Examination of the Structural Relations Between Posttraumatic Stress Disorder Symptoms and Reckless/Self-Destructive Behaviors

Post-traumatic stress disorder as a risk factor for major adverse cardiovascular events: a cohort study of a South African medical insurance scheme

AIMS

Prior research, largely focused on US male veterans, indicates an increased risk of cardiovascular disease among individuals with post-traumatic stress disorder (PTSD). Data from other settings and populations are scarce. The objective of this study is to examine PTSD as a risk factor for incident major adverse cardiovascular events (MACEs) in South Africa.

METHODS

We analysed reimbursement claims (2011-2020) of a cohort of South African medical insurance scheme beneficiaries aged 18 years or older. We calculated adjusted hazard ratios (aHRs) for associations between PTSD and MACEs using Cox proportional hazard models and calculated the effect of PTSD on MACEs using longitudinal targeted maximum likelihood estimation.

RESULTS

We followed 1,009,113 beneficiaries over a median of 3.0 years (IQR 1.1-6.0). During follow-up, 12,662 (1.3%) persons were diagnosed with PTSD and 39,255 (3.9%) had a MACE. After adjustment for sex, HIV status, age, population group, substance use disorders, psychotic disorders, major depressive disorder, sleep disorders and the use of antipsychotic medication, PTSD was associated with a 16% increase in the risk of MACEs (aHR 1.16, 95% confidence interval (CI) 1.05-1.28). The risk ratio for the effect of PTSD on MACEs decreased from 1.59 (95% CI 1.49-1.68) after 1 year of follow-up to 1.14 (95% CI 1.11-1.16) after 8 years of follow-up.

CONCLUSION

Our study provides empirical support for an increased risk of MACEs in males and females with PTSD from a general population sample in South Africa. These findings highlight the importance of monitoring cardiovascular risk among individuals diagnosed with PTSD.

Relations Between Posttraumatic Stress Disorder Symptoms and Positive Memory Characteristics Among Women Reporting Intimate Partner Violence: A Micro-Longitudinal Study

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 (M_age = 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.

The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5: A Systematic Review of Existing Psychometric Evidence

The PTSD Checklist for DSM-5 (PCL-5) is a widely used self-rated measure of DSM-5 PTSD symptoms. The goal of this systematic review was to synthesize research on the psychometric properties of the PCL-5 to guide clinical and research applications. We focused on reliability, validity, factor structure, optimal cutoff scores, and sensitivity to clinical change indices. A systematic review of the literature following PRISMA guidelines was conducted using PubMed, PsycINFO, CINAHL, and PTSDpubs with search terms capturing selected psychometric indices of the PCL-5. The inclusion criteria were: peer-reviewed publication in English; primary focus on the PCL-5 psychometrics; empirical study; and study with adult samples. The search yielded 265 studies; 56 papers (amounting to 64 studies) met inclusion criteria and were reviewed. Findings generally indicated evidence for: acceptable internal consistency and test-retest reliability; construct validity; a 7-factor Hybrid Model; recommended cutoff scores between 31-33; and ability to index sensitivity to clinical change. To further advance knowledge and applications of the PCL-5, we need more research on abbreviated versions of the PCL-5, bifactor modeling as applied to the PCL-5, as well as on PCL-5 item difficulty estimates, discrimination parameters, and clinical change score estimates.

Positive Affect Processes and Posttraumatic Stress Disorder Symptoms: Findings from an Open Label and Uncontrolled Pilot Study using the Positive Memory Processing Technique

Recently, a five-session Processing of Positive Memories Technique (PPMT) was proposed as a novel intervention for posttraumatic stress disorder (PTSD). One purported outcome of and mechanism underlying PPMT's effects on PTSD is improved positive affect processes. In this uncontrolled pilot study, we examined whether PPMT was associated with decreases in PTSD severity; and whether changes in positive affect levels, reactivity, and dysregulation related to changes in PTSD severity across sessions. The sample included 16 trauma-exposed participants seeking services at a University Psychology Clinic (Mage=27.44 years; 68.80% women). Multilevel linear growth models examined the main effects of each positive affect variable and their interactions with time on PTSD severity. PTSD severity decreased across PPMT treatment in each model (bs=-0.43 to -0.33; d=-0.03; ps<.001-0.008). There was a main effect of positive emotion dysregulation (b=1.16, d=0.11; p=0.009), but not of positive affect levels (p=0.821) or reactivity (p=0.356) on PTSD severity. However, positive affect processes did not modify the trajectory of PTSD severity across treatment. Regarding PTSD symptom clusters, there was an interaction between positive affect levels and time on alterations in arousal and reactivity (AAR) cluster severity (b=-0.01, p=0.036); individuals with positive affect levels 1 SD above the mean (b=-0.18, p<0.01) and at the mean (b=-0.10, p=0.01) had greater decreases in AAR cluster severity across treatment compared to individuals with positive affect levels 1 SD below the mean (b=-0.02, p=0.710). Findings suggest that PPMT may relate to improved PTSD symptoms; and that positive affect levels/dysregulation may be worthwhile targets for future investigations.

Longitudinal associations between PTSD and sleep disturbances among World Trade Center responders

OBJECTIVE/BACKGROUND

Post-traumatic stress disorder (PTSD) is characterized by substantial disruptions in sleep quality, continuity, and depth. Sleep problems also may exacerbate PTSD symptom severity. Understanding how PTSD and sleep may reinforce one another is critical for informing effective treatments.

PATIENTS/METHODS

In a sample of 452 World Trade Center 9/11 responders (mean age = 55.22, 89.4% male, 66.1% current or former police), we examined concurrent and cross-lagged associations between PTSD symptom severity, insomnia symptoms, nightmares, and sleep quality at 3 time points ∼1 year apart. Data were analyzed using random intercept cross-lagged panel models.

RESULTS

PTSD symptom severity and sleep variables were relatively stable across time (intraclass correlation coefficients: 0.63 to 0.84). Individuals with more insomnia symptoms, more nightmares, and poorer sleep quality had greater PTSD symptom severity, on average. Within-person results revealed that greater insomnia symptoms and nightmares at Time 1 were concurrently associated with greater PTSD symptoms at Time 1. Insomnia symptoms were also concurrently associated with PTSD symptoms at Times 2 and 3, respectively. Cross-lagged and autoregressive results revealed that PTSD symptoms and nightmares predicted nightmares at the next timepoint.

CONCLUSIONS

Overall, results suggest PTSD and sleep problems may be linked at the same point in time but may not always influence each other longitudinally. Further, individuals who experience more sleep disturbances on average may suffer from more debilitating PTSD. Evidence-based treatments for PTSD may consider incorporating treatment of underlying sleep disturbances and nightmares.

Clusters of Trauma Types as Measured by the Life Events Checklist for DSM-5

Experiences of potentially traumatic events (PTE), commonly assessed with the Life Events Checklist for DSM-5 (LEC-5), can be both varied in pattern and type. An understanding of LEC-assessed PTE type clusters and their relation to psychopathology can enhance research feasibility (e.g., address low base rates for certain PTE types), research communication/comparisons via the use of common terminology, and nuanced trauma assessments/treatments. To this point, the current study examined (1) clusters of PTE types assessed by the LEC-5; and (2) differential relations of these PTE type clusters to mental health correlates (i.e., posttraumatic stress disorder [PTSD] severity, depression severity, emotion dysregulation, reckless and self-destructive behaviors [RSDBs]). A trauma-exposed community sample of 408 participants was recruited via Amazon's Mechanical Turk (M age = 35.90 years; 56.50% female). Network analyses indicated three PTE type clusters: Accidental/Injury Traumas (LEC-5 items 1, 2, 3, 4, 12), Victimization Traumas (LEC-5 items 6, 8, 9), and Predominant Death Threat Traumas (LEC-5 items 5, 7, 10, 11, 13-16). Multiple regression analyses indicated that the Victimization Trauma Cluster significantly predicted PTSD severity (β = .23, p <.001), depression severity (β = .20, p =.001), and negative emotion dysregulation (β = .22, p <.001); and the Predominant Death Threat Trauma Cluster significantly predicted engagement in RSDBs (β = 31, p <.001) and positive emotion dysregulation (β = .26, p <.001), accounting for the influence of other PTE Clusters. Results support three PTE type classifications assessed by the LEC-5, with important clinical and research implications.