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van der Does FH, Nagamine M, van der Wee NJ, Chiba T, Edo N, Kitano M, Vermetten E, Giltay EJ. PTSD Symptom dynamics after the great east japan earthquake: mapping the temporal structure using Dynamic Time Warping. Eur J Psychotraumatol 2023; 14:2241732. [PMID: 37560810 PMCID: PMC10416748 DOI: 10.1080/20008066.2023.2241732] [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: 12/01/2022] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 08/11/2023] Open
Abstract
Background: After the Great East Japan Earthquake [GEJE], approximately 70,000 Japan Ground Self Defense Force [JGSDF] personnel were deployed, risking Post-Traumatic Stress Disorder [PTSD]. The network approach to psychopathology suggests that symptoms may cause and exacerbate each other, resulting in the emergence and maintenance of disorders, including PTSD. It is therefore important to further explore the temporal interplay between symptoms. Most studies assessing the factor structure of the Impact of Event Scale-Revised [IES-R] have used cross-sectional designs. In this study, the structure of the IES-R was re-evaluated while incorporating the temporal interplay between symptoms.Methods: Using Dynamic Time Warping [DTW] the distances between PTSD symptoms on the IES-R were modelled in 1120 JGSDF personnel. Highly correlated symptoms were clustered at the group level using Distatis three-way principal component analyses of the distance matrices. The resulting clusters were compared to the original three subscales of the IES-R using a Confirmatory Factor Analysis (CFA).Results: The DTW analysis yielded four symptom clusters: Intrusion (five items), Hyperarousal (six items), Avoidance (six items), and Dissociation (five items). CFA yielded better fit estimates for this four-factor solution (RMSEA = 0.084, CFI = 0.918, TLI = 0.906), compared to the original three subscales of the IES-R (RMSEA = 0.103, CFI = 0.873, TLI = 0.858).Conclusions: DTW offers a new method of modelling the temporal relationships between symptoms. It yielded four IES-R symptom clusters, which may facilitate understanding of PTSD as a complex dynamic system.
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Affiliation(s)
| | - Masanori Nagamine
- Division of Behavioral Science, National Defense Medical College Research Institute, Saitama, Japan
| | - Nic J.A. van der Wee
- Department of Psychiatry, Leiden University Medical Center (LUMC),Leiden, the Netherlands
| | - Toshinori Chiba
- Department of Psychiatry, Japan Self-Defense Force Hanshin Hospital, Kawanishi, Japan
| | - Naoki Edo
- Division of Behavioral Science, National Defense Medical College Research Institute, Saitama, Japan
| | - Masato Kitano
- Division of Behavioral Science, National Defense Medical College Research Institute, Saitama, Japan
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center (LUMC),Leiden, the Netherlands
| | - Erik J. Giltay
- Department of Psychiatry, Leiden University Medical Center (LUMC),Leiden, the Netherlands
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Health Campus The Hague, Leiden University, The Hague, the Netherlands
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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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Isabirye RA, Namuli JD, Kinyanda E. Prevalence and factors associated with post traumatic stress disorder among field police patrol officers serving in Kampala Metropolitan region. BMC Psychiatry 2022; 22:706. [PMID: 36380315 PMCID: PMC9666967 DOI: 10.1186/s12888-022-04317-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Occupation groups like police officers and fire fighters are exposed to a number of traumatic events which put them at a risk of developing post-traumatic stress disorder (PTSD). Previous studies have found the prevalence of PTSD in police officers to vary between 7 and 19%. However, most of these studies have been undertaken in western setting with little research having been undertaken in sub-Saharan Africa including Uganda. OBJECTIVE To determine the prevalence and factors associated with post-traumatic stress disorder among field police patrol officers serving in Kampala Metropolitan Police (KMP) North Region. METHODS This was a cross sectional study that was conducted on 392 field police patrol officers serving in KMP North Region. Diagnosis of PTSD was undertaken using the Clinician Administered PTSD Scale for DSM-5. In order to assess for psychiatric comorbidities, the study used the Mini International Neuropsychiatric Interview (M.I.N.I.) RESULTS: In this study, the prevalence of PTSD was 7.4%. An additional 62.5% had sub-threshold PTSD, which was defined as, the presence of at least one PTSD symptom but not meeting full criteria for PTSD diagnosis. The factors found to be significantly associated with PTSD were all related to the presence of psychiatric comorbidities, namely the presence of: a current major depressive episode (aOR = 4.7; 95% CI: 1.5- 14.8; p = .009); an alcohol use disorder (aOR = 5.1; 95% CI: 2.0-13.0; p = .001); and presence of dissociation symptoms (aOR = 6.7; 95% CI: 2.0-22.2; p = .002). CONCLUSION PTSD is one of the common psychiatric disorders experienced by serving police officers in Uganda. The tendency of PTSD in this group to co-occur with other psychiatric disorders means that any treatment program to address it should be part of a comprehensive multi-disorder mental health treatment programme in the police office.
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Affiliation(s)
- Rogers Agenda Isabirye
- Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda.
| | - Justine Diana Namuli
- grid.11194.3c0000 0004 0620 0548Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Eugene Kinyanda
- grid.415861.f0000 0004 1790 6116 Mental Health Section, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
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Bertolazi AN, Mann KC, Lima AVPB, Hidalgo MPL, John AB. Post-traumatic stress disorder prevalence and sleep quality in fire victims and rescue workers in southern Brazil: a cross-sectional study. Public Health 2022; 209:4-13. [PMID: 35749927 DOI: 10.1016/j.puhe.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 03/17/2022] [Accepted: 05/08/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This survey was conducted to evaluate the prevalence of post-traumatic stress disorder (PTSD) and the sleep quality in victims and rescue team of the third deadliest nightclub fire in the world. STUDY DESIGN A cross-sectional study. METHODS Participants were victims and rescue workers exposed to a fire at a nightclub, which occurred in January 2013 in Southern Brazil. The Pittsburgh Sleep Quality Index (PSQI), composed of seven subjective sleep variables (including daytime dysfunction), and PTSD Checklist - Civilian version (PCL-C) were applied to all people who sought medical attention at the local reference center in the first year after the event. Comprehensive information was obtained concerning sociodemographic factors, health status, and sleep complaints. RESULTS A total of 370 individuals, 190 victims and 180 rescue workers, were included. Participants were 70% male, with an average age of 29 years. The prevalence of PTSD was 31.9%, ranging from 24.4% for rescue workers to 38.9% for victims. The prevalence of poor sleep quality was 65.9%, ranging from 56.1% for rescue workers to 75.3% for victims. Most of the participants with PTSD (91.5%) had PSQI scores >5 (poor sleepers), against 54.0% of the non-PTSD individuals. All seven PSQI subscores showed significant differences between PTSD and non-PTSD individuals, especially daytime dysfunction. Sex, shift work, previous psychiatric disease, and sleep quality remained associated with PTSD in adjusted models, with a prevalence ratio (95% CI) of 1.76 (1.28-2.43) in females, 1.73 (1.17-2.55) in shift workers, 1.36 (1.03-1.80) in individuals with psychiatric disease history, and 5.42 (2.55-11.52) in poor sleepers. CONCLUSIONS The presence of daytime dysfunction increased by at least tenfold the prevalence of PTSD in this sample. Considering that daytime dysfunction was shown to be strongly associated with PTSD, sleep-related issues should be addressed in the assessment of individuals exposed to traumatic events, both victims and rescuers. Factors like shift work and female sex were also associated with PTSD, especially among victims.
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Affiliation(s)
- A N Bertolazi
- Post-Graduate Program in Psychiatry and Behavior Sciences, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil; Pulmonary Service, Hospital Universitário de Santa Maria (HUSM), Santa Maria, RS, Brazil.
| | - K C Mann
- Pulmonary Service, Hospital Universitário de Santa Maria (HUSM), Santa Maria, RS, Brazil
| | - A V P B Lima
- Pulmonary Service, Hospital Universitário de Santa Maria (HUSM), Santa Maria, RS, Brazil
| | - M P L Hidalgo
- Post-Graduate Program in Psychiatry and Behavior Sciences, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil; Chronobiology and Sleep Laboratory, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - A B John
- Chronobiology and Sleep Laboratory, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Sleep Disorders Center, Pulmonary Service, HCPA, Porto Alegre, RS, Brazil
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Synergistic Effect of History of Cardiovascular Disease and Mental Distress on Post-Traumatic Stress Disorder after the Great East Japan Earthquake: The Fukushima Health Management Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910283. [PMID: 34639586 PMCID: PMC8508551 DOI: 10.3390/ijerph181910283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
Cardiovascular disease (CVD) and mental distress have been suggested to be associated with post-traumatic stress disorder (PTSD), but the effect of their combination on PTSD is unknown. We reviewed the synergistic effects of the history of CVD and mental distress on the possibility of PTSD among residents in Fukushima after the Great East Japan Earthquake. This cross-sectional study was conducted among 38,392 participants aged 40–74 years in the evacuation area who applied for the Fukushima Health Management Study in Fiscal Year 2011. Relative excess risk due to interaction (RERI), attributable proportion (AP), odds ratio (OR), and 95% confidence interval (CI) were calculated to investigate the combined effect of history of CVD and mental distress on PTSD. We identified 8104 probable cases of PTSD (21.1%). History of CVD, mental distress, and their combination were positively associated with probable PTSD: the multivariable ORs (95% CIs) were 1.44 (1.04, 2.01), 20.08 (18.14, 22.22), and 26.60 (23.07, 30.67), respectively. There was a significant increase in RERI: the corresponding RERI (95% CI) and AP were 6.08 (3.16, 9.00) and 22.9%. Gender-specific analyses showed similar associations. Thus, we found a supra-additive association of history of CVD and mental distress with probable PTSD after the disaster.
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Dias Campos F, Chambel MJ, Lopes S, Dias PC. Post-Traumatic Stress Disorder in the Military Police of Rio de Janeiro: Can a Risk Profile Be Identified? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052594. [PMID: 33807636 PMCID: PMC7967303 DOI: 10.3390/ijerph18052594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
Background: Significant exposure to critical incidents characteristic of military police work has a potentially traumatic effect and multiple consequences for the mental health of these professionals, such as Post Traumatic Stress Disorder (PTSD). This study aims to investigate the occurrence of PTSD in this occupational group and its correlations with socio-demographic and occupational variables. Methods: This is a cross-sectional study of Rio de Janeiro’s Military Police officers (n = 3.577). Data was collected from self-reported questionnaires applied in an institutional health program. Post-Traumatic Stress Disorder Checklist—Civilian version was used to assess PTSD. Results: Rates of 16.9% for full PTSD and 26.7% for partial PTSD were found. Based on logistic regression analysis, female officers and police officers in lower ranks of the military hierarchy and performing administrative duties were found to be at most risk of developing PTSD. Conclusions: These results suggest the need to further understand the predictive organizational and individual variables of PTSD correlated with the increased vulnerability of professionals in order to contribute to institutional policies for the prevention and rehabilitation of these cases.
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Affiliation(s)
- Fernanda Dias Campos
- Military Police of the State of Rio de Janeiro, Rio de Janeiro 20031-040, Brazil;
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, 1649-013 Lisboa, Portugal; (M.J.C.); (S.L.)
| | - Maria José Chambel
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, 1649-013 Lisboa, Portugal; (M.J.C.); (S.L.)
| | - Sílvia Lopes
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, 1649-013 Lisboa, Portugal; (M.J.C.); (S.L.)
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 4710-302 Braga, Portugal
| | - Paulo C. Dias
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 4710-302 Braga, Portugal
- Correspondence:
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Lees T, Elliott JL, Gunning S, Newton PJ, Rai T, Lal S. A systematic review of the current evidence regarding interventions for anxiety, PTSD, sleepiness and fatigue in the law enforcement workplace. INDUSTRIAL HEALTH 2019; 57:655-667. [PMID: 30760652 PMCID: PMC6885597 DOI: 10.2486/indhealth.2018-0088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 01/25/2019] [Indexed: 05/21/2023]
Abstract
Law enforcement is inherently stressful, and police officers are particularly vulnerable to mental and physical disorders. As such, researchers are currently assessing intervention strategies that may combat or manage these psychological, physical and mental issues. To review most recent information regarding anxiety, PTSD, and sleepiness and fatigue and identify the interventions and treatments proposed to overcome work related stressors and associated mental illnesses inflicting law enforcement officers. The EMBASE, OVID MEDLINE and PsycINFO databases were canvassed for articles investigating anxiety, post-traumatic stress disorder, sleepiness, and fatigue. Initial article selections were made based on title, whilst final inclusion was informed by a full critical appraisal with respect to the primary and secondary effects. The systematic search returned 363 records, of which 183 were unique. Following screening, 43 records were included in the final review. The included literature assessed the efficacy of several interventions, and provided a number of recommendations regarding interventions, and policy. Moreover, literature indicates that police officers benefit from interventions targeting work-related stress and potential psychological disorders, if these interventions are continuous. Furthermore, larger controlled studies are required to further elucidate the benefits of psychosocial intervention in law enforcement.
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Affiliation(s)
- Ty Lees
- Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, Australia
| | - Jaymen L Elliott
- Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, Australia
| | - Simon Gunning
- School of Life Sciences, University of Technology Sydney, Australia
| | - Phillip J Newton
- Nursing Research Centre, Western Sydney University and Western Sydney Local Health District, Australia
| | - Tapan Rai
- School of Mathematical and Physical Sciences, University of Technology Sydney, Australia
| | - Sara Lal
- Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, Australia
- Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, Australia
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Sherwood L, Hegarty S, Vallières F, Hyland P, Murphy J, Fitzgerald G, Reid T. Identifying the Key Risk Factors for Adverse Psychological Outcomes Among Police Officers: A Systematic Literature Review. J Trauma Stress 2019; 32:688-700. [PMID: 31553502 DOI: 10.1002/jts.22431] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 03/05/2019] [Accepted: 03/13/2019] [Indexed: 12/18/2022]
Abstract
It is well established that police work is highly stressful; however, a paucity of evidence limits our knowledge and understanding of the factors that may lead to, compromise, and/or compound psychological distress for this unique population. To address this lack, the current systematic review was conducted to reveal the individual, organizational, and operational risk factors that have been identified in the research literature to date and their associations with depression, anxiety, posttraumatic stress disorder (PTSD), and burnout. We performed searches on literature published between January 2008 and January 2018 and identified a total of 20 studies that met our inclusion criteria. The results indicated that individual factors, including high levels of neuroticism, low social support, and engaging in passive or avoidant coping strategies, were associated with adverse psychological outcomes. This review identified low social support from colleagues as the most common risk factor linked to adverse psychological outcomes. Other organizational risk factors associated with such outcomes included high work demands, low resources, and low reward. This article demonstrates that individual, organizational, and operational factors all impact the negative psychological outcomes of police officers to some degree. In particular, the current review suggests that certain negative psychological outcomes are likely a result of a combination of risk factors across the three domains of risk, highlighting the necessity to observe psychological risk of police in a more comprehensive way.
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Affiliation(s)
- Larissa Sherwood
- Centre for Global Health, School of Psychology, Trinity College Dublin
| | - Siobhan Hegarty
- Centre for Global Health, School of Psychology, Trinity College Dublin
| | | | | | - Jamie Murphy
- Psychology Research Institute, School of Psychology, Ulster University
| | | | - Tracey Reid
- Collaborative Network for Training and Excellence in Psychotraumatology
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Boyd JE, Protopopescu A, O’Connor C, Neufeld RWJ, Jetly R, Hood HK, Lanius RA, McKinnon MC. Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD. Eur J Psychotraumatol 2018; 9:1463794. [PMID: 29805778 PMCID: PMC5965037 DOI: 10.1080/20008198.2018.1463794] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/20/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Posttraumatic Stress Disorder (PTSD) is associated with significant functional impairment in important areas, including interpersonal relationships and occupational or educational roles. Preliminary evidence suggests that the dissociative subtype of PTSD (PTSD+DS), characterized by marked symptoms of depersonalization and derealization, is associated with increased functional impairment and disease severity, including among military members and veterans diagnosed with PTSD. Similarly, first responders (e.g. police, fire, paramedics) have also been found to experience dissociative symptoms. Despite these findings, little work has investigated whether dissociative symptoms are related to heightened functional impairment among these populations. Objective: We examined the relation between functional impairment and symptom level variables, including dissociative symptoms of depersonalization and derealization among military members, veterans, and first responders with probable PTSD. We further investigated the hypothesis that dissociative symptoms mediate the relation between PTSD symptomatology and functional impairment. Method: Eighty-one medical charts of inpatients at a residential PTSD treatment programme were accessed via retrospective review. Sixty-two were included in the present analyses. Comparison of means on symptom measures between first responders and military members/veterans were conducted, followed by correlational and mediation analyses. Results: Compared with first responders, military members and veterans showed higher levels of derealization, functional impairment, alexithymia, anxiety, and depression. Within the total sample, dissociative symptoms emerged as the strongest correlate of functional impairment and, among the dissociative symptom clusters, derealization symptoms demonstrated the strongest relation with impairment. Mediation analyses revealed that total dissociative symptoms and derealization symptoms significantly mediated the relation between PTSD symptoms and functional impairment. Conclusions: These findings highlight the importance of assessing and treating dissociative symptoms, consistent with the dissociative subtype of PTSD, among military members, veterans, and first responders with PTSD. Successful recovery on a functional and symptomatic level may necessitate treatment of dissociative symptoms, particularly derealization.
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Affiliation(s)
- Jenna E. Boyd
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
| | - Alina Protopopescu
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
| | - Charlene O’Connor
- Homewood Research Institute, Guelph, Canada
- Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, Canada
| | - Richard W. J. Neufeld
- Department of Neuroscience, Western University, London, Canada
- Department of Psychiatry, Western University, London, Canada
- Department of Psychology, Western University, London, Canada
| | - Rakesh Jetly
- Defence Research and Development Canada, Toronto, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Heather K. Hood
- Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Ruth A. Lanius
- Homewood Research Institute, Guelph, Canada
- Department of Neuroscience, Western University, London, Canada
- Department of Psychiatry, Western University, London, Canada
- Imaging Division, Lawson Health Research Institute, London, Canada
| | - Margaret C. McKinnon
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
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Vance MC, Kovachy B, Dong M, Bui E. Peritraumatic distress: A review and synthesis of 15 years of research. J Clin Psychol 2018. [PMID: 29543336 DOI: 10.1002/jclp.22612] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
CONTEXT Although the subjective trauma exposure criterion was removed from the DSM-5 criteria set for posttraumatic stress disorder (PTSD), emerging literature suggests that peritraumatic distress may be useful in predicting outcomes after exposure to a stressful event. METHOD We conducted a comprehensive review of the literature examining the association between peritraumatic distress and PTSD and other psychiatric outcomes. The 57 studies herein varied in both experimental design and target populations. RESULTS Forty-eight studies found associations between peritraumatic distress and PTSD outcome measures, 23 found associations between peritraumatic distress and other psychiatric outcomes, and three found associations between peritraumatic distress and PTSD-related symptoms or other psychiatric outcomes after non-Criterion A stressful events by DSM-5 criteria. CONCLUSION Peritraumatic distress is associated with PTSD symptom severity, other psychiatric symptoms, and severity of PTSD-related symptoms after exposure to non-Criterion A events, suggesting that peritraumatic distress is a risk factor for various psychiatric outcomes and furthering our understanding of the impact of subjective experience on trauma psychopathology.
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Affiliation(s)
- Mary C Vance
- Institute for Healthcare Policy and Innovation, University of Michigan
| | | | | | - Eric Bui
- Harvard Medical School.,Massachusetts General Hospital
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11
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Abstract
A major issue in the study of dissociation concerns the cross-cultural validity of definitions and measurements used to identify and classify dissociative disorders. There is also extensive debate on the etiological factors underlying dissociative experiences. Cross-cultural research is essential to elucidate these issues, particularly regarding evidence obtained from countries in which the study of dissociation is still in its infancy. The aim of this article was to discuss Brazilian research on the topic of dissociation, highlighting its contributions for the understanding of dissociative experiences in nonclinical populations and for the validity and relevance of dissociative disorders in the contexts of psychiatry, psychology, and psychotherapy. We also consider the ways in which dissociative experiences are assimilated by Brazilian culture and religious expressions, and the implications of Brazilian studies for the sociocultural investigation of dissociation. We conclude by addressing the limitations of these studies and potential areas for future research.
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12
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Price M. Psychiatric Disability in Law Enforcement Officers. BEHAVIORAL SCIENCES & THE LAW 2017; 35:113-123. [PMID: 28303590 DOI: 10.1002/bsl.2278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/20/2017] [Accepted: 01/30/2017] [Indexed: 06/06/2023]
Abstract
Law enforcement officers all across the world are exposed to violence, confrontation, and traumatic incidents. They regularly witness death and suffering and are at risk of personal injury. Psychiatric sequelae include an increased risk for trauma-related symptoms, depression, alcohol-use disorders, and stress-related medical conditions. Law enforcement officers have been applying for early disability retirement pensions at an increased rate for stress-related psychiatric and medical conditions. As a result, law enforcement agencies are prematurely losing valuable resources, officers with training and experience. Departments have become proactive in trying to address mental health issues to prevent psychiatric disability by implementing employee wellness plans and stress reduction interventions. Programs have been developed to mitigate the effects of stress on law enforcement personnel. Many law enforcement agencies have developed strategies to encourage early confidential referral for psychiatric treatment. They utilize peer support groups and employee assistance programs and develop alliances with mental health professionals. When these approaches fail, a fitness for duty process can be used to identify impairment in work functioning due to psychiatric factors with the prospect of later returning the officer to full duty. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Marilyn Price
- Harvard Medical School, Law and Psychiatry Service, Massachusetts General Hospital, I Bowdoin Square 10th Floor, 15 New Chardon, Boston, MA, 02114
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Măirean C, Ceobanu CM. The relationship between suppression and subsequent intrusions: the mediating role of peritraumatic dissociation and anxiety. ANXIETY STRESS AND COPING 2016; 30:304-316. [PMID: 27873541 DOI: 10.1080/10615806.2016.1263839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Although previous studies showed that thought and emotion suppression represent risk factors for intrusions development, the mechanisms that explain these relations were less explored. This study aims to examine the relationships between thought and emotion suppression and the symptoms of intrusion following the exposure to a trauma-related event. Moreover, we explored if these relationships would be mediated by peritraumatic state dissociation and state anxiety. DESIGN AND METHODS The trauma film paradigm was used and the participants were students (N = 148) experimentally exposed to an aversive film to model a traumatic experience. Thought and emotion suppression were measured before the trauma exposure. After exposure, the participants completed scales for measuring state dissociation and state anxiety. Intrusive images and thoughts of the film were recorded in the subsequent week using an intrusion diary. RESULTS Thought suppression predicted intrusive thoughts frequency, and this effect was mediated by the peritraumatic anxiety. State anxiety predicted both intrusive images and thoughts, while state dissociation only predicted intrusive images. CONCLUSIONS Intrusive images and intrusive thoughts are different phenomena and they are predicted by different variables. The practical implications of these results for posttraumatic stress disorder treatment and secondary traumatization are discussed.
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Affiliation(s)
- Cornelia Măirean
- a Faculty of Psychology and Education Sciences, Psychology Department , Alexandru Ioan Cuza University of Iasi , Iasi , Romania
| | - Ciprian Marius Ceobanu
- a Faculty of Psychology and Education Sciences, Psychology Department , Alexandru Ioan Cuza University of Iasi , Iasi , Romania
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Lilly MM, London MJ, Mercer MC. Predictors of Obesity and Physical Health Complaints Among 911 Telecommunicators. Saf Health Work 2015; 7:55-62. [PMID: 27014492 PMCID: PMC4792921 DOI: 10.1016/j.shaw.2015.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 08/21/2015] [Accepted: 09/01/2015] [Indexed: 11/29/2022] Open
Abstract
Background This study aims to: (1) examine rates of obesity and physical health complaints among 911 telecommunicators; and (2) document the role of emotion dysregulation, psychological inflexibility, duty-related distress and dissociation, and psychopathology in predicting obesity and physical health complaints in this population. Methods The sample consisted of 911 telecommunicators from across the country (N = 758). Participants completed an online survey assessing their mental and physical health functioning. Results A total of 82.5% of the sample reported a body mass index that fell within the overweight or obese category and an average of 17 physical health complaints within the past month. Peritraumatic reactions (distress and dissociation), emotion dysregulation, and psychological inflexibility had effects on physical health largely through psychopathology (alcohol abuse, post-traumatic stress disorder, and depression). Conclusion Development of adapted prevention and intervention efforts with this population is needed.
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Affiliation(s)
- Michelle M Lilly
- Northern Illinois University, Department of Psychology, DeKalb, IL, USA
| | - Melissa J London
- Northern Illinois University, Department of Psychology, DeKalb, IL, USA
| | - Mary C Mercer
- Northern Illinois University, Department of Psychology, DeKalb, IL, USA
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Maximino C, Silva RXDC, da Silva SDNS, Rodrigues LDSDS, Barbosa H, de Carvalho TS, Leão LKDR, Lima MG, Oliveira KRM, Herculano AM. Non-mammalian models in behavioral neuroscience: consequences for biological psychiatry. Front Behav Neurosci 2015; 9:233. [PMID: 26441567 PMCID: PMC4561806 DOI: 10.3389/fnbeh.2015.00233] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/18/2015] [Indexed: 01/04/2023] Open
Abstract
Current models in biological psychiatry focus on a handful of model species, and the majority of work relies on data generated in rodents. However, in the same sense that a comparative approach to neuroanatomy allows for the identification of patterns of brain organization, the inclusion of other species and an adoption of comparative viewpoints in behavioral neuroscience could also lead to increases in knowledge relevant to biological psychiatry. Specifically, this approach could help to identify conserved features of brain structure and behavior, as well as to understand how variation in gene expression or developmental trajectories relates to variation in brain and behavior pertinent to psychiatric disorders. To achieve this goal, the current focus on mammalian species must be expanded to include other species, including non-mammalian taxa. In this article, we review behavioral neuroscientific experiments in non-mammalian species, including traditional "model organisms" (zebrafish and Drosophila) as well as in other species which can be used as "reference." The application of these domains in biological psychiatry and their translational relevance is considered.
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Affiliation(s)
- Caio Maximino
- Laboratório de Neurociências e Comportamento, Departamento de Morfologia e Ciências Fisiológicas, Campus VIII – Marabá, Universidade do Estado do ParáMarabá, Brazil
| | - Rhayra Xavier do Carmo Silva
- Laboratório de Neurociências e Comportamento, Departamento de Morfologia e Ciências Fisiológicas, Campus VIII – Marabá, Universidade do Estado do ParáMarabá, Brazil
| | - Suéllen de Nazaré Santos da Silva
- Laboratório de Neurociências e Comportamento, Departamento de Morfologia e Ciências Fisiológicas, Campus VIII – Marabá, Universidade do Estado do ParáMarabá, Brazil
| | - Laís do Socorro dos Santos Rodrigues
- Laboratório de Neurociências e Comportamento, Departamento de Morfologia e Ciências Fisiológicas, Campus VIII – Marabá, Universidade do Estado do ParáMarabá, Brazil
| | - Hellen Barbosa
- Laboratório de Neurociências e Comportamento, Departamento de Morfologia e Ciências Fisiológicas, Campus VIII – Marabá, Universidade do Estado do ParáMarabá, Brazil
| | - Tayana Silva de Carvalho
- Universität Duisburg-EssenEssen, Germany
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do ParáBelém, Brazil
| | - Luana Ketlen dos Reis Leão
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do ParáBelém, Brazil
| | - Monica Gomes Lima
- Laboratório de Neurociências e Comportamento, Departamento de Morfologia e Ciências Fisiológicas, Campus VIII – Marabá, Universidade do Estado do ParáMarabá, Brazil
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do ParáBelém, Brazil
| | - Karen Renata Matos Oliveira
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do ParáBelém, Brazil
| | - Anderson Manoel Herculano
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do ParáBelém, Brazil
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Kalaf J, Vilete LMP, Volchan E, Fiszman A, Coutinho ESF, Andreoli SB, Quintana MI, de Jesus Mari J, Figueira I. Peritraumatic tonic immobility in a large representative sample of the general population: association with posttraumatic stress disorder and female gender. Compr Psychiatry 2015; 60:68-72. [PMID: 25891640 DOI: 10.1016/j.comppsych.2015.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/06/2015] [Accepted: 04/02/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tonic immobility is an involuntary response to inescapable life-threatening events. Peritraumatic tonic immobility has been reported in convenience samples of female victims of sexual assault and in mixed-gender victims of different types of trauma. This study evaluated peritraumatic tonic immobility in a representative general population sample and its association with posttraumatic stress disorder (PTSD) and gender. METHODS 3231 victims of traumatic events aged 15-75 years responded to the Tonic Immobility Scale. PTSD and traumatic events were assessed using the Composite International Diagnostic Interview (CIDI 2.1). We calculated the means and the standard deviations of Tonic Immobility Scale scores stratified by PTSD and gender. The association between tonic immobility scores and gender was explored controlling for potential confounders through a multiple linear regression model. RESULTS Tonic immobility scores were more than double in those who met criteria for PTSD and were almost four points higher in women. Gender differences remained statistically significant even after adjustment for confounding variables. LIMITATIONS The cross-sectional and retrospective design may have given rise to recall bias. Results presented here may not apply to small and medium rural areas and the CIDI 2.1 can lead to a certain degree of misclassification. CONCLUSIONS We have expanded the scope of previous investigations on peritraumatic tonic immobility which were based on convenience samples only, showing its occurrence in victims of traumatic events using a large representative sample of the general population. Furthermore, we confirmed in an unbiased sample the association between peritraumatic tonic immobility and PTSD and female gender.
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Affiliation(s)
- Juliana Kalaf
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil.
| | | | - Eliane Volchan
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (IBCCF-UFRJ), Rio de Janeiro, RJ, Brazil
| | - Adriana Fiszman
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil
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Madan N, Bellin E, Haden SC. Avoidant Coping as a Mediator between Persistent Dissociation and PTSD. J Am Psychoanal Assoc 2015; 63:541-8. [PMID: 26185292 DOI: 10.1177/0003065115594602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Neeru Madan
- Department of Psychology, Long Island University, Brooklyn
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Maia DB, Nóbrega A, Marques-Portella C, Mendlowicz MV, Volchan E, Coutinho ES, Figueira I. Peritraumatic tonic immobility is associated with PTSD symptom severity in Brazilian police officers: a prospective study. ACTA ACUST UNITED AC 2014; 37:49-54. [PMID: 25466958 DOI: 10.1590/1516-4446-2013-1267] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 06/03/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Peritraumatic reactions feature prominently among the main predictors for development of posttraumatic stress disorder (PTSD). Peritraumatic tonic immobility (PTI), a less investigated but equally important type of peritraumatic response, has been recently attracting the attention of researchers and clinicians for its close association with traumatic reactions and PTSD. Our objective was to investigate the role of PTI, peritraumatic panic, and dissociation as predictors of PTSD symptoms in a cohort of police recruits (n=132). METHODS Participants were asked to complete the following questionnaires during academy training and after the first year of work: Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C), Physical Reactions Subscale (PRS), Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Tonic Immobility Scale (TIS), and Critical Incident History Questionnaire. RESULTS Employing a zero-inflated negative binomial regression model, we found that each additional point in the TIS was associated with a 9% increment in PCL-C mean scores (RM = 1.09), whereas for PRS, the increment was 7% (RM = 1.07). As the severity of peritraumatic dissociation increased one point in the PDEQ, the chance of having at least one symptom in the PCL-C increased 22% (OR = 1.22). CONCLUSIONS Our findings highlight the need to expand investigation on the incidence and impact of PTI on the mental health of police officers.
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Affiliation(s)
- Deborah B Maia
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Augusta Nóbrega
- Polícia Militar do Estado de Goiás (PMGO), Goiânia, GO, Brazil
| | - Carla Marques-Portella
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niterói, RJ, Brazil
| | - Eliane Volchan
- Instituto de Biofísica Carlos Chagas Filho (IBCCF), UFRJ, Rio de Janeiro, RJ, Brazil
| | - Evandro S Coutinho
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Yoo YS, Cho OH, Cha KS, Boo YJ. Factors Influencing Post-traumatic Stress in Korean Forensic Science Investigators. Asian Nurs Res (Korean Soc Nurs Sci) 2013; 7:136-41. [DOI: 10.1016/j.anr.2013.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 05/15/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022] Open
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Passos RBF, Figueira I, Mendlowicz MV, Moraes CL, Coutinho ESF. Exploratory factor analysis of the Brazilian version of the Post-Traumatic Stress Disorder Checklist: civilian version (PCL-C). REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2012; 34:155-61. [PMID: 22729411 DOI: 10.1590/s1516-44462012000200007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 06/11/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the factor structure of the Brazilian Portuguese version of the Post-Traumatic Stress Disorder Checklist-civilian version (PCL-C), in order to complement its validation process in Brazil. METHOD An exploratory factor analysis with promax rotation was conducted in 175 ambulance workers of the Emergence Rescue Group (GSE from Portuguese) of the Rio de Janeiro fire brigade and 343 military police officers (MP) (150 from an elite unit of the state of Goiás). RESULTS The results revealed a two-factor solution: re-experience/avoidance, numbing/hyperarousal. All variables loaded highly in at least one factor, except for one; variable 16. This item may have had a bad performance because the analysis was based on a sample of police officers, whose professional activity demands hypervigilance as one of its basic characteristics. Internal consistency values were acceptable. CONCLUSIONS Avoidance and numbing seem to be independent dimensions, differently from what is expected according to the DSM-IV. Therefore, new trials should be carried out in other populations, with victims of different kinds of trauma, and including females, to verify these findings.
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Exploratory factor analysis of the Brazilian version of the Post-Traumatic Stress Disorder Checklist - Civilian Version (PCL-C). BRAZILIAN JOURNAL OF PSYCHIATRY 2012. [DOI: 10.1016/s1516-4446(12)70033-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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