1
|
Mahoney CT, Beck BM, Dixon KE, Horne SD, Lawyer SR. Conceptualizing impulsivity as a construct in relation to posttraumatic stress disorder symptom severity among women. J Trauma Stress 2024. [PMID: 38853630 DOI: 10.1002/jts.23060] [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: 12/23/2023] [Revised: 04/10/2024] [Accepted: 04/26/2024] [Indexed: 06/11/2024]
Abstract
Despite the established association between posttraumatic stress disorder (PTSD) and impulsivity, the literature is limited regarding impulsivity as a multifaceted construct. That is, the field's understanding of how PTSD symptoms may increase particular impulsive tendencies and behaviors is constrained by examining impulsivity solely as an umbrella term. The aim of the present study was to determine if there are differential associations between PTSD symptom severity and various components of impulsivity across multiple self-report measures. A sample of 215 undergraduate women (M age = 19.77 years, SD = 1.91, Range: 18-39 years) completed the PTSD Checklist for DSM-5 (PCL-5), Barratt Impulsiveness Scale (BIS-11), short version of the UPPS-P Impulsive Behavior Scale (SUPPS-P), and Delaying Gratification Inventory (DGI). Structural equation modeling was used to examine associations between PTSD symptoms and each measure's subscales. The findings included significant predictions from PTSD symptoms to the BIS-11 Attentional Impulsiveness subscale, β = .23, SE = .07, 95% CI [.09, .37]; DGI Physical Pleasures, β = -.24, SE = .07, 95% CI [-.38, -.11], and Achievement subscales, β = -.19, SE = .08, 95% CI [-.34, -.04]; and the SUPPS-P Positive Urgency, β = .22, SE = .08, 95% CI [.07, .37], and Negative Urgency subscales, β = .32, SE = .07, 95% CI [.19, .46]. These results have implications for precision medicine approaches that emphasize targeting these specific facets of impulsivity, with likely downstream effects on health risk behaviors for emerging adult women.
Collapse
Affiliation(s)
- Colin T Mahoney
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
- Lyda Hill Institute for Human Resilience, Colorado Springs, Colorado, USA
| | - Brigitta M Beck
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Kelly E Dixon
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Shantel D Horne
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Steven R Lawyer
- Department of Psychology, Idaho State University, Pocatello, Idaho, USA
| |
Collapse
|
2
|
Contractor AA, Slavish DC, Wang S, Weiss NH. Posttraumatic stress symptoms and positive autobiographical memory characteristics in everyday life. J Trauma Stress 2024. [PMID: 38838082 DOI: 10.1002/jts.23064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024]
Abstract
Individuals with posttraumatic stress symptoms (PTSS) report difficulties engaging with positive autobiographical memories. Extending this line of research, we examined daily-level concurrent and lagged associations between PTSS severity and positive memory characteristics (vividness, coherence, accessibility, time perspective, sensory details, visual perspective, emotional intensity, sharing, distancing, and valence). The sample included 88 trauma survivors (Mage = 39.89 years, 59.1% female) who completed seven daily measures of PTSS and positive memory characteristics. Multilevel models examined concurrent and lagged associations between PTSS severity and positive memory characteristics. The results indicated that days with higher PTSS severity were associated with less accessibility, β = -.21, p < .001; less visual perspective, β = -0.13, p = .034; and lower positive valence of the memory, β = -.19, p = .003, as well as more emotional intensity associated with, β = .13, p = .041, and more distancing from, β = .21, p < .001, the memory. Supplemental lagged analyses indicated that higher previous-day PTSS severity was associated with more next-day distancing from, β = .15, p = .042, and sensory details of, β = .17, p = .016, the memory. Findings suggest that individuals with more severe PTSS have difficulties accessing positively valenced memories from a first-person perspective, are more distant from the recalled positive memory, and report more emotional intensity when retrieving the memory. Thus, improving access to and reducing distance from positive autobiographical memories, as well as addressing emotional intensity surrounding the retrieval of these memories, may be potential clinical targets for PTSS interventions.
Collapse
Affiliation(s)
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Siyuan Wang
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| |
Collapse
|
3
|
Szyfer Lipinsky A, Goldner L, Hadar D, Saint-Arnault D. Predicting Recovery Pathways in Jewish Ultra-Orthodox Intimate Partner Violence Survivors: A Structural Equation Modeling Approach. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241255738. [PMID: 38819011 DOI: 10.1177/08862605241255738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Cultural and religious norms, as well as trauma-related cognitions and recovery actions, are known to impact the well-being of survivors of intimate partner violence (IPV). Although acknowledged as a key component, there is scant research on the recovery trajectories of women who have experienced IPV, in particular on survivors from collectivistic societies such as the Jewish Ultra-Orthodox (JUO) community in Israel. A mediation model examined the recovery process of 261 Israeli JUO survivors. In particular, it tested whether the normalization of violence and women's endorsement of Jewish religious norms that justify violence would be directly and negatively associated with women's well-being and positively associated with psychopathology. Additionally, it examined whether women's normalization of violence and support of religious norms would positively predict women's negative trauma-related cognitions. In turn, these cognitions were expected to negatively predict women's engagement in recovery actions, help-seeking behaviors, and faith-based responses but positively predict disengagement responses. The model further posited that women's engagement in steps toward recovery, help-seeking behaviors, and faith-based responses would positively predict women's well-being and negatively predict psychopathology. In contrast, women's disengagement responses would negatively predict women's well-being and positively predict their psychopathology. Bootstrap results indicated that supporting religious norms positively predicted women's trauma-related cognitions, which then negatively predicted women's recovery actions, help-seeking behaviors, and faith-based responses but positively predicted women's disengagement responses. Women's recovery actions and faith-based responses positively predicted women's well-being, while disengagement responses positively predicted women's psychopathology. Contrary to expectations, help-seeking behaviors positively predicted psychopathology.
Collapse
|
4
|
Georgescu T, Nedelcea C, Gorbănescu A, Papasteri C, Cosmoiu AM, Vasile DL, Letzner RD. Psychometric evaluation of the PCL-5: assessing validity, diagnostic utility, and bifactor structures. Eur J Psychotraumatol 2024; 15:2333222. [PMID: 38699832 PMCID: PMC11073431 DOI: 10.1080/20008066.2024.2333222] [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: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 05/05/2024] Open
Abstract
Background: The changes DSM-5 brought to the diagnostic criteria for posttraumatic stress disorder (PTSD) resulted in revising the most widely used instrument in assessing PTSD, namely the Posttraumatic Checklist for DSM-5 (PCL-5).Objective: This study examined the psychometric properties of the Romanian version of the PCL-5, tested its diagnostic utility against the Structured Clinical Interview for DSM-5 (SCID-5), and investigated the latent structure of PTSD symptoms through correlated symptom models and bifactor modelling.Method: A total sample of 727 participants was used to test the psychometric properties and underlying structure of the PCL-5 and 101 individuals underwent clinical interviews using SCID-5. Receiver operating characteristic curve (ROC) analyses were performed to test the diagnostic utility of the PCL-5 and identify optimal cut-off scores based on Youden's J index. Confirmatory Factor Analyses (CFAs) and bifactor modelling were performed to investigate the latent structure of PTSD symptoms.Results: Estimates revealed that the PCL-5 is a valuable tool with acceptable diagnostic accuracy compared to SCID-5 diagnoses, indicating a cut-off score of >47. The CFAs provide empirical support for Anhedonia, Hybrid, and bifactor models. The findings are limited by using retrospective, self-report data and the high percentage of female participants.Conclusions: The PCL-5 is a psychometrically sound instrument that can be useful in making provisional diagnoses within community samples and improving trauma-informed practices.
Collapse
Affiliation(s)
- Teodora Georgescu
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Cătălin Nedelcea
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Adrian Gorbănescu
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Claudiu Papasteri
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Ana Maria Cosmoiu
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Diana Lucia Vasile
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Ramona Daniela Letzner
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| |
Collapse
|
5
|
Rodríguez MN, Colgan DD, Leyde S, Pike K, Merrill JO, Price CJ. Trauma exposure across the lifespan among individuals engaged in treatment with medication for opioid use disorder: differences by gender, PTSD status, and chronic pain. Subst Abuse Treat Prev Policy 2024; 19:25. [PMID: 38702783 PMCID: PMC11067259 DOI: 10.1186/s13011-024-00608-8] [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: 12/13/2023] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND There is little study of lifetime trauma exposure among individuals engaged in medication treatment for opioid use disorder (MOUD). A multisite study provided the opportunity to examine the prevalence of lifetime trauma and differences by gender, PTSD status, and chronic pain. METHODS A cross-sectional study examined baseline data from participants (N = 303) enrolled in a randomized controlled trial of a mind-body intervention as an adjunct to MOUD. All participants were stabilized on MOUD. Measures included the Trauma Life Events Questionnaire (TLEQ), the Brief Pain Inventory (BPI), and the Posttraumatic Stress Disorder Checklist (PCL-5). Analyses involved descriptive statistics, independent sample t-tests, and linear and logistic regression. RESULTS Participants were self-identified as women (n = 157), men (n = 144), and non-binary (n = 2). Fifty-seven percent (n = 172) self-reported chronic pain, and 41% (n = 124) scored above the screening cut-off for PTSD. Women reported significantly more intimate partner violence (85%) vs 73%) and adult sexual assault (57% vs 13%), while men reported more physical assault (81% vs 61%) and witnessing trauma (66% vs 48%). Men and women experienced substantial childhood physical abuse, witnessed intimate partner violence as children, and reported an equivalent exposure to accidents as adults. The number of traumatic events predicted PTSD symptom severity and PTSD diagnostic status. Participants with chronic pain, compared to those without chronic pain, had significantly more traumatic events in childhood (85% vs 75%). CONCLUSION The study found a high prevalence of lifetime trauma among people in MOUD. Results highlight the need for comprehensive assessment and mental health services to address trauma among those in MOUD treatment. TRIAL REGISTRATION NCT04082637.
Collapse
Affiliation(s)
- Monique N Rodríguez
- Department of Individual, Family, and Community Education, University of New Mexico USA, Simpson Hall MSC053042, 502 Campus, Blvd, Albuquerque, NM, 87131, USA
| | - Dana D Colgan
- Department of Neurology, Oregon Health and Science University USA, 3818 SW Sam Jackson Parkway, Portland, OR, 97229, USA
- Helfgott Research Center, National University of Natural Medicine USA, Portland, USA
| | - Sarah Leyde
- School of Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Kenneth Pike
- Department of Child Family and Population Health Nursing, University of Washington USA, Seattle, USA
| | - Joseph O Merrill
- School of Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Cynthia J Price
- Department of Biobehavioral Nursing and Health Informatics, University of WA, Seattle, USA.
| |
Collapse
|
6
|
Hammock JA, López-Castro T, Fox AD. Prior incarceration, restrictive housing, and posttraumatic stress disorder symptoms in a community sample of persons who use drugs. HEALTH & JUSTICE 2024; 12:20. [PMID: 38668954 PMCID: PMC11046833 DOI: 10.1186/s40352-024-00276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Criminalization of drugs in the United States (US) has extensive consequences for people who use drugs (PWUD). Incarceration and substance use overlap with 65% of the US prison population meeting substance use disorder (SUD) criteria. Exposure to the criminal-legal system negatively impacts the health of PWUD. PTSD is commonly comorbid with SUDs, and exposure to restrictive housing (RH) during incarceration may worsen mental health. Because PWUD are disproportionately incarcerated, experiences occurring during incarceration, such as RH, may contribute to the development or exacerbation of PTSD and SUDs. This study of PWUD investigated prior criminal-legal system exposure and its association with PTSD symptoms in community-dwelling PWUD. METHODS This cross-sectional study recruited PWUD from syringe service programs (SSP). Inclusion criteria were: age 18+, current or past opioid use disorder, and SSP enrollment. Data collected included: sociodemographics; incarceration, substance use, SUD treatment history, and PTSD assessments (Life Events Checklist for DSM-5 and the PTSD Checklist for DSM-5). Bivariate testing and multivariate logistic regression analyses, with probable PTSD as the dependent variable and a three-level variable for criminal legal history as the independent variable, were conducted to determine whether incarceration and RH were associated with probable PTSD. RESULTS Of 139 participants, 78% had an incarceration history with 57% of these having a history of RH. 57% of participants screened positive for probable PTSD, and physical assault was the most common traumatic exposure. Any history of incarceration was not associated with probable PTSD diagnosis; however, in multivariate testing, adjusting for age, sex, and substance use, a history of RH (adjusted odds ratio [aOR]: 3.76, 95% CI 1.27-11.11) was significantly associated with probable PTSD. CONCLUSIONS RH and PTSD were both exceptionally common in a sample of SSP participants. RH can be detrimental to physical and mental health. Clinicians and policy makers may not consider incarceration as a traumatic experience for PWUD; however, our data suggest that among highly marginalized PWUD, prior exposure to incarceration and RH may add an additional burden to their daily struggles, namely PTSD.
Collapse
Affiliation(s)
- James A Hammock
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Teresa López-Castro
- The City College of New York, City University of New York, 160 Convent Ave, New York, NY, 10031, USA
| | - Aaron D Fox
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA.
- Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA.
| |
Collapse
|
7
|
Franco Z, Ruffalo L, Curry B, Gollin-Graves M, Ahamed SI, Winstead O, Hooyer K, Pazdera M, Rein L, Lizarraga Mazaba J, Hossain MF, Stoffel V, Flower M, Madiraju P, Melka S, Berte K, Whittle J. Impact of veteran-led peer mentorship on posttraumatic stress disorder. J Trauma Stress 2024. [PMID: 38635149 DOI: 10.1002/jts.23038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/05/2024] [Accepted: 03/23/2024] [Indexed: 04/19/2024]
Abstract
Peer mentorship shows promise as a strategy to support veteran mental health. A community-academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at baseline, midpoint, and 12-week discharge using the PTSD Checklist for DSM-5 (PCL-5), Deployment Risk and Resilience Inventory-2, Social Adaptation Self-evaluation Scale, and Values in Action Survey. Brief weekly check-in surveys reinforced mentor contact and assessed retention. The sample included 307 veterans who were served by 17 veteran peer mentors. Mixed-effects linear models found a modest effect for PTSD symptom change, with a mean PCL-5 score reduction of 4.04 points, 95% CI [-6.44, -1.64], d = 0.44. More symptomatic veterans showed a larger effect, with average reductions of 9.03 points, 95% CI [-12.11, -5.95], d = 0.77. There were no significant findings for other outcome variables. Compared to younger veterans, those aged 32-57 years were less likely to drop out by 6 weeks, aORs = 0.32-0.26. Week-by-week hazard of drop-out was lower with mentors ≥ 35 years old, aHR = 0.62, 95% CI [0.37, 1.05]. Unadjusted survival differed by mentor military branch, p = .028, but the small mentor sample reduced interpretability. Like many community research efforts, this study lacked a control group, limiting the inferences that can be drawn. Continued study of veteran peer mentorship is important as this modality is often viewed as more tolerable than therapy.
Collapse
Affiliation(s)
- Zeno Franco
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leslie Ruffalo
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bob Curry
- Great Lakes Dryhootch, Milwaukee, Wisconsin, USA
| | | | - Sheikh Iqbal Ahamed
- Department of Computer Science, Marquette University, Milwaukee, Wisconsin, USA
| | | | - Katinka Hooyer
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Myah Pazdera
- Office of Community Engagement, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lisa Rein
- Institute for Health & Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jose Lizarraga Mazaba
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Md Fitrat Hossain
- Department of Computer Science, Marquette University, Milwaukee, Wisconsin, USA
| | - Virginia Stoffel
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Mark Flower
- Mental Health America of Wisconsin, Milwaukee, Wisconsin, USA
| | - Praveen Madiraju
- Department of Computer Science, Marquette University, Milwaukee, Wisconsin, USA
| | - Stephen Melka
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Karen Berte
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Jeffrey Whittle
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| |
Collapse
|
8
|
Bartal A, Jagodnik KM, Chan SJ, Dekel S. AI and narrative embeddings detect PTSD following childbirth via birth stories. Sci Rep 2024; 14:8336. [PMID: 38605073 PMCID: PMC11009279 DOI: 10.1038/s41598-024-54242-2] [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: 10/10/2023] [Accepted: 02/10/2024] [Indexed: 04/13/2024] Open
Abstract
Free-text analysis using machine learning (ML)-based natural language processing (NLP) shows promise for diagnosing psychiatric conditions. Chat Generative Pre-trained Transformer (ChatGPT) has demonstrated preliminary initial feasibility for this purpose; however, whether it can accurately assess mental illness remains to be determined. This study evaluates the effectiveness of ChatGPT and the text-embedding-ada-002 (ADA) model in detecting post-traumatic stress disorder following childbirth (CB-PTSD), a maternal postpartum mental illness affecting millions of women annually, with no standard screening protocol. Using a sample of 1295 women who gave birth in the last six months and were 18+ years old, recruited through hospital announcements, social media, and professional organizations, we explore ChatGPT's and ADA's potential to screen for CB-PTSD by analyzing maternal childbirth narratives. The PTSD Checklist for DSM-5 (PCL-5; cutoff 31) was used to assess CB-PTSD. By developing an ML model that utilizes numerical vector representation of the ADA model, we identify CB-PTSD via narrative classification. Our model outperformed (F1 score: 0.81) ChatGPT and six previously published large text-embedding models trained on mental health or clinical domains data, suggesting that the ADA model can be harnessed to identify CB-PTSD. Our modeling approach could be generalized to assess other mental health disorders.
Collapse
Affiliation(s)
- Alon Bartal
- The School of Business Administration, Bar-Ilan University, Ramat Gan, 5290002, Israel
| | - Kathleen M Jagodnik
- The School of Business Administration, Bar-Ilan University, Ramat Gan, 5290002, Israel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Sabrina J Chan
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA.
| |
Collapse
|
9
|
Sistad RE, Kimerling R, Schnurr PP, Bovin MJ. The impact of screening positive for hazardous alcohol use on the diagnostic accuracy of the PTSD Checklist for DSM-5 among veterans. J Trauma Stress 2024; 37:328-336. [PMID: 38085555 DOI: 10.1002/jts.22999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/12/2023] [Accepted: 11/04/2023] [Indexed: 04/04/2024]
Abstract
The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) is a widely used self-report measure of PTSD symptoms that has demonstrated strong psychometric properties across settings and samples. Co-occurring hazardous alcohol use and PTSD are prevalent among veterans, and the effects of alcohol use may impact the performance of the PCL-5. However, this possibility is untested. In this study, we evaluated the PCL-5 diagnostic accuracy for veterans who did and did not screen positive for hazardous alcohol use according to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Participants were 385 veterans recruited from Veterans Affairs primary care clinics. Results indicated that PCL-5 performance, AUC = .904, 95% CI [.870, .937], did not differ as a product of hazardous alcohol use. PCL-5 diagnostic utility was comparably high for veterans with, AUC = .904; 95% CI [.846, .962], and without, AUC = .904 95% CI [.861, .946], positive AUDIT-C screens. Although optimally efficient cutoff scores for veterans who screened positive were higher (i.e., 34-36) than for those with negative screens (i.e., 30), neither were significantly different from the overall PCL-5 cutoff score (i.e., 32), suggesting that neither veterans with nor without positive AUDIT-C screens require differential PCL-5 cutoff scores. The results do underscore the importance of using PCL-5 cutoff scores in concert with clinical judgment when establishing a provisional PTSD diagnosis and highlight the need for additional study of the impact of comorbidities on PCL-5 diagnostic accuracy and cutoff scores.
Collapse
Affiliation(s)
- Rebecca E Sistad
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Rachel Kimerling
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, California, USA
- Center for Innovation to Implementation, Palo Alto, California, USA
| | - Paula P Schnurr
- Executive Division, National Center for PTSD, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Michelle J Bovin
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Riviere LA, Kim PY, Baker MD, Beymer MR. Training, Deployment Preparation, and Behavioral Health of New York National Guard Personnel Deployed to Assist with COVID-19 Decedent Work. Mil Med 2024; 189:e705-e713. [PMID: 37847572 DOI: 10.1093/milmed/usad395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/26/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION A small body of research conducted mostly among civilians has shown that adequate training and preparation can prevent or reduce the development of behavioral health problems in first responders. Several civilian studies have shown that social support is protective against behavioral health problems. However, very few studies have examined the impact of these factors on the behavioral health of military first responders. Military first responders, who serve in the aftermath of natural disasters and disease outbreaks such as the coronavirus disease 2019 (COVID-19) pandemic, are often members of the National Guard (NG). The purpose of this study was to examine the impact of mortuary affairs training/handling human remains, role preparation, equipment preparation, and unit social support provided to families on the behavioral health of New York (NY) NG personnel deployed to assist the NY Office of Chief Medical Examiner with handling the remains of COVID-19 decedents. MATERIALS AND METHODS We invited 410 NYNG personnel who deployed for the Office of Chief Medical Examiner mission to complete an anonymous online questionnaire 3 to 6 months post-mission. Of the 158 participants, we used the data of the 141 participants who provided consent. Standard behavioral health measures (depression, anxiety, post-traumatic stress disorder, alcohol misuse, and insomnia) as well as study-specific items designed to understand the unique dynamics of this deployment were included. Hierarchical logistic regression analysis was used to examine the relationships between mortuary training, role preparation, equipment preparation, and unit support with behavioral health. RESULTS Close to two-thirds of the sample reported that they had not been trained in mortuary affairs/handling human remains before the mission. We also found that that lower levels of role preparation and unit support provided to the service members' families increased the odds of meeting criteria for one or more behavioral health problems, but that training in mortuary affairs and equipment preparation was unrelated to behavioral health. CONCLUSIONS Our research points to the importance of emotionally and cognitively preparing service members for the specific dynamics of a deployment and the roles that that they are expected to play. Furthermore, it suggests that supporting the families of NG personnel during domestic missions can benefit the behavioral health of the NG personnel. Additional research is needed to corroborate these findings, particularly the impact of unit support provided to family members on service members' behavioral health.
Collapse
Affiliation(s)
- Lyndon A Riviere
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Paul Y Kim
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Matthew D Baker
- New York Army National Guard, Connecticut Street Armory-C, Buffalo, NY 14213, USA
| | - Matthew R Beymer
- Division of Behavioral and Social Health Outcomes Practice, Defense Centers for Public Health-Aberdeen, Aberdeen Proving Ground, MD 21010, USA
| |
Collapse
|
11
|
Bartal A, Jagodnik KM, Chan SJ, Dekel S. OpenAI's Narrative Embeddings Can Be Used for Detecting Post-Traumatic Stress Following Childbirth Via Birth Stories. RESEARCH SQUARE 2024:rs.3.rs-3428787. [PMID: 37886525 PMCID: PMC10602164 DOI: 10.21203/rs.3.rs-3428787/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
Free-text analysis using Machine Learning (ML)-based Natural Language Processing (NLP) shows promise for diagnosing psychiatric conditions. Chat Generative Pre-trained Transformer (ChatGPT) has demonstrated preliminary initial feasibility for this purpose; however, whether it can accurately assess mental illness remains to be determined. This study evaluates the effectiveness of ChatGPT and the text-embedding-ada-002 (ADA) model in detecting post-traumatic stress disorder following childbirth (CB-PTSD), a maternal postpartum mental illness affecting millions of women annually, with no standard screening protocol. Using a sample of 1,295 women who gave birth in the last six months and were 18+ years old, recruited through hospital announcements, social media, and professional organizations, we explore ChatGPT's and ADA's potential to screen for CB-PTSD by analyzing maternal childbirth narratives. The PTSD Checklist for DSM-5 (PCL-5; cutoff 31) was used to assess CB-PTSD. By developing an ML model that utilizes numerical vector representation of the ADA model, we identify CB-PTSD via narrative classification. Our model outperformed (F1 score: 0.82) ChatGPT and six previously published large language models (LLMs) trained on mental health or clinical domains data, suggesting that the ADA model can be harnessed to identify CB-PTSD. Our modeling approach could be generalized to assess other mental health disorders.
Collapse
Affiliation(s)
- Alon Bartal
- The School of Business Administration, Bar-Ilan University, Max and Anna Web, Ramat Gan, 5290002, Israel
| | - Kathleen M. Jagodnik
- The School of Business Administration, Bar-Ilan University, Max and Anna Web, Ramat Gan, 5290002, Israel
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, 02114, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, 02115, Massachusetts, USA
| | - Sabrina J. Chan
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, 02114, Massachusetts, USA
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, 02114, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, 02115, Massachusetts, USA
| |
Collapse
|
12
|
Bartal A, Jagodnik KM, Chan SJ, Dekel S. OpenAI's Narrative Embeddings Can Be Used for Detecting Post-Traumatic Stress Following Childbirth Via Birth Stories. RESEARCH SQUARE 2024:rs.3.rs-3428787. [PMID: 37886525 PMCID: PMC10602164 DOI: 10.21203/rs.3.rs-3428787/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Free-text analysis using Machine Learning (ML)-based Natural Language Processing (NLP) shows promise for diagnosing psychiatric conditions. Chat Generative Pre-trained Transformer (ChatGPT) has demonstrated preliminary initial feasibility for this purpose; however, whether it can accurately assess mental illness remains to be determined. This study evaluates the effectiveness of ChatGPT and the text-embedding-ada-002 (ADA) model in detecting post-traumatic stress disorder following childbirth (CB-PTSD), a maternal postpartum mental illness affecting millions of women annually, with no standard screening protocol. Using a sample of 1,295 women who gave birth in the last six months and were 18+ years old, recruited through hospital announcements, social media, and professional organizations, we explore ChatGPT's and ADA's potential to screen for CB-PTSD by analyzing maternal childbirth narratives. The PTSD Checklist for DSM-5 (PCL-5; cutoff 31) was used to assess CB-PTSD. By developing an ML model that utilizes numerical vector representation of the ADA model, we identify CB-PTSD via narrative classification. Our model outperformed (F1 score: 0.82) ChatGPT and six previously published large language models (LLMs) trained on mental health or clinical domains data, suggesting that the ADA model can be harnessed to identify CB-PTSD. Our modeling approach could be generalized to assess other mental health disorders.
Collapse
Affiliation(s)
- Alon Bartal
- The School of Business Administration, Bar-Ilan University, Max and Anna Web, Ramat Gan, 5290002, Israel
| | - Kathleen M. Jagodnik
- The School of Business Administration, Bar-Ilan University, Max and Anna Web, Ramat Gan, 5290002, Israel
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, 02114, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, 02115, Massachusetts, USA
| | - Sabrina J. Chan
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, 02114, Massachusetts, USA
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, 02114, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, 02115, Massachusetts, USA
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Zhang F, Xu H, Liu Q, Sun Y, Yan W, Ouyang H, Liu W. Single session of interpretation bias modification helped to improve fear of COVID-19 and COVID-19-related post-traumatic stress symptoms. BMJ MENTAL HEALTH 2024; 27:e300871. [PMID: 38302409 PMCID: PMC10836354 DOI: 10.1136/bmjment-2023-300871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) are frequently observed in those who have experienced trauma events like the COVID-19 outbreak. The cognitive model of PTSS highlights the relationship between PTSS and negative interpretation bias. OBJECTIVE The present study aimed to modify interpretation bias and to improve PTSS as well as PTSS-related fear. METHODS 59 participants with high PTSS levels were recruited and randomly allocated to either the interpretation modification programme (IMP) intervention group or the interpretation control condition (ICC) control group. PTSS, negative interpretation bias, fear of COVID-19, and depression and anxiety symptoms were assessed before and after training. FINDINGS Intention-to-treat analyses showed that compared with ICC, participants receiving IMP generated fewer negative interpretations for ambiguous scenarios, and the group-by-time interaction effect was significant. IMP also illustrated a more significant change in fear after training compared with ICC. Although no effects of training conditions were found on PTSS, the interaction of training conditions with fear reduction could predict PTSS improvement. CONCLUSIONS IMP could improve negative interpretations and fear related to COVID-19 and might help to ameliorate PTSS. CLINICAL IMPLICATIONS The role of PTSS-related emotion should be considered when exploring the effectiveness of IMP. IMP is a flexible approach that can be tailored to the specific characteristics of the traumatic event, which makes it suitable for a broader range of traumatised individuals.
Collapse
Affiliation(s)
- Fan Zhang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Huijing Xu
- Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Qian Liu
- Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Yingchao Sun
- Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Wenjie Yan
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Hui Ouyang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Weizhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| |
Collapse
|
15
|
Fenlon EE, Pinciotti CM, Jones AC, Rippey CS, Wild H, Hubert TJJ, Tipsword JM, Badour CL, Adams TG. Assessment of Comorbid Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder. Assessment 2024; 31:126-144. [PMID: 37904505 DOI: 10.1177/10731911231208403] [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: 11/01/2023]
Abstract
Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are commonly comorbid and share prominent features (e.g., intrusions, safety behaviors, and avoidance). Excellent self-report and clinician-administered assessments exist for OCD and PTSD individually, but few assess both disorders, and even fewer provide instruction on differential diagnosis or detection of comorbid OCD and PTSD. To address this gap in the literature, the current paper aims to (1) highlight diagnostic and functional similarities and differences between OCD and PTSD to inform differential diagnosis, (2) outline assessment recommendations for individuals with suspected comorbid OCD and PTSD, OCD with a significant trauma history or posttraumatic symptoms, or PTSD with significant obsessive-compulsive symptoms, and (3) explore future directions to evaluate and improve methods for assessing co-occurring OCD and PTSD.
Collapse
Affiliation(s)
| | | | - Alyssa C Jones
- Ralph H. Johnson VA Health Care System, Charleston, SC, USA
- Medical University of South Carolina, Charleston, USA
| | | | | | | | | | | | - Thomas G Adams
- University of Kentucky, Lexington, USA
- Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
16
|
Brook J, Duguid B, Miller N. Symptoms of post-traumatic stress disorder in early career nurses during the COVID-19 pandemic: A longitudinal survey study. J Clin Nurs 2023; 32:8063-8077. [PMID: 37793658 DOI: 10.1111/jocn.16879] [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: 04/04/2023] [Revised: 07/27/2023] [Accepted: 08/21/2023] [Indexed: 10/06/2023]
Abstract
AIM To investigate the mental well-being of early career nurses working in the United Kingdom during the COVID-19 pandemic, with a particular emphasis on symptoms related to post-traumatic stress disorder. DESIGN A longitudinal survey study. METHODS Data were acquired at three timepoints during the COVID-19 pandemic (between May 2020 and March 2021) to determine whether symptoms of post-traumatic stress disorder persisted over time. Quantitative measures of well-being were supplemented with survey data on the nurses' experiences of working during the pandemic. RESULTS Twenty-seven per cent of participants suffered from persistent symptoms of post-traumatic stress while working as nurses during the pandemic. The nurses' baseline resilience, as well as their perception of the quality of their work environment, were significant negative predictors of symptoms of post-traumatic stress. Participants identified a range of strategies that would have helped them during the crisis, including visible, consistent and empathetic leadership, adequate training and a supportive work environment. CONCLUSION The context of the pandemic has highlighted the vulnerability of the psychological well-being of early career nurses in the workforce. Immediate implementation of some of the more simple interventions suggested in this paper would provide early career nurses with rapid support. More complex support mechanisms should be given immediate consideration, with a view to implementation in the longer term. IMPLICATIONS FOR THE PROFESSION This study contributes new knowledge about the psychological well-being of early career nurses working during the pandemic and suggests support mechanisms that will be crucial for the retention of these nurses in the profession. A measurement of resilience may be useful for determining the appropriate level of support to provide to early career nurses. IMPACT Early career nurses are vulnerable to attrition from the profession. This could be exacerbated if the psychological well-being of these nurses is not being supported. Around 25% of early career nurses suffered from persistent symptoms of post-traumatic stress disorder while working as nurses during the height of the pandemic, which is a novel finding compared to other longitudinal studies. Understanding the psychological well-being of early career nurses working during a crisis period (such as a pandemic) equips nurse managers with appropriate strategies to improve nurses' emotional health and to enhance their retention within the workforce. The current findings may be of interest to clinical practitioners who have responsibility for the retention of nursing staff. No patient or public contribution. One of the authors is a statistician.
Collapse
Affiliation(s)
- Judy Brook
- City, University of London, Northampton Square, London, UK
| | | | - Naomi Miller
- City, University of London, Northampton Square, London, UK
| |
Collapse
|
17
|
Blanchard BE, Johnson M, Campbell SB, Reed DE, Chen S, Heagerty PJ, Marx BP, Kaysen D, Fortney JC. Minimal important difference metrics and test-retest reliability of the PTSD Checklist for DSM-5 with a primary care sample. J Trauma Stress 2023; 36:1102-1114. [PMID: 37845820 PMCID: PMC10754254 DOI: 10.1002/jts.22975] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/18/2023]
Abstract
The PTSD Checklist for DSM-5 (PCL-5) is a measure of posttraumatic stress disorder (PTSD) symptom severity that is widely used for clinical and research purposes. Although previous work has examined metrics of minimal important difference (MID) of the PCL-5 in veteran samples, no work has identified PCL-5 MID metrics among adults in primary care in the United States. In this secondary analysis, data were evaluated from primary care patients (N = 971) who screened positive for PTSD and participated in a large clinical trial in federally qualified health centers in three U.S. states. Participants primarily self-identified as women (70.2%) and White (70.3%). We calculated test-retest reliability using clinic registry data and multiple distribution- and anchor-based metrics of MID using baseline and follow-up survey data. Test-retest reliability (Pearson's r, Spearman's ρ, intraclass correlation coefficient) ranged from adequate to excellent (.79-.94), with the shortest time lag demonstrating the highest reliability estimate. The MID for the PCL-5 was estimated using multiple approaches. Distribution-based approaches indicated an MID range of 8.5-12.5, and anchor-based approaches indicated an MID range of 9.8-11.7. Taken together, the MID metrics indicate that PCL-5 change scores of 9-12 likely reflect real change in PTSD symptoms and indicate at least an MID for patients, whereas PCL-5 change scores of 5 or less likely are not reliable. These findings can help inform clinicians using the PCL-5 in similar populations to track patient responses to treatment and help researchers interpret PCL-5 score changes in clinical trials.
Collapse
Affiliation(s)
- Brittany E. Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sarah B. Campbell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- VA Health Services Research and Development Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - David E. Reed
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - Shiyu Chen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patrick J. Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington, USA
| | - Brian P. Marx
- VA Boston Healthcare System, National Center for PTSD, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - John C. Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- VA Health Services Research and Development Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| |
Collapse
|
18
|
Lathan EC, Petri JM, Haynes T, Sonu SC, Mekawi Y, Michopoulos V, Powers A. Evaluating the Performance of the Primary Care Posttraumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) in a Trauma-Exposed, Socioeconomically Vulnerable Patient Population. J Clin Psychol Med Settings 2023; 30:791-803. [PMID: 36715813 PMCID: PMC9885055 DOI: 10.1007/s10880-023-09941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
The properties and utility of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) remain unstudied in community-based populations. This study evaluates the performance of the PC-PTSD-5 to determine whether it can be used as a brief alternative to the PTSD Checklist for DSM-5 (PCL-5) in a large public hospital in the southeastern United States. Participants (N = 422; 92.7% Black; 85.8% female; Mage = 42.0 years, SDage = 13.4 years) completed the PCL-5 and PC-PTSD-5 after recruitment from medical clinic waiting rooms and admission lists. Using chance-corrected test quality indices and item response theory (IRT) analyses, we determined optimal cut-scores for screening and examined item performance. Approximately 45.0% of the sample screened positive for probable DSM-5 PTSD using the PCL-5. The PC-PTSD-5 demonstrated high internal consistency and strong associations with PCL-5 scores (total, r = .79; items, rs = .51-.61). A cut-score of one was optimally sensitive for screening (κ[1] = .96), and a cut-score of four had the highest quality of probable efficiency (κ[.5] = .66) for detecting self-reported DSM-5 PTSD on the PCL-5. IRT analyses indicated Item 1 (nightmares, intrusive memories) provided the most information, and other items may not be incrementally useful for this sample. Findings provide preliminary support for the use of the PC-PTSD-5 as a brief alternative to the PCL-5 among chronically trauma-exposed patients in the public healthcare setting.
Collapse
Affiliation(s)
- Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA.
| | - Jessica M Petri
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
| | - Tamara Haynes
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
- Department of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Stan C Sonu
- Department of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of General Pediatrics and Adolescent Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
- Emory National Primate Research Center, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
| |
Collapse
|
19
|
Afshari A, Torabi M, Navkhasi S, Aslani M, Khazaei A. Navigating into the unknown: exploring the experience of exposure to prehospital emergency stressors: a sequential explanatory mixed-methods. BMC Emerg Med 2023; 23:136. [PMID: 37968617 PMCID: PMC10648310 DOI: 10.1186/s12873-023-00906-7] [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: 09/23/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION The unpredictability of prehospital emergencies combined with constantly changing circumstances can lead to increased stress and mental health issues among Emergency Medical Technicians (EMTs). To accurately determine the stress-inducing factors in the prehospital environment, it is important to first identify the stressful events that occur in this environment. Therefore, this study strives to provide a thorough analysis of the stressors in the prehospital environment. METHODS Sequential explanatory mixed methods were conducted in Hamadan prehospital emergency centers in 2022. The study included 251 EMTs, who were selected through a method in the quantitative phase. The quantitative part used a questionnaire consisting of basic information and the Posttraumatic Stress Questionnaire (PCL-5). In the qualitative phase, 17 with extensive experience in dealing with prehospital stressors were selected based on their PCL-5 scores (above 33). The qualitative phase analysis was carried out using the contractual content method using the Graneheim and Ladman's approach. Statistical analyzes for the quantitative and qualitative phases were performed using SPSS 21 and maxqda 10, respectively. RESULTS The study revealed that the EMTs had an average PTSD score of 21. 60 ± 11. 45. Multivariate linear regression analysis showed that the number of shifts had a statistically significant relationship with PTSD scores (t = 26.38, P < 0.001). The qualitative phase of the study included 17 interviews, resulting in 14 subcategories, which consisted of four categories: "the overall impact of the stress crisis on technicians," "missing links in the communication network in incident management," "professional shortcomings in pre-hospital care," and "the complex and multifaceted context of stressful pre-hospital emergencies." Additionally, the study's theme was centered around "surveying the experiences of EMTs in stressful environments." CONCLUSION As the number of shifts increased, the primary cause of the high prevalence of PTSD in EMTs was revealed. Prehospital emergency stress can be reduced and managed more skillfully by adjusting various factors such as shortening workdays, offering continuous training, augmenting workforce, supplying ambulance equipment insurance, refraining from hiring personnel devoid of clinical training, hiring psychologists, hiring midwives in an emergency, updating prehospital protocols and guidelines, encouraging cooperation between EMTs and other relief groups, and utilizing cutting-edge technologies.
Collapse
Affiliation(s)
- Ali Afshari
- Department of Medical Surgical Nursing, Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Torabi
- Department of Nursing, Malayer School of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sasan Navkhasi
- Department of Prehospital Emergency Medicine, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Marzieh Aslani
- Instructor of Critical Care Nursing, Department of Nursing, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Afshin Khazaei
- Department of Prehospital Emergency Medicine, Asadabad School of Medical Sciences, Asadabad, Iran.
| |
Collapse
|
20
|
Williamson V, Murphy D, Bonson A, Aldridge V, Serfioti D, Greenberg N. Restore and Rebuild (R&R) - a feasibility pilot study of a co-designed intervention for moral injury-related mental health difficulties. Eur J Psychotraumatol 2023; 14:2256204. [PMID: 37732994 PMCID: PMC10515691 DOI: 10.1080/20008066.2023.2256204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/27/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Moral injury can significantly negatively impact mental health, but currently no validated treatment for moral injury-related mental health difficulties exists in a UK context. This study aimed to examine whether the Restore and Rebuild (R&R) treatment was feasible to deliver, acceptable and well tolerated by UK military veterans with moral injury related mental health difficulties. METHOD The R&R treatment was delivered to 20 patients who reported distress related to exposure to a morally injurious event(s) during military service. R&R is a 20-session psychotherapy with key themes of processing the event, self compassion, connecting with others and core values. Treatment was delivered online, weekly, one-to-one by a single therapist. Qualitative interviews with patients and the therapist who delivered R&R were conducted to explore acceptability and analysed using thematic analysis. RESULTS Following treatment, patients experienced a significant reduction in symptoms of post-traumatic stress disorder, depression, alcohol misuse and moral injury related distress. R&R was found to be well tolerated by patients and improved their perceived wellbeing. CONCLUSIONS These results provide preliminary evidence that veterans struggling with moral injury related mental ill health can benefit from R&R treatment.
Collapse
Affiliation(s)
- Victoria Williamson
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s Centre for Military Health Research, King’s College London, London, UK
| | | | | | | | - Danai Serfioti
- Institute of Psychiatry, Psychology and Neuroscience, King’s Centre for Military Health Research, King’s College London, London, UK
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Neil Greenberg
- Institute of Psychiatry, Psychology and Neuroscience, King’s Centre for Military Health Research, King’s College London, London, UK
| |
Collapse
|
21
|
Russo JE, Dhruve DM, Oliveros AD. Childhood Trauma and PTSD Symptoms: Disentangling the Roles of Emotion Regulation and Distress Tolerance. Res Child Adolesc Psychopathol 2023; 51:1273-1287. [PMID: 37039922 DOI: 10.1007/s10802-023-01048-x] [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] [Accepted: 02/27/2023] [Indexed: 04/12/2023]
Abstract
Research documents that a history of childhood trauma increases risk for post-traumatic stress disorder (PTSD), greater emotion regulation difficulties (ERD), and reduced distress tolerance (DT). Independent lines of research implicate ERD and DT as transdiagnostic risk factors and link them to PTSD. To elucidate how such mechanisms may influence the etiology, maintenance, and treatment of PTSD, the current study investigates the distinct mediating roles of emotion regulation and DT, exploring which explains a larger indirect effect from childhood trauma to PTSD symptom severity. Participants (N = 385, aged 18-48) who endorsed a history of childhood trauma provided retrospective report of cumulative childhood trauma exposure, and of current ERD, DT, and PTSD symptom severity. Single and dual mediation analyses were used to assess indirect effects through ERD and DT in the relation between cumulative childhood trauma exposure and current PTSD symptom severity. ERD and DT were significantly and inversely related. Higher current self-ratings of PTSD symptom severity were explained by cumulative childhood trauma through ERD (B = 0.93, p < 0.001) and DT (B = 0.50, p < 0.05). The full model explained 36% of the variance in PTSD symptom severity. Current findings provide preliminary evidence of DT and emotion regulation (with specific facets identified) as distinct mechanisms in the development of PTSD. Of clinical relevance, current findings support post-trauma processing theories that contend individuals' recovery requires accepting and learning to modulate trauma-related emotional states. Implications for methods of treatment and prevention are discussed.
Collapse
Affiliation(s)
- Jenna E Russo
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS, 39762, USA.
| | - Deepali M Dhruve
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS, 39762, USA
| | - Arazais D Oliveros
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS, 39762, USA
| |
Collapse
|
22
|
Salim SR, Bhuptani PH, Eshelman LR, LaPlena NM, Messman TL. Trauma-Related Shame Mediates the Associations Between Self-Blame, Bisexual Minority Stress, and Rape-Related PTSD Symptoms. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:10259-10281. [PMID: 37232183 DOI: 10.1177/08862605231172487] [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: 05/27/2023]
Abstract
Bisexual women experience higher rates of rape and post-traumatic stress disorder (PTSD) prevalence compared to heterosexual and lesbian women. In addition, bisexual women experience unique antibisexual stigma and minority stress, which are associated with post-trauma outcomes. The aim of the current study was to test trauma-related shame as a mechanism in the relations of self-blame and bisexual minority stress (i.e., antibisexual stigma and internalized binegativity) with rape-related PTSD symptom. The sample consisted of 192 cisgender bisexual women (ages 18-35 years) who reported an experience of rape since the age of 18. Results from path analysis conducted in Mplus indicated that trauma-related shame mediated the link between self-blame and rape-related PTSD severity, as well as the links from antibisexual stigma and internalized binegativity to rape-related PTSD severity. There was also an indirect serial effect from antibisexual stigma to internalized binegativity to shame to PTSD severity. Thus, findings highlight the mechanistic role of trauma-related shame in rape-related PTSD symptoms. We identified two risk pathways: (a) general/universal risk from self-blame about rape and shame to PTSD severity and (b) group-specific risk from bisexual minority stress and shame to PTSD severity. Results indicate that reducing trauma-related shame may be an important target to improve post-rape outcomes. Finally, stigma associated with rape and sexual violence as well as antibisexual stigma must be eradicated to improve post-trauma outcomes among bisexual survivors.
Collapse
|
23
|
Walter KH, Otis NP, Hose MK, Ober KM, Glassman LH. The effectiveness of the National Veterans Summer Sports Clinic for veterans with probable posttraumatic stress disorder. Front Psychol 2023; 14:1207633. [PMID: 37492451 PMCID: PMC10363688 DOI: 10.3389/fpsyg.2023.1207633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/16/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Recreational and adaptive sports programs may be beneficial therapeutic interventions for improving psychological outcomes among veterans and service members with posttraumatic stress disorder (PTSD) because they provide opportunities for exercise, socialization, respite, and time outdoors. Although there are an increasing number of sports programs for veterans and service members with PTSD, data evaluating the outcomes of such programs are limited. Materials and methods The sample included 74 U.S. veterans who participated in the National Veterans Summer Sports Clinic (NVSSC), an annual, week-long adaptive sports program in San Diego, California. Participants were categorized into two subgroups: those who met criteria for probable PTSD using the PTSD Checklist for DSM-5 (n = 20) and those who did not (n = 54). Participants completed self-report assessments before and after each daily activity, before and after the program, and 3 months following program completion. Results Over the course of NVSSC program participation, the diagnostic subgroups (probable PTSD vs. no PTSD) did not significantly differ on changes in depression, positive affect, negative affect, or insomnia. Compared to those without PTSD, veterans with PTSD experienced greater reduction in generalized anxiety during the program (MD = -3.07, p = 0.034). Veterans with PTSD also experienced significant improvements in PTSD symptoms at postprogram (MD = -23.76, p < 0.001). For both groups, significant benefits were shown during the program but rebounded by the 3-month follow-up. Over the course of each daily activity, positive affect (MD = 2.71, p < 0.001) and depression/anxiety scores significantly decreased (MD = -0.75, p < 0.001), with no differences between PTSD diagnostic groups across time (ps = 0.714 and 0.961, respectively). Conclusion Veterans with and without PTSD benefited from participation in the NVSSC. Participants with probable PTSD experienced greater improvements in generalized anxiety at postprogram only; there were no other significant differences between the two groups at postprogram or at 3-month follow-up. In line with prior research, benefits for those with PTSD were lost by 3-month follow-up, suggesting that regular engagement in recreational and adaptive sports may be necessary to sustain psychological health improvements.
Collapse
Affiliation(s)
- Kristen H. Walter
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Nicholas P. Otis
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
| | | | | | - Lisa H. Glassman
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
| |
Collapse
|
24
|
Contractor AA, Batley PN, Compton SE, Weiss NH. Relations Between Posttraumatic Stress Disorder Symptoms and Positive Memory Characteristics Among Women Reporting Intimate Partner Violence: A Micro-Longitudinal Study. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:7266-7295. [PMID: 36541198 DOI: 10.1177/08862605221143200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Evidence links posttraumatic stress disorder (PTSD) symptoms to positive autobiographical memory characteristics. To extend this research, we uniquely utilized micro-longitudinal data to examine (1) the trajectory of PTSD symptom count across 30 days; and (2) if more vividness and accessibility of retrieved positive memories at the daily level predicted decreases in the trajectory of PTSD symptom count across 30 days. The current study was a secondary data analysis of a larger study. The sample included 74 women who reported physical or sexual victimization in the past 30 days by their current male partner and reported the use of alcohol and/or drugs during that time (Mage = 39.68 years; 37.80% with diagnostic PTSD; 43.2% White; 37.8% Black or African American). They completed thrice daily measures of PTSD symptoms and positive memory characteristics (vividness and accessibility) across 30 days. Results of the random effects longitudinal multilevel model indicated that, on average, the relation between PTSD symptom count and positive memory vividness was positive and statistically significant (0.19, 95% Confidence Interval [CI] [0.2, 0.35]); and the relation between PTSD symptom count and positive memory accessibility was positive and statistically significant (0.31, 95% CI [0.15, 0.47]). The relationship between PTSD symptom count and positive memory vividness/accessibility (i.e., slopes) varied significantly across participants, with a wide range of positive and negative regression coefficients. Future research needs to investigate why and how positive memory vividness and accessibility may relate to trajectories of PTSD symptoms over time, with potential clinical implications for positive memory interventions addressing PTSD.
Collapse
|
25
|
Wolitzky-Taylor K, Smit T, Vujanovic AA, Zvolensky MJ. Transdiagnostic Processes Linking Posttraumatic Stress Disorder Symptoms to Alcohol Use Severity. J Dual Diagn 2023; 19:97-110. [PMID: 37389859 DOI: 10.1080/15504263.2023.2225373] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Objective: The high comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is well-established and complex. However, there is a need to explore transdiagnostic constructs that may underlie this association to better understand what accounts for this comorbidity and to inform treatment development. Method: Thus, the present study utilized a large, cross-sectional dataset (N = 513; Mage = 38.25 years, SD = 10.07; 49.9% female), based on national recruitment, to (1) examine whether the associations between PTSD symptom severity (PCL-5) and alcohol use severity (AUDIT) were statistically mediated by (a) anxiety sensitivity (SSASI); and (b) difficulties with emotion regulation (DERS-16); and (2) examine whether coping motives for drinking moderate this indirect effect. Sex assigned at birth was included as a covariate. Results: When examining the hypothesized mediators (SSASI and DERS-16) in separate models, there was a statistically significant indirect effect of PCL-5 on AUDIT through both SSASI and DERS. However, when both SSASI and DERS were entered into a model simultaneously, only SSASI served as a statistically significant mediator. Coping motives for drinking did not moderate the observed indirect effect. Conclusions: The current findings highlight anxiety sensitivity and emotion regulation as transdiagnostic processes that may explain, at least partially, the relationship between PTSD symptom severity and alcohol use; however, stronger evidence was evident for anxiety sensitivity. These findings may help inform the development of refined, streamlined interventions for PTSD and alcohol use that directly target these processes.
Collapse
Affiliation(s)
- Kate Wolitzky-Taylor
- Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, California, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
26
|
Jin L, Compton SE, Sameen DE, Cornish MV, Contractor AA. Mental Health Symptom Profiles and Treatment Parameters Among Asian Indians: Latent Profile Analyses. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01040-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
|
27
|
Possemato K, Johnson E, Barrie K, Ghaus S, Noronha D, Wade M, Greenbaum MA, Rosen C, Cloitre M, Owen J, Jain S, Beehler G, Prins A, Seal K, Kuhn E. A Randomized Clinical Trial of Clinician-Supported PTSD Coach in VA Primary Care Patients. J Gen Intern Med 2023:10.1007/s11606-023-08130-6. [PMID: 36932268 PMCID: PMC10022983 DOI: 10.1007/s11606-023-08130-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is common in primary care patients; however, evidence-based treatments are typically only available in specialty mental healthcare settings and often not accessed. OBJECTIVE To test the effectiveness of a brief primary care-based treatment, Clinician-Supported PTSD Coach (CS PTSD Coach) was compared with Primary Care Mental Health Integration-Treatment as Usual (PCMHI-TAU) in (1) reducing PTSD severity, (2) engaging veterans in specialty mental health care, and (3) patient satisfaction with care. DESIGN Multi-site randomized pragmatic clinical trial. PARTICIPANTS A total of 234 veterans with PTSD symptoms who were not currently accessing PTSD treatment. INTERVENTION CS PTSD Coach was designed to be implemented in Veterans Affairs PCMHI and combines mental health clinician support with the "PTSD Coach" mobile app. Four 30-min sessions encourage daily use of symptom management strategies. MAIN MEASURES PTSD severity was measured by clinician-rated interviews pre- and post-treatment (8 weeks). Self-report measures assessed PTSD, depression, and quality of life at pretreatment, posttreatment, and 16- and 24-week follow-ups, and patient satisfaction at post-treatment. Mental healthcare utilization was extracted from medical records. KEY RESULTS Clinician-rated PTSD severity did not differ by condition at post-treatment. CS PTSD Coach participants improved more on patient-reported PTSD severity at post-treatment than TAU participants (D = .28, p = .021). Coach participants who continued to have problematic PTSD symptoms at post-treatment were not more likely to engage in 2 sessions of specialty mental health treatment than TAU participants. Coach participants engaged in 74% more sessions in the intervention and reported higher treatment satisfaction than TAU participants (p < .001). CONCLUSIONS A structured 4-session intervention designed to align with patient preferences for care resulted in more patient-reported PTSD symptom relief, greater utilization of mental health treatment, and overall treatment satisfaction than TAU, but not more clinician-rated PTSD symptom relief or engagement in specialty mental health.
Collapse
Affiliation(s)
- Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.
| | - Emily Johnson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Kimberly Barrie
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | | | | | - Michael Wade
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Mark A Greenbaum
- National Center for PTSD, Palo Alto, CA, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Craig Rosen
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Marylene Cloitre
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jason Owen
- National Center for PTSD, Palo Alto, CA, USA
| | - Shaili Jain
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory Beehler
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | | | - Karen Seal
- San Francisco VA Health Care System, San Francisco, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Eric Kuhn
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
28
|
Messman BA, Jin L, Slavish DC, Alghraibeh AM, Aljomaa SS, Contractor AA. The role of positive affect processes in the association between posttraumatic stress disorder symptoms and sleep: A multi-study design. J Affect Disord 2023; 324:511-520. [PMID: 36603602 DOI: 10.1016/j.jad.2022.12.125] [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: 06/27/2022] [Revised: 11/04/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) symptoms have been linked to sleep disturbances. Limited work has explored how positive affect processes may account for this relationship. Advancing research in this area, we utilized a multi-study design to investigate the role of positive affect processes (levels of positive affect, positive emotionality, hedonic deficits, negative affect interference) in the PTSD-sleep association. METHODS Data from 149 trauma-exposed firefighters (Mage = 38.93 ± 9.65, 5.40 % women) were collected between September 2021 and November 2021, and data from 119 trauma-exposed community members (Mage = 29.60 ± 8.67, 68.10 % women) were collected between February 2021 and December 2021. Participants completed an online survey on PTSD symptoms, sleep disturbances, and positive affect processes. RESULTS Positive affect levels (b = 0.03, 95 % confidence interval [CI] [0.01, 0.06]; firefighter sample), positive emotionality (b = 0.07, CI [0.03, 0.13]; community sample), and negative affect interference (b = 0.06, CI [0.01, 0.14]; community sample) significantly accounted for the associations between PTSD symptom severity and sleep disturbances controlling for the effects of gender and age. CONCLUSION Findings highlight the role of positive affect processes in the link between PTSD and sleep, and support addressing positive affect processes as potential targets in clinical interventions for co-occurring PTSD-sleep problems.
Collapse
Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA.
| | - Ling Jin
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Ahmad M Alghraibeh
- Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Suliman S Aljomaa
- Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | | |
Collapse
|