Acupuncture for combat post-traumatic stress disorder: trial development and methodological approach for a randomized controlled clinical trial

Assessing the impact of the coronavirus pandemic on the mental health status of intensive care unit nurses: a systematic review

INTRODUCTION

The Coronavirus pandemic (COVID-19) was first identified in December 2019 in Wuhan, China, and later caused a severe health crisis, causing massive disruptions to most healthcare systems worldwide. During this pandemic period, the structure of the Intensive Care Unit (ICU) activities changed fast. It was observed that the mental health of ICU nurses reached levels of extreme clinical and psychological concern. This paper aims to shed light on how COVID-19 affected ICU nurses' mental health.

METHODS

A literature review of articles published on this topic from January 2020 to December 2024. English-language, peer-reviewed, mixed-methods, qualitative, and quantitative research on the mental health outcomes of ICU nurses were included while studies without primary data, non-ICU nurses, and non-peer-reviewed publications were excluded. To identify relevant literature, we searched five databases, including PubMed, MEDLINE, CINAHL, Web of Science, and Embase. Additionally, grey literature sources, including Google Scholar and Research Gate, were also searched. Narrative synthesis was used to evaluate both quantitative and qualitative data.

RESULTS

A total of 23 articles were reviewed. The most prevalent mental health issues were depression, anxiety, fear, and post-traumatic stress disorder (PTSD). The effects of burnout, illness, exhaustion, physical strain, sleep disturbances, and ongoing job stress were equally detrimental to the health of ICU nurses. The nurses' health declined as a result of the new procedures and working environment, the enormous workload, the continued exhaustion, the concerns for their families and themselves being infected by COVID-19, the social reaction, and seeing the death toll rise.

CONCLUSION

The COVID-19 pandemic had a negative impact on nurses' mental health well-being such as stress, depression, post-traumatic stress disorder, insomnia, anxiety, and fear. Sustainable support systems, networks and plans ought to be made available. Due to unique working conditions of ICU nurses and in readiness for similar pandemics in future, legislators should focus on the mental health of ICU nurses because they play a critical role in managing public health crises as frontline health solders.

Effectiveness of Acupuncture and Brief Telehealth Intervention for Individuals With Posttraumatic Stress Disorder

PURPOSE

This open-trial pilot study evaluated the feasibility and effectiveness of acupuncture with brief therapy (ABT) for individuals with posttraumatic stress disorder (PTSD).

METHOD

Participants included 27 individuals with PTSD diagnoses confirmed using the Clinician-Administered PTSD Scale for DSM-5. Before ABT, 22 participants completed eight acupuncture sessions and three telehealth sessions of a brief treatment program for PTSD (Brief Relaxation, Education, and Trauma Healing [BREATHE]).

RESULTS

ABT significantly reduced PTSD symptoms, depression symptoms, anxiety, and improved trauma-related cognition.

CONCLUSION

Acupuncture can play an important role in mental health recovery, and combining acupuncture with a brief, telehealth-based treatment (BREATHE) may assist recovery among individuals with PTSD. [Journal of Psychosocial Nursing and Mental Health Services, 62(11), 35-45.].

Acupuncture for Combat-Related Posttraumatic Stress Disorder: A Randomized Clinical Trial

Importance

Current interventions for posttraumatic stress disorder (PTSD) are efficacious, yet effectiveness may be limited by adverse effects and high withdrawal rates. Acupuncture is an emerging intervention with positive preliminary data for PTSD.

Objective

To compare verum acupuncture with sham acupuncture (minimal needling) on clinical and physiological outcomes.

Design, Setting, and Participants

This was a 2-arm, parallel-group, prospective blinded randomized clinical trial hypothesizing superiority of verum to sham acupuncture. The study was conducted at a single outpatient-based site, the Tibor Rubin VA Medical Center in Long Beach, California, with recruitment from April 2018 to May 2022, followed by a 15-week treatment period. Following exclusion for characteristics that are known PTSD treatment confounds, might affect biological assessment, indicate past nonadherence or treatment resistance, or indicate risk of harm, 93 treatment-seeking combat veterans with PTSD aged 18 to 55 years were allocated to group by adaptive randomization and 71 participants completed the intervention protocols.

Interventions

Verum and sham were provided as 1-hour sessions, twice weekly, and participants were given 15 weeks to complete up to 24 sessions.

Main Outcomes and Measures

The primary outcome was pretreatment to posttreatment change in PTSD symptom severity on the Clinician-Administered PTSD Scale-5 (CAPS-5). The secondary outcome was pretreatment to posttreatment change in fear-conditioned extinction, assessed by fear-potentiated startle response. Outcomes were assessed at pretreatment, midtreatment, and posttreatment. General linear models comparing within- and between-group were analyzed in both intention-to-treat (ITT) and treatment-completed models.

Results

A total of 85 male and 8 female veterans (mean [SD] age, 39.2 [8.5] years) were randomized. There was a large treatment effect of verum (Cohen d, 1.17), a moderate effect of sham (d, 0.67), and a moderate between-group effect favoring verum (mean [SD] Δ, 7.1 [11.8]; t90 = 2.87, d, 0.63; P = .005) in the intention-to-treat analysis. The effect pattern was similar in the treatment-completed analysis: verum d, 1.53; sham d, 0.86; between-group mean (SD) Δ, 7.4 (11.7); t69 = 2.64; d, 0.63; P = .01). There was a significant pretreatment to posttreatment reduction of fear-potentiated startle during extinction (ie, better fear extinction) in the verum but not the sham group and a significant correlation (r = 0.31) between symptom reduction and fear extinction. Withdrawal rates were low.

Conclusions and Relevance

The acupuncture intervention used in this study was clinically efficacious and favorably affected the psychobiology of PTSD in combat veterans. These data build on extant literature and suggest that clinical implementation of acupuncture for PTSD, along with further research about comparative efficacy, durability, and mechanisms of effects, is warranted.

Trial Registration

ClinicalTrials.gov Identifier: NCT02869646.

Efficacy and underlying mechanisms of acupuncture therapy for PTSD: evidence from animal and clinical studies

As a major public health problem, posttraumatic stress disorder (PTSD) has a substantial impact on individuals and society. The total excess economic burden of PTSD in the US is estimated to be more than $232.2 billion a year. Acupuncture is widely used in patients with PTSD, and an increasing number of studies have been undertaken to assess the efficacy and underlying mechanisms of acupuncture for the treatment of individuals with PTSD. However, there has not yet been a review that simultaneously elucidates the therapeutic efficacy and biological mechanisms of acupuncture. We wished to examine the efficacy and underlying mechanisms of acupuncture for the treatment of individuals with PTSD. We conducted this review in three sections as follows: a meta-analysis, an acupoint analysis, and mechanism research. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure Database (CNKI), WanFang Database, China Biology Medicine Database (CBM), Chinese Science and Technology Journals Database (VIP), and other databases were searched from 1 January 2012 to 27 November 2022. Based on the included studies, we first determined whether acupuncture is more effective than psychological treatment or pharmacological treatment for treating and improving the quality of life of individuals with PTSD by meta-analysis. Second, the most commonly used acupoints and parameters of acupuncture were summarized based on animal and clinical studies. Third, we attempt to summarize the current mechanisms of acupuncture in the treatment of PTSD. Finally, 56 acupoint analyses, eight meta-analyses, and 33 mechanistic studies were included. Acupuncture outperformed pharmacotherapy treatment in improving symptom scores by CAPS, HAMA, HAMD, PCL-C, and SCL-90 somatization for PTSD and outperformed psychotherapy treatment in improving symptom scores by CAPS PCL-C and HAMD, according to the meta-analysis. GV20 was the most frequently used acupuncture point in clinical studies and animal studies, with a 78.6% application rate. Acupuncture may be effective in treating PTSD by regulating the structure and components of several brain areas, regulating the neuroendocrine system, and involving signaling pathways. In conclusion, this finding indicates that acupuncture has promising potential for treating PTSD.