Is a Criterion A trauma necessary to elicit posttraumatic stress symptoms?

OBJECTIVE

The posttraumatic stress disorder (PTSD) diagnosis has undergone substantial revision since its first appearance in the DSM-III. Much of the controversy surrounds the definition of trauma, or Criterion A. Our study sought to evaluate the DSM-5-TR's Criterion A and severity of PTSD symptoms in college students.

METHOD

Participants were 1500 college students who completed an online questionnaire about mental health symptoms. Responses to the Criterion A assessment were double coded by researchers to determine if the DSM-5-TR's Criterion A was met. Interpersonal agreement between raters was high (kappa = .81). Participants were compared across groups based on their PTSD Criterion A status: (1) DSM-Congruent, (2) DSM-Incongruent, (3) DSM-Ambiguous, and (4) Denied Trauma, using analysis of variance and multiple regression.

RESULTS

Participants who reported a trauma that was coded as Criterion A by researchers had the highest levels of PTSD symptoms, even after controlling for perceived stress, depression, anxiety, and gender (p < .001). Comparing across groups, the DSM-Congruent Criterion A group had significantly higher overall PTSS than those in the DSM-Incongruent Criterion A group and also significantly higher hyperarousal symptoms. However, the DSM-Congruent Criterion A group did not differ from the DSM-Ambiguous trauma group on any PTSD symptom cluster.

CONCLUSIONS

The lack of significant differences in scores between individuals with DSM- Congruent, DSM-Incongruent, and DSM-Ambiguous traumas provides evidence about the subjective nature of trauma and how college-age individuals interpret their symptoms of PTSD. Clinical implications are discussed.

"I Haven't Been Diagnosed, but I Should Be"-Insight Into Self-diagnoses of Common Mental Health Disorders: Cross-sectional Study

BACKGROUND

In recent years, social media has become a rich source of mental health data. However, there is a lack of web-based research on the accuracy and validity of self-reported diagnostic information available on the web.

OBJECTIVE

An analysis of the degree of correspondence between self-reported diagnoses and clinical indicators will afford researchers and clinicians higher levels of trust in social media analyses. We hypothesized that self-reported diagnoses would correspond to validated disorder-specific severity questionnaires across 2 large web-based samples.

METHODS

The participants of study 1 were 1123 adults from a national Qualtrics panel (mean age 34.65, SD 12.56 years; n=635, 56.65% female participants,). The participants of study 2 were 2237 college students from a large university in the Midwest (mean age 19.08, SD 2.75 years; n=1761, 75.35% female participants). All participants completed a web-based survey on their mental health, social media use, and demographic information. Additionally, the participants reported whether they had ever been diagnosed with a series of disorders, with the option of selecting "Yes"; "No, but I should be"; "I don't know"; or "No" for each condition. We conducted a series of ANOVA tests to determine whether there were differences among the 4 diagnostic groups and used post hoc Tukey tests to examine the nature of the differences.

RESULTS

In study 1, for self-reported mania (F3,1097=2.75; P=.04), somatic symptom disorder (F3,1060=26.75; P<.001), and alcohol use disorder (F3,1097=77.73; P<.001), the pattern of mean differences did not suggest that the individuals were accurate in their self-diagnoses. In study 2, for all disorders but bipolar disorder (F3,659=1.43; P=.23), ANOVA results were consistent with our expectations. Across both studies and for most conditions assessed, the individuals who said that they had been diagnosed with a disorder had the highest severity scores on self-report questionnaires, but this was closely followed by individuals who had not been diagnosed but believed that they should be diagnosed. This was especially true for depression, generalized anxiety, and insomnia. For mania and bipolar disorder, the questionnaire scores did not differentiate individuals who had been diagnosed from those who had not.

CONCLUSIONS

In general, if an individual believes that they should be diagnosed with an internalizing disorder, they are experiencing a degree of psychopathology similar to those who have already been diagnosed. Self-reported diagnoses correspond well with symptom severity on a continuum and can be trusted as clinical indicators, especially in common internalizing disorders such as depression and generalized anxiety disorder. Researchers can put more faith into patient self-reports, including those in web-based experiments such as social media posts, when individuals report diagnoses of depression and anxiety disorders. However, replication and further study are recommended.

Posttraumatic stress symptom severity is associated with impaired processing of emotional faces in a large international sample

Trauma exposure and posttraumatic stress symptoms (PTSS) are associated with biases in emotional face processing. Existing research has utilized a variety of methodological techniques to demonstrate hyperreactivity to threatening cues in posttraumatic stress disorder (PTSD; i.e., fearful faces), but studies to date have shown conflicting findings, including both increased and decreased time fixating on fearful faces. Moreover, the impact of PTSS severity on emotional face processing in the general population is unknown, as the generalizability of prior work is limited. The current study aimed to examine the associations between PTSS and sensitivity to detecting differences in fearful, angry, and happy faces in a large international sample. Participants were 1,182 visitors (M_age = 31.13 years, SD = 13.57, range: 18-85 years) to TestMyBrain.org who completed three emotion sensitivity tasks and the PTSD Checklist for DSM-5. The results indicated that higher PTSS scores were associated with poorer performance in detecting happiness, fear, and anger, ps < .001, with the largest effect for fear, f ² = .06, controlling for age and gender. Participants who experienced more recent and more direct trauma exposure displayed higher levels of PTSS, with a small but significant effect whereby more direct trauma exposure was associated with higher (i.e., better) scores for anger and fear, f² s = .02. Women showed heightened sensitivity to detecting fear compared to men, d = 0.17. The present findings underscore the value of citizen science initiatives that allow researchers to obtain clinical data from diverse samples with a high degree of PTSS variability.

Ongoing challenges responding to behavioural and psychological symptoms of dementia

BACKGROUND

Mid- to late-stage dementia is often characterized by behavioural and psychological symptoms, including, but not limited to physical and verbal aggression.

INTRODUCTION

Although there is a considerable research about the prevalence, aetiology, and management of behavioural and psychological symptoms of dementia, there is limited research about the experience of caring for people with such symptoms in long-term aged care facilities.

AIM

The aims of the study were to describe: (i) nurses' experiences of caring for people with behavioural and psychological symptoms of dementia in long-term aged care facilities, and (ii) strategies nurses used to deal with these symptoms.

METHODS

A qualitative exploratory and descriptive design, involving focus group interviews with 30 nurses from three long-term aged care units in Australia. The transcripts were analysed using inductive content analysis.

RESULTS

The findings revealed five interrelated themes: (i) working under difficult conditions, (ii) behavioural and psychological symptoms of dementia: an everyday encounter, (iii) making sense of behavioural and psychological symptoms of dementia, (iv) attempting to manage behavioural and psychological symptoms of dementia, and (v) feeling undervalued.

CONCLUSION

This study highlighted the difficult conditions under which nurses worked and the complexity of caring for individuals who have behavioural and psychological symptoms of dementia.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Organizational efforts to enhance the quality of care for individuals with behavioural and psychological symptoms of dementia in long-term aged care facilities should extend beyond staff education to heed nurses' concerns about organizational barriers to interpersonal care.

The decline in Activities of Daily Living at Discharge (DADLD) index: stratifying patients at lower and higher risk

BACKGROUND

Decreased ability to perform Activities of Daily Living (ADLs) during hospitalisation has negative consequences for patients and health service delivery.

OBJECTIVE

To develop an Index to stratify patients at lower and higher risk of a significant decline in ability to perform ADLs at discharge.

DESIGN

Prospective two cohort study comprising a derivation (n=389; mean age 82.3 years; SD± 7.1) and a validation cohort (n=153; mean age 81.5 years; SD± 6.1).

PATIENTS AND SETTING

General medical patients aged ≥ 70 years admitted to three university-affiliated acute care hospitals in Brisbane, Australia.

MEASUREMENT AND MAIN RESULTS

The short ADL Scale was used to identify a significant decline in ability to perform ADLs from premorbid to discharge. In the derivation cohort, 77 patients (19.8%) experienced a significant decline. Four significant factors were identified for patients independent at baseline: 'requiring moderate assistance to being totally dependent on others with bathing'; 'difficulty understanding others (frequently or all the time)'; 'requiring moderate assistance to being totally dependent on others with performing housework'; a 'history of experiencing at least one fall in the previous 90 days prior to hospital admission' in addition to 'independent at baseline', which was protective against decline at discharge. 'Difficulty understanding others (frequently or all the time)' and 'requiring moderate assistance to being totally dependent on others with performing housework' were also predictors for patients dependent in ADLs at baseline. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of the DADLD dichotomised risk scores were: 83.1% (95% CI 72.8; 90.7); 60.5% (95% CI 54.8; 65.9); 34.2% (95% CI 27.5; 41.5); 93.5% (95% CI 89.2; 96.5). In the validation cohort, 47 patients (30.7%) experienced a significant decline. Sensitivity, specificity, PPV and NPV of the DADLD were: 78.7% (95% CI 64.3; 89.3); 69.8% (95% CI 60.1, 78.3); 53.6% (95% CI 41.2; 65.7); 88.1% (95% CI 79.2; 94.1).

CONCLUSIONS

The DADLD Index is a useful tool for identifying patients at higher risk of decline in ability to perform ADLs at discharge.

Screening for delirium within the interRAI acute care assessment system

OBJECTIVES

To develop and validate a screening strategy for delirium within the inter RAI acute care comprehensive assessment system.

DESIGN

Prospective validation cohort study.

SETTING

Acute general medical wards in two acute care metropolitan hospitals in Brisbane, Australia.

PARTICIPANTS

Two hundreds thirty-nine subjects with and without delirium, aged 70 and older.

MEASUREMENTS

Trained research nurses assessed subjects within 36 hours of hospital admission using the inter-RAI acute care (AC) system which includes four observational delirium items: Acute change mental status from baseline (ACMS), mental function varies over the course of the day (MFV), episode of disorganised speech (EDS), and easily distracted (ED). Geriatricians assessed subjects face to face within 4 hours of nurses' assessment using the Diagnostic and statistical manual of mental disorders (DSM IV) criteria and clinical judgement to determine delirium presence. Based on the performance of each delirium feature and to achieve highest predictive accuracy, a combination algorithm of either ACMS or MFV was developed and compared with the reference standard diagnosis determined by geriatricians.

RESULTS

Geriatricians diagnosed delirium in 52 of 239 (21.7%) subjects aged 70-102 years. The area under the receiver operator characteristics (AUC) for interRAI-AC delirium screener algorithm was 0.87 (95% CI; 0.80, 0.93), sensitivity 82%, specificity 91%, positive and negative predictive value of 0.72% and 95%, and likelihood ratio of 9.6 achieving the highest predictive accuracy of all possible combination of 4 delirium features. Underlying pre-morbid cognitive impairment did not undermine validity of the screening strategy, AUC 0.85 (95% CI; 0.74, 0.95), sensitivity 90% and specificity 69%.

CONCLUSION

The interRAI AC delirium screening strategy is a valid measure of delirium in older subjects in acute medical wards.