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Cohen M, Nakash O, Apter-Levy Y. Gender Differences in the Relationship between Lifetime Exposure to Trauma and the Development of Pathological Personality Traits. J Trauma Dissociation 2024; 25:394-407. [PMID: 38376101 DOI: 10.1080/15299732.2024.2320436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024]
Abstract
Gender differences in the prevalence, types and outcomes of traumas have consistently been reported in the literature. Other research has documented that exposure to trauma is associated with the development and maintenance of pathological personality traits. In the current study, we examined the moderating role of gender in the association between lifetime exposure to trauma and pathological personality traits. The sample included 148 clients who sought treatment at a community mental health clinic. All participants completed online questionnaires including demographic information, the Trauma History Questionnaire (THQ), and the Personality Inventory for DSM-5-Brief Form (PID-5-BF) at the entry to treatment. Our findings documented a significant association between exposure to trauma and pathological personality traits in men, but not in women. Furthermore, this pattern of results was specifically evident within two personality domains: antagonism and detachment. These findings contribute to the theoretical understanding of the interplay between trauma, gender, and the development of pathological personality traits. They expand upon the growing knowledge about the mental health crisis among boys and men by shedding light on the unique vulnerabilities that men face in response to traumatic experiences and how these experiences can have a lasting impact on their adaptive functioning. Consequently, at the clinical level, the current study emphasizes the importance of paying particular attention to men's trauma histories and explicitly exploring these during the intake session.
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Affiliation(s)
- Michal Cohen
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
- School for Social Work, Smith College, Northampton, Massachusetts, USA
| | - Ora Nakash
- School for Social Work, Smith College, Northampton, Massachusetts, USA
| | - Yael Apter-Levy
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
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2
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Chiu HTS, Low DCW, Chan AHT, Meiser-Stedman R. Relationship between anxiety sensitivity and post-traumatic stress symptoms in trauma-exposed adults: A meta-analysis. J Anxiety Disord 2024; 103:102857. [PMID: 38507961 DOI: 10.1016/j.janxdis.2024.102857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/21/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
Given the high rate of trauma exposure among the general population, it is important to delineate the risk factors for post-traumatic stress disorder (PTSD). While historically implicated in panic disorder, anxiety sensitivity is increasingly found to play a role in PTSD. The present review investigated the size of the relationship between anxiety sensitivity and PTSD symptoms among trauma exposed adults. A systematic search on multiple electronic databases (PTSDpubs, CINAHL, MEDLINE and PsycINFO) generated a total of 1025 records, among which 52 (n = 15173) met study inclusion criteria and were included in our random effects meta-analysis. Our results indicated a medium effect size (r = .46, 95% CI =.41,.50) for the relationship between anxiety sensitivity and PTSD symptoms. There was significant between-study heterogeneity. Furthermore, sub-group analyses revealed that study design (cross-sectional vs. longitudinal) may significantly moderate the association between anxiety sensitivity and PTSD severity. No moderation effect was found for assessment of PTSD through interview versus questionnaire, interpersonal versus non-interpersonal trauma, or low versus high study quality. Such patterns of results are consistent with cognitive models of PTSD. Clinical implications, strengths and limitations of the review were discussed.
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Affiliation(s)
- Henry Tak Shing Chiu
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
| | - Debbie Chi Wing Low
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Angel Hiu Tung Chan
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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3
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Fearon D, Perlman CM, Leatherdale S, Hirdes JP, Dubin J. Classification of traumatic life events and substance use among persons admitted to inpatient psychiatry in Ontario, Canada. J Psychiatr Res 2024; 172:236-243. [PMID: 38412786 DOI: 10.1016/j.jpsychires.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Trauma is commonly overlooked or undiagnosed in clinical care settings. Undetected trauma has been associated with elevated substance use highlighting the need to prioritize identifying individuals with undetected trauma through common characteristics. OBJECTIVE The purpose of this study is to identify classifications of traumatic life experiences and substance use among persons admitted to inpatient psychiatry in Ontario and to identify covariates associated with classification membership. STUDY DESIGN A population-based retrospective cohort study was conducted using interRAI Mental Health (MH) assessment data. Individuals were included who experienced traumatic life events (N = 10,125), in Ontario, Canada between January 1, 2015, to December 31, 2019. RESULTS Eight latent classes were identified that ranged from low (i.e., Class 1: Interpersonal Issues, Without Substance use) to high (i.e., Class 8: Widespread Trauma, Alcohol & Cannabis Addiction) complexity patterns of traumatic life events and substance use indicators. Classifications with similar trauma profiles were differentiated by patterns of substance use. For example, individuals in Class 2: Safety & Relationship Issues, Without Substance use and Class 3: Safety & Relationship Issues, Alcohol & Cannabis both had many estimates centered around the experience of victimization (e.g., victim of sexual assault, victim of physical assault, victim of emotional abuse). Multinomial logistic regression models highlighted additional factors associated with classifications such as homelessness, where those who were homeless were 2.09-4.02 times more likely to be in Class 6: Widespread Trauma & Substance Addiction. INTERPRETATION Trauma exposures are complex and varied among persons in inpatient psychiatry and can be further differentiated by substance use patterns. These findings provide a population-based estimate of the trauma experiences of persons in inpatient settings in Ontario, Canada. Findings demonstrate the importance of using comprehensive assessment to support clinical decision making in relation to trauma and substance.
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Affiliation(s)
- Danielle Fearon
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | | | - Scott Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Joel Dubin
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
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Stein J, El-Haj-Mohamad R, Stammel N, Vöhringer M, Wagner B, Nesterko Y, Böttche M, Knaevelsrud C. Changes in trauma appraisal during brief internet-based exposure and cognitive restructuring treatment for Arabic-speaking people with PTSD. Eur J Psychotraumatol 2024; 15:2324631. [PMID: 38511498 PMCID: PMC10962287 DOI: 10.1080/20008066.2024.2324631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/01/2024] [Indexed: 03/22/2024] Open
Abstract
Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood.Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD.Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets.Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment.Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology.Trial registration: German Clinical Trials Register identifier: DRKS00010245.
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Affiliation(s)
- Jana Stein
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Rayan El-Haj-Mohamad
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Nadine Stammel
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Max Vöhringer
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Yuriy Nesterko
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Maria Böttche
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Brewerton TD, Gavidia I, Suro G, Perlman MM. Associations between major depressive and bipolar disorders and eating disorder, PTSD, and comorbid symptom severity in eating disorder patients. Eur Eat Disord Rev 2024; 32:188-200. [PMID: 37788327 DOI: 10.1002/erv.3035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 09/05/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Major depressive disorder (MDD) and bipolar disorder (BD) are commonly comorbid with eating disorders (EDs). However, there is limited data about the clinical features of such patients, especially their association with traumatic histories and PTSD, which occur commonly in patients admitted to residential treatment. METHODS Adults (≥18 years, 91% female, n = 2155) admitted to residential ED treatment were evaluated upon admission for DSM-5 defined MDD and BD. Patients were divided into three groups based on an admission diagnosis of no mood disorder (NMD), MDD, and BD (types I and II) and compared on a number of demographic variables, clinical features and assessments. RESULTS Mood disorders occurred in 76.4% of participants. There were statistically significant differences across groups in most measures with the BD group showing higher rates and doses of traumatic events; higher current PTSD; higher BMIs; higher severity of ED, depression and state-trait anxiety symptoms; worse quality of life; and higher rates of substance use disorders. Similarly, the MDD group had higher rates than the NMD group on most measures. CONCLUSIONS These findings have important implications for prevention, treatment and long-term follow-up and highlight the need for early trauma-focused treatment of ED patients with comorbid mood disorders and PTSD.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Timothy D. Brewerton, MD, LLC, Mt. Pleasant, South Carolina, USA
- Monte Nido and Affiliates, Miami, Florida, USA
| | | | - Giulia Suro
- Monte Nido and Affiliates, Miami, Florida, USA
| | - Molly M Perlman
- Monte Nido and Affiliates, Miami, Florida, USA
- Department of Psychiatry and Behavioral Health, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
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Sprunger JG, Girard JM, Chard KM. Associations between transdiagnostic traits of psychopathology and hybrid posttraumatic stress disorder factors in a trauma-exposed community sample. J Trauma Stress 2024. [PMID: 38426947 DOI: 10.1002/jts.23023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 03/02/2024]
Abstract
Dimensional conceptualizations of psychopathology hold promise for understanding the high rates of comorbidity with posttraumatic stress disorder (PTSD). Linking PTSD symptoms to transdiagnostic dimensions of psychopathology may enable researchers and clinicians to understand the patterns and breadth of behavioral sequelae following traumatic experiences that may be shared with other psychiatric disorders. To explore this premise, we recruited a trauma-exposed online community sample (N = 462) and measured dimensional transdiagnostic traits of psychopathology using parceled facets derived from the Personality Inventory for DSM-5 Faceted-Short Form. PTSD symptom factors were measured using the PTSD Checklist for DSM-5 and derived using confirmatory factor analysis according to the seven-factor hybrid model (i.e., Intrusions, Avoidance, Negative Affect, Anhedonia, Externalizing Behaviors, Anxious Arousal, And Dysphoric Arousal). We observed hypothesized associations between PTSD factors and transdiagnostic traits indicating that some transdiagnostic dimensions were associated with nearly all PTSD symptom factors (e.g., emotional lability: rmean = .35), whereas others showed more unique relationships (e.g., hostility-Externalizing Behavior: r = .60; hostility with other PTSD factors: rs = .12-.31). All PTSD factors were correlated with traits beyond those that would appear to be construct-relevant, suggesting the possibility of indirect associations that should be explicated in future research. The results indicate the breadth of trait-like consequences associated with PTSD symptom exacerbation, with implications for case conceptualization and treatment planning. Although PTSD is not a personality disorder, the findings indicate that increased PTSD factor severity is moderately associated with different patterns of trait-like disruptions in many areas of functioning.
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Affiliation(s)
- Joel G Sprunger
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jeffrey M Girard
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Kathleen M Chard
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- PTSD Division, Cincinnati VA Medical Center, Cincinnati, Ohio, USA
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7
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Woodward MJ, Griffith EL, Free BL, Bowen ME, Majeed R, Beyer MS, Beck JG. Do latent profiles of self-reported anxiety, depression, and PTSD map onto clinician ratings? An examination with intimate partner violence survivors. J Anxiety Disord 2024; 101:102806. [PMID: 38061324 DOI: 10.1016/j.janxdis.2023.102806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE Studies exploring latent profiles of mental health in trauma survivors have largely relied on self-report, making it unclear whether these patterns correspond with clinician-assessed psychopathology. The purpose of the current study was to examine latent profiles of self-reported PTSD, depression, and anxiety in a sample of 387 women who had experienced intimate partner violence (IPV) and investigate whether profiles mapped onto clinician-rated measures of the same outcomes. METHOD Participants completed a series of semi-structured interviews and self-report measures assessing PTSD, depression, and anxiety. RESULTS Latent profile analyses revealed a 3-profile solution characterized by Low (22.48 %), Moderate (37.98 %), and High (39.53 %) self-reported symptomology. Clinician ratings were significant predictors of membership in the low vs. moderate vs. high symptomology profiles. However, normalized means showed discrepancies between self-report and clinician assessment regarding which issue was rated most severe. CONCLUSIONS Results suggest that while latent modeling approaches relying on self-report may adequately approximate common underlying patterns of psychopathology, they have limitations in identifying which disorders are most salient for clinical intervention.
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Malgaroli M, Szuhany KL, Riley G, Miron CD, Park JH, Rosenthal J, Chachoua A, Meyers M, Simon NM. Heterogeneity of posttraumatic stress, depression, and fear of cancer recurrence in breast cancer survivors: a latent class analysis. J Cancer Surviv 2023; 17:1510-1521. [PMID: 35224684 PMCID: PMC10037701 DOI: 10.1007/s11764-022-01195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/19/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Breast cancer survivors may demonstrate elevated psychological distress, which can also hinder adherence to survivorship care plans. Our goal was to study heterogeneity of behavioral health and functioning in breast cancer survivors, and identify both risk and protective factors to improve targets for wellness interventions. METHODS Breast cancer survivors (n = 187) consented to complete self-reported psychological measures and to access their medical records. Latent class analysis (LCA) was used to classify heterogeneous subpopulations based on levels of depression, post-traumatic stress, fear of cancer recurrence, cancer-related pain, and fatigue. Multinomial logistic regression and auxiliary analysis in a 3-step modeling conditional approach was used to identify characteristics of the group based on demographics, treatment history and characteristics, and current medication prescriptions. RESULTS Three subpopulations of breast cancer survivors were identified from the LCA: a modal Resilient group (48.2%, n = 90), a Moderate Symptoms group (34%, n = 65), and an Elevated Symptoms group (n = 17%, n = 32) with clinically-relevant impairment. Results from the logistic regression indicated that individuals in the Elevated Symptoms group were less likely to have a family history of breast cancer; they were more likely to be closer to time of diagnosis and younger, have received chemotherapy and psychotropic prescriptions, and have higher BMI. Survivors in the Elevated Symptoms group were also less likely to be prescribed estrogen inhibitors than the Moderate Symptoms group. CONCLUSIONS This study identified subgroups of breast cancer survivors based on behavioral, psychological, and treatment-related characteristics, with implications for targeted monitoring and survivorship care plans. IMPLICATIONS FOR CANCER SURVIVORS Results showed the majority of cancer survivors were resilient, with minimal psychological distress. Results also suggest the importance of paying special attention to younger patients getting chemotherapy, especially those without a family history of breast cancer.
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Affiliation(s)
- Matteo Malgaroli
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA.
| | - Kristin L Szuhany
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Gabriella Riley
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Carly D Miron
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Jae Hyung Park
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY, 10010, USA
| | - Jane Rosenthal
- Perlmutter Cancer Center, NYU Grossman School of Medicine, 160 E 34th St, New York, NY, 10016, USA
| | - Abraham Chachoua
- Perlmutter Cancer Center, NYU Grossman School of Medicine, 160 E 34th St, New York, NY, 10016, USA
| | - Marleen Meyers
- Perlmutter Cancer Center, NYU Grossman School of Medicine, 160 E 34th St, New York, NY, 10016, USA
| | - Naomi M Simon
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
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Castillo-Navarrete JL, Vicente B, Schmidt K, Moraga-Escobar E, Rojas-Ponce R, Lagos P, Macaya X, Guzman-Castillo A. Interaction of Val66Met BDNF and 5-HTTLPR polymorphisms with prevalence of post-earthquake 27-F PTSD in Chilean population. PeerJ 2023; 11:e15870. [PMID: 37692110 PMCID: PMC10484206 DOI: 10.7717/peerj.15870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/18/2023] [Indexed: 09/12/2023] Open
Abstract
Post-traumatic stress (PTSD) disorder is a mental health condition that can occur after experiencing or witnessing a traumatic event. The 27-F earthquake that struck Chile in 2010 was one such event that had a significant impact on the mental health of the population. A study was conducted to investigate the prevalence of PTSD and its associated factors among survivors of this earthquake. The study was a longitudinal design, involving a sample of 913 patients aged 18 to 75 years who attended 10 Primary Care Centers in Concepción, Chile. The Composite International Diagnostic Interview (CIDI) was used to assess both depressive episodes (DE) and PTSD before and after the earthquake. The study also involved genotyping studies using saliva samples from the participants, specifically focusing on the Val66Met and 5-HTTLPR polymorphisms. Statistical analysis was performed to examine the association between different variables and the presence of PTSD. These variables included demographic factors, family history of psychiatric disorders, DE, childhood maltreatment experiences, and critical traumatic events related to the earthquake. The results showed that the incidence of post-earthquake PTSD was 11.06%. No significant differences were found between the groups of participants who developed post-earthquake PTSD regarding the Val66Met or 5-HTTLPR polymorphisms. However, a significant association was found between the concomitant diagnosis of DE and the development of post-earthquake PTSD. The presence of DE doubled the risk of developing post-earthquake PTSD. The number of traumatic events experienced also had a statistically significant association with an increased risk of developing post-earthquake PTSD. The study's limitations include the potential interference of different DE subtypes, the complexity of quantifying the degree of earthquake exposure experienced by each individual, and events entailing social disruption, such as looting, that can profoundly influence distress. In conclusion, the study found that PTSD following the 27-F earthquake in Chile was associated with a concomitant diagnosis of DE and the number of traumatic events experienced. The study did not find a significant association between PTSD and the Val66Met or 5-HTTLPR polymorphisms. The researchers recommend that mental health professionals should prioritize the detection and treatment of concomitant depressive episodes and exposure to critical traumatic events in survivors of disasters. They also suggest that further research is needed to better understand the relationship between genetic factors and post-disaster PTSD.
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Affiliation(s)
- Juan-Luis Castillo-Navarrete
- Programa Neurociencias, Psiquiatría y Salud Mental, NEPSAM, Universidad de Concepción, Concepción, Chile
- Departamento de Tecnología Médica, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Programa Doctorado Salud Mental, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Benjamin Vicente
- Programa Neurociencias, Psiquiatría y Salud Mental, NEPSAM, Universidad de Concepción, Concepción, Chile
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Kristin Schmidt
- Programa Neurociencias, Psiquiatría y Salud Mental, NEPSAM, Universidad de Concepción, Concepción, Chile
- Programa Doctorado Salud Mental, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Esteban Moraga-Escobar
- Programa Neurociencias, Psiquiatría y Salud Mental, NEPSAM, Universidad de Concepción, Concepción, Chile
| | - Romina Rojas-Ponce
- Programa Neurociencias, Psiquiatría y Salud Mental, NEPSAM, Universidad de Concepción, Concepción, Chile
- Programa Doctorado Salud Mental, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Departamento de Farmacología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Paola Lagos
- Programa Neurociencias, Psiquiatría y Salud Mental, NEPSAM, Universidad de Concepción, Concepción, Chile
- Departamento de Farmacología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Ximena Macaya
- Programa Neurociencias, Psiquiatría y Salud Mental, NEPSAM, Universidad de Concepción, Concepción, Chile
- Facultad de Odontología, Universidad de Concepción, Concepción, Chile
| | - Alejandra Guzman-Castillo
- Programa Neurociencias, Psiquiatría y Salud Mental, NEPSAM, Universidad de Concepción, Concepción, Chile
- Programa Doctorado Salud Mental, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Departamento de Ciencias Básicas y Morfología, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
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Smith ML, Seegulam V, Szentkúti P, Horváth-Puhó E, Galea S, Lash TL, Rosellini AJ, Schnurr PP, Sørensen HT, Gradus JL. Risk of psychopathology following traumatic events among immigrants and native-born persons in Denmark. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1305-1316. [PMID: 36449069 DOI: 10.1007/s00127-022-02391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Immigrants may have increased risk of mental disorders compared with native-born persons. We aimed to expand the limited research on immigrants' posttraumatic psychopathology related to traumatic experiences in their country of resettlement. METHODS We obtained data from a cohort of Danish residents with ≥ 1 traumatic event recorded in health and administrative national registries during 1994-2016. We calculated risks of posttraumatic stress disorder (PTSD), depression, and substance use disorders (SUD) within 5 years post-trauma among native-born Danes and immigrants who had been in Denmark for ≥ 10 years at the time of their index trauma (including immigrants overall and immigrants from specific regions). Risks were compared via age- and sex-standardized risk ratios (SRR) with 95% confidence intervals (CI). We restricted to persons with no record of the disorder under investigation in the 10 years pre-trauma, and stratified by non-interpersonal (e.g., transport accidents) versus interpersonal trauma (e.g., assaults). RESULTS Following non-interpersonal trauma, immigrants were more likely than native-born Danes to be diagnosed with PTSD (SRR = 5.2, 95% CI 4.6, 5.9), about as likely to be diagnosed with depression (SRR = 0.98, 95% CI 0.92, 1.1), and less likely to be diagnosed with SUD (SRR = 0.89, 95% CI 0.82, 0.95). Results were similar following interpersonal trauma, except the SRR for PTSD was reduced in magnitude (SRR = 3.0, 95% CI 1.7, 5.4). There were differences by region of birth. CONCLUSION Immigrants to Denmark have higher risk of PTSD following traumatic experiences than do native-born Danes, possibly due to the combined influence of adverse pre-, peri-, and/or post-migration experiences.
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Affiliation(s)
- Meghan L Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Vijaya Seegulam
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sandro Galea
- School of Public Health, Boston University, 715 Albany St., Boston, MA, 02118, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anthony J Rosellini
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Paula P Schnurr
- National Center for PTSD Executive Division, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
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11
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Cho A, Wood JJ, Ferrer E, Rosenau K, Storch EA, Kendall PC. Empirically-identified subgroups of children with autism spectrum disorder and their response to two types of cognitive behavioral therapy. Dev Psychopathol 2023; 35:1188-1202. [PMID: 34866567 DOI: 10.1017/s0954579421001115] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Autism spectrum disorder (ASD) is heterogeneous and likely entails distinct phenotypes with varying etiologies. Identifying these subgroups may contribute to hypotheses about differential treatment responses. The present study aimed to discern subgroups among children with ASD and anxiety in context of the five-factor model of personality (FFM) and evaluate treatment response differences to two cognitive-behavioral therapy treatments. The present study is a secondary data analysis of children with ASD and anxiety (N=202; ages 7-13; 20.8% female) in a cognitive behavioral therapy (CBT) randomized controlled trial (Wood et al., 2020). Subgroups were identified via latent profile analysis of parent-reported FFM data. Treatment groups included standard-of-practice CBT (CC), designed for children with anxiety, and adapted CBT (BIACA), designed for children with ASD and comorbid anxiety. Five subgroups with distinct profiles were extracted. Analysis of covariance revealed CBT response was contingent on subgroup membership. Two subgroups responded better to BIACA on the primary outcome measure and a third responded better to BIACA on a peer-social adaptation measure, while a fourth subgroup responded better to CC on a school-related adaptation measure. These findings suggest that the FFM may be useful in empirically identifying subgroups of children with ASD, which could inform intervention selection decisions for children with ASD and anxiety.
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Affiliation(s)
- Anchuen Cho
- University of California, Los Angeles, 405 Hilgard Ave., 3132A Moore Hall, Los Angeles, CA90095, USA
| | - Jeffrey J Wood
- University of California, Los Angeles, 405 Hilgard Ave., 3132A Moore Hall, Los Angeles, CA90095, USA
| | - Emilio Ferrer
- University of California, Davis, 1 Shields Ave., 135 Young Hall, Davis, CA95616, USA
| | - Kashia Rosenau
- University of California, Los Angeles, 405 Hilgard Ave., 3132A Moore Hall, Los Angeles, CA90095, USA
| | - Eric A Storch
- Baylor College of Medicine, 7200 Cambridge St, Houston, TX77030, USA
| | - Philip C Kendall
- Temple University, 1701 North 13th St., Weiss Hall, Philadelphia, PA19122, USA
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12
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Carter SE, Sumner JA. Introduction to the Special Section on the International Society for Traumatic Stress Studies 38th Annual Meeting: Trauma as a transdiagnostic risk factor across the lifespan. J Trauma Stress 2023; 36:659-661. [PMID: 37527057 DOI: 10.1002/jts.22962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023]
Abstract
This article serves as an introduction to the special section in the Journal of Traumatic Stress related to the 38th annual meeting of the International Society for Traumatic Stress Studies, held in Atlanta, Georgia (USA) in November 2022. The theme of this meeting, "Trauma as a Transdiagnostic Risk Factor Across the Lifespan," provided an opportunity to recognize the far-reaching impact of trauma and how traumatic experiences can become embedded into the mind, body, and societal spirit. This introductory article outlines the importance of harnessing multiple perspectives to address these wide-ranging sequelae of trauma and provides an overview of the series of contributions to the special section.
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Affiliation(s)
- Sierra E Carter
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Jennifer A Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
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Haws JK, Laifer LM, Acosta LM, Ralston AL, Ruggiero KJ, Davidson TM, Andrews AR. A Distinction Without a Difference? A Multi-Method Approach to Understanding PTSD and Depression Symptom Overlap Among Disaster-Exposed Adolescents. Res Child Adolesc Psychopathol 2023; 51:1021-1035. [PMID: 36881210 DOI: 10.1007/s10802-023-01042-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
Among adolescents exposed to trauma, posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) commonly co-occur. Despite the prevalence of comorbidity, the question of how PTSD and MDD are related and appropriate conceptual models for understanding their linkage in adolescence remains unclear. This study applies a multi-methodological approach to advance conceptual and theoretical understanding of the overlap between PTSD and MDD diagnoses/symptoms. We tested three methodological approaches with three distinct theoretical underpinnings on the structure of each disorder proposed in the literature: confirmatory factor analysis (CFA) with dimensional constructs, latent class analysis (LCA) with person-based categorical constructs, and network analysis with symptom-to-symptom associations. Across the three different analytical approaches, there was a significant overlap between PTSD and MDD. Overall, there was no compelling evidence for distinct boundaries between disorders among trauma-exposed adolescents. Instead, we found considerable evidence that the typical latent-construct-based conceptualizations, whether categorical or dimensional, may need revision.
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Affiliation(s)
- James Kyle Haws
- Department of Family Medicine, and the Adult and Child Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, 13199 E. Montview Blvd, Suite 300, Aurora, CO, 80045, USA.
| | - Lauren M Laifer
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Laura M Acosta
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Allura L Ralston
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Tatiana M Davidson
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Arthur R Andrews
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
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14
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Ney LJ, Akosile W, Davey C, Pitcher L, Felmingham KL, Mayo LM, Hill MN, Strodl E. Challenges and considerations for treating PTSD with medicinal cannabis: the Australian clinician's perspective. Expert Rev Clin Pharmacol 2023; 16:1093-1108. [PMID: 37885234 DOI: 10.1080/17512433.2023.2276309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Preclinical and experimental research have provided promising evidence that medicinal cannabis may be efficacious in the treatment of posttraumatic stress disorder (PTSD). However, implementation of medicinal cannabis into routine clinical therapies may not be straightforward. AREAS COVERED In this review, we describe some of the clinical, practical, and safety challenges that must be addressed for cannabis-based treatment of PTSD to be feasible in a real-world setting. These issues are especially prevalent if medicinal cannabis is to be combined with trauma-focused psychotherapy. EXPERT OPINION Future consideration of the clinical and practical considerations of cannabis use in PTSD therapy will be essential to both the efficacy and safety of the treatment protocols that are being developed. These issues include dose timing and titration, potential for addiction, product formulation, windows of intervention, and route of administration. In particular, exposure therapy for PTSD involves recall of intense emotions, and the interaction between cannabis use and reliving of trauma memories must be explored in terms of patient safety and impact on therapeutic outcomes.
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Affiliation(s)
- Luke J Ney
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Wole Akosile
- Greater Brisbane Clinical School, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Chris Davey
- Department of Psychiatry, Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | | | - Kim L Felmingham
- School of Psychological Sciences, Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Leah M Mayo
- Department of Psychiatry, Mathison Centre for Mental Health Research, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Matthew N Hill
- Department of Psychiatry, Mathison Centre for Mental Health Research, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Esben Strodl
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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15
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Baluku MM, Nansubuga F, Kibanja GM, Ouma S, Balikoowa R, Nansamba J, Ruto G, Kawooya K, Musanje K. Associations of psychological inflexibility with posttraumatic stress disorder and adherence to COVID-19 control measures among refugees in Uganda: The moderating role of coping strategies. J Contextual Behav Sci 2023; 28:278-288. [PMID: 37197224 PMCID: PMC10163792 DOI: 10.1016/j.jcbs.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
Refugees are vulnerable to developing mental health problems. The unprecedented appearance and rapid spread of COVID-19 exacerbated this vulnerability, especially in low-income countries where refugees survive on humanitarian aid and live in congested settlements. These appalling living conditions are a stressor, making adherence to COVID-19 control measures impractical and an additional psychological strain for refugees. The present study examined how psychological inflexibility is associated with adherence to COVID-19 control measures. A sample of 352 refugees from Kampala City and Bidibidi settlements were recruited. Refugees with high levels of psychological inflexibility reported higher PTSD symptom severity and low adherence to COVID-19 control measures. Moreover, PTSD severity mediated the association between psychological inflexibility and adherence, while avoidance coping moderated both direct and indirect effects. Interventions for reducing psychological inflexibility and avoidance coping may be essential in boosting adherence to measures relevant to the current and future status of the pandemic, along with other crises that refugees face.
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Affiliation(s)
| | | | | | - Samuel Ouma
- Makerere University, School of Psychology, Uganda
| | | | | | - Grace Ruto
- Makerere University, Research and Innovations Fund (Mak-RIF) Secretariat, Uganda
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Brewerton TD, Gavidia I, Suro G, Perlman MM. Eating disorder patients with and without PTSD treated in residential care: discharge and 6-month follow-up results. J Eat Disord 2023; 11:48. [PMID: 36973828 PMCID: PMC10044735 DOI: 10.1186/s40337-023-00773-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION We studied whether provisional posttraumatic stress disorder (PTSD) moderated discharge (DC) and 6-month follow-up (FU) outcomes of multi-modal, integrated eating disorder (ED) residential treatment (RT) based upon principles of cognitive processing therapy (CPT). METHODS ED patients [N = 609; 96% female; mean age (± SD) = 26.0 ± 8.8 years; 22% LGBTQ +] with and without PTSD completed validated assessments at admission (ADM), DC and 6-month FU to measure severity of ED, PTSD, major depressive disorder (MDD), state-trait anxiety (STA) symptoms, and eating disorder quality of life (EDQOL). We tested whether PTSD moderated the course of symptom change using mixed models analyses and if ED diagnosis, ADM BMI, age of ED onset and LGBTQ + orientation were significant covariates of change. Number of days between ADM and FU was used as a weighting measure. RESULTS Despite sustained improvements with RT in the total group, the PTSD group had significantly higher scores on all measures at all time points (p ≤ .001). Patients with (n = 261) and without PTSD (n = 348) showed similar symptom improvements from ADM to DC and outcomes remained statistically improved at 6-month FU compared to ADM. The only significant worsening observed between DC and FU was with MDD symptoms, yet all measures remained significantly lower than ADM at FU (p ≤ .001). There were no significant PTSD by time interactions for any of the measures. Age of ED onset was a significant covariate in the EDI-2, PHQ-9, STAI-T, and EDQOL models such that an earlier age of ED onset was associated with a worse outcome. ADM BMI was also a significant covariate in the EDE-Q, EDI-2, and EDQOL models, such that higher ADM BMI was associated with a worse ED and quality of life outcome. CONCLUSIONS Integrated treatment approaches that address PTSD comorbidity can be successfully delivered in RT and are associated with sustained improvements at FU. Improving strategies to prevent post-DC recurrence of MDD symptoms is an important and challenging area of future work.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Timothy D. Brewerton, MD, LLC, Mount Pleasant, SC, USA.
- Monte Nido and Affiliates, Miami, FL, USA.
| | | | | | - Molly M Perlman
- Monte Nido and Affiliates, Miami, FL, USA
- Department of Psychiatry and Behavioral Health, Florida International University College of Medicine, Miami, FL, USA
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17
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Norton SE, Hunt C, Lah S. Fear of sleep in people with epilepsy. Epilepsy Res 2023; 192:107124. [PMID: 36940587 DOI: 10.1016/j.eplepsyres.2023.107124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
More than one third of people with epilepsy (PWE) report experiencing insomnia. This is highly concerning given that sleep loss both triggers and exacerbates seizures. It is therefore paramount that we understand the underlying mechanisms of insomnia in PWE. Nevertheless, research in this area remains limited, with little understanding of the emerging or maintaining factors of insomnia in PWE. Therefore, the current study sought to explore fear of sleep as a novel explanation for the increased rate of insomnia in PWE, and whether fear of sleep was related to post-seizure trauma. We recruited 184 PWE and 197 healthy controls via social media and collected data using a series of online questionnaires. We found that fear of sleep did not significantly differ between the epilepsy and control group. In the epilepsy group, fear of sleep seemed to be largely driven by trauma, especially post-seizure trauma but also non-seizure related trauma, along with anxiety and higher seizure frequency. Fear of sleep in the control group was also largely driven by trauma, but also anxiety and depression. Finally, we found more severe and prevalent insomnia in PWE relative to controls, and in both groups, fear of sleep was the most significant contributor to insomnia. Our novel findings carry important clinical implications. First, they point to the central role of trauma in fear of sleep not only in PWE but also in the general population. Our findings also indicate that fear of sleep is an important maintaining factor of insomnia. Ultimately, these results suggest that all individuals with insomnia may benefit from insomnia interventions targeted at trauma, depression, anxiety, and fear of sleep. PWE are likely to benefit from additional treatment components for seizure-related trauma and seizure management. To better understand the reliability and generalisability of our novel findings, future research should further assess fear of sleep and its role in maintaining insomnia in the epilepsy population.
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Affiliation(s)
- Shanae Ella Norton
- Department of Psychology, University of Sydney, Camperdown, Sydney, Australia
| | - Caroline Hunt
- Department of Psychology, University of Sydney, Camperdown, Sydney, Australia
| | - Suncica Lah
- Department of Psychology, University of Sydney, Camperdown, Sydney, Australia.
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18
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Clauss K, Gorday JY, Bardeen JR. Investigating the specific domains of the cognitive attentional syndrome that predict posttraumatic stress symptoms: The moderating effect of attentional control. J Anxiety Disord 2023; 94:102670. [PMID: 36701955 DOI: 10.1016/j.janxdis.2023.102670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 11/08/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
The metacognitive model of posttraumatic stress disorder (PTSD) suggests that persistent use of the maladaptive self-regulation strategies that comprise the cognitive attentional syndrome (CAS) increases the likelihood of developing PTSD symptoms following trauma exposure. The metacognitive model also suggests that flexible regulation of attention might be protective against developing maladaptive outcomes that are associated with the CAS. The aims of this study were to (1) examine associations between all seven domains of the CAS and PTSD symptoms using a recently developed, multidimensional measure of the CAS, and (2) examine the moderating effect of self-reported attentional control on associations between the CAS and PTSD symptoms. Participants were trauma-exposed community adults (N = 237) who completed a battery of self-report measures. Results from linear regression analyses showed that worry, substance use, and internal threat monitoring accounted for unique variance in PTSD symptoms when all seven CAS domains were entered into the same model. Moderation analyses showed that attentional control dampened the effect of the CAS, specifically external threat monitoring, on PTSD symptoms. Study results support attentional control as a protective factor against the maladaptive effects of the CAS on PTSD symptoms.
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Affiliation(s)
- Kate Clauss
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Julia Y Gorday
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Joseph R Bardeen
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA.
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19
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Pierce B, Kirsh T, Ferguson AR, Neylan TC, Ma S, Kummerfeld E, Cohen BE, Nielson JL. Causal discovery replicates symptomatic and functional interrelations of posttraumatic stress across five patient populations. Front Psychiatry 2023; 13:1018111. [PMID: 36793783 PMCID: PMC9924232 DOI: 10.3389/fpsyt.2022.1018111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/30/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction Approximately half of individuals with posttraumatic stress disorder (PTSD) may meet criteria for other psychiatric disorders, and PTSD symptoms are associated with diminished health and psychosocial functioning. However, few studies examine the longitudinal progression of PTSD symptoms concurrent with related symptom domains and functional outcomes, such that may neglect important longitudinal patterns of symptom progression beyond PTSD specifically. Methods Therefore, we used longitudinal causal discovery analysis to examine the longitudinal interrelations among PTSD symptoms, depressive symptoms, substance abuse, and various other domains of functioning in five longitudinal cohorts representing veterans (n = 241), civilians seeking treatment for anxiety disorders (n = 79), civilian women seeking treatment for post-traumatic stress and substance abuse (n = 116), active duty military members assessed 0-90 days following TBI (n = 243), and civilians with a history of TBI (n = 43). Results The analyses revealed consistent, directed associations from PTSD symptoms to depressive symptoms, independent longitudinal trajectories of substance use problems, and cascading indirect relations from PTSD symptoms to social functioning through depression as well as direct relations from PTSD symptoms to TBI outcomes. Discussion Our findings suggest PTSD symptoms primarily drive depressive symptoms over time, tend to show independence from substance use symptoms, and may cascade into impairment in other domains. The results have implications for refining conceptualization of PTSD co-morbidity and can inform prognostic and treatment hypotheses about individuals experiencing PTSD symptoms along with co-occurring distress or impairment.
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Affiliation(s)
- Benjamin Pierce
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Thomas Kirsh
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
| | - Adam R. Ferguson
- Department of Neurological Surgery, Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Thomas C. Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Psychiatry and Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Sisi Ma
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Erich Kummerfeld
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
| | - Beth E. Cohen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jessica L. Nielson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
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20
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Kim GS, Shim MS, Won CW, Kim M, Lee S, Kim N, Park MK. Patterns and predictors of fall injury transitions among Korean older adult fallers: a 2-year longitudinal study. Sci Rep 2022; 12:22188. [PMID: 36564434 DOI: 10.1038/s41598-022-26665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This study was conducted to identify fall injury patterns, the transition from the baseline to follow-up, and the factors associated with the identified fall injury patterns using data obtained from the Korean Frailty and Aging Cohort Study. The participants were 566 community-dwelling older adults with fall experience. Three fall injury patterns were identified as the baseline and follow-up periods. The probability that the participant in the "fracture injury" pattern at Time 1 transitioned to the "fracture injury" pattern at Time 2 was 0.098. The factors associated with the "bruising and/or sprain injury" pattern were education level (relative risk ratio [RRR] = 0.55, p = 0.012), alcohol consumption (RRR = 0.50, p = 0.034), and balancing in tandem position (RRR = 2.77, p < 0.001). In the "fracture injury" pattern, male (RRR = 0.22, p = 0.038), frailty score (RRR = 0.58, p = 0.042), "bruising injury" (RRR = 0.23, p = 0.007), and "sprain injury" (RRR = 0.20, p = 0.007) at the baseline were significant factors. The findings indicate that previous fall experiences, higher alcohol consumption, lower frailty scores, and poor balance levels are associated with fall injury patterns. These patterns should be considered when developing prevention interventions.
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21
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Roeckner AR, Sogani S, Michopoulos V, Hinrichs R, van Rooij SJH, Rothbaum BO, Jovanovic T, Ressler KJ, Stevens JS. Sex-dependent risk factors for PTSD: a prospective structural MRI study. Neuropsychopharmacology 2022; 47:2213-2220. [PMID: 36114284 PMCID: PMC9630503 DOI: 10.1038/s41386-022-01452-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/18/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022]
Abstract
Female individuals are more likely to be diagnosed with PTSD following trauma exposure than males, potentially due, in part, to underlying neurobiological factors. Several brain regions underlying fear learning and expression have previously been associated with PTSD, with the hippocampus, amygdala, dorsal anterior cingulate cortex (dACC), and rostral ACC (rACC) showing altered volume and function in those with PTSD. However, few studies have examined how sex impacts the predictive value of subcortical volumes and cortical thickness in longitudinal PTSD studies. As part of an emergency department study completed at the Grady Trauma Project in Atlanta, GA, N = 93 (40 Female) participants were enrolled within 24 h following a traumatic event. Multi-echo T1-weighted MRI images were collected one-month post-trauma exposure. Bilateral amygdala and hippocampal volumes and rACC and dACC cortical thickness were segmented. To assess the longitudinal course of PTSD, the PTSD Symptom Scale (PSS) was collected 6 months post-trauma. We investigated whether regional volume/thickness interacted with sex to predict later PTSD symptom severity, controlling for PSS score at time of scan, age, race, and trauma type, as well as intracranial volume (ICV) for subcortical volumes. There was a significant interaction between sex and rACC for 6-month PSS, such that right rACC thickness was positively correlated with 6-month PSS scores in females, but not in males. In examining PTSD symptom subtypes and depression symptoms, greater rACC thickness in females predicted greater avoidance symptoms, while smaller rACC thickness in males predicted greater depression symptoms. Amygdala and hippocampus volume and dACC thickness showed no main effect or interaction with sex. The current findings provide evidence for sex-based differences in how brain volume predicts future PTSD severity and symptoms and supports the rACC as being a vital region regarding PTSD. Gender differences should be assessed in future longitudinal PTSD MRI studies for more accurate identification of future PTSD risk following trauma.
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22
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Opie E, Werbeloff N, Hayes J, Osborn D, Pitman A. Suicidality in patients with post-traumatic stress disorder and its association with receipt of specific secondary mental healthcare treatments. Int J Psychiatry Clin Pract 2022:1-10. [PMID: 36369845 DOI: 10.1080/13651501.2022.2140679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a risk factor for suicidality (suicidal ideation, and suicide attempt). This study described the prevalence of suicidality amongst a representative sample of individuals with PTSD and the association between suicidality and receipt of five PTSD treatments. METHODS We analysed deidentified data for patients being treated for PTSD at Camden and Islington NHS Foundation Trust between 2009 and 2017 obtained via the Clinical Record Interactive Search tool. We described the sample's sociodemographic and clinical characteristics and used stepwise logistic regression to investigate the association between suicidality and receipt of four, specific PTSD treatments: psychotherapy, antidepressant/antianxiety medication, antipsychotics, benzodiazepines. We used Cox proportional hazards regression to investigate the association between suicidality and hospital/crisis team admission. RESULTS Of 745 patients diagnosed with PTSD, 60% received psychotherapy and 66% received psychotropic medication. Those who reported suicidality (6%) were no more likely than those who did not to be prescribed antidepressant/antianxiety medication, but were more likely to receive antipsychotics (AOR = 2.27, 95% CI 1.15 - 4.47), benzodiazepines (AOR 2.28, 95% CI 1.17 - 4.44), psychotherapy (AOR 2.60, 95% CI 1.18 - 5.73) and to be admitted to hospital/crisis team (AOR 2.84, 95% 1.82 - 4.45). CONCLUSION In this sample, patients with PTSD and suicidality were more likely to receive psychiatric medication, psychotherapy and psychiatric admission than those who were not suicidal. Overall patients were more likely to receive psychotropic medication than psychotherapy. Adherence to clinical guidelines is important in this population to improve treatment outcomes and reduce the risk of suicide.KEY POINTSNICE guidelines recommend psychological therapy be first line treatment for PTSD, yet we identified that fewer people diagnosed with PTSD received therapy compared to psychotropic medication.Patients with suicidality were more likely to receive antipsychotics and benzodiazepines, yet not antidepressant/antianxiety medication although given that suicidality is characteristic of severe depression, it might be assumed from stepped care models that antidepressant/antianxiety medication be prescribed before antipsychotics.The high proportion of patients prescribed antipsychotics suggests a need for better understanding of psychosis symptoms among trauma-exposed populations.Identifying which combinations of symptoms are associated with suicidal thoughts could help tailor trauma-informed approaches to discussing therapy and medication.
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Affiliation(s)
- Elena Opie
- UCL Division of Psychiatry, University College London, UK
- Whittington Health, London, UK
| | - Nomi Werbeloff
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Tel Aviv, Israel
| | - Joseph Hayes
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - David Osborn
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Alexandra Pitman
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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23
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Renner V, Joraschky P, Kirschbaum C, Schellong J, Petrowski K. Pro- and anti-inflammatory cytokines Interleukin-6 and Interleukin-10 predict therapy outcome of female patients with posttraumatic stress disorder. Transl Psychiatry 2022; 12:472. [PMID: 36351891 DOI: 10.1038/s41398-022-02230-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
PTSD patients show alterations of the immune system, mainly a 'low-grade inflammation'. Psychotherapeutic treatments are meant to reduce symptom burden of PTSD patients but 30-50% of PTSD patients do not benefit from psychotherapy. Therefore, in this study, the predictive effect of cytokine levels on therapy outcome are investigated. Pro- (IL-6) and anti-inflammatory (IL-10) cytokines in female PTSD patients (N = 17) were assessed under acute stress during a Trier social stress test (TSST) before therapeutic treatment. The predictive effects of IL-6 and IL-10 on therapy outcome (SCL_GSI, BDI) after an inpatient psychotherapeutic treatment at the University Medical Center Carl Gustav Carus, Technische Universität Dresden was investigated. Areas under the curve with respect to ground (AUCG) and increase (AUCI) for IL-6 and IL-10 levels during the TSST were calculated and used as predictors in regression analyses with pre-treatment scores. Models including all three predictors show good model fits (R2 = 0.255 to 0.744). Models including AUCG and AUCI scores show superior fits compared with models including pre-treatment scores alone (ΔR2 = 0.196 to 0.444). IL-6 AUCG and AUCI scores are significant predictors for post-treatment SCL-GSI and BDI (β = -0.554 to 0.853), whereas IL-10 AUCG significantly predicts SCL-GSI and BDI (β = -0.449 to -0.509). Therefore, pro- and anti-inflammatory IL-6 and IL-10 levels under acute stress before therapy predict therapy outcome of female PTSD patients regarding general symptom burden and depressive symptoms. Future studies should further address the link between inflammation and therapy outcome, especially underlying mechanisms and influencing factors.
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24
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Hawn SE, Hawrilenko M, McDowell Y, Campbell S, Garcia NM, Simpson TL. An in-depth look at latent classes of DSM-5 psychiatric comorbidity among individuals with PTSD: Clinical indicators and treatment utilization. J Clin Psychol 2022; 78:2214-2244. [PMID: 35973077 PMCID: PMC9561047 DOI: 10.1002/jclp.23429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 04/25/2022] [Accepted: 07/26/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with high comorbidity rates across the full range of psychiatric disorders. However, little is known about how psychiatric comorbidity manifests among people with PTSD, particularly with regard to concurrent diagnoses. METHOD Latent class analysis (LCA) was used to characterize discrete classes of PTSD comorbidity using past year DSM-5 diagnostic standards among a large nationally representative epidemiologic sample of U.S. adults. Follow-up analyses compared participant characteristics across latent classes. RESULTS The LCA was best characterized by five classes: low comorbidity, distress-fear, distress-externalizing, mania-fear-externalizing, and mania-externalizing. Excluding the low comorbidity class, proportions of borderline and schizotypal personality disorder were high across classes. CONCLUSION Participant characteristics across classes of past year PTSD comorbidity are explored through the lens of case conceptualization and treatment planning utility.
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Affiliation(s)
- Sage E. Hawn
- National Center for PTSD, Boston VA Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Matthew Hawrilenko
- VA Puget Sound Healthcare System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | | | - Sarah Campbell
- VA Puget Sound Healthcare System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | | | - Tracy L. Simpson
- VA Puget Sound Healthcare System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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25
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Zapata I, Eyre AW, Alvarez CE, Serpell JA. Latent class analysis of behavior across dog breeds reveal underlying temperament profiles. Sci Rep 2022; 12. [PMID: 36115919 PMCID: PMC9482611 DOI: 10.1038/s41598-022-20053-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Latent class analysis (LCA) is a type of modeling analysis approach that has been used to identify unobserved groups or subgroups within multivariate categorical data. LCA has been used for a wide array of psychological evaluations in humans, including the identification of depression subtypes or PTSD comorbidity patterns. However, it has never been used for the assessment of animal behavior. Our objective here is to identify behavioral profile-types of dogs using LCA. The LCA was performed on a C-BARQ behavioral questionnaire dataset from 57,454 participants representing over 350 pure breeds and mixed breed dogs. Two, three, and four class LCA models were developed using C-BARQ trait scores and environmental covariates. In our study, LCA is shown as an effective and flexible tool to classify behavioral assessments. By evaluating the traits that carry the strongest relevance, it was possible to define the basis of these grouping differences. Groupings can be ranked and used as levels for simplified comparisons of complex constructs, such as temperament, that could be further exploited in downstream applications such as genomic association analyses. We propose this approach will facilitate dissection of physiological and environmental factors associated with psychopathology in dogs, humans, and mammals in general.
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26
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Woodfield R, Boduszek D, Willmott D. Latent profiles of PTSD, anxiety and depression and association with trauma exposure within prison personnel. European Journal of Trauma & Dissociation 2022. [DOI: 10.1016/j.ejtd.2022.100268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Byrow Y, Liddell B, O'Donnell M, Mau V, McMahon T, Bryant R, Benson G, Nickerson A. Profiles of post-migration stressors and mental health in refugees: A latent class analysis. Psychiatry Res 2022; 311:114494. [PMID: 35287045 DOI: 10.1016/j.psychres.2022.114494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/27/2022] [Accepted: 03/05/2022] [Indexed: 11/23/2022]
Abstract
Studies have documented the mental health effects of pre-migration trauma on resettled refugees and identified distinct psychological symptom profiles using person centred statistical techniques (e.g., latent class analysis; LCA). These techniques have advanced our understanding of the complex presentation of trauma and psychopathology in refugees. The current study employs LCA to examine patterns of exposure to stressors including post-migration stressors, allowing us to identify patterns of post-migration stress exposure and their association with mental health outcomes. Participants were 1085 Arabic, Farsi, Tamil, or English speaking adult refugees. Pre-migration trauma, post-migration stressors, PTSD, depression, anger, and functional impairment was measured. LCA was conducted to identify distinct classes of post-migration stressors and associations with mental health and adjustment in the resettlement environment. Latent class analysis revealed 5 classes of participants: high difficulties class (7.2%), immigration fear class (14.4%), social disconnection class (17.3%), moderate difficulties class (28.9%) and a low difficulties class (32.3%). Each of the five classes shared commonalities in addition to key differences associated with specific demographic characteristics and psychopathology. Post-migration stressors appear to map onto distinct profiles, which uniquely contribute to functional impairment and mental health outcomes in refugees. These findings have substantial implications for public health and social services working with resettled refugee communities.
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28
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Powers A, Petri JM, Sleep C, Mekawi Y, Lathan EC, Shebuski K, Bradley B, Fani N. Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample. J Anxiety Disord 2022; 88:102558. [PMID: 35378368 PMCID: PMC9107503 DOI: 10.1016/j.janxdis.2022.102558] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/04/2022] [Accepted: 03/19/2022] [Indexed: 11/19/2022]
Abstract
There is debate about the validity of the complex posttraumatic stress disorder (CPTSD) diagnosis and whether disturbances in self-organization (DSO) in CPTSD can be differentiated from borderline personality disorder (BPD). How PTSD is defined may matter. The present study used exploratory structural equation modeling (ESEM) to replicate and extend prior work by including two models to examine how PTSD (ICD-11, DSM-5), DSO, and BPD symptoms relate. Participants (N = 470; 98.1% women; 97.7% Black) were recruited from medical clinics within an urban hospital. PTSD, CPTSD, and BPD were assessed using semi-structured interviews and trauma-related avoidance, aggressive behavior, and anxious attachment were assessed using self-report measures. ESEM models of PTSD, DSO, and BPD symptoms were run. We found a three-factor ESEM model of CPTSD (ICD-11 PTSD and DSO symptoms) and BPD symptoms best fit the data and found support for discriminant validity between factors across trauma-related avoidance, aggressive behavior, and anxious attachment. For DSM-5 PTSD, a two-factor ESEM model was best-fitting (PTSD and DSO/BPD). The findings demonstrate clear distinguishing and overlapping features of ICD-11 PTSD, CPTSD, and BPD and the necessity to consider the diagnostic structure of PTSD in determining the additive value of CPTSD as a distinct construct.
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Affiliation(s)
- Abigail Powers
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Jessica M Petri
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Emma C Lathan
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Karen Shebuski
- Department of Counseling and Psychological Services, Georgia State University, Atlanta, GA, USA
| | - Bekh Bradley
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Atlanta, GA, USA
| | - Negar Fani
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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29
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Gradus JL, Rosellini AJ, Szentkúti P, Horváth-Puhó E, Smith ML, Galatzer-Levy I, Lash TL, Galea S, Schnurr PP, Sørensen HT. Using Danish national registry data to understand psychopathology following potentially traumatic experiences. J Trauma Stress 2022; 35:619-630. [PMID: 35084778 PMCID: PMC9035023 DOI: 10.1002/jts.22777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/20/2022]
Abstract
Research on posttraumatic psychopathology has focused primarily on posttraumatic stress disorder (PTSD); other posttraumatic psychiatric diagnoses are less well documented. The present study aimed to (a) develop a methodology to derive a cohort of individuals who experienced potentially traumatic events (PTEs) from registry-based data and (b) examine the risk of psychopathology within 5 years of experiencing a PTE. Using data from Danish national registries, we created a cohort of individuals with no age restrictions (range: 0-108 years) who experienced at least one of eight possible PTEs between 1994 and 2016 (N = 1,406,637). We calculated the 5-year incidence of nine categories of ICD-10 psychiatric disorders among this cohort and examined standardized morbidity ratios (SMRs) comparing the incidence of psychopathology in this group to the incidence in a nontraumatic stressor cohort (i.e., nonsuicide death of a relative; n = 423,270). Stress disorders (2.5%), substance use disorders (4.1%), and depressive disorders (3.0%) were the most common diagnoses following PTEs. Overall, the SMRs for the associations between any PTE and psychopathology varied from 1.9, 95% CI [1.9, 2.0], for stress disorders to 5.2, 95% CI [5.1. 5.3], for personality disorders. All PTEs except pregnancy-related trauma were associated with all forms of psychopathology. Associations were consistent regardless of whether a stress disorder was present. Traumatic experiences have a broad impact on psychiatric health. The present findings demonstrate one approach to capturing trauma exposure in medical record registry data. Increased traumatic experience characterization across studies will help improve the field's understanding of posttraumatic psychopathology.
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Affiliation(s)
- Jaimie L. Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anthony J. Rosellini
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Meghan L. Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Isaac Galatzer-Levy
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Timothy L. Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Paula P. Schnurr
- National Center for PTSD Executive Division, White River Junction, Vermont, USA,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Henrik T. Sørensen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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30
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Carmassi C, Pedrinelli V, Dell'Oste V, Bertelloni CA, Grossi C, Gesi C, Cerveri G, Dell'Osso L. PTSD and Depression in Healthcare Workers in the Italian Epicenter of the COVID-19 Outbreak. Clin Pract Epidemiol Ment Health 2022; 17:242-252. [PMID: 35173794 PMCID: PMC8728562 DOI: 10.2174/1745017902117010242] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/12/2021] [Accepted: 09/24/2021] [Indexed: 12/27/2022]
Abstract
Background: Increasing evidence highlights the susceptibility of Healthcare Workers to develop psychopathological sequelae, including Post-Traumatic Stress Disorder (PTSD) and depression, in the current COronaVIrus Disease-19 (COVID-19) pandemic, but little data have been reported in the acute phase of the pandemic. Objective: To explore Healthcare Workers’ mental health reactions in the acute phase of the COVID-19 pandemic in the first European epicenter (Lodi/Codogno, Italy), with particular attention to post-traumatic stress and depressive symptoms and their interplay with other psychological outcomes. Methods: 74 Healthcare Workers employed at the Azienda Socio Sanitaria Territoriale of Lodi (Lombardy, Italy) were recruited and assessed by means of the Impact of Event Scale- Revised, the Professional Quality of Life Scale-5, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 item, the Resilience Scale and the Work and Social Adjustment Scale. Socio-demographic and clinical variables were compared across three subgroups of the sample (No PTSD, PTSD only, PTSD and depression). Results: A total of 31% of subjects endorsed a diagnosis of PTSD and 28.4% reported PTSD comorbid with major depression. Females were more prone to develop post-traumatic stress and depressive symptoms. Subjects with PTSD and depression groups showed high levels of PTSD, depression, burnout and impairment in functioning. Anxiety symptoms were higher in both PTSD and depression and PTSD groups rather than in the No PTSD group. Conclusion: Our results showed high rates of PTSD and depression among Healthcare Workers and their comorbidity overall being associated with worse outcomes. Current findings suggest that interventions to prevent and treat psychological implications among Healthcare Workers facing infectious outbreaks are needed.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | | | - Chiara Grossi
- Department of Mental Health and Addiction, ASST Lodi, Lodi, Italy
| | - Camilla Gesi
- Department of Mental Health and Addiction, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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31
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Kaplan J, Somohano V, Eddy A, Oken B, Wahbeh H. Mindful nonreactivity moderates the relationship between posttraumatic stress disorder and depression. J Loss Trauma 2022; 27:593-607. [PMID: 36618880 PMCID: PMC9815478 DOI: 10.1080/15325024.2022.2030019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PTSD and depression represent major individual and societal burdens. Depression is commonly comorbid with PTSD among veterans, although buffers of this relationship are unclear. We evaluated whether facets of mindfulness moderated the relationship between PTSD and depression in veterans with PTSD (N = 70). Three facets - nonjudging, acting with awareness, and nonreactivity - were assessed as moderators. Results indicated nonreactivity significantly attenuated the relationship between PTSD and depression (p=.013), such that veterans with high nonreactivity (+1 SD) showed a nonsignificant relationship between PTSD and depression, whereas veterans with average (Mean; p<.001) and low (-1 SD; p<.001) nonreactivity exhibited a significant relationship.
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Affiliation(s)
- Josh Kaplan
- Department of Neurology, Oregon Health & Science University,Department of Neurology, Oregon Health & Science University, 3250 SW Sam Jackson Park Road, Portland, OR 97239,
| | - Vanessa Somohano
- Mental Health and Neuroscience Division, VA Portland Healthcare System
| | - Ashley Eddy
- School of Graduate Psychology, Pacific University
| | - Barry Oken
- Department of Neurology, Oregon Health & Science University
| | - Helané Wahbeh
- Department of Neurology, Oregon Health & Science University,Research, Institute of Noetic Sciences
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32
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Scott E, May M, Silva G, Taylor R, Fenlon N, Lowery-Gionta E, Matson L. Variation in trauma-related behavioral effects using a preclinical rat model of three predator exposure stress. Stress 2022; 25:276-290. [PMID: 35920240 DOI: 10.1080/10253890.2022.2105647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The underlying mechanisms of trauma-related disorders are challenging to discover and the disorders are difficult to treat, in part due to the complex and varied expressions of response to traumatic stress. These challenges will be easier to overcome as more is understood about the variability in response to trauma. Incorporating assessment of variability into animal models of traumatic stress may allow better translation to clinical research and treatment development. In this study, we characterized variability in behavioral responses following traumatic stress exposure using a predator exposure (PE) animal model. Elevated plus maze (EPM) and acoustic startle response (SR) were used to study avoidance and arousal symptoms in male Sprague-Dawley rats. Behavioral data were compared between control (n = 31) and predator-exposed (n = 30) rats. PE behavior was clustered using k-means principal components analysis. Four clusters and three distinct subgroups were identified and were characterized as avoidant (Cluster 4, 30%), moderately avoidant (Clusters 2 and 3, 49%), and unaffected (Cluster 1, 17%). These results demonstrate that rodent responses to PE are varied, similar to human presentations following traumatic stress, suggesting it may be possible to develop treatment strategies for varied symptom presentations using a preclinical animal model.
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Affiliation(s)
- Emily Scott
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Matthew May
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Gabriella Silva
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Rachel Taylor
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Nicole Fenlon
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Emily Lowery-Gionta
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Liana Matson
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
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33
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Lei H, Chen C, Hagiwara K, Kusumi I, Tanabe H, Inoue T, Nakagawa S. Symptom Patterns of the Occurrence of Depression and Anxiety in a Japanese General Adult Population Sample: A Latent Class Analysis. Front Psychiatry 2022; 13:808918. [PMID: 35211043 PMCID: PMC8861440 DOI: 10.3389/fpsyt.2022.808918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Given the high comorbidity and shared risk factors between depression and anxiety, whether they represent theoretically distinct disease entities or are just characteristics of a common negative affect dimension remains debated. Employing a data-driven and person-centered approach, the present study aims to identify meaningful and discrete symptom patterns of the occurrence of depression and anxiety. METHODS Using data from an adult sample from the Japanese general population (n = 403, including 184 females, age = 42.28 ± 11.87 years), we applied latent class analysis to identify distinct symptom patterns of depression (PHQ-9) and anxiety (STAI Y1). To empirically validate the derived class memberships, we tested the association between the derived classes and personal profiles including childhood experiences, life events, and personality traits. RESULTS The best-fitting solution had four distinct symptom patterns or classes. Whereas both Class 1 and 2 had high depression, Class 1 showed high anxiety due to high anxiety-present symptoms (e.g., "I feel nervous") while Class 2 showed moderate anxiety due to few anxiety-absent symptoms (e.g., "I feel calm"). Class 3 manifested mild anxiety symptoms due to lacking responses on anxiety-absent items. Class 4 manifested the least depressive and anxiety-present symptoms as well as the most anxiety-absent symptoms. Importantly, whereas both Class 1 and 2 had higher childhood neglect and reduced reward responsiveness, etc. compared to Class 4 (i.e., the most healthy class), only Class 1 had greater negative affect and reported more negative life events. CONCLUSIONS To our knowledge, this is the first latent class analysis that examined the symptom patterns of depression and anxiety in Asian subjects. The classes we identified have distinct features that confirm their unique patterns of symptom endorsement. Our findings may provide insights into the etiology of depression, anxiety, and their comorbidity.
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Affiliation(s)
- Huijie Lei
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Chong Chen
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kosuke Hagiwara
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hajime Tanabe
- Faculty of Humanities and Social Sciences, Shizuoka University, Shizuoka, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Shin Nakagawa
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
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34
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Eder-Moreau E, Zhu X, Fisch CT, Bergman M, Neria Y, Helpman L. Neurobiological Alterations in Females With PTSD: A Systematic Review. Front Psychiatry 2022; 13:862476. [PMID: 35770056 PMCID: PMC9234306 DOI: 10.3389/fpsyt.2022.862476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Most females experience at least one traumatic event in their lives, but not all develop PTSD. Despite considerable research, our understanding of the key factors that constitute risk for PTSD among females is limited. Previous research has largely focused on sex differences, neglecting within group comparisons, thereby obviating differences between females who do and do not develop PTSD following exposure to trauma. In this systematic review, we conducted a search for the extent of existing research utilizing magnetic resonance imaging (MRI) to examine neurobiological differences among females of all ages, with and without PTSD. Only studies of females who met full diagnostic criteria for PTSD were included. Fifty-six studies were selected and reviewed. We synthesized here findings from structural MRI (sMRI), functional MRI (fMRI), diffusion tensor imaging (DTI), and resting state functional connectivity (rs-FC MRI) studies, comparing females with and without PTSD. A range of biopsychosocial constructs that may leave females vulnerable to PTSD were discussed. First, the ways timing and type of exposure to trauma may impact PTSD risk were discussed. Second, the key role that cognitive and behavioral mechanisms may play in PTSD was described, including rumination, and deficient fear extinction. Third, the role of specific symptom patterns and common comorbidities in female-specific PTSD was described, as well as sex-specific implications on treatment and parenting outcomes. We concluded by identifying areas for future research, to address the need to better understand developmental aspects of brain alterations, the differential impact of trauma types and timing, the putative role of neuroendocrine system in neurobiology of PTSD among females, and the impact of social and cultural factors on neurobiology in females with PTSD.
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Affiliation(s)
- Elizabeth Eder-Moreau
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Xi Zhu
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Chana T Fisch
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Maja Bergman
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Yuval Neria
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Liat Helpman
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel.,Psychiatric Research Unit, Tel Aviv Medical Center, Tel Aviv, Israel
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35
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Jung H, Lee D, Lee D. Longitudinal transitions in patterns of post-traumatic stress disorder symptoms and psychological distress among South Korean adults with traumatic experiences. Stress Health 2021; 37:871-886. [PMID: 33740290 DOI: 10.1002/smi.3046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/07/2022]
Abstract
This study aimed to investigate transitions in patterns of post-traumatic stress disorder (PTSD) symptoms and psychological distress among South Koreans with traumatic experiences. This study consists of two parts: In Part 1 the time since trauma ranged between 0 and 41 years, while in Part 2 participants experienced at least one traumatic event within the previous three years. We identified subgroups and transitions between classes over a one-year period using latent profile analysis and latent transition analysis. First, in Part 1, four classes were identified at T1 and T2. Second, we explored whether age, sex, time since trauma, and time perspective (TP) predicted class membership at T1. Age, past-negative (PN), present-fatalistic, and future TPs were significant predictors of class membership at T1. Finally, sex, PN, and future TPs were identified as significant predictors of class transition over time. The same analysis was conducted in Part 2 with individuals chosen from the Part 1 participants. Differential effects of TP on class membership and transitions in PTSD symptoms and psychological distress indicated the need for intervention programs that consider the TP profiles of individuals with traumatic experiences.
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Affiliation(s)
- Hayoung Jung
- Department of Education, College of Education, Sungkyunkwan University, South Korea
| | - DongHun Lee
- Department of Education, College of Education, Sungkyunkwan University, South Korea
| | - Deokhee Lee
- Department of Education, College of Education, Sungkyunkwan University, South Korea
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Connolly RD, Speed D, Hesson J. Probabilities of PTSD and Related Substance Use Among Canadian Adults. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cheng ZH, Lozier CC, Lewis MM, O'neil ME, Luoma JB, Morasco BJ. Investigating the role of psychological inflexibility, mindfulness, and self-compassion in PTSD. Journal of Contextual Behavioral Science 2021; 22:102-7. [DOI: 10.1016/j.jcbs.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Stewart RW, Villalobos BT, Dueweke AR, Rodriguez JH, Nicasio AV, Alto M, Orengo-Aguayo R. A Pilot Trial of Universal School-Based Mental Health Screening in El Salvador: Traumatic Stress in an Underresourced School Environment. J Trauma Stress 2021; 34:955-966. [PMID: 34297864 PMCID: PMC10019777 DOI: 10.1002/jts.22716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/29/2021] [Accepted: 05/08/2021] [Indexed: 01/27/2023]
Abstract
Salvadoran youth have an elevated risk of trauma exposure and related mental health problems. However, investigations of childhood trauma exposure and mental health sequelae in El Salvador are limited. The present study aimed to (a) explore the prevalence of exposure to potentially traumatic events and symptoms of posttraumatic stress, anxiety, and depression and (b) evaluate the associations between specific trauma types and emotional functioning among Salvadoran youth. A total of 1,296 youth aged 8-21 years from seven public schools completed self-report measures of trauma exposure, posttraumatic stress symptoms (PTSS), anxiety, and depression. Participants reported high levels of trauma exposure, endorsing an average of 3.62 (SD = 2.32) trauma types. In total, 34.5% of participants reported clinically elevated PTSS; fewer youths reported elevated depressive (8.7%) and anxiety symptoms (8.6%). Although boys reported exposure to more trauma types than girls, d = 0.22, girls were more likely to endorse elevated PTSS, V = .11; anxiety, V = .06; and depression, V = .10. Adolescents reported exposure to more trauma types than younger children, d = 0.23, and were more likely to endorse elevated PTSS, V = .07; anxiety, V = .13; and depression, V = .16. Undergoing a frightening medical procedure, OR = 2.30; female sex, OR = 1.92; witnessing domestic violence, OR = 1.70; and experiencing war between gangs, OR = 1.61, were strong predictors of elevated PTSS. This broad, school-based screening was a critical step toward better understanding the rate of trauma exposure and trauma-related symptoms among Salvadoran youth.
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Affiliation(s)
- Regan W Stewart
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bianca T Villalobos
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Aubrey R Dueweke
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Andel V Nicasio
- PhD Clinical Psychology Program, Albizu University, San Juan Campus, San Juan, Puerto Rico, USA
| | - Michelle Alto
- Johns Hopkins University, Bloomberg School of Public Health, Department of Mental Health, Baltimore, Maryland, USA
| | - Rosaura Orengo-Aguayo
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Soydas S, Smid GE, Lenferink LIM, Djelantik AAMJ, Goodfellow B, Wilson R, Boelen PA. Psychopathology in a treatment-seeking sample of homicidally bereaved individuals: Latent class analysis. J Affect Disord 2021; 292:234-241. [PMID: 34134021 DOI: 10.1016/j.jad.2021.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Violently bereaved individuals are at increased risk of developing severe and comorbid disorders. Comorbidity may increase psychiatric symptom severity and suicide risk and decrease psychosocial functioning compared with having one disorder. We aimed to identify subgroups of individuals with similar symptom patterns, describe prevalence rates and overall levels of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) per class, and explore associations between class membership and personal and homicide related variables. METHODS We investigated the comorbidity of symptoms of PGD, PTSD, MDD, and GAD in a sample of 923 treatment-seeking homicidally bereaved individuals by deploying latent class analysis. RESULTS Three subgroups were identified: (i) a moderate distress, low depression class (12.4%), (ii) a high distress, moderate depression class (42.7%), and (iii) a high distress and high depression class (45.0%). Prevalence rates and total scores of the questionnaires followed the pattern of iii ≥ ii ≥ i (ps ≤ .001). Being female and having experienced prior life stress distinguished between all classes (ps ≤ .05). LIMITATIONS The data-driven analytic approach and reliance on self-reported routine outcome monitoring data limit the generalizability and validity of the study. Strengths include the large sample size and the inclusion of four measures in a treatment-seeking, violently bereaved sample. CONCLUSIONS Classes were most clearly distinguishable based on symptom severity, indicating high comorbidity following bereavement by homicide. This argues for an integrated treatment that targets different complaints simultaneously rather than successively.
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Affiliation(s)
- Suzan Soydas
- Utrecht University, Department of Clinical Psychology, Utrecht, the Netherlands; ARQ National Psychotrauma Center, Diemen, the Netherlands.
| | - Geert E Smid
- ARQ National Psychotrauma Center, Diemen, the Netherlands; University of Humanistic Studies, Utrecht, the Netherlands
| | - Lonneke I M Lenferink
- Utrecht University, Department of Clinical Psychology, Utrecht, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands; University of Twente, Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, Enschede, the Netherlands
| | - A A Manik J Djelantik
- University Medical Centre Utrecht, Department of Psychiatry, Utrecht, the Netherlands; Altrecht GGZ, Department Youth - KOOS, Utrecht, the Netherlands
| | | | - Rachel Wilson
- ASSIST Trauma Care, Rugby, the United Kingdom; NHS England, Liverpool, the United Kingdom
| | - Paul A Boelen
- Utrecht University, Department of Clinical Psychology, Utrecht, the Netherlands; ARQ National Psychotrauma Center, Diemen, the Netherlands
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Schwartzkopff L, Gutermann J, Steil R, Müller-Engelmann M. Which Trauma Treatment Suits me? Identification of Patients' Treatment Preferences for Posttraumatic Stress Disorder (PTSD). Front Psychol 2021; 12:694038. [PMID: 34456808 PMCID: PMC8387597 DOI: 10.3389/fpsyg.2021.694038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
Several psychotherapy treatments exist for posttraumatic stress disorder. This study examines the treatment preferences of treatment-seeking traumatized adults in Germany and investigates the reasons for their treatment choices. Preferences for prolonged exposure, cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), psychodynamic psychotherapy and stabilization were assessed via an online survey. Reasons for preferences were analyzed by means of thematic coding by two independent rates. 104 traumatized adults completed the survey. Prolonged exposure and CBT were each preferred by nearly 30%, and EMDR and psychodynamic psychotherapy were preferred by nearly 20%. Stabilization was significantly less preferred than all other options, by only 4%. Significantly higher proportions of patients were disinclined to choose EMDR and stabilization. Patients who preferred psychodynamic psychotherapy were significantly older than those who preferred CBT. Reasons underlying preferences included the perceived treatment mechanisms and treatment efficacy. Traumatized patients vary in their treatment preferences. Preference assessments may help clinicians comprehensively address patients' individual needs and thus improve therapy outcomes.
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Affiliation(s)
- Laura Schwartzkopff
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Jana Gutermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
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Assmann N, Fassbinder E, Schaich A, Lee CW, Boterhoven de Haan K, Rijkeboer M, Arntz A. Differential Effects of Comorbid Psychiatric Disorders on Treatment Outcome in Posttraumatic Stress Disorder from Childhood Trauma. J Clin Med 2021; 10:3708. [PMID: 34442005 DOI: 10.3390/jcm10163708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/09/2021] [Accepted: 08/14/2021] [Indexed: 01/15/2023] Open
Abstract
Patients with posttraumatic stress disorder (PTSD) frequently have comorbid diagnoses such as major depressive disorder (MDD) and anxiety disorders (AD). Studies into the impact of these comorbidities on the outcome of PTSD treatment have yielded mixed results. The different treatments investigated in these studies might explain the varied outcome. The purpose of this study was to examine the impact of these comorbidities on the outcome of two specific PTSD treatments. MDD and AD were analyzed as predictors and moderators in a trial comparing 12 sessions of either eye movement desensitization and reprocessing (EMDR) or imagery rescripting (IR) in 155 adult patients with PTSD from childhood trauma. The primary outcome was reduction of PTSD symptoms (clinician-administered PTSD Scale for DSM-5, CAPS-5) assessed at eight-week follow-up and a secondary outcome was self-report PTSD symptoms (Impact of Event Scale, IES-R). MDD was not a predictor of treatment outcome but did have a significant moderator effect. Patients with MDD showed a better outcome if they were treated with IR, whereas patients without MDD improved more in the EMDR condition. No impact of AD emerged. It seems essential to consider comorbid MDD when planning PTSD treatment to improve treatment outcomes. More research is needed to replicate our findings and focus on different kinds of PTSD treatments and other comorbidities.
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Sekowski M, Gambin M, Hansen K, Holas P, Hyniewska S, Wyszomirska J, Pluta A, Sobańska M, Łojek E. Risk of Developing Post-traumatic Stress Disorder in Severe COVID-19 Survivors, Their Families and Frontline Healthcare Workers: What Should Mental Health Specialists Prepare For? Front Psychiatry 2021; 12:562899. [PMID: 34163377 PMCID: PMC8215154 DOI: 10.3389/fpsyt.2021.562899] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/05/2021] [Indexed: 11/25/2022] Open
Abstract
Given the high mortality of the coronavirus disease 2019 (COVID-19), having severe COVID-19 may be a life-threatening event, especially for individuals at high risk of complications. Therefore, in the article we try to answer two questions that are relevant to public mental health: Can we define groups who are at higher risk of developing pandemic-related PTSD? How can health specialists prepare for it? Given the results of previous research on PTSD in epidemic (e.g., SARS) survivors, we suggest that mental health professionals in countries touched by the pandemic should prepare for an increase in the PTSD prevalence, specifically in: individuals who have had severe COVID-19; family members of these patients and of patients who have died; and frontline healthcare workers witnessing COVID-19 patients' sudden deaths, or numerous life-threatening situations. We postulate that these groups at risk should be routinely screened for PTSD in primary medical and pediatric care. Mental health services should prepare for providing therapeutic interventions for individuals with PTSD in the vulnerable groups, and support to their families, especially children.
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Affiliation(s)
- Marcin Sekowski
- Department of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | | | | | - Paweł Holas
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Sylwia Hyniewska
- Department of Experimental Psychology, University College London, London, United Kingdom
| | - Julia Wyszomirska
- Department of Psychology, Medical University of Silesia, Katowice, Poland
| | | | - Marta Sobańska
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Emilia Łojek
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
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Kieseppä V, Jokela M, Holm M, Suvisaari J, Gissler M, Lehti V. Post-traumatic stress disorder among immigrants living in Finland: Comorbidity and mental health service use. Psychiatry Res 2021; 300:113940. [PMID: 33906030 DOI: 10.1016/j.psychres.2021.113940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/10/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to compare differences in comorbidity between immigrants and Finnish-born controls, and to examine the treatment received by immigrants with PTSD. Our original data included all the immigrants living in Finland by the end of 2010 and matched controls. For this study, we selected individuals who had received a diagnosis of PTSD during 2010-2015 (immigrants: n = 754, Finnish-born controls: n = 311). We compared the frequency of different comorbid conditions between immigrants and natives. Multinomial logistic regression was used to predict categorized treatment intensity with the region of origin and length of residence among the immigrants. Psychiatric comorbidity was much more extensive among the Finnish-born controls than among immigrants. Immigrants from Africa and the Middle East more often received treatment of low intensity compared with immigrants from Western countries. The length of residence was associated with more frequent treatment. The important differences in comorbidity and background characteristics between immigrants and natives should be taken into account in planning treatment guidelines for PTSD. The disparities in treatment intensity across different immigrant groups indicate a need to improve the services for immigrants with PTSD.
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Affiliation(s)
- Valentina Kieseppä
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Markus Jokela
- Department of Psychology and Logopedics, Medicum, University of Helsinki, Helsinki, Finland
| | - Minna Holm
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Venla Lehti
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Barbieri A, Visco-Comandini F, Alunni Fegatelli D, Dessì A, Cannella G, Stellacci A, Pirchio S. Patterns and predictors of PTSD in treatment-seeking African refugees and asylum seekers: A latent class analysis. Int J Soc Psychiatry 2021; 67:386-396. [PMID: 32962504 DOI: 10.1177/0020764020959095] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the empirical and clinical relevance of understanding posttraumatic stress disorder (PTSD) heterogeneity in refugees and asylum-seekers, very few studies have examined the manner in which PTSD symptoms manifest in such populations. AIMS This study sought to investigate patterns and predictors of DSM-5 PTSD in a treatment-seeking sample of African refugees. METHODS Participants were 122 African refugees and asylum-seekers living in Italy who completed measures of trauma exposure and PTSD symptoms. Latent class analysis (LCA) was used to identify PTSD symptom profiles, and predictors of class membership were identified via multinomial logistic regression. RESULTS Among participants, 79.5% had a probable diagnosis of PTSD. Three PTSD classes were identified by LCA: Pervasive (32.0%) with high probabilities of all symptoms, high-Threat (45.9%) with higher probabilities of intrusions and avoidance symptoms, moderate-Avoidance (22.1%) with high probability of thoughts/feelings avoidance. None of the examined variables (legal status, gender, age, education, months spent in Italy, number of traumatic events, employment) significantly predicted class membership with the relevant exception of reception conditions. Specifically, living in large reception centres (over 1,000 people) significantly predicted Pervasive PTSD class membership compared to high/Threat PTSD class and to moderate/Avoidance class. CONCLUSION This study provides evidence for distinct patterns of PTSD symptomatology in refugees and asylum seekers. We identified three classes which present both qualitative and quantitative differences in symptoms: Pervasive class, high-Threat class and a new moderate class, characterised by avoidance symptoms. Reception conditions contributed to the emergence of the Pervasive PTSD profile characterised by the symptoms highest severity. These findings highlight that stressors in the post-migration environment, as inadequate reception conditions in large facilities, may have detrimental effect on refugees' mental health. We emphasise the importance for host countries to implement reception models that provide effective protection and integration to this vulnerable population.
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Affiliation(s)
| | | | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Sabine Pirchio
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
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Albanese BJ, Preston TJ, Bedford C, Macatee RJ, Schmidt NB. Distress Intolerance Prospectively Predicts Traumatic Intrusions Following an Experimental Trauma in a Non-clinical Sample. Cogn Ther Res 2021. [DOI: 10.1007/s10608-021-10228-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rosellini AJ, Szentkúti P, Horváth-Puhó E, Smith ML, Galatzer-Levy I, Lash TL, Galea S, Schnurr PP, Sørensen HT, Gradus JL. Latent classes of posttraumatic psychiatric comorbidity in the general population. J Psychiatr Res 2021; 136:334-342. [PMID: 33636689 PMCID: PMC8485142 DOI: 10.1016/j.jpsychires.2021.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023]
Abstract
Some narrow patterns of posttraumatic psychiatric comorbidity are well-established (e.g., posttraumatic stress disorder and substance use). However, broad multi-diagnosis profiles of posttraumatic comorbidity are poorly characterized. The goal of the current study was to use latent class analysis (LCA) to identify profiles of posttraumatic psychopathology from 11 International Classification of Diseases (ICD-10) diagnostic categories (e.g., stress, substance, depressive, psychosis, personality). Danish national registries were used to identify 166,539 individuals (median age = 41 years, range = <1 to >100) who experienced a traumatic event between 1994 and 2016 and were diagnosed with one or more mental disorders within 5 years. Two through 14-class LCA solutions were evaluated. A 13-class solution (a) provided the best fit, with the Bayes and Akaike Information Criteria reaching a minimum, (b) was broadly consistent with prior LCA studies, and (c) included several novel classes reflecting differential patterns of posttraumatic psychopathology. Three classes were characterized by high comorbidity: broad high comorbidity (M # diagnoses = 4.3), depression with stress/substance use/personality/neurotic disorders (M# diagnoses = 3.8), and substance use with personality/stress/psychotic disorders (M # diagnoses = 3.1). The other 10 classes were characterized by distinct patterns of mild comorbidity or negligible comorbidity. Compared to the mild and negligible comorbidity classes, individuals in high comorbidity classes were younger, had lower income, and had more pre-event psychiatric disorders. Results suggest that several different comorbidity patterns should be assessed when studying and treating posttraumatic psychopathology.
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Affiliation(s)
- Anthony J Rosellini
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Meghan L Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Paula P Schnurr
- National Center for PTSD Executive Division, White River Junction, VT, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jaimie L Gradus
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Qassem T, Aly-ElGabry D, Alzarouni A, Abdel-Aziz K, Arnone D. Psychiatric Co-Morbidities in Post-Traumatic Stress Disorder: Detailed Findings from the Adult Psychiatric Morbidity Survey in the English Population. Psychiatr Q 2021; 92:321-30. [PMID: 32705407 DOI: 10.1007/s11126-020-09797-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Post Traumatic Stress Disorder (PTSD) is a condition which causes great sufferance to the individuals affected. The occurrence of comorbidities in PTSD is a frequent event with a negative impact on outcome. This study investigated the frequency of PTSD in relation to comorbidities by analyzing the results of the 2007 'Adult Psychiatric Morbidity Survey' in the English population, which included data on comorbidities. A population study conducted in the United Kingdom, this survey investigated the frequency of PTSD in the community and the relationship to comorbidities by adopting a random design to minimize selection bias, stratified by region and socioeconomic characteristics, and weighted according to design and non-response. The survey interviewed 7403 adults living in private households. Socio-demographic characteristics and psychiatric morbidity were systematically assessed. Results indicated that PTSD prevalence was 2.9%, with an excess in women (3.3%) compared to men (2.4%) as reported by the 2007 survey. Comorbidity was a very frequent occurrence in PTSD reaching 78.5% in affected cases. Major depression was the commonest condition and its frequency increased with symptoms severity up to 54%. Among anxiety disorders, social phobia was the most frequent, followed by generalized anxiety disorder, obsessive-compulsive disorder, agoraphobia and panic disorder. Substance use disorders were also common. The presence of psychotic symptoms was particularly significant with over 30% prevalence in PTSD. These results indicate that attention needs to be devoted to the presence of comorbidities. In view of the impact of comorbidities on PTSD severity, chronicity and functional impairment, early detection and treatment are likely to improve outcome.
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Abstract
This case study displays the successful application of Prolonged Exposure (PE) for a client with diagnoses of Posttraumatic Stress Disorder (PTSD), Attention Deficit Hyperactivity Disorder (ADHD), and Generalized Anxiety Disorder (GAD). To our knowledge ADHD has not been examined as a predictor or moderator of PE outcomes. As such, practitioners have precious little information about how to proceed in such cases, which highlights the importance of careful individual assessment and case conceptualization. There is also a dearth of information on the effects of combining PE (a research-supported psychological intervention for PTSD) with psychostimulant medication (a research-supported pharmacological intervention for ADHD). The present case study illustrates a positive synergy between psychostimulant treatment and PE. The unique adjustments made to deliver services (including in the face of COVID-19) are described as well as what this case suggests about the effects of psychostimulant use on PTSD symptoms and the new learning that occurs during PE.
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Affiliation(s)
- Yuval Neria
- Departments of Psychiatry and Epidemiology and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
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50
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Kachadourian LK, Harpaz-Rotem I, Tsai J, Southwick S, Pietrzak RH. Mindfulness as a mediator between trauma exposure and mental health outcomes: Results from the National Health and Resilience in Veterans Study. Psychol Trauma 2021; 13:223-230. [PMID: 33475404 DOI: 10.1037/tra0000995] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Exposure to traumatic life events is associated with increased risk of posttraumatic stress disorder (PTSD) and other mental health problems such as suicidal ideation (SI), alcohol use disorder (AUD), and decreased quality of life (QOL). Mindfulness, which involves attending to the present moment, may help individuals cope with traumatic events by increasing acceptance of trauma-related experiences and decreasing trauma-related negative affect and avoidance of trauma reminders. The current study evaluated whether mindful attention to the present moment mediated the association between number of lifetime traumas and mental health. METHOD The sample consisted of 1,268 trauma-exposed U.S. veterans who participated in the National Health and Resilience in Veterans Study, a nationally representative study of U.S. veterans. On average, the sample was 60.6 years of age (SD = 15.2, range = 20-94), predominantly male (89.8%), Caucasian (75.0%), and noncombat veterans (59.2%). RESULTS Path analyses revealed that mindfulness partially mediated the relation between number of lifetime traumas and PTSD symptoms (β = -.55), AUD (β = -.17), and QOL (β = .38), and fully mediated the relation between number of lifetime traumas and SI (β = -.36). CONCLUSIONS The relationship between lifetime trauma burden and various mental health issues of relevance to U.S. veterans may be mediated by mindfulness, or the ability to pay attention to the present moment. Interventions that bolster mindfulness may help mitigate the negative impact of cumulative traumas in this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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