department of Psychology , University of North Texas , Denton , TX , USA
| | - Nicole H Weiss
- d Department of Psychology , University of Rhode Island , Kingston , RI , USA
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36
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Contractor AA, Caldas SV, Dolan M, Natesan P, Weiss NH. Invariance of the Construct of Posttraumatic Stress Disorder: A Systematic Review. J Trauma Stress 2019; 32:287-298. [PMID: 30942923 DOI: 10.1002/jts.22389] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 11/10/2022]
Abstract
We conducted a systematic review of studies that have evaluated invariance of the construct of posttraumatic stress disorder (PTSD) to summarize their conclusions related to invariance/noninvariance and sources of noninvariance. In November 2017, we searched Pubmed, PSYCINFO, PILOTS Web of Science, CINAHL, Medline, and Psychological and Behavioral Science Collection for abstracts and articles with these inclusionary criteria: peer-reviewed, including DSM-IV or DSM-5 PTSD invariance as a main study aim, use of multigroup confirmatory factor analyses, and use of an independent PTSD instrument or module. In total, 45 articles out of 1,169 initially identified abstracts met inclusion criteria. Research assistants then followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to complete a secondary search and independently extract data. Results indicated that DSM-IV dysphoric arousal and DSM-5 hybrid model factors demonstrated the most stability; sources of instability were some intrusion (distress to trauma cues), dysphoria/numbing (traumatic amnesia, foreshortened future, emotional numbness, detachment), and arousal (hypervigilance) items. The PTSD Checklist and PTSD Reaction Index were most often used to assess PTSD in studies investigating its invariance; however, these measures demonstrated partial conceptual equivalence of PTSD across subgroups. Instead, clinician-administered measures demonstrated more conceptual equivalence across subgroups. Age, gender, cultural/linguistic factors, and sample diversity had the least moderating effect on PTSD's symptom structure. Our review demonstrates the need to examine invariance of the PTSD construct following recommended guidelines for each empirical and clinical trial study to draw meaningful multigroup comparative conclusions.
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Affiliation(s)
| | | | - Megan Dolan
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Prathiba Natesan
- Department of Educational Psychology, University of North Texas, Denton, Texas, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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