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Akbar R, Arya V, Conroy E, Wilcox HC, Page A. Posttraumatic stress disorder and risk of suicidal behavior: A systematic review and meta-analysis. Suicide Life Threat Behav 2023; 53:163-184. [PMID: 36385705 DOI: 10.1111/sltb.12931] [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: 04/28/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study conducted a systematic review and meta-analysis of the association between posttraumatic stress disorder (PTSD) and (i) death by suicide, (ii) attempted suicide (AS), and (iii) suicidal ideation (SI). METHODS The systematic review identified seven studies on PTSD and suicide, 33 studies for AS, and 20 studies for SI. A series of stratified meta-analyses were conducted to estimate pooled effects, in addition to meta-regression to investigate sources of heterogeneity. RESULTS A higher relative risk of suicide was evident among those diagnosed with PTSD (RR = 2.09 [95% confidence interval (CI): 1.11-3.94]), with strongest associations among combat veterans (RR = 3.97, 95% CI 2.22-7.10). A lower relative risk of suicide among those with PTSD and co-morbid psychiatric conditions was evident (RR = 0.74, 95% CI 0.63-0.86). A strong association between PTSD and attempted suicide (RR = 4.05, 95% CI 3.14-5.23) and suicidal ideation (RR = 2.91, 95% CI 2.22-3.82) was also found, with a consistently strong association among those with co-morbid psychiatric conditions and non-clinical cohorts. CONCLUSION This review found a strong association between PTSD and death by suicide, attempted suicide, and suicidal ideation, and also suicide among veteran populations. Early identification and treatment of PTSD across both clinical and non-clinical cohorts should be a priority for suicide prevention.
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Affiliation(s)
- Rahat Akbar
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Vikas Arya
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Elizabeth Conroy
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Holly C Wilcox
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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Abstract
AbstractPost traumatic stress disorder (PTSD) is a well recognised condition which occurs in people who have been exposed to severe trauma as victims, potential victims or witnesses. A review of case notes of all prisoners transferred since 1988 to a national forensic psychiatric hospital following traumatic hanging events in prison revealed that all patients had psychological symptoms and four had symptoms probably fulfilling PTSD according to DSM III R criteria. Our findings are discussed with reference to the literature on PTSD, the nature of the prison environment, the premorbid personality of prisoners, and the implications for dealing with the effect of suicide within a prison setting.
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Panagioti M, Gooding PA, Tarrier N. A meta-analysis of the association between posttraumatic stress disorder and suicidality: the role of comorbid depression. Compr Psychiatry 2012; 53:915-30. [PMID: 22483367 DOI: 10.1016/j.comppsych.2012.02.009] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE A considerable number of studies have reported an increased frequency of suicidal behaviors among individuals diagnosed with posttraumatic stress disorder (PTSD). This study aims, first, to provide a comprehensive systematic review and meta-analysis of the association between a PTSD diagnosis and frequency of suicidality and, second, to examine the role of comorbid depression in the association between suicidality and PTSD. METHODS Searches of Medline (June 2010), EMBASE (June 2010), PsycINFO (June 2010), PILOTS (June 2010), and Web of Science (June 2010) were conducted to identify studies that examined the association between PTSD and suicidality. The studies had to include an effect size of the association between PTSD and suicidality to be included in the meta-analysis. Sixty-three studies were eligible for inclusion in the meta-analysis. Overall and subgroup effect sizes were examined. RESULTS A highly significant positive association between a PTSD diagnosis and suicidality was found. The PTSD-suicidality association persisted across studies using different measures of suicidality, current and lifetime PTSD, psychiatric and nonpsychiatric samples, and PTSD populations exposed to different types of traumas. Comorbid major depression significantly compounded the risk for suicide in PTSD populations. CONCLUSION The current meta-analysis provides strong evidence that a PTSD diagnosis is associated with increased suicidality. The crucial role of comorbid major depression in the etiology of suicidality in PTSD is also supported.
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Affiliation(s)
- Maria Panagioti
- School of Psychological Sciences, University of Manchester, Manchester, United Kingdom
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Davidson G, Leavey G. Promoting mental health in Northern Ireland: addressing division, inequality and stigma. JOURNAL OF PUBLIC MENTAL HEALTH 2010. [DOI: 10.5042/jpmh.2010.0698] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
There is a gap in the literature regarding suicide risk among traumatized individuals with post-traumatic stress disorder (PTSD) and this article aims to systematically review literature on the relationship between PTSD and suicidal behavior and ideation. A meta-analysis of 50 articles that examined the association between PTSD and past and current suicidal ideation and behavior was conducted. There was no evidence for an increased risk of completed suicide in individuals with PTSD. PTSD was associated with an increased incidence of prior attempted suicide and prior and current suicidal ideation. Controlling for other psychiatric disorders (including depression) weakened, but did not eliminate, this association. The evidence indicates that there is an association between PTSD and suicidality with several factors, such as concurrent depression and the pre-trauma psychiatric condition, possibly mediating this relationship. There are significant clinical implications of the reported relationship for suicide risk assessment and therapy, and further studies might help to understand the mediating pathways between PTSD and increased suicide risk.
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Affiliation(s)
- Karolina Krysinska
- Center for Suicide Prevention Studies in Young People, University of Queensland, Brisbane, Australia.
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Murphy H. ‘The Troubles’, geographies of mental health in Northern Ireland and re-conceptualizing social capital. CRITICAL PUBLIC HEALTH 2008. [DOI: 10.1080/09581590600602161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Healey A. Systemic Therapy In A Cloture of Conflict: Developing A Therapeutic Conversation. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/13575279608410460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Arlene Healey
- a Young People's Centre , 10 College Gardens, Belfast
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Murphy H, Lloyd K. Civil conflict in Northern Ireland and the prevalence of psychiatric disturbance across the United Kingdom: a population study using the British household panel survey and the Northern Ireland household panel survey. Int J Soc Psychiatry 2007; 53:397-407. [PMID: 18018662 DOI: 10.1177/0020764007078340] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To date, no large-scale cross-comparative study of psychiatric morbidity in the United Kingdom has been carried out until recently when the Northern Ireland Household Panel Survey (NIHPS) included the General Health Questionnaire (GHQ-12) in 2001. The GHQ-12 has been included in the British Household Panel Survey (BHPS) since 1991 for England and since 1999 for both Scotland and Wales. The purpose of this article is to compare rates of psychiatric morbidity across the United Kingdom, given that one region in particular, Northern Ireland, has experienced political conflict and civil strife for more than 35 years. AIMS To assess the impact of low-intensity warfare on rates of psychiatric morbidity in Northern Ireland and to compare these with psychiatric morbidity rates across England, Scotland and Wales. METHOD The sample consisted of 17,343 respondents completing the GHQ-12 across the United Kingdom. In England, 8286 respondents completed the GHQ-12 while 2729, 3165 and 3163 respondents from Wales, Scotland and Northern Ireland completed the GHQ-12 respectively. Results were then weighted according to population size. RESULTS Rates of psychiatric morbidity varied across each UK region. Wales had the highest mean GHQ-12 score (11.54), followed by Northern Ireland (11.41). English respondents had the lowest mean score (11.02). The difference in mean scores across the four regions in the UK was statistically significant (F= 5.04, df = 3, p < 0.001). Post-hoc analyses indicated that the mean scores for England differed significantly from those for Wales and Northern Ireland but not for Scotland. Region accounted for less than 1% of the variation in GHQ-12 scores. CONCLUSIONS Psychiatric morbidity rates for adults in Northern Ireland are comparable to other parts of the United Kingdom and we propose that individuals in Northern Ireland use a range of coping strategies to moderate the impact of the conflict in everyday life. These include habituation to the violence, denial and social cohesion, evidenced in the tightly knit Unionist and Nationalist communities. Particular concern was noted over GHQ-12 scores for Wales and while social and economic factors are acknowledged in our commentary, we conclude that further research appears to be crucial in understanding and preventing poorer rates of mental health in this region.
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Affiliation(s)
- Helen Murphy
- Critical Psychology Research Group, School of Psychology, University of East London, UK.
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A tariff system for nervous shock: introducing the total impact score. Ir J Psychol Med 2004; 21:48-52. [PMID: 30308765 DOI: 10.1017/s0790966700008284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study was designed to test a proposed relationship between the total impact score (devised by the authors) and the quantum of damages in compensation received by victims of criminal and political violence. In so doing, the authors sought to develop a mathematical formula which could be used to quantify damages in a simple and expeditious manner. METHOD Data on 2,191 victims of violence was collated forming three databases of information, on the incident, on the victim and on the outcomes. A tool of measurement of the psychosocial impact of the traumatic event was designed (the Total Impact Score). Information on a subsample of the 208 survivors of attempted assassination was then selected and the TIS for each individual was calculated and examined for correlations with other variables including the quantum damages awarded. RESULTS The TIS was shown to have validity as a measure of the psychosocial impact of a traumatic event upon an individual. The analysis showed a significant relationship between the TIS and quantum awarded. This relationship was used to generate a mathematical formula which could be used to calculate quantum damages in any case. Compensation = £500 × (10(0037t+0.059y) -1), where t is the TIS and y is the number of years after 1985. CONCLUSIONS The TIS can be taken as a valid tool for quantifying the psychosocial impact of a traumatic event or violent act. The tool consists of a checklist of readily ascertainable outcome variables each of which can be scored and a TIS calculated. From this score the amount of damages can be ascertained. The authors believe that this measurement tool represents a fair and equitable method of calculating a case's worth.
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John LA. Mental health, illness and communal violence in Northern Ireland. Int Psychiatry 2003. [DOI: 10.1192/s1749367600007621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Many psychologically informed books and papers have been published during the past 30 years that have explored different elements of the Northern Ireland problem. These have ranged from Padraig O'Malley's (1990) fascinating examination of the world of the hunger strikers and their families, to a recent socio-psychological study of sectarianism in young children, which was sponsored by the Community Relations Council (Connolly et al, 2002). The latter careful piece of work demonstrated that while children of three years of age are beginning to identify different cultural symbols, there is not much evidence of sectarian attitudes until about five or six years of age. By this time they have not only begun to recognise and identify with partisan symbols, but also to express deeply antagonistic sectarian attitudes. These are not wholly unexpected findings, but the purpose of good research is to enquire whether things are in fact the way one might expect them to be. When it comes to research on clinical psychiatry there is less material but the most interesting and unexpected finding that emerges from the published work of psychiatrists in Northern Ireland is the limited evidence of any increased violence-related psychiatric illness in the population as a whole.
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Jehel L, Paterniti S, Brunet A, Duchet C, Guelfi JD. Prediction of the occurrence and intensity of post-traumatic stress disorder in victims 32 months after bomb attack. Eur Psychiatry 2003; 18:172-6. [PMID: 12814850 DOI: 10.1016/s0924-9338(03)00043-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Our objective was to identify factors that predict occurrence and severity of post-traumatic stress disorder (PTSD) after a terrorism attack. POPULATION We evaluated 32 victims of a bomb attack in a Paris subway in December 1996 at 6 and 32 months. METHOD Sociodemographic characteristics, clinical data and physical injuries were used to predict PTSD occurrence and severity in 32 victims. The Watson's PTSD Inventory (PTSD-I) and the Impact of Event Scale (IES) by Horowitz were used to evaluate occurrence and severity of PTSD, respectively. RESULTS Thirty-nine percent of participants met PTSD criteria at 6 months, 25% still had PTSD at 32 months. Women had PTSD 32 months after the bomb attack more frequently than men. Employment predicted PTSD severity at 32 months. PTSD scores assessed by PTSD-I at 6 months were significantly and positively associated with IES scores at 32-month follow-up (r = 0.55, P = 0.004). Psychotropic drug use before the bomb attack significantly predicted PTSD occurrence and severity at 6 and 32 months. In a linear regression model, physical injuries, employment status and psychotropic drug use before the bomb attack were independent predictors of severity of PTSD at 32 months. CONCLUSIONS Bomb attack exposure resulted in persisting PTSD in a significant proportion of victims; the severity was predicted at 32 months by physical injuries and psychotropic drug use before the terrorism attack and by the PTSD score few months after the bomb attack.
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Affiliation(s)
- Louis Jehel
- Unité de psychiatrie et psychotraumatisme, CHU Tenon (AP-HP), 4 rue de la Chine, 75970 Paris cedex 20, France.
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Abstract
A major incident occurred in a Northern Ireland bar in March 1997. One hundred and fifty customers were held at gunpoint. No one sustained any serious physical injury. Six months after the incident 68 individuals were assessed by means of a semistructured interview. Higher than expected levels of posttraumatic stress disorder (PTSD) were found. The severity of the incident, but not perceived life threat, was associated with the development of PTSD. The results of this preliminary study show that even in the absence of physical injury, significant psychopathology can occur.
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Affiliation(s)
- Oscar E Daly
- Department of Psychiatry, Lagan Valley Hospital, Lisburn, Northern Ireland.
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McGarvey B, Collins S. Can models of post-traumatic stress disorder contribute to the application of cognitive therapy by nurse therapists when dealing with individuals affected by the Omagh bombing? An overview. J Psychiatr Ment Health Nurs 2001; 8:477-87. [PMID: 11842475 DOI: 10.1046/j.1365-2850.2001.00358.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As mental health professionals practising in an evolving multidisciplinary trauma and recovery team in Omagh, Northern Ireland, the by now infamous Omagh bombing of 15 August 1998 brought abruptly to attention the potential for adverse psychological consequences resulting from exposure to such trauma. As nurse therapists, this event provoked interest in the entity of post-traumatic stress disorder (PTSD) as being one of the possible negative psychological consequences, and the relevance and application of cognitive theory and practice in its treatment. Whilst recognizing that there is no single cognitive theory or model of anxiety disorder, this paper focuses on the approach of Beck and allied approaches when referring to cognitive theory and practice. It is intended to proffer a broad overview of areas the authors consider relevant in order to develop an appreciation of the entity of PTSD, and its evolution, having given a synopsis of the event that provoked interest. Finally, acknowledgement and a brief explication of some of the theoretical models of PTSD to date will be made, and the relevance and application of cognitive theory and principals in the treatment of the disorder will be considered.
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Affiliation(s)
- B McGarvey
- Tyrone Community Mental Health Team, Lissan House, Tyrone, Northern Ireland
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15
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Mintz M, Yovel G, Gigi A, Myslobodsky MS. Dissociation between startle and prepulse inhibition in rats exposed to gamma radiation at day 15 of embryogeny. Brain Res Bull 1998; 45:289-96. [PMID: 9510421 DOI: 10.1016/s0361-9230(97)00373-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The role of prenatal trauma in disordered sensory gating was explored in albino rats of the Sprague-Dawley strain. Pregnant rats were exposed to 1.5 Gy (0.15 Gy/min) of the whole-body gamma radiation on days 15, 17, or 19 of gestation. Controls were sham-exposed during 10 min in the same conditions. Exposed and control offsprings were evaluated for the auditory startle response (ASR) and its gating by either the habituation process or by the preceding weak sensory stimulus in the prepulse inhibition of startle (PPI) procedure. The tests were conducted when the animals reached 27 and 57 days of age. A noticeable hyperresponding and delayed habituation of startle were found in rats exposed at E15, with meager effects in rats exposed at E17 and E19. Maximal deficit was obtained on tests conducted on P57 but not on P27. However, in rats pretreated with amphetamine, dysfunctional startle was unmasked already on the P27 test. By contrast, PPI was insensitive to the damaging effect of prenatal irradiation at either period. This dissociation is reminiscent of one observed in patients with posttraumatic stress disorder (PTSD).
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Affiliation(s)
- M Mintz
- Department of Psychology, Tel-Aviv University, Israel
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Dorahy MJ, Alan Lewis C. Trauma-induced dissociation and the psychological effects of the “Troubles” in Northern Ireland: An overview and integration. ACTA ACUST UNITED AC 1998. [DOI: 10.1080/03033910.1998.10558194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Difede J, Apfeldorf WJ, Cloitre M, Spielman LA, Perry SW. Acute psychiatric responses to the explosion at the World Trade Center: a case series. J Nerv Ment Dis 1997; 185:519-22. [PMID: 9284867 DOI: 10.1097/00005053-199708000-00008] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- J Difede
- Department of Psychiatry, New York Hospital-Cornell Medical Center, New York 10021, USA
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Wilson FC, Poola AD, Trew K. Psychological distress in police officers following critical incidents. ACTA ACUST UNITED AC 1997. [DOI: 10.1080/03033910.1997.10558150] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Deering CG, Glover SG, Ready D, Eddleman HC, Alarcon RD. Unique patterns of comorbidity in posttraumatic stress disorder from different sources of trauma. Compr Psychiatry 1996; 37:336-46. [PMID: 8879908 DOI: 10.1016/s0010-440x(96)90015-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
While there are many studies of comorbidity in combat veterans with posttraumatic stress disorder (PTSD), studies of PTSD from other sources of trauma (e.g., disasters, crimes, and civil violence) are just beginning to emerge. This is the first formal review comparing patterns of comorbidity in PTSD from different sources of trauma. Specific attention is given to the relative frequencies of substance abuse, depression, generalized anxiety, phobic, panic, somatization, psychotic, and personality disorders. The findings reveal that although similarities exist, the comorbidity profiles differ according to the type of trauma experienced and the population studied. Additionally, the evidence suggests that the associated psychiatric disorders are not truly comorbid, but are interwoven with the PTSD.
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Affiliation(s)
- C G Deering
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Daly O, Fleming B, Loughrey G. Psychological sequelae to assassination attempts. MEDICINE, SCIENCE, AND THE LAW 1996; 36:25-27. [PMID: 8907853 DOI: 10.1177/002580249603600105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The experiences of nine subjects who were the victims of assassination attempts are described. All but one were the victims of shootings or attempted shootings. Post Traumatic Stress Disorder (PTSD) was an almost invariable response. Brief alcohol abuse was quite common. Most subjects displayed considerable feelings of anger. Only a minority expressed anger against their assailants while much anger was displaced towards the medical profession and institutions of the state. This displacement of anger is discussed as are the implications for treatment of such displacement.
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Affiliation(s)
- O Daly
- Stress Disorders Clinic, Department of Psychiatry, Lagan Valley Hospital, Antrim, Northern Ireland
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Saldanha D, Goel DS, Kapoor S, Garg A, Kochhar HK. POST-TRAUMATIC STRESS DISORDER IN POLY-TRAUMA CASES. Med J Armed Forces India 1996; 52:35-39. [PMID: 28769334 PMCID: PMC5530272 DOI: 10.1016/s0377-1237(17)30832-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Six hundred and one patients, who sustained injuries in militant activities, admitted during a 7 month period to a zonal referral hospital were studied. The majority, 54.6% from the Armed Forces and 38.8% from the para-military forces, were in the age group of 22-53 years. There were 40 (6.7%) civilian casualties. These were in the age group of 20-45 years. A large number (75.7%) of the casualties manifested with post-traumatic stress symptoms. 24.3% of them were rated as post-traumatic stress disorder. Six months follow-up revealed persistence of post-traumatic stress disorder in 17.1% of the cases. By one year, 42.1% who responded to the follow-up letters had persistence of post-traumatic stress disorder in 4.95%. Early recognition of this psychic trauma and preventive strategies are discussed.
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Affiliation(s)
- D Saldanha
- Classified Specialist (Psychiatry), 92 Base Hospital, C/O 56 APO
| | - D S Goel
- Senior Adviser (Psychiatry), Military Hospital, Jodhpur
| | - S Kapoor
- Graded Specialist (Surgery), 92 Base Hospital, C/O 56 APO
| | - A Garg
- Graded Specialist (Surgery), 92 Base Hospital, C/O 56 APO
| | - H K Kochhar
- Classified Specialist (Surgery), 92 Base Hospital, C/O 56 APO
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Abstract
BACKGROUND In March 1987, the P&O car ferry Herald of Free Enterprise capsized killing 193 passengers. Seventy-five survivors and relatives were referred by their solicitors to the authors for assessment of psychological injury. METHOD Information was gathered retrospectively and systematically from clinical notes and legal reports. RESULTS The commonest symptoms suffered were sleep disturbance, loss of concentration and increased anger. The commonest diagnoses were post-traumatic stress disorder, other anxiety states and depression. Depressive symptoms were commoner in those who had been bereaved, anxiety symptoms were commoner in those who had not. Reluctance to discuss symptoms and to attend a psychiatric clinic was a common feature. CONCLUSIONS As expected, bereavement led to grief and depressive symptoms, whilst passengers who were not bereaved were more likely to suffer anxiety symptoms. Contrary to expectations, the degree of immersion during the accident did not influence the type or degree of symptoms. Those with worse symptoms were more likely to attend the clinic. Women showed more affective symptoms and men more substance abuse.
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Cairns E, Wilson R, Gallagher T, Trew K. Psychology's contribution to understanding conflict in Northern Ireland. ACTA ACUST UNITED AC 1995. [DOI: 10.1207/s15327949pac0102_3] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Malt UF, Karlehagen S, Hoff H, Herrstromer U, Hildingson K, Tibell E, Leymann H. The effect of major railway accidents on the psychological health of train drivers--I. Acute psychological responses to accident. J Psychosom Res 1993; 37:793-805. [PMID: 8301620 DOI: 10.1016/0022-3999(93)90169-g] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The acute psychological reactions of 101 train drivers to on-the-track accidents were studied by means of clinical interviews and questionnaires (Impact of Event Scale, GHQ-20 and a questionnaire addressing stress symptoms, pre-accident expectancies and worries). More than half of the train drivers reported moderate to high intrusive distress (mean 11.3) within hours to days after the accident but only 1/3 reported symptoms of acute psychophysiological arousal. Intrusive symptoms related to visual impressions were most frequently reported. Avoidance was less prevalent (mean 8.8). Clinical interviews, relationship between pre-accident worries and severity of the acute responses and positive correlation between GHQ-scores relating to the fortnight preceding the accident and IES-intrusion scores, suggest that premorbid variables may influence the stress response. Involvement in more than two previous accidents invoked a feeling of vulnerability and produced stronger acute responses. Post-accident experiences involving various personal contacts did not correlate with the stress responses in this study and only a few drivers experienced such events in a negative way. Denial of the possibility of being involved in accidents was not associated with increased risk of strong acute responses, indicating that denial does not predict poor outcome in healthy persons exposed to situations where possibility of avoiding the event is outside the control of the person.
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Affiliation(s)
- U F Malt
- Department of Psychosomatic and Behavioural Medicine, University of Oslo, National Hospital, Norway
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Affiliation(s)
- R C Evans
- Department of Accident and Emergency Medicine, Cardiff Royal Infirmary, UK
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O'Brien LS, Hughes SJ. Symptoms of post-traumatic stress disorder in Falklands veterans five years after the conflict. Br J Psychiatry 1991; 159:135-41. [PMID: 1888961 DOI: 10.1192/bjp.159.1.135] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A group of 64 Falklands war veterans who were still serving in the British Army were studied and compared with a group of matched controls. Half the veterans reported some symptoms of post-traumatic stress disorder, and 22% were rated as having the complete PTSD syndrome. Presence of the symptoms was associated with intensity of combat experience and the retrospective report of emotional difficulties in the initial period on return from the war.
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Affiliation(s)
- L S O'Brien
- Department of Psychotherapy, Royal Liverpool Hospital
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Curran PS, Gregg W. Psychiatric aspects of terrorist violence in Northern Ireland (1969 to 1989). Med Leg J 1990; 58 ( Pt 2):83-96. [PMID: 2152146 DOI: 10.1177/002581729005800204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Curran PS, Bell P, Murray A, Loughrey G, Roddy R, Rocke LG. Psychological consequences of the Enniskillen bombing. Br J Psychiatry 1990; 156:479-82. [PMID: 2386855 DOI: 10.1192/bjp.156.4.479] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Eleven people were killed and 60 injured in the Enniskillen bombing of November 1987. Survivors were psychologically appraised six months and one year later. At six months 50% had developed post-traumatic stress disorder (PTSD). This group comprised more females than males. However, all victims had high scores on the GHQ. We found no correlation between psychological injury (as measured by the GHQ) and physical injury (as measured by the ISS), calling into question previous assertions.
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Abstract
AbstractSome problems related to the formal diagnosis of Post-Traumatic Stress Disorder (PTSD) and the social implications of the concepts incorporated in the diagnosis are addressed. Increasing worldwide evidence of the circumstances likely to produce a PTSD and of patients of all ages and races satisfying the criteria for the diagnosis suggests a problem of epidemic proportions requiring intensive study.
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A guide to the literature on aggressive behavior. Aggress Behav 1989. [DOI: 10.1002/1098-2337(1989)15:2<183::aid-ab2480150207>3.0.co;2-g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Differences between natural and man-made disaster are described, deleterious psychological effects of technological components catastrophe appearing to be longer lasting. The psychological components of the experience of survival are outlined, and the concept of post-traumatic stress disorder located within this. Bereavement reactions, complicated by enhancement of the factors accompanying sudden, violent death, are also described, and risk factors noted. Finally, the development of community-based preventative mental health programmes which are acceptable to victims are detailed, emphasising restoration of the victims' sense of control over their own lives and the value of self-help. The role of counselling and specialist treatment is placed in this context.
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