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Bolaséll LT, Abadi AM, Brunnet AE, Kristensen CH, Eisma MC. Correlates of prolonged grief, posttraumatic stress and depression symptoms in Brazilian COVID-19 bereaved adults. DEATH STUDIES 2024:1-10. [PMID: 39067005 DOI: 10.1080/07481187.2024.2381775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
The Coronavirus pandemic has hit Brazil exceptionally hard, with more than 700.000 confirmed deaths due to COVID-19, corresponding to an estimated 6.3 million bereaved people. Yet, the mental health consequences among COVID-19 bereaved Brazilians, and the associated loss-related variables have been largely unexplored. Therefore, we aimed to clarify the associations of loss-related characteristics and circumstances with prolonged grief, posttraumatic stress, and depression symptoms experienced by COVID-19-bereaved Brazilian adults. A sample of 371 Brazilian COVID-19 bereaved adults (90% women) completed an online survey. The loss of a partner or first-degree relative, a positive assessment of the healthcare received by the deceased, and the perceived helpfulness of hospital visits in the grief process significantly correlated with prolonged grief and posttraumatic stress symptoms. The findings suggest that farewell ceremonies and positive hospital care experiences may mitigate distress among COVID-19-bereaved Brazilian adults.
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Affiliation(s)
- Laura T Bolaséll
- Centre for Studies and Research in Traumatic Stress (NEPTE), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alice M Abadi
- Centre for Studies and Research in Traumatic Stress (NEPTE), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alice E Brunnet
- CLIPSYD, Department of Psychology, Université Paris-Nanterre, Nanterre, France
| | - Christian H Kristensen
- Centre for Studies and Research in Traumatic Stress (NEPTE), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
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de Souza Junior S, Monteiro Fabricio Gama C, Menezes Gonçalves R, Lorrany Campos Guerra T, Volchan E, Erthal FS, Mocaiber I, de Paula Antunes David I, Catarina Lima Portugal L, Mendlowicz MV, Berger W, de Oliveira L, Garcia Pereira M. Tonic immobility triggered by COVID-19-related trauma is associated with long-term PTSD symptoms. J Anxiety Disord 2024; 105:102894. [PMID: 38959538 DOI: 10.1016/j.janxdis.2024.102894] [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: 12/14/2023] [Revised: 05/01/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024]
Abstract
During the COVID-19 pandemic healthcare workers were repeatedly exposed to traumatic experiences. Facing life-threatening events and repeated exposure to traumatic duty-related situations may cause posttraumatic stress disorder (PTSD). While tonic immobility has been considered a key vulnerability factor for PTSD, little is known about this relationship in the long term. In this study, we aimed to determine whether peritraumatic tonic immobility triggered by COVID-19-related trauma predicts PTSD symptom severity six to twelve months later. We conducted an online longitudinal survey using the PTSD Checklist for the DSM-5 (PCL-5) and the Tonic Immobility Scale to assess PTSD symptoms and the tonic immobility response, respectively. Multivariate regression models revealed a significant association between tonic immobility and PTSD symptoms. Each one-unit increase in the tonic immobility score was associated with a 1.5 % increase in the average PTSD symptom score six to twelve months after the traumatic event that triggered the tonic immobility. Furthermore, participants who showed significant or extreme levels of tonic immobility were 3.5 times or 7.3 times more likely to have a probable PTSD diagnosis, respectively. Hence, peritraumatic tonic immobility seems to have a lasting deleterious effect on mental health. Psychological treatment for health care professionals is urgent, and psychoeducation about the involuntary, biological nature of tonic immobility is essential to reduce suffering.
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Affiliation(s)
- Sérgio de Souza Junior
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Camila Monteiro Fabricio Gama
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Raquel Menezes Gonçalves
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Thayssa Lorrany Campos Guerra
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil
| | - Eliane Volchan
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Cidade Universitária, Rio de Janeiro, RJ 21941-902, Brazil; Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, Rio de Janeiro, RJ 22290140, Brazil
| | - Fátima Smith Erthal
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Cidade Universitária, Rio de Janeiro, RJ 21941-902, Brazil; Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, Rio de Janeiro, RJ 22290140, Brazil
| | - Izabela Mocaiber
- Laboratório de Psicofisiologia Cognitiva, Departamento de Ciências da Natureza, Instituto de Humanidades e Saúde, Universidade Federal Fluminense, Rua Recife s/nº, Jardim Bela Vista, Rio das Ostras, RJ 28890-000, Brazil; Programa de pós-graduação em Medicina (Neurologia/Neurociências), Universidade Federal Fluminense, Niterói, Brasil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Isabel de Paula Antunes David
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Liana Catarina Lima Portugal
- Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Centro Biomédico, Universidade do Estado do Rio de Janeiro, Avenida Professor Manuel de Abreu 444, 5º Andar, Vila Isabel, Rio de Janeiro, RJ 20550-170, Brazil
| | - Mauro Vitor Mendlowicz
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, Rio de Janeiro, RJ 22290140, Brazil
| | - William Berger
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, Rio de Janeiro, RJ 22290140, Brazil
| | - Leticia de Oliveira
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil.
| | - Mirtes Garcia Pereira
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de pós-graduação em Medicina (Neurologia/Neurociências), Universidade Federal Fluminense, Niterói, Brasil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil.
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Bolaséll LT, Castro da Cruz Oliveira V, Frimm VC, Menda CC, Maria Rodrigues CS, Kristensen CH. "I Have No Words": A Qualitative Study About the Traumatic Experience of Violent Death. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1136-1152. [PMID: 34911403 DOI: 10.1177/00302228211051532] [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: 11/17/2022]
Abstract
Individuals bereaved by violent death have a higher risk of developing psychopathology. Consistent data concerning the subjective experience during the traumatic event of the death are still scarce. This study aimed to explore the traumatic experience of the violent death of a loved one. Nine reports of patients bereaved by violence were selected and transcribed. Reports were analyzed using Bardin's Content Analysis. Two final categories were generated. It was observed that most participants remembered details about the traumatic event or the time they were told about the violent death. There were two factors described as important when coping with the loss, social support during the traumatic event, and receiving detailed information from the authorities and others present in that moment. This study provides relevant data for future interventions during violent situations by health and security professionals.
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Affiliation(s)
- Laura Teixeira Bolaséll
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Study and Research in Traumatic Stress, PUCRS, Porto Alegre, Brazil
| | - Vitoria Castro da Cruz Oliveira
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Study and Research in Traumatic Stress, PUCRS, Porto Alegre, Brazil
| | - Vitor Corrêa Frimm
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Study and Research in Traumatic Stress, PUCRS, Porto Alegre, Brazil
| | - Cynthia Castiel Menda
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Study and Research in Traumatic Stress, PUCRS, Porto Alegre, Brazil
| | - Caroline Santa Maria Rodrigues
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Studies in Families and Individuals (CEFI), Porto Alegre, Brazil
| | - Christian Haag Kristensen
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Study and Research in Traumatic Stress, PUCRS, Porto Alegre, Brazil
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Portugal LCL, Ramos TC, Fernandes O, Bastos AF, Campos B, Mendlowicz MV, da Luz M, Portella C, Berger W, Volchan E, David IA, Erthal F, Pereira MG, de Oliveira L. Machine learning applied to fMRI patterns of brain activation in response to mutilation pictures predicts PTSD symptoms. BMC Psychiatry 2023; 23:719. [PMID: 37798693 PMCID: PMC10552290 DOI: 10.1186/s12888-023-05220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The present study aimed to apply multivariate pattern recognition methods to predict posttraumatic stress symptoms from whole-brain activation patterns during two contexts where the aversiveness of unpleasant pictures was manipulated by the presence or absence of safety cues. METHODS Trauma-exposed participants were presented with neutral and mutilation pictures during functional magnetic resonance imaging (fMRI) collection. Before the presentation of pictures, a text informed the subjects that the pictures were fictitious ("safe context") or real-life scenes ("real context"). We trained machine learning regression models (Gaussian process regression (GPR)) to predict PTSD symptoms in real and safe contexts. RESULTS The GPR model could predict PTSD symptoms from brain responses to mutilation pictures in the real context but not in the safe context. The brain regions with the highest contribution to the model were the occipito-parietal regions, including the superior parietal gyrus, inferior parietal gyrus, and supramarginal gyrus. Additional analysis showed that GPR regression models accurately predicted clusters of PTSD symptoms, nominal intrusion, avoidance, and alterations in cognition. As expected, we obtained very similar results as those obtained in a model predicting PTSD total symptoms. CONCLUSION This study is the first to show that machine learning applied to fMRI data collected in an aversive context can predict not only PTSD total symptoms but also clusters of PTSD symptoms in a more aversive context. Furthermore, this approach was able to identify potential biomarkers for PTSD, especially in occipitoparietal regions.
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Affiliation(s)
- Liana Catarina Lima Portugal
- Neurophysiology Laboratory, Department of Physiological Sciences, Roberto Alcantara Gomes Biology Institute, Biomedical Center, Universidade do Estado do Rio de Janeiro, Boulevard 28 de Setembro, 87 - Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil
| | - Taiane Coelho Ramos
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil
- Mídiacom Lab, Institute of Computing, Universidade Federal Fluminense, Av. Gal. Milton Tavares de Souza, s/n, São Domingos, Niterói, RJ, 24210-310, Brazil
| | - Orlando Fernandes
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil
| | - Aline Furtado Bastos
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, 373 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Bruna Campos
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, 373 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Mauro Vitor Mendlowicz
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Mariana da Luz
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Carla Portella
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - William Berger
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Eliane Volchan
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, 373 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Isabel Antunes David
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil
| | - Fátima Erthal
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, 373 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Mirtes Garcia Pereira
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil
| | - Leticia de Oliveira
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil.
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Hinchey LME, Grasser LR, Saad B, Gorski K, Pernice F, Javanbakht A. The Predictive Utility of Trauma Subtypes in the Assessment of Mental Health Outcomes for Persons Resettled as Refugees. J Immigr Minor Health 2023; 25:274-281. [PMID: 36260186 PMCID: PMC9991939 DOI: 10.1007/s10903-022-01407-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/24/2022]
Abstract
Pre-migration trauma, a psychological risk factor for refugees, is often measured using cumulative indices. However, recent research suggests that trauma subtypes, rather than cumulative trauma, may better predict psychological outcomes. This study investigated the predictive utility of trauma subtypes in the assessment of refugee mental health. Multiple regression was used to determine whether cumulative trauma or trauma subtypes explained more variance in depression, anxiety, and post-traumatic stress disorder (PTSD) symptom scores in 70 Syrian and Iraqi refugees. Subtype models performed better than cumulative trauma models for PTSD (cumulative R2 = 0.138; subtype R2 = 0.32), anxiety (cumulative R2 = 0.061; subtype R2 = 0.246), and depression (cumulative R2 = 0.041; subtype R2 = 0.184). Victimization was the only subtype significantly associated with PTSD (p < 0.001; r2 = 0.210), anxiety (p < 0.001; r2 = 0.162), and depression (p = 0.002; r2 = 0.140). Cumulative trauma was predictive of PTSD symptoms only (p = 0.003; r2 = 0.125). Trauma subtypes were more informative than cumulative trauma, indicating their utility for improving predictive efforts in research and clinical contexts.
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Affiliation(s)
- Liza Marie-Emilie Hinchey
- Department of Theoretical and Behavioral Foundations, Wayne State University, 5425 Gullen Mall Education Building, Room 351, Detroit, MI, 48202, USA.
| | - Lana Ruvolo Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
| | - Bassem Saad
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
| | - Kathleen Gorski
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
| | - Francesca Pernice
- Department of Theoretical and Behavioral Foundations, Wayne State University, 5425 Gullen Mall Education Building, Room 351, Detroit, MI, 48202, USA
| | - Arash Javanbakht
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
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Zylberstajn C, Messina Coimbra B, Oliveira-Watanabe TT, Rangel Maciel M, Calsavara VF, Olff M, Feijo Mello M, Feijo Mello A. The Relationship between Lifetime Exposure to Potentially Traumatic Events, Peritraumatic Dissociation, and PTSD in a Sample of Sexually Assaulted Women in Sao Paulo, Brazil. J Trauma Dissociation 2023; 24:252-267. [PMID: 36271690 DOI: 10.1080/15299732.2022.2136326] [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] [Indexed: 02/07/2023]
Abstract
Sexually assaulted women represent a particularly high-risk group for developing post-traumatic stress disorder (PTSD). Potentially traumatic events (PTEs) and peritraumatic dissociation (PD) are known risk factors for PTSD. However, little is known about how previous trauma affects PD and how this relationship affects PTSD. We aimed to investigate whether PD acts as a mediator between PTEs and PTSD severity in a sample of recently sexually assaulted women in Sao Paulo, Brazil. Seventy-four sexually assaulted women aged 18-44 completed questionnaires and structured interviews on PTSD, PD, and PTEs. We examined direct and indirect effects of variables using causal mediation analysis. Lifetime exposure to PTEs was a risk factor for PD, but PD was not a risk factor for PTSD symptom severity. Also, PD was not a mediator between PTEs and PTSD severity. We provided recommendations on how to further explore the relationship between lifetime traumatic exposure, PTSD, and peritraumatic dissociation.
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Affiliation(s)
- Cecilia Zylberstajn
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Bruno Messina Coimbra
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Thauana T Oliveira-Watanabe
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Mariana Rangel Maciel
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Vinicius F Calsavara
- Cedars‑Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | - Miranda Olff
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Marcelo Feijo Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea Feijo Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Fernandes O, Marra da Silva R, Rego Ramos L, Gama TM, Lobo I, Guerra Leal Souza G, Arruda Sanchez T. The impact of a violent community on mental health and the benefits of a sport program for social development. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:51-66. [PMID: 35583853 DOI: 10.1002/jcop.22877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
The aim of the present study was to evaluate the impact of a violent environment on mental health and the impact of a sport for social development (SSD) program on quality of life, mental distress symptoms, and heart rate variability (HRV). HRV and psychometric data were measured from 20 men professional athletes assisted by the SSD and 20 men living in the same violent community. The comparison of groups revealed greater sympathetic parameters of HRV, positive affect, and quality of life in the SSD group. Multiple regression analysis showed that the quality of life in the SSD group was positively predicted by positive affect, while in the control group the quality of life was negatively predicted by their history of traumatic events. Both groups reported high levels of exposure to traumatic events and posttraumatic stress symptoms. However, this study demonstrates the benefits of SSD programs in mental health.
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Affiliation(s)
- Orlando Fernandes
- Laboratório de Neuroimagem e Psicofisiologia, Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ruy Marra da Silva
- Laboratório de Neuroimagem e Psicofisiologia, Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-graduação em Cardiologia, Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucas Rego Ramos
- Laboratório de Neuroimagem e Psicofisiologia, Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tamires M Gama
- Laboratório de Neuroimagem e Psicofisiologia, Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabela Lobo
- Grupo de Psicobiologia/Laboratório Integrado de Morfologia, Instituto de Biodiversidade e Sustentabilidade/NUPEM, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
| | - Gabriela Guerra Leal Souza
- Laboratório de Psicofisiologia, Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Tiago Arruda Sanchez
- Laboratório de Neuroimagem e Psicofisiologia, Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-graduação em Cardiologia, Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Beyond fear: Patients with posttraumatic stress disorder fail to engage in safety cues. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Van der Watt ASJ, Dalvie N, Seedat S. Weekly telephone mood monitoring is associated with decreased suicidality and improved sleep quality in a clinical sample. Psychiatry Res 2022; 317:114821. [PMID: 36088835 DOI: 10.1016/j.psychres.2022.114821] [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: 12/14/2021] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 01/04/2023]
Abstract
Sleep disturbances and suicidality are common presentations of mood and anxiety disorders. If not closely monitored post-discharge, patients may be at an increased risk of symptom worsening and completed suicide. We explored the associations between telephone mood monitoring, suicidality, and sleep quality in a clinical sample. Fifty inpatients (mean age = 39.49, SD = 11.17; female = 74%) with a mood and/or anxiety disorder were telephonically monitored weekly post-discharge for16 weeks for depression and mania. Suicidality and sleep quality were assessed at intake (pre-discharge), and at weeks 4, 8, 12, and 16 post-discharge. ANOVA indicated that suicidality significantly decreased, and sleep quality improved over 16 weeks. Linear regression analysis indicated that depression severity at week 1 post-discharge significantly predicted suicidality and sleep quality at week 16. Mania severity at week 1 post-discharge predicted sleep quality, but not suicidality, at week 16. Participants generally had positive experiences of the monitoring and perceived it as helpful. Monitoring of mood state, suicidality, and sleep quality post-discharge may allow for early detection of relapse when initiated at 1-week post-discharge. This is a potentially cost-effective intervention and may relieve the burden on the mental healthcare system, especially when face-to-face consultations are not possible.
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Affiliation(s)
- A S J Van der Watt
- Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa.
| | - N Dalvie
- Department of Psychiatry, Lentegeur Hospital, Cape Town, Western Cape, South Africa
| | - S Seedat
- Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa
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10
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Measurement invariance of six language versions of the post-traumatic stress disorder checklist for DSM-5 in civilians after traumatic brain injury. Sci Rep 2022; 12:16571. [PMID: 36195725 PMCID: PMC9532419 DOI: 10.1038/s41598-022-20170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/09/2022] [Indexed: 11/08/2022] Open
Abstract
Traumatic brain injury (TBI) is frequently associated with neuropsychiatric impairments such as symptoms of post-traumatic stress disorder (PTSD), which can be screened using self-report instruments such as the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). The current study aims to inspect the factorial validity and cross-linguistic equivalence of the PCL-5 in individuals after TBI with differential severity. Data for six language groups (n ≥ 200; Dutch, English, Finnish, Italian, Norwegian, Spanish) were extracted from the CENTER-TBI study database. Factorial validity of PTSD was evaluated using confirmatory factor analyses (CFA), and compared between four concurrent structural models. A multi-group CFA approach was utilized to investigate the measurement invariance (MI) of the PCL-5 across languages. All structural models showed satisfactory goodness-of-fit with small between-model variation. The original DSM-5 model for PTSD provided solid evidence of MI across the language groups. The current study underlines the validity of the clinical DSM-5 conceptualization of PTSD and demonstrates the comparability of PCL-5 symptom scores between language versions in individuals after TBI. Future studies should apply MI methods to other sociodemographic (e.g., age, gender) and injury-related (e.g., TBI severity) characteristics to improve the monitoring and clinical care of individuals suffering from PTSD symptoms after TBI.
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11
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Machado AV, Gonçalves RM, Gama CMF, Vilete LMP, Berger W, Passos RBF, Mendlowicz MV, Souza GGL, Pereira MG, Mocaiber I, de Oliveira L. The different impacts of COVID-19 on the mental health of distinct health care worker categories. J Health Psychol 2022; 28:434-449. [PMID: 36113021 PMCID: PMC10076179 DOI: 10.1177/13591053221120968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The present study sought to explore the factors associated with the odds of having probable depression and posttraumatic stress disorder (PTSD) related to traumatic COVID-19 experiences and their impact on health care workers in distinct categories. In this cross-sectional study, 1843 health care workers (nurses, nurse technicians, physicians, physical therapists, and other healthcare workers) were recruited via convenience sampling. A survey was administered to obtain information regarding sociodemographic, occupational, and mental health status. Descriptive statistics and multivariable logistic regression were used for the analyses. Being a nurse technician was associated with an odds ratio of 1.76 for probable PTSD. No relation was observed between health care worker categories and the odds of probable depression. Additionally, being female and not receiving adequate PPE were related to greater odds of having probable PTSD and depression.
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12
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Calegaro VC, Ramos-Lima LF, Hoffmann MS, Zoratto G, Kerber N, Costa FCD, Picinin VD, Köchler J, Rodrigues L, Maciel L, Braun LE, Girardi FL, Cecatto GO, Weber LP, Rodrigues BF, Bertolazi AN, Oliveira JMD, Negretto BL, Mello AFD. Closed doors: Predictors of stress, anxiety, depression, and PTSD during the onset of COVID-19 pandemic in Brazil. J Affect Disord 2022; 310:441-451. [PMID: 35569607 PMCID: PMC9107931 DOI: 10.1016/j.jad.2022.05.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The rise in mental health problems in the population directly or indirectly because of the coronavirus disease 2019 (COVID-19) pandemic is a major concern. The aim of this study was to investigate and compare independent predictors of symptoms of stress, anxiety, depression, and posttraumatic stress disorder (PTSD) in Brazilians one month after the implementation of measures of social distancing. METHODS This cross-sectional study was performed using a web-based survey. The Depression, Anxiety, and Stress Scale (DASS-21) and PTSD Checklist for DSM-5 (PCL-5) were the outcomes. Data were gathered regarding demographics, social distancing, economic problems, exposure to the news of the pandemic, psychiatric history, sleep disturbances, traumatic situations, and substance use. The Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) was also administered. The predictors of the symptoms were investigated using hierarchical multiple linear regression. RESULTS Of a sample of 3587 participants, approximately two-thirds considered that their mental health worsened after the beginning of the social restriction measures. The most important predictors of the symptoms investigated were the intensity of the distress related to the news of the pandemic, younger age, current psychiatric diagnosis, trouble sleeping, emotional abuse or violence, and economic problems. CONCLUSIONS These results confirmed the hypothesis that the pandemic impacted the mental health of the population and indicated that the level of distress related to the news was the most important predictor of psychological suffering.
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Affiliation(s)
- Vitor Crestani Calegaro
- Department of Neuropsychiatry, Federal University of Santa Maria, Santa Maria, Brazil; Educational Actions Coordination, Federal University of Santa Maria, Santa Maria, Brazil; University Hospital of Santa Maria, Santa Maria, Brazil; Postgraduate Program in Psychiatry and Medical Psychology, Federal University of São Paulo, São Paulo, Brazil.
| | | | - Mauricio Scopel Hoffmann
- Department of Neuropsychiatry, Federal University of Santa Maria, Santa Maria, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil; Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Gustavo Zoratto
- Course of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| | - Natália Kerber
- Course of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| | | | | | - Julia Köchler
- Course of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| | - Leonardo Rodrigues
- Course of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| | - Luisa Maciel
- Course of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| | | | | | | | | | | | - Alessandra Naimaier Bertolazi
- University Hospital of Santa Maria, Santa Maria, Brazil; Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Medical Clinic, Federal University of Santa Maria
| | | | | | - Andrea Feijó de Mello
- Postgraduate Program in Psychiatry and Medical Psychology, Federal University of São Paulo, São Paulo, Brazil; Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
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Gama CMF, de Souza Junior S, Gonçalves RM, Santos EDC, Machado AV, Portugal LCL, Passos RBF, Erthal FS, Vilete LMP, Mendlowicz MV, Berger W, Volchan E, de Oliveira L, Pereira MG. Tonic immobility is associated with posttraumatic stress symptoms in healthcare professionals exposed to COVID-19-related trauma. J Anxiety Disord 2022; 90:102604. [PMID: 35917747 PMCID: PMC9272678 DOI: 10.1016/j.janxdis.2022.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has exposed healthcare workers (HCW) to traumatic situations that might lead to the development of posttraumatic stress disorder (PTSD). An important vulnerability factor for PTSD is the peritraumatic tonic immobility (TI) reaction, an involuntary and reflexive defensive response evoked by an intense and inescapable threat. TI is largely understudied in humans and has not been investigated during trauma related to COVID-19. For HCW, the pandemic context might be experienced as an intense and potentially inescapable threat, i.e., an overwhelming situation. Here, we investigated if TI response occurred during traumatic events related to the pandemic and its association with posttraumatic stress symptoms (PTSS). An online survey of 1001 HCW investigated COVID-19-related traumatic experiences, TI and PTSS. TI was reported for all types of traumatic events, and multivariate regression models revealed that TI was significantly associated with PTSS severity. HCW who reported high TI scores exhibited an increase of 9.08 times the probability of having a probable diagnosis of PTSD. Thus, TI was evoked by pandemic-related traumatic situations and associated with PTSS severity and higher odds of a PTSD diagnosis. Tonic immobility occurrence should be screened, and psychoeducation about its reflexive biological nature should be introduced.
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Affiliation(s)
- Camila Monteiro Fabricio Gama
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Sérgio de Souza Junior
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Raquel Menezes Gonçalves
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Emmanuele da Conceição Santos
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Arthur Viana Machado
- Laboratório de Psicofisiologia Cognitiva, de Ciencias da NaturezaDepartamento de Ciências da Natureza, Instituto de Humanidades e Saúde, Universidade Federal Fluminense, Rua Recife s/no Jardim Bela Vista, 28890-000 Rio das Ostras, RJ, Brazil.
| | - Liana Catarina Lima Portugal
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil; Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Centro Biomédico, Universidade do Estado do Rio de Janeiro, Avenida Professor Manuel de Abreu 444, 5º andar, Vila Isabel, 20550-170 Rio de Janeiro, RJ, Brazil.
| | - Roberta Benitez Freitas Passos
- Departamento de Medicina Geral, Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro, Rua Mariz e Barros 775, 7a. enfermaria, Maracanã, 20270-004 Rio de Janeiro, RJ, Brazil.
| | - Fátima Smith Erthal
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Bloco G, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Ilha do Fundão 21949-900, RJ, Brazil.
| | - Liliane Maria Pereira Vilete
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil; Instituto de Psiquiatria da UFRJ, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil.
| | - Mauro Vitor Mendlowicz
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil; Departamento de Psiquiatria e Saúde Mental, Universidade Federal Fluminense, Avenida Marquês de Paraná, 303, prédio anexo, 3º andar, Centro, 24030-215 Niteroi, RJ, Brazil.
| | - William Berger
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil.
| | - Eliane Volchan
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Bloco G, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Ilha do Fundão 21949-900, RJ, Brazil.
| | - Leticia de Oliveira
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Mirtes Garcia Pereira
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
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14
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Leite L, Esper NB, Junior JRML, Lara DR, Buchweitz A. An exploratory study of resting-state functional connectivity of amygdala subregions in posttraumatic stress disorder following trauma in adulthood. Sci Rep 2022; 12:9558. [PMID: 35688847 PMCID: PMC9187646 DOI: 10.1038/s41598-022-13395-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/03/2022] [Indexed: 11/09/2022] Open
Abstract
We carried out an exploratory study aimed at identifying differences in resting-state functional connectivity for the amygdala and its subregions, right and left basolateral, centromedial and superficial nuclei, in patients with Posttraumatic Stress Disorder (PTSD), relative to controls. The study included 10 participants with PTSD following trauma in adulthood (9 females), and 10 controls (9 females). The results suggest PTSD was associated with a decreased (negative) functional connectivity between the superficial amygdala and posterior brain regions relative to controls. The differences were observed between right superficial amygdala and right fusiform gyrus, and between left superficial amygdala and left lingual and left middle occipital gyri. The results suggest that among PTSD patients, the worse the PTSD symptoms, the lower the connectivity. The results corroborate the fMRI literature that shows PTSD is associated with weaker amygdala functional connectivity with areas of the brain involved in sensory and perceptual processes. The results also suggest that though the patients traumatic experience occured in adulthood, the presence of early traumatic experiences were associated with negative connectivity between the centromedial amygdala and sensory and perceptual regions. We argue that the understanding of the mechanisms of PTSD symptoms, its behaviors and the effects on quality of life of patients may benefit from the investigation of brain function that underpins sensory and perceptual symptoms associated with the disorder.
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Affiliation(s)
- Leticia Leite
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, 90619-900, Brazil.
| | - Nathalia Bianchini Esper
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, 90619-900, Brazil
- Brain Institute (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, 90610-000, Brazil
| | - José Roberto M Lopes Junior
- School of Psychology and Health, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, 90050-170, Brazil
| | | | - Augusto Buchweitz
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, 90619-900, Brazil.
- Brain Institute (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, 90610-000, Brazil.
- Department of Psychology, University of Connecticut, Stamford, 06269-1020, United States of America.
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15
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Identifying posttraumatic stress disorder staging from clinical and sociodemographic features: a proof-of-concept study using a machine learning approach. Psychiatry Res 2022; 311:114489. [PMID: 35276574 DOI: 10.1016/j.psychres.2022.114489] [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: 01/12/2022] [Revised: 02/16/2022] [Accepted: 02/26/2022] [Indexed: 11/23/2022]
Abstract
This proof-of-concept study aimed to investigate the viability of a predictive model to support posttraumatic stress disorder (PTSD) staging. We performed a naturalistic, cross-sectional study at two Brazilian centers: the Psychological Trauma Research and Treatment (NET-Trauma) Program at Universidade Federal of Rio Grande do Sul, and the Program for Research and Care on Violence and PTSD (PROVE), at Universidade Federal of São Paulo. Five supervised machine-learning algorithms were tested: Elastic Net, Gradient Boosting Machine, Random Forest, Support Vector Machine, and C5.0, using clinical (Clinician-Administered PTSD Scale version 5) and sociodemographic features. A hundred and twelve patients were enrolled (61 from NET-Trauma and 51 from PROVE). We found a model with four classes suitable for the PTSD staging, with best performance metrics using the C5.0 algorithm to CAPS-5 15-items plus sociodemographic features, with an accuracy of 65.6% for the train dataset and 52.9% for the test dataset (both significant). The number of symptoms, CAPS-5 total score, global severity score, and presence of current/previous trauma events appear as main features to predict PTSD staging. This is the first study to evaluate staging in PTSD with machine learning algorithms using accessible clinical and sociodemographic features, which may be used in future research.
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16
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Kwobah EK, Misra S, Ametaj AA, Stevenson A, Stroud RE, Koenen KC, Gelaye B, Kariuki SM, Newton CR, Atwoli L. Traumatic experiences assessed with the life events checklist for Kenyan adults. J Affect Disord 2022; 303:161-167. [PMID: 35167925 PMCID: PMC7612412 DOI: 10.1016/j.jad.2022.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/23/2021] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Life Events Checklist (LEC-5) has been widely used to assess for exposure to potentially traumatic life events (PTEs), but its psychometric properties have not been evaluated in Kenya. The objectives of this study were to determine the frequency and types of PTEs within this setting and to examine the construct validity of LEC-5 in Kenya. METHODS The LEC-5 was administered to 5316 participants in the ongoing multisite case-control study of Neuropsychiatric Genetics of African Populations-Psychosis. We used exploratory factor analysis to assess LEC-5 structure, and conducted confirmatory factor analyses to compare these results with two other models: a six-factor model based on the only prior EFA of the LEC and a theoretical seven-factor model. RESULTS The majority (63.4% overall and 64.4% of cases and 62.4% of controls) of participants had experienced at least one PTE in their lifetime. Results of the exploratory factor analyses for LEC-5 yielded a seven-factor solution with eigenvalues greater than one, accounting for 55.3% of the common variance. Based on confirmatory factor analyses, all three models had good fit for our sample, but the theoretical seven-factor model had the best fit. LIMITATIONS The study did not assess if the participants perceived experiences as traumatic, we did not carry out test retest reliability or and we did not consider cultural variations in perception of trauma. CONCLUSION This study provides evidence of a high prevalence of traumatic life events and for the construct validity of LEC-5 in assessing PTE exposures in a Kenyan setting.
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Affiliation(s)
- Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya.
| | - Supriya Misra
- Department of Public Health, San Francisco State University, San Francisco, CA, USA
| | - Amantia A Ametaj
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Anne Stevenson
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Rocky E Stroud
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Symon M Kariuki
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya; Department of Public Health, Pwani University, Kilifi, Kenya; Department of Psychiatry, University of Oxford, United Kingdom
| | - Charles R Newton
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya; Department of Public Health, Pwani University, Kilifi, Kenya; Department of Psychiatry, University of Oxford, United Kingdom
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya; Brain and Mind Institute and Medical College East Africa, Aga Khan University Nairobi, Kenya
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Patel AR, Newman E, Richardson J. A pilot study adapting and validating the Harvard Trauma Questionnaire (HTQ) and PTSD checklist-5 (PCL-5) with Indian women from slums reporting gender-based violence. BMC Womens Health 2022; 22:22. [PMID: 35090450 PMCID: PMC8795349 DOI: 10.1186/s12905-022-01595-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/04/2022] [Indexed: 01/07/2023] Open
Abstract
Background Despite high rates of gender-based violence (GBV) in India, culturally sensitive measures that examine universal and culturally relevant trauma reactions are lacking. Although the Harvard Trauma Questionnaire (HTQ) has been used in India, no study has adapted the measure in full for use with this population. Similarly, the PTSD checklist-5 (PCL-5) has not yet been validated in India. This study describes the adaptation, validation, and results from the adapted HTQ, and embedded PCL-5, for Indian women from slums reporting GBV. Method This study used the adaptation framework proposed by the HTQ measure developers. The adapted HTQ contained a (1) trauma screen relevant for stressors faced by Indian women from slums, (2) description of the index trauma, (3) description of any ongoing stressors, (4) universal trauma reactions (i.e., PTSD measured by the PCL-5), and culturally relevant trauma reactions (i.e., idioms of distress measured by a scale developed for the study). This measure was piloted on 111 women from Indian slums in face-to-face interviews. Trauma characteristics, types of ongoing stressors, and psychometric properties of the PCL-5 and idioms of distress scale were explored. These scales were validated against measures of depression (PHQ-9), anxiety (GAD-7), and somatic complaints (PHQ-15). Results The majority of participants (77%) reported physical beatings, 18% reported unwanted sexual touch, and 28.8% reported infidelity as the primary emotional abuse. Further, 96.7% of GBV was perpetrated by partner or family member and over half reported ongoing stressors (e.g., poverty-related strain). The PCL-5 embedded in the HTQ yielded good internal consistency (Cronbach’s alpha = .88) as did the idioms of distress scale with deletion of one item (Cronbach’s alpha = .80). Both scales were externally valid, yielding large correlations with depression, anxiety, and somatic complaints (rs between .54 and .80, ps < .05). Discussion This is the first study to develop a comprehensive measure of trauma exposure with universal and culturally relevant trauma reactions in India. This study also enhances HTQ usage in India by delineating all the steps in the adaptation process. Results can inform the development of trauma-focused interventions for Indian women from slums. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01595-3.
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Affiliation(s)
- Anushka R Patel
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA. .,Department of Psychiatry and Behavioral Sciences, Trauma Recovery Center, University of California San Francisco, 2727 Mariposa St, San Francisco, CA, 94110, USA.
| | - Elana Newman
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA
| | - Julia Richardson
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA
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Proença CR, Markowitz JC, Coimbra BM, Cogo-Moreira H, Maciel MR, Mello AF, Mello MF. Interpersonal psychotherapy versus sertraline for women with posttraumatic stress disorder following recent sexual assault: a randomized clinical trial. Eur J Psychotraumatol 2022; 13:2127474. [PMID: 36267873 PMCID: PMC9578463 DOI: 10.1080/20008066.2022.2127474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Sexual assault often triggers posttraumatic stress disorder (PTSD), a potentially chronic severe mental disorder. Most guidelines recommend selective serotonin reuptake inhibitors (SSRIs) and trauma-focused psychotherapies as treatment options. Interpersonal Psychotherapy (IPT), adapted for PTSD (IPT-PTSD), focuses on interpersonal consequences of trauma rather than confronting the trauma itself. Studies have found IPT-PTSD efficaciously reduced PTSD symptoms with limited attrition. No efficacy trials have compared IPT-PTSD and SSRI. We hypothesized IPT would reduce PTSD, anxiety, and depressive symptoms more than sertraline among women with PTSD following a recent sexual assault. Objectives: To compare the efficacy of IPT-PTSD to SSRI sertraline in a 14-week randomized clinical trial for women with PTSD following a recent sexual assault. Methods: Seventy-four women with PTSD who had suffered sexual assault in the last six months were randomly assigned to 14 weeks of IPT-PTSD (n = 39) or sertraline (n = 35). Instruments assessed PTSD, anxiety, and depressive symptoms. This randomized clinical trial was conducted in São Paulo, Brazil, using the Clinician-Administered PTSD Scale-5 (CAPS-5) as the primary outcome measure. Results: Both treatments significantly reduced PTSD, anxiety, and depressive symptoms, without between-group outcome differences. CAPS-5 mean decreased from 42.5 (SD = 9.4) to 27.1 (SD = 15.9) with sertraline and from 42.6 (SD = 9.1) to 29.1 (SD = 15.5) with IPT-PTSD. Attrition was high in both arms (p = .40). Conclusions: This trial showed within-group improvements without differences between IPT-PTSD and sertraline treatment of PTSD. Our findings suggest that non-exposure-based psychotherapies may benefit patients with PTSD, although we did not directly compare these treatments to an exposure therapy. Brazilian Clinical Trials Registry RBR-3z474z.
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Affiliation(s)
- Cecília R Proença
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - John C Markowitz
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Bruno M Coimbra
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Hugo Cogo-Moreira
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
| | - Mariana R Maciel
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea F Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo F Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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19
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Oliveira RD, Mendlowicz MV, Berger W, Luz MPD, Marques-Portella C, Figueira I, Araújo AXGD. Unnecessarily prolonged suffering: a case of missed diagnosis of post-traumatic stress disorder in a teaching hospital. JORNAL BRASILEIRO DE PSIQUIATRIA 2021. [DOI: 10.1590/0047-2085000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT We described a case in which a heavily-traumatized patient had been under psychiatric treatment for seven years (five of them in a university mental health clinic) but was never diagnosed with PTSD and, therefore, did not receive the proper treatment for a very long period. After the correct diagnosis was made and personalized treatment instituted, the patient has shown marked improvement in functionality and wellbeing. The key element in this case, was the adequacy of psychiatric training. Our report suggests that psychiatrists are not being adequately trained to identify traumatic events and to diagnose atypical cases of PTSD. With that in mind, we emphasize that theoretical modules on trauma and trauma-related disorders and practical training in specialized PTSD clinics should be incorporated into the psychiatric residency training programs wherever they may be missing, particularly in countries most impacted by violence. Furthermore, continuing medical education on trauma and PTSD should be provided by medical associations and journals to keep physicians updated on recent progress in the field.
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20
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Bolaséll LT, da Cruz Oliveira VC, Kristensen CH. The Effects of Exposure to Factors Related to Death in Mental Health. JOURNAL OF LOSS & TRAUMA 2021. [DOI: 10.1080/15325024.2021.1959854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Laura Teixeira Bolaséll
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul PUCRS, Porto Alegre, Brazil
| | | | - Christian Haag Kristensen
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul PUCRS, Porto Alegre, Brazil
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21
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Gama CMF, Portugal LCL, Gonçalves RM, de Souza Junior S, Vilete LMP, Mendlowicz MV, Figueira I, Volchan E, David IA, de Oliveira L, Pereira MG. The invisible scars of emotional abuse: a common and highly harmful form of childhood maltreatment. BMC Psychiatry 2021; 21:156. [PMID: 33731084 PMCID: PMC7968325 DOI: 10.1186/s12888-021-03134-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/12/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Childhood maltreatment (CM) is unfortunately widespread globally and has been linked with an increased risk of a variety of psychiatric disorders in adults, including posttraumatic stress disorder (PTSD). These associations are well established in the literature for some maltreatment forms, such as sexual and physical abuse. However, the effects of emotional maltreatment are much less explored, even though this type figures among the most common forms of childhood maltreatment. Thus, the present study aims to investigate the impact of each type of childhood maltreatment, both individually and conjointly, on revictimization and PTSD symptom severity using a nonclinical college student sample. METHODS Five hundred and two graduate and undergraduate students participated in the study by completing questionnaires assessing lifetime traumatic experiences in general, maltreatment during childhood and PTSD symptoms. Bivariate and multivariate negative binomial regressions were applied to examine the associations among childhood maltreatment, revictimization, and PTSD symptom severity. RESULTS Our results showed that using bivariate models, all types of CM were significantly associated with revictimization and PTSD symptom severity. Multivariate models showed that emotional abuse was the type of maltreatment associated with the highest incidence rates of revictimization and PTSD symptom severity. CONCLUSIONS These data provide additional evidence of the harmful effects of childhood maltreatment and its long-term consequences for individuals' mental health. Notably, the findings highlight the importance of studying the impacts of emotional abuse, which seems to be a highly prevalent, understudied, and chronic form of maltreatment that is as toxic as other maltreatment forms.
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Affiliation(s)
- Camila Monteiro Fabricio Gama
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Liana Catarina Lima Portugal
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Raquel Menezes Gonçalves
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Sérgio de Souza Junior
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Liliane Maria Pereira Vilete
- Laboratório Integrado de Pesquisa em Estresse, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Av Venceslau Bras 71, Rio de Janeiro, 22290-140, Brazil
| | - Mauro Vitor Mendlowicz
- Laboratório Integrado de Pesquisa em Estresse, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Av Venceslau Bras 71, Rio de Janeiro, 22290-140, Brazil
- Departamento de Psiquiatria e Saúde Mental, Universidade Federal Fluminense, Niterói, Brazil
| | - Ivan Figueira
- Laboratório Integrado de Pesquisa em Estresse, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Av Venceslau Bras 71, Rio de Janeiro, 22290-140, Brazil
| | - Eliane Volchan
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Rio de Janeiro, 21941-902, Brazil
| | - Isabel Antunes David
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Leticia de Oliveira
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Mirtes Garcia Pereira
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil.
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22
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Oliveira-Watanabe TT, Ramos-Lima LF, Zylberstajn C, Calsavara V, Coimbra BM, Maciel MR, Freitas LHM, Mello MF, Mello AF. Validation of the Brazilian-Portuguese Version of the Clinician Administered Post Traumatic Stress Disorder Scale-5. Front Psychiatry 2021; 12:614735. [PMID: 34239457 PMCID: PMC8257951 DOI: 10.3389/fpsyt.2021.614735] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of this study was to validate CAPS-5 for the Brazilian-Portuguese language on a sample of 128 individuals from two centers (from the cities of São Paulo and Porto Alegre) who have been recently exposed to a traumatic event. Methods: We performed a reliability analysis between interviewers (with a subset of 32 individuals), an internal consistency analysis, and a confirmatory factorial analysis for the validation study. Results: The inter-rater reliability of the total PTSD symptom severity score was high [intraclass correlation coefficient =0.994, 95% CI (0.987-0.997), p < 0.001]. Cohen's Kappa for individual items ranged between 0.759 and 1. Cronbach's alpha coefficients indicated high internal consistency for the CAPS-5 full scale (α = 0.826) and an acceptable level of internal consistency for the four symptom clusters. The confirmatory factorial analysis for the 20-item original CAPS-5 did not fit the data well. A 15-item model with better results was then established by excluding the following CAPS-5 items: dissociative amnesia, recklessness, distorted cognitions, irritability, and hypervigilance. Conclusion: Despite the limitation of the predominance of female victims, and the high number of sexually assaulted women in our sample, the model with only 15 items provided a good fit to the data with high internal consistency (α = 0.835).
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Affiliation(s)
- Thauana Torres Oliveira-Watanabe
- Post-Graduate Program in Medical Psychology and Psychiatry, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Program for Research and Care on Violence (PROVE) and Post Traumatic Stress Disorder, Federal University of São Paulo, São Paulo, Brazil
| | - Luis Francisco Ramos-Lima
- Psychological Trauma Research and Treatment Program, Post Traumatic Stress Disorder, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Cecilia Zylberstajn
- Post-Graduate Program in Medical Psychology and Psychiatry, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Program for Research and Care on Violence (PROVE) and Post Traumatic Stress Disorder, Federal University of São Paulo, São Paulo, Brazil
| | - Vinicius Calsavara
- Program for Research and Care on Violence (PROVE) and Post Traumatic Stress Disorder, Federal University of São Paulo, São Paulo, Brazil
| | - Bruno Messina Coimbra
- Post-Graduate Program in Medical Psychology and Psychiatry, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Program for Research and Care on Violence (PROVE) and Post Traumatic Stress Disorder, Federal University of São Paulo, São Paulo, Brazil
| | - Mariana Rangel Maciel
- Post-Graduate Program in Medical Psychology and Psychiatry, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Program for Research and Care on Violence (PROVE) and Post Traumatic Stress Disorder, Federal University of São Paulo, São Paulo, Brazil
| | - Lucia Helena Machado Freitas
- Psychological Trauma Research and Treatment Program, Post Traumatic Stress Disorder, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil.,Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande Do Sul, Porto Alegre, Brazil
| | - Marcelo Feijo Mello
- Post-Graduate Program in Medical Psychology and Psychiatry, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Program for Research and Care on Violence (PROVE) and Post Traumatic Stress Disorder, Federal University of São Paulo, São Paulo, Brazil
| | - Andrea Feijo Mello
- Post-Graduate Program in Medical Psychology and Psychiatry, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Program for Research and Care on Violence (PROVE) and Post Traumatic Stress Disorder, Federal University of São Paulo, São Paulo, Brazil
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23
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Portugal LCL, Gama CMF, Gonçalves RM, Mendlowicz MV, Erthal FS, Mocaiber I, Tsirlis K, Volchan E, David IA, Pereira MG, de Oliveira L. Vulnerability and Protective Factors for PTSD and Depression Symptoms Among Healthcare Workers During COVID-19: A Machine Learning Approach. Front Psychiatry 2021; 12:752870. [PMID: 35095589 PMCID: PMC8790177 DOI: 10.3389/fpsyt.2021.752870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/08/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Healthcare workers are at high risk for developing mental health problems during the COVID-19 pandemic. There is an urgent need to identify vulnerability and protective factors related to the severity of psychiatric symptoms among healthcare workers to implement targeted prevention and intervention programs to reduce the mental health burden worldwide during COVID-19. Objective: The present study aimed to apply a machine learning approach to predict depression and PTSD symptoms based on psychometric questions that assessed: (1) the level of stress due to being isolated from one's family; (2) professional recognition before and during the pandemic; and (3) altruistic acceptance of risk during the COVID-19 pandemic among healthcare workers. Methods: A total of 437 healthcare workers who experienced some level of isolation at the time of the pandemic participated in the study. Data were collected using a web survey conducted between June 12, 2020, and September 19, 2020. We trained two regression models to predict PTSD and depression symptoms. Pattern regression analyses consisted of a linear epsilon-insensitive support vector machine (ε-SVM). Predicted and actual clinical scores were compared using Pearson's correlation coefficient (r), the coefficient of determination (r2), and the normalized mean squared error (NMSE) to evaluate the model performance. A permutation test was applied to estimate significance levels. Results: Results were significant using two different cross-validation strategies to significantly decode both PTSD and depression symptoms. For all of the models, the stress due to social isolation and professional recognition were the variables with the greatest contributions to the predictive function. Interestingly, professional recognition had a negative predictive value, indicating an inverse relationship with PTSD and depression symptoms. Conclusions: Our findings emphasize the protective role of professional recognition and the vulnerability role of the level of stress due to social isolation in the severity of posttraumatic stress and depression symptoms. The insights gleaned from the current study will advance efforts in terms of intervention programs and public health messaging.
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Affiliation(s)
- Liana C L Portugal
- Neurophysiology Laboratory, Department of Physiological Sciences, Roberto Alcantara Gomes Biology Institute, Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Camila Monteiro Fabricio Gama
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Raquel Menezes Gonçalves
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Mauro Vitor Mendlowicz
- Department of Psychiatry and Mental Health, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Fátima Smith Erthal
- Laboratory of Neurobiology, Institute of Biophysics Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - Izabela Mocaiber
- Laboratory of Cognitive Psychophysiology, Department of Natural Sciences, Institute of Humanities and Health, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Konstantinos Tsirlis
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Eliane Volchan
- Laboratory of Neurobiology, Institute of Biophysics Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - Isabel Antunes David
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Mirtes Garcia Pereira
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Leticia de Oliveira
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal Fluminense University, Rio de Janeiro, Brazil
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24
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Coimbra BM, Yeh M, D'Elia AT, Maciel MR, Carvalho CM, Milani AC, Mozzambani A, Juruena M, Belangero SI, Jackowski AP, Poyares D, Mello AF, Mello MF. Posttraumatic Stress Disorder and Neuroprogression in Women Following Sexual Assault: Protocol for a Randomized Clinical Trial Evaluating Allostatic Load and Aging Process Acceleration. JMIR Res Protoc 2020; 9:e19162. [PMID: 33206061 PMCID: PMC7710442 DOI: 10.2196/19162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/20/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a prevalent, chronic, and severe disorder related to traumatic events. Women are disproportionately affected by PTSD than men and are more at risk in the occurrence of sexual assault victimization. Estimates suggest that 50% of women develop PTSD following sexual assault and successful clinical management can be challenging. Growing evidence has implicated neural, immune, and endocrine alterations underpinning PTSD, but only few studies have assessed the evolution of acute PTSD in women. OBJECTIVE This study aims to measure whether the onset of PTSD is associated with accelerated aging in women following sexual assault. We hypothesize that the increase of allostatic load caused by PTSD leads to neuroprogression. We will implement a randomized clinical trial to compare responses to treatment with either interpersonal psychotherapy adapted for PTSD (IPT-PTSD) or the selective serotonin reuptake inhibitor sertraline. METHODS We will include women between 18 and 45 years of age, who experienced sexual assault from 1 to 6 months before the initial evaluation, and present with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnosis of PTSD. Baseline evaluation will comprise clinical and psychometric assessments, structural and functional magnetic resonance imaging, neuropsychological testing, polysomnography, evaluation of immune and endocrine parameters, and genetic analyses. Age-matched female healthy controls will be included and subjected to the same evaluation. Patients will be randomized for treatment in 1 of the 2 arms of the study for 14 weeks; follow-up will continue until 1 year after inclusion via treatment as usual. The researchers will collect clinical and laboratory data during periodic clinical assessments up to 1-year follow-up. RESULTS Data collection started in early 2016 and will be completed by the end of the first semester of 2020. Analyses will be performed soon afterward, followed by the elaboration of several articles. Articles will be submitted in early 2021. This research project has obtained a grant from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2014/12559-5). CONCLUSIONS We expect to provide insight into the consequences of recent sexual assault exposure in women by investigating the degree of neuroprogression developing from an early stage of PTSD. We also expect to provide important evidence on the efficacy of a non-exposure psychotherapy (IPT-PTSD) to mitigate PTSD symptoms in recently sexually assaulted women. Further, we aim to obtain evidence on how treatment outcomes are associated with neuroprogression measures. TRIAL REGISTRATION Brazilian Clinical Trials Registry RBR-3z474z; http://www.ensaiosclinicos.gov.br/rg/RBR-3z474z/. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/19162.
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Affiliation(s)
- Bruno Messina Coimbra
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mary Yeh
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Teresa D'Elia
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mariana Rangel Maciel
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carolina Muniz Carvalho
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
- Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Carolina Milani
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Adriana Mozzambani
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mario Juruena
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College, London, United Kingdom
| | - Sintia Iole Belangero
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
- Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Andrea Parolin Jackowski
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Dalva Poyares
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Andrea Feijo Mello
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Feijo Mello
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
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25
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Van Praag DLG, Fardzadeh HE, Covic A, Maas AIR, von Steinbüchel N. Preliminary validation of the Dutch version of the Posttraumatic stress disorder checklist for DSM-5 (PCL-5) after traumatic brain injury in a civilian population. PLoS One 2020; 15:e0231857. [PMID: 32310970 PMCID: PMC7170250 DOI: 10.1371/journal.pone.0231857] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 04/02/2020] [Indexed: 11/18/2022] Open
Abstract
The Posttraumatic stress disorder checklist (PCL) is the most widely used questionnaire to screen for symptoms of posttraumatic stress disorder (PTSD), based on the Diagnostic and Statistical manual of Mental disorders (DSM-IV) criteria. In the latest edition of the DSM (DSM-5), the criteria for PTSD were revised leading to the development of the PCL-5. So far, there is no validated Dutch version of the PCL-5. The aim of this study is to determine psychometric characteristics of the Dutch translation and linguistic validation of the PCL-5 and to evaluate internal consistency, criterion and structural validity. In a population of 495 civilian, traumatic brain injury patients, the PCL-5, the Generalized anxiety disorder questionnaire and the Depression scale of the Patient health questionnaire were administered. The PCL-5 was translated in Dutch following a strict procedure of linguistic validation and cognitive debriefing. Results show an excellent internal consistency and high criterion validity. Confirmatory factor analysis demonstrated a good fit for the four-factor DSM-5 model, but a superior fit for the six-factor Anhedonia model and the seven-factor Hybrid model, similar to the English version of the PCL-5. Preliminary validation of the Dutch translation of the PCL-5 was proven to be psychometrically sound and can be used for clinical and academic purposes, specifically for TBI patients. Future research should examine concurrent and discriminant validity for the Dutch translation in broader populations at risk for PTSD, and include a structured interview to evaluate diagnostic utility.
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Affiliation(s)
- Dominique L. G. Van Praag
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
- * E-mail:
| | - Haghish Ebad Fardzadeh
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen (UMG)/Georg-August-University, Göttingen, Germany
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen (UMG)/Georg-August-University, Göttingen, Germany
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen (UMG)/Georg-August-University, Göttingen, Germany
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26
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Michalopoulos LM, Meinhart M, Yung J, Barton SM, Wang X, Chakrabarti U, Ritchey M, Haroz E, Joseph N, Bass J, Bolton P. Global Posttrauma Symptoms: A Systematic Review of Qualitative Literature. TRAUMA, VIOLENCE & ABUSE 2020; 21:406-420. [PMID: 29699456 DOI: 10.1177/1524838018772293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Exposure to potentially traumatic events is a global health problem, especially in low- and middle-income countries. Assessments for symptoms resulting from trauma exposure rely heavily on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria for post-traumatic stress disorder (PTSD), which may not be relevant in all regions of the globe. We examined posttrauma symptoms that were not limited to Western constructs of mental health (i.e., PTSD). In a systematic review, we searched nine databases to identify posttrauma symptoms arising in qualitative literature published before July 17, 2017. A total of 17,938 records were identified and 392 met inclusion criteria. The 392 studies represented data on 400 study populations from 71 different nationalities/ethnicities. The presence and frequency of posttrauma symptoms were examined across all regions. Fisher's exact tests were also conducted to compare frequencies in posttrauma symptoms across region and gender. Based on a weighted analysis across regions, a list of global posttrauma symptoms (N = 85) was compiled into an item bank. We found that the majority of DSM-5 PTSD symptoms were mentioned across regions (with the exception of inability to recall specific aspects of the trauma and blame of self or others for the event). Across all regions, we also found a number of symptoms mentioned that were not part of PTSD and its associated features. Findings suggest that assessing posttrauma symptoms solely based on PTSD may be limiting to global populations. Research, policy, and practice implications are discussed.
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Affiliation(s)
- Lynn Murphy Michalopoulos
- Global Health and Mental Health Unit, Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | | | - Justina Yung
- Columbia University School of Social Work, New York, NY, USA
| | | | - Xinyi Wang
- Columbia University School of Social Work, New York, NY, USA
| | | | - Megan Ritchey
- Yale University School of Nursing, New Haven, CT, USA
| | - Emily Haroz
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nakita Joseph
- Columbia University School of Social Work, New York, NY, USA
| | - Judith Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul Bolton
- Department of International Health, Center for Refugee and Disaster Response Baltimore, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Donat JC, Lobo NDS, Jacobsen GDS, Guimarães ER, Kristensen CH, Berger W, Mendlowicz MV, Lima EDP, Vasconcelos AG, Nascimento E. Translation and cross-cultural adaptation of the International Trauma Questionnaire for use in Brazilian Portuguese. SAO PAULO MED J 2019; 137:270-277. [PMID: 31483012 PMCID: PMC9744007 DOI: 10.1590/1516-3180.2019.0066070519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The most recent editions of diagnostic manuals have proposed important modifications in posttraumatic stress disorder (PTSD) criteria. The International Trauma Questionnaire (ITQ) is the gold-standard measurement for assessing PTSD and complex PTSD in accordance with the model of the 11th International Classification of Diseases (ICD-11). OBJECTIVE The aim of this study was to adapt the ITQ for the Brazilian context. DESIGN AND SETTING The translation and cross-cultural adaptation of the ITQ for use in Brazilian Portuguese was performed in trauma research facilities in Porto Alegre, Rio de Janeiro and Belo Horizonte, Brazil. METHODS The adaptation followed five steps: (1) translation; (2) committee synthesis; (3) experts' evaluation through the content validity index (CVI) and assessment of interrater agreement though kappa statistics; (4) comprehension test with clinical and community samples (n = 35); and (5) final back-translation and authors' evaluation. RESULTS Two independent translations were conducted. While working on a synthesis of these translations, the committee proposed changes in six items to adapt idiomatic expressions or to achieve a more accurate technical fit. Both the expert judges' evaluation (CVI > 0.7; k > 0.55) and the pretest in the target population (mean comprehension > 3) indicated that the adapted items were adequate and comprehensible. The final back-translation was approved by the authors of the original instrument. CONCLUSION ITQ in its Brazilian Portuguese version achieved satisfactory content validity, thus providing a tool for Brazilian research based on PTSD models of the ICD-11.
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Affiliation(s)
- Júlia Candia Donat
- MSc. Psychologist and Researcher, Postgraduate Program on Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - Nathália dos Santos Lobo
- Psychology Undergraduate Student, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - Gabriela dos Santos Jacobsen
- BSc. Psychologist and Researcher, Postgraduate Program on Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - Eduardo Reuwsaat Guimarães
- MSc. Psychologist and Researcher, Postgraduate Program on Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - Christian Haag Kristensen
- PhD. Psychologist and Professor, Postgraduate Program on Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - William Berger
- PhD. Psychiatrist and Professor, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro (RJ), Brazil.
| | - Mauro Vitor Mendlowicz
- PhD. Psychiatrist and Professor, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), and Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), Rio de Janeiro (RJ), Brazil.
| | - Eduardo de Paula Lima
- PhD. Psychologist and Postdoctoral Student, Department of Psychology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Alina Gomide Vasconcelos
- PhD. Psychologist and Postdoctoral Student, Department of Psychology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Elizabeth Nascimento
- PhD. Psychologist and Professor, Department of Psychology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
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Howell KH, Thurston IB, Schwartz LE, Jamison LE, Hasselle AJ. Protective Factors associated with Resilience in Women Exposed to Intimate Partner Violence. PSYCHOLOGY OF VIOLENCE 2018; 8:438-447. [PMID: 30393573 PMCID: PMC6208361 DOI: 10.1037/vio0000147] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Research on adversity is often skewed toward assessing problematic functioning; yet many women display resilience following traumatic experiences. Examining individual, relational, community, and cultural variables can provide new knowledge about protective factors associated with resilience in women exposed to intimate partner violence (IPV). Controlling for demographics and circumstances of the violence, this study evaluated predictors of resilience, including spirituality, social support, community cohesion, and ethnic identity. METHOD The sample consisted of 112 women (Mage =32.12, SD=5.78) exposed to physical, psychological, and/or sexual intimate partner violence in the past 6 months. Approximately 70% of participants were Black. Hierarchical linear regression modeling was conducted to examine factors related to resilience. Model 1 included demographics (age, education, and socioeconomic status) and stressful life experiences. Model 2 added circumstances of the violence: IPV severity, IPV perpetration by participant, and number of violent partners. The third and final model added spirituality, social support, community cohesion, and ethnic identity. RESULTS The final model was significant, F(11, 97)=6.63; p<.001, adj. R2 =36.5%; with greater social support (β=.24; p=.009), more spirituality (β=.28; p=.002), and fewer violent relationships (β= -.25; p=.003) predicting higher resilience among women exposed to IPV. CONCLUSION While risk factors associated with IPV are well-researched, little is known about factors related to resilient functioning, especially among minority populations. Knowledge gained from this study can advance the field of violence research by its identification of potentially mutable variables related to resilience. Such research could be applied to developing strength-based interventions for at-risk populations of violence-exposed women.
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Affiliation(s)
- Kathryn H Howell
- Assistant Professor, Department of Psychology, University of Memphis, 356 Psychology Building, Memphis, TN 38152-3230
| | - Idia B Thurston
- Assistant Professor, Department of Psychology, University of Memphis, 310 Psychology Building, Memphis, TN 38152-3230
| | - Laura E Schwartz
- Doctoral Candidate, Department of Psychology, University of Memphis, 202 Psychology Building, Memphis, TN 38152-3230
| | - Lacy E Jamison
- Doctoral Candidate, Department of Psychology, University of Memphis, 202 Psychology Building, Memphis, TN 38152-3230
| | - Amanda J Hasselle
- Doctoral Candidate, Department of Psychology, University of Memphis, 202 Psychology Building, Memphis, TN 38152-3230
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