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Remigio-Baker RA, Hungerford LD, Lee-Tauler SY, Bailie JM, Caswell M, Babakhanyan I, Ettenhofer ML. Disparities in mental health symptoms recovery across race/ethnicity and education level following mild traumatic brain injury. Dialogues Health 2022; 1:100048. [PMID: 38515877 PMCID: PMC10953859 DOI: 10.1016/j.dialog.2022.100048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 03/23/2024]
Abstract
Purpose The purpose of this study was to investigate the relationship between race/ethnicity and post-concussive mental health (i.e., depressive, post-traumatic stress disorder [PTSD]) and neurobehavioral symptoms among service members, and whether this association differed by education level. Methods The study sample consisted of 524 patients from a multidisciplinary US military outpatient treatment facility for post-concussive symptoms. Poisson regression with robust error variance was utilized to investigate outcome (i.e., clinically-elevated depressive [Patient Health Questionnaire-8 ≥15], PTSD [PTSD Checklist, DSM 5 ≥38] and neurobehavioral [Neurobehavioral Symptom Inventory >75th percentile] symptoms at admission and last follow-up in this cohort study. Modification by education level (low [no college degree] vs. high [associate's degree or higher]) was additionally evaluated. Results The relationship between race/ethnicity and mental health/neurobehavioral symptoms varied by education level (p-interaction: depressive symptoms = 0.002, PTSD symptoms = 0.035, neurobehavioral symptoms = 0.040). Specifically, non-Whites were at a significantly higher prevalence for clinically-elevated depressive symptoms post-treatment than Whites, but only among those with higher education level (PR = 2.22, CI = 1.37-3.59). A similar trend was demonstrated for PTSD and neurobehavioral symptoms. Conclusion Military healthcare may need to increase depression-focused treatment options that are acceptable for racial/ethnic minority patients, particularly those with higher education, while they are recovering from comorbid traumatic brain injury.
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Affiliation(s)
- Rosemay A. Remigio-Baker
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
| | - Lars D. Hungerford
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Su Yeon Lee-Tauler
- Henry M. Jackson Foundation, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M. Bailie
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Melissa Caswell
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Ida Babakhanyan
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Mark L. Ettenhofer
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
- University of California, San Diego, La Jolla, CA, USA
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Smith BM, Thomasson M, Yang YC, Sibert C, Stocco A. When Fear Shrinks the Brain: A Computational Model of the Effects of Posttraumatic Stress on Hippocampal Volume. Top Cogn Sci 2021; 13:499-514. [PMID: 34174028 DOI: 10.1111/tops.12537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/11/2020] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric disorder often characterized by the unwanted re-experiencing of a traumatic event through nightmares, flashbacks, and/or intrusive memories. This paper presents a neurocomputational model using the ACT-R cognitive architecture that simulates intrusive memory retrieval following a potentially traumatic event (PTE) and predicts hippocampal volume changes observed in PTSD. Memory intrusions were captured in the ACT-R rational analysis framework by weighting the posterior probability of re-encoding traumatic events into memory with an emotional intensity term I to capture the degree to which an event was perceived as dangerous or traumatic. It is hypothesized that (1) increasing the intensity I of a PTE will increase the odds of memory intrusions, and (2) increased frequency of intrusions will result in a concurrent decrease in hippocampal size. A series of simulations were run and it was found that I had a significant effect on the probability of experiencing traumatic memory intrusions following a PTE. The model also found that I was a significant predictor of hippocampal volume reduction, where the mean and range of simulated volume loss match results of existing meta-analyses. The authors believe that this is the first model to both describe traumatic memory retrieval and provide a mechanistic account of changes in hippocampal volume, capturing one plausible link between PTSD and hippocampal volume.
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Affiliation(s)
- Briana M Smith
- Department of Bioengineering, University of Washington.,Department of Psychology, University of Washington
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McCunn P, Richardson JD, Jetly R, Dunkley B. Diffusion Tensor Imaging Reveals White Matter Differences in Military Personnel Exposed to Trauma with and without Post-traumatic Stress Disorder. Psychiatry Res 2021; 298:113797. [PMID: 33582526 DOI: 10.1016/j.psychres.2021.113797] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a debilitating mental health condition that develops in response to exposure to a traumatic event. The purpose of this study was to investigate white matter differences using diffusion tensor imaging (DTI) in trauma exposed military personnel with and without PTSD. METHODS Data were acquired in compliance with the Hospital for Sick Children and Canadian Armed Forces Research Ethics Boards for the following groups: military personnel with PTSD (PTSD, n = 23), trauma exposed military personnel with no PTSD diagnosis (TE, n = 25) and civilian controls (CC, n =13) . All participants were male. DTI was acquired on a Siemens Trio 3T MRI. Maps of Fractional Anisotropy (FA), Mean Diffusivity (MD), Axial Diffusivity (AD), and Radial Diffusivity (RD) were analyzed using Tract-Based Spatial Statistics (TBSS). RESULTS In the PTSD and TE groups, FA was significantly greater within the hippocampus, corpus callosum, cingulum, and several associated white matter tracts. Elevated FA was shown to be largely due to reduced RD suggesting a possible structural substrate that underscores neurophysiological connectivity. CONCLUSIONS This study reinforces previous findings showing differences in DTI metrics within the limbic system in military personnel exposed to trauma with and without PTSD.
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Affiliation(s)
- Patrick McCunn
- Neurosciences & Mental Health, The Hospital for Sick Children (SickKids) Research Institute, Toronto, Ontario.
| | - J Don Richardson
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario; Department of Psychiatry, Western University, London, Ontario; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario; Operational Stress Injury Clinic, St. Joseph's Health Care, London, Ontario, Canada
| | - Rakesh Jetly
- Canadian Forces Health Services Group HQ, Department of National Defence, Ottawa, Ontario
| | - Benjamin Dunkley
- Neurosciences & Mental Health, The Hospital for Sick Children (SickKids) Research Institute, Toronto, Ontario; Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto, Ontario; Department of Medical Imaging, University of Toronto, Toronto, Ontario
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Cotrone TS, Hocog CB, Ramsey JT, Sanchez MA, Sullivan HM, Scrimgeour AG. Phenotypic characterization of frontal cortex microglia in a rat model of post-traumatic stress disorder. Brain Behav 2021; 11:e02011. [PMID: 33434400 PMCID: PMC7994680 DOI: 10.1002/brb3.2011] [Citation(s) in RCA: 6] [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: 05/13/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is an anxiety disorder induced by psychologically traumatic events. Using a rat model, this study aimed to determine whether psychological trauma alters relative expression between pro-inflammatory and anti-inflammatory markers in microglia. To meet this goal, expression of genes encoding i-NOS, arginase, TNF-α, interleukin-10, CD74, and Mannose Receptor C was analyzed on multiple days following trauma exposure. METHODS Single-prolonged stress (SPS) was used to model PTSD in male Sprague-Dawley rats. Twenty-four rats (12 Controls and 12 SPS-exposed) were sacrificed on Days 1, 3, and 7 post-SPS. Twenty-four (12 Controls and 12 SPS-exposed) additional rats were exposed to classical fear conditioning on Day 7, and fear extinction on Days 8, 9, 10, 15, 16, and 17. Freezing behavior was measured to assess fear resolution. Microglial isolates were collected from the frontal cortex, and RNA was extracted. Changes in relative expression of target genes were quantified via RT-PCR. RESULTS SPS rats showed significant decreases in IL-10 and TNF-α expression and increases in the i-NOS:Arginase and TNF-α:IL-10 ratios compared to Controls on Day 1, but not on Day 3 or Day 7 for any of the dependent variables. Day 17 SPS rats showed a significant decrease in IL-10 expression and an increase in the TNF-α:IL-10 ratio, further characterized by a significant inverse relationship between IL-10 expression and fear persistence. CONCLUSION Psychological trauma impacts the immunological phenotype of microglia of the frontal cortex. Consequently, future studies should further evaluate the mechanistic role of microglia in PTSD pathology.
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Affiliation(s)
- Thomas S Cotrone
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Charina B Hocog
- Veterinary Support and Oversight Branch, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Joseph T Ramsey
- Veterinary Support and Oversight Branch, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Marcus A Sanchez
- Veterinary Support and Oversight Branch, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Heather M Sullivan
- Veterinary Support and Oversight Branch, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Angus G Scrimgeour
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
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Elbogen EB, Alsobrooks A, Battles S, Molloy K, Dennis PA, Beckham JC, McLean SA, Keith JR, Russoniello C. Mobile Neurofeedback for Pain Management in Veterans with TBI and PTSD. Pain Med 2021; 22:329-337. [PMID: 31697371 PMCID: PMC7901853 DOI: 10.1093/pm/pnz269] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Chronic pain is common in military veterans with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Neurofeedback, or electroencephalograph (EEG) biofeedback, has been associated with lower pain but requires frequent travel to a clinic. The current study examined feasibility and explored effectiveness of neurofeedback delivered with a portable EEG headset linked to an application on a mobile device. DESIGN Open-label, single-arm clinical trial. SETTING Home, outside of clinic. SUBJECTS N = 41 veterans with chronic pain, TBI, and PTSD. METHOD Veterans were instructed to perform "mobile neurofeedback" on their own for three months. Clinical research staff conducted two home visits and two phone calls to provide technical assistance and troubleshoot difficulties. RESULTS N = 36 veterans returned for follow-up at three months (88% retention). During this time, subjects completed a mean of 33.09 neurofeedback sessions (10 minutes each). Analyses revealed that veterans reported lower pain intensity, pain interference, depression, PTSD symptoms, anger, sleep disturbance, and suicidal ideation after the three-month intervention compared with baseline. Comparing pain ratings before and after individual neurofeedback sessions, veterans reported reduced pain intensity 67% of the time immediately following mobile neurofeedback. There were no serious adverse events reported. CONCLUSIONS This preliminary study found that veterans with chronic pain, TBI, and PTSD were able to use neurofeedback with mobile devices independently after modest training and support. While a double-blind randomized controlled trial is needed for confirmation, the results show promise of a portable, technology-based neuromodulatory approach for pain management with minimal side effects.
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Affiliation(s)
- Eric B Elbogen
- Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amber Alsobrooks
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sara Battles
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kiera Molloy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Paul A Dennis
- Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jean C Beckham
- Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Julian R Keith
- Department of Psychology, University of North Carolina-Wilmington, Wilmington, North Carolina, USA
| | - Carmen Russoniello
- Center for Applied Psychophysiology, East Carolina University, Greenville, North Carolina, USA
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Levitt EE, Syan SK, Sousa S, Costello MJ, Rush B, Samokhvalov AV, McCabe RE, Kelly J, MacKillop J. Optimizing screening for depression, anxiety disorders, and post-traumatic stress disorder in inpatient addiction treatment: A preliminary investigation. Addict Behav 2021; 112:106649. [PMID: 32979691 DOI: 10.1016/j.addbeh.2020.106649] [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] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Substance use disorders (SUD) are frequently comorbid with other psychiatric conditions, but a comprehensive diagnostic assessment is often not feasible clinically. Efficient psychometrically-validated screening tools exist for commonly comorbid conditions, but cutoff accuracies have typically not been evaluated in addiction treatment settings. This study examined the performance of several widely-used screening measures in relation to diagnostic status from a clinical interview to identify and validate cutoff scores in an inpatient SUD treatment setting. METHOD Participants were 99 patients in a large residential SUD treatment program in Ontario, Canada. Participants completed a screening battery, including the Patient Health Questionnaire - 9 (PHQ-9), Generalized Anxiety Disorder - 7 (GAD-7), and Post-Traumatic Stress Disorder Checklist-5 (PCL-5), and underwent a semi-structured diagnostic clinical interview. Receiver operating characteristic curves were used to determine optimal cutoff scores on the screening tool against the interview-based diagnosis. RESULTS Area under the curve (AUC) was statistically significant for all screens and were as follows: PHQ-9 = 0.70 (95% CI = 0.59-0.80), GAD-7 = 0.74 (95% CI = 0.63-0.84), and PCL-5 = 0.79 (95% CI = 0.66-0.91). The optimal accuracy cutoff scores based on sensitivity and specificity were: PHQ-9 ≥ 16, GAD-7 ≥ 9, the PCL-5 ≥ 42. CONCLUSIONS In general, the candidate screeners performed acceptably in this population. However, the optimal cutoff scores were notably higher than existing guidelines for depression and PTSD, potentially due to the general elevations in negative affectivity among individuals initiating SUD treatment. Further validation of these cutoff values is warranted. PUBLIC HEALTH SIGNIFICANCE This study provides modified screening cutoff scores for major depression, anxiety disorders, and post-traumatic stress disorder in addiction treatment settings.
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Affiliation(s)
- E E Levitt
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, Canada; Homewood Research Institute, Guelph, Canada
| | - S K Syan
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, Canada; Homewood Research Institute, Guelph, Canada
| | - S Sousa
- Homewood Research Institute, Guelph, Canada
| | | | - B Rush
- Homewood Research Institute, Guelph, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - A V Samokhvalov
- Homewood Research Institute, Guelph, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - R E McCabe
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, Canada
| | - J Kelly
- Recovery Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - J MacKillop
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, Canada; Homewood Research Institute, Guelph, Canada.
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Abbaspour S, Tajik R, Atif K, Eshghi H, Teimori G, Ghodrati-Torbati A, Zandi A. Prevalence and Correlates of Mental Health Status Among Pre-Hospital Healthcare Staff. Clin Pract Epidemiol Ment Health 2020; 16:17-23. [PMID: 32508966 PMCID: PMC7254819 DOI: 10.2174/1745017902016010017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/23/2019] [Revised: 02/27/2020] [Accepted: 03/07/2020] [Indexed: 12/25/2022]
Abstract
Introduction: Mental stress amongst pre-hospital Emergency Medical Services (EMS) workers is an iceberg phenomenon; owing to unique occupational stressors faced by them. This study was aimed to examine the mental health status of pre-hospital EMS workers and its correlation with Post-Traumatic Stress Disorder (PTSD) and Work Environment Scale (WES). Methods: This cross-sectional study incorporated 224 emergency EMS members from urban and road EMS bases in eastern Iran in 2018. General Health Questionnaire (GHQ-28), Post-Traumatic Stress Disorder Checklist-Civilian version (PTSD-C), and Work Environment Scale (WES) were used as research instruments. Data were analyzed via SPSS Statistics software (version 21); while p<0.05 was considered significant. Results: The mean age of participants was 31.91±6.9 years; 36(16.1%) had PTSD ≥50, which increased with age (p-0.01), number of offspring (p-0.022) and time working at the EMS (p-0.002). Mean WES scores were 73.41±12.27; with a significant impact of marital status (p-0.007), the number of offspring (p-0.023), qualification (p-0.019) and less time working at the EMS (p-0.008). Mental distress was recorded in 89(39.7%) individuals. Multivariate logistic regression revealed that members at higher risk of mental distress were; those with associate’s degree (adjusted OR 3.192; 95% CI, 1.456-6.998), individuals with 1 or 2 offspring (adjusted OR 2.03; 95% CI, 0.992-4.156; adjusted OR 3.380; 95% CI, 1.483-7.704, respectively), and those with PTSD equal or higher than 50 (adjusted OR 2.504; 95% CI, 1.063-5.903), with a reverse impact of WES (p>0.05). Conclusion: PTSD adversely affected mental health and clinical performance of the subjects; while work-place environment augmented working spirit as well as psychological resilience. Strategies aiming at stress-dilution and improvements in a professional environment cannot be over-emphasized.
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Affiliation(s)
- Sedigheh Abbaspour
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Reza Tajik
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Khaula Atif
- Department of Health Care Administration, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Hossein Eshghi
- Vice Chancellery of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Gholamheidar Teimori
- Department of Occupational Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.,Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Abbas Ghodrati-Torbati
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Anahita Zandi
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
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González JL, Alonso-Fernández M, Matías-Pompa B, Carretero I, Nieto-Bona MP, López-López A. Cardiovascular Responses of Women with Fibromyalgia to a Laboratory Stressor: Does Post-traumatic Stress Disorder Comorbidity Matter? Pain Med 2019; 20:988-999. [PMID: 30476240 DOI: 10.1093/pm/pny210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES This study compared cardiovascular responses to a laboratory trauma-unrelated stressor of two groups of women diagnosed with fibromyalgia (FM), one of them with comorbid post-traumatic stress disorder (PTSD), with a group of healthy controls in order to detect the possible existence of differences linked to comorbidity. DESIGN Case-controls. METHODS Eighteen women diagnosed with FM and comorbid PTSD, 18 women diagnosed with FM and no PTSD, and 38 healthy women were exposed to an arithmetic task with harassment while blood pressure and heart rate were measured during task exposure and recovery. RESULTS Although heart rate response evidenced a general blunted reactivity for both groups of FM patients, only those with comorbid PTSD presented lower levels of reactivity in terms of their systolic blood pressure response. In addition, systolic blood pressure response was sensitive to the presence of depression in both groups of FM patients and controls. Finally, although both groups of FM patients showed significantly slower rates of recovery, their final recovery state was not worse after twelve minutes of recording. CONCLUSIONS Results of this study point to comorbid PTSD as a significant contributor to the blunted cardiovascular reactivity observed in FM patients, which may be dependent to a great extent on depressive symptomatology. As some degree of cardiovascular response to stress is functional in that it mobilizes energy and triggers the necessary compensatory mechanisms to manage stressors, this study supports the well-recognized clinical strategies of detection and treatment of PTSD and concomitant depression in the management of FM.
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Affiliation(s)
- José Luis González
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
| | - Miriam Alonso-Fernández
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
| | - Borja Matías-Pompa
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
| | - Isabel Carretero
- Department of Psychology and Pedagogy, San Pablo CEU University, King Juan Carlos University, Madrid, Spain
| | - Ma Paz Nieto-Bona
- Department of Basic Health Sciences, King Juan Carlos University, Madrid, Spain
| | - Almudena López-López
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
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Morina N, Kuenburg A, Schnyder U, Bryant RA, Nickerson A, Schick M. The Association of Post-traumatic and Postmigration Stress with Pain and Other Somatic Symptoms: An Explorative Analysis in Traumatized Refugees and Asylum Seekers. Pain Med 2019; 19:50-59. [PMID: 28340069 DOI: 10.1093/pm/pnx005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective Post-traumatic stress disorder (PTSD) and somatic symptoms, such as pain, are frequently seen in refugees. Their relationship is poorly understood, and the treatment of these comorbid conditions can be very challenging. The current cross-sectional study examined pain and other somatic symptoms and their relationship with trauma history, PTSD symptom clusters, and current living difficulties among treatment-seeking refugees. Methods One hundred thirty-four treatment-seeking traumatized refugees (78% male, mean age = 42 years) were assessed regarding lifetime traumatic experiences, symptoms of post-traumatic stress, overall pain and somatic symptoms, and postmigration living difficulties. Results An exploratory factor analysis of the 12 somatic symptoms revealed two distinct factors: somatic symptoms related to bodily dysfunction ("weakness") and somatic symptoms related to increased sympathetic activity ("arousal"). DSM-5 PTSD Criteria D "alterations in cognitions and mood" and E "alterations in arousal and reactivity" were primarily related to "weakness," while PTSD Criterion E "alterations in arousal and reactivity" and postmigration living difficulties were associated with "arousal." Overall pain was associated primarily with living difficulties and PTSD Criterion D and Criterion E. Conclusions Results indicate that somatic symptoms are of considerable concern among traumatized refugees and that different patterns of somatic symptoms are associated with different clusters of PTSD symptoms. The findings contribute to the better understanding of the symptom presentation of traumatized people who are experiencing somatization and potentially inform treatment directions and highlight the importance of screening for PTSD in refugees presenting with pain and somatic symptoms.
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Affiliation(s)
- Naser Morina
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexa Kuenburg
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Matthis Schick
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Papadakaki M, Tsalkanis A, Sarris M, Pierrakos G, Eleonora Ferraro O, Stamouli MA, Orsi C, Otte D, Tzamalouka G, Lajunen T, Özkan T, Morandi A, Gnardellis C, Chliaoutakis J. Physical, psychological and economic burden of two-wheel users after a road traffic injury: Evidence from intensive care units of three EU countries. J Safety Res 2018; 67:155-163. [PMID: 30553418 DOI: 10.1016/j.jsr.2018.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 06/04/2018] [Accepted: 10/10/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION This study aimed to assess the physical, psychological, and economic burden shouldered by severely injured two-wheel users in three European countries as well as the cost resulting from their hospitalization. METHODS A total of seven public hospitals were involved in three countries: Greece, Italy, and Germany. Participants enrolled during a 12-month period starting in April 2013. Eligibility criteria included an injury sustained at Road Traffic Crashes (RTC) irrespective of the type of vehicle, hospitalization 1 day in the Intensive Care Unit (ICU) or sub-ICU, and age 18 years or over. Patients were interviewed at 1, 6, and 12 months upon admission. The study used widely recommended classifications for injury severity (Abbreviated Injury Severity [AIS]; Maximum Abbreviated Injury Severity [MAIS]) and standardized measures such as the Disability Assessment Schedule II (WHODAS 2.0), "Impact of Event Scale" (IES-R), Center for Epidemiological Studies Depression Scale (CES-D Scale). Health Care Expenditure was assessed through the Monash University Accident Research Centre (MUARC's) framework, which included measures of 'Direct' and 'Indirect' costs. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. RESULTS A total of 54 two-wheel users enrolled in the study in all the countries and 32 completed all follow-up questionnaires. Physical disability increased over 12 months following the injury. Post Traumatic Stress Disorder (PTSD) symptoms of avoidance remained at high levels over the study period. PTSD symptoms of intrusion improved significantly during the second half of the year under investigation. The total annual cost of injury for the two-wheel users who were hospitalized in the selected ICU of all the partner countries for severe injury in 2013/2014, was estimated at €714,491 made up of €123,457 direct and €591,034 indirect costs. Men, aged 50-64 years and those who sustained slight injuries primarily at the lower extremities presented higher indirect costs per person. A total of €1032.092 was spent on hospitalization payments. Women, aged 65+ and those who sustained severe injuries at the central body region presented higher direct costs per person. Women, aged 50-64 years, those with severe injuries and a major injury at the central body and the upper body region presented the highest hospitalization costs per person. CONCLUSIONS There is a need for effective strategies to early detect and treat groups at risk of being confronted with prolonged psychosocial and economic consequences. PRACTICAL IMPLICATIONS A holistic understanding of the impact of injury on individuals is important in order to achieve effective treatment of psychological co-morbidities in a timely manner.
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Affiliation(s)
- Maria Papadakaki
- Laboratory of Health and Road Safety, Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Estavromenos, P.C. 71004 Heraklion, Greece.
| | - Angelos Tsalkanis
- Department of Social Work, School of Health and Social Welfare, University of West Attica, Athens, Greece.
| | - Markos Sarris
- Department of Health Care Units and Business Administration, University of West Attica, Athens, Greece.
| | - George Pierrakos
- Department of Health Care Units and Business Administration, University of West Attica, Athens, Greece.
| | - Ottavia Eleonora Ferraro
- Centre of Study and Research on Road Safety, Medical School, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy.
| | - Maria-Angeliki Stamouli
- Department of Health Care Units and Business Administration, University of West Attica, Athens, Greece
| | - Chiara Orsi
- Centre of Study and Research on Road Safety, Medical School, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy
| | - Dietmar Otte
- Hannover Medical University, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Georgia Tzamalouka
- Laboratory of Health and Road Safety, Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Estavromenos, P.C. 71004 Heraklion, Greece
| | - Timo Lajunen
- Suomalainen liikennetutkimuskeskus, Traffic Research Centre of Finland, Helsinki, Finland.
| | - Türker Özkan
- Suomalainen liikennetutkimuskeskus, Traffic Research Centre of Finland, Helsinki, Finland.
| | - Anna Morandi
- Centre of Study and Research on Road Safety, Medical School, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy.
| | | | - Joannes Chliaoutakis
- Laboratory of Health and Road Safety, Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Estavromenos, P.C. 71004 Heraklion, Greece.
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11
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Lee SH, Kim EJ, Noh JW, Chae JH. Factors Associated with Post-traumatic Stress Symptoms in Students Who Survived 20 Months after the Sewol Ferry Disaster in Korea. J Korean Med Sci 2018; 33:e90. [PMID: 29495137 PMCID: PMC5835586 DOI: 10.3346/jkms.2018.33.e90] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/27/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Sewol ferry disaster caused national shock and grief in Korea. The present study examined the prevalence and associated factors of post-traumatic stress disorder (PTSD) symptoms among the surviving students 20 months after that disaster. METHODS This study was conducted using a cross-sectional design and a sample of 57 students (29 boys and 28 girls) who survived the Sewol ferry disaster. Data were collected using a questionnaire, including instruments that assessed psychological status. A generalized linear model using a log link and Poisson distribution was performed to identify factors associated with PTSD symptoms. RESULTS The results showed that 26.3% of participants were classified in the clinical group by the Child Report of Post-traumatic Symptoms score. Based on a generalized linear model, Poisson distribution, and log link analyses, PTSD symptoms were positively correlated with the number of exposed traumatic events, peers and social support, peri-traumatic dissociation and post-traumatic negative beliefs, and emotional difficulties. On the other hand, PTSD symptoms were negatively correlated with psychological well-being, family cohesion, post-traumatic social support, receiving care at a psychiatry clinic, and female gender. CONCLUSION This study uncovered risk and protective factors of PTSD in disaster-exposed adolescents. The implications of these findings are considered in relation to determining assessment and interventional strategies aimed at helping survivors following similar traumatic experiences.
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Affiliation(s)
- So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Korea
| | - Eun Ji Kim
- Maumtodoc Mental Health Clinic, Ansan, Korea.
| | - Jin Won Noh
- Department of Healthcare Management, Eulji University, Seoul, Korea
| | - Jeong Ho Chae
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul St. Mary's Hospital, Seoul, Korea
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12
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Ota Y, Korshunova N, Demura M, Katsuyama M, Katsuyama H, Rahayu SR, Saijoh K. Association between posttraumatic stress disorder (PTSD) severity and ego structure of the Nanai people. Environ Health Prev Med 2017; 22:59. [PMID: 29165146 PMCID: PMC5664442 DOI: 10.1186/s12199-017-0666-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A man-made chemical disaster occurred in the Amur River, leading to posttraumatic stress disorder (PTSD) in the Nanai people indigenous to the river's surrounding area. PTSD severity measured by the total scores of Impact of Event Scale-Revised (IES-R) (Total-I) and Clinician-Administered PTSD Scale (CAPS) (Total-C) were not always identical in terms of demographic and ethnocultural characters. It is possible that the results derived using the Total-I and Total-C may differ for persons with different backgrounds and/or individual characteristics. In this study, the associations between PTSD severity and personal characteristics were evaluated. METHODS The study was a field-type survey including 187 randomly selected participants (75 males and 112 females). In addition to Total-I/Total-C, scores for each IES-R/CAPS item, Intrusion, Avoidance, and Hyperarousal, and Ego Structure Test by Ammon (ISTA) score were examined to evaluate their personal characteristics. RESULTS No specific trends in ISTA score were obvious among four groups defined according to Total-I/Total-C. The results of principal component analysis showed that all IES-R/CAPS items contributed positively to the 1st axis but to the 2nd axis in a different manner. ISTA items did not always show correlations to each other, but principal component analysis suggested that Construct contributed positively and Destruct and Deficient (with the exception of Destruct sexuality) contributed negatively. High IES-R scores were associated with Construct Aggression and Deficient Inner demarcation, but high CAPS score was less likely to exhibit Construct Narcissism. CONCLUSION To avoid the misdiagnosis of PTSD, usage of both IES-R/CAPS may be required. Simultaneous application of personality/ego tests may be helpful, but appropriate numbers of their questions would be important.
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Affiliation(s)
- Yoko Ota
- Department of Hygiene, School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Natalia Korshunova
- Department of Hygiene, School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Masashi Demura
- Department of Hygiene, School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Midori Katsuyama
- Department of Hygiene, School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Hironobu Katsuyama
- Department of Public Health, Kawasaki Medical University, Kurashiki, Japan
| | - Sri Ratna Rahayu
- Department of Hygiene, School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Kiyofumi Saijoh
- Department of Hygiene, School of Medicine, Kanazawa University, Kanazawa, Japan.
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13
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Yildiz PD, Ayers S, Phillips L. The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. J Affect Disord 2017; 208:634-645. [PMID: 27865585 DOI: 10.1016/j.jad.2016.10.009] [Citation(s) in RCA: 324] [Impact Index Per Article: 46.3] [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: 04/25/2016] [Revised: 10/04/2016] [Accepted: 10/16/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time. METHODS PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure. RESULTS 59 studies (N =24267) met inclusion criteria: 35 studies of prenatal PTSD and 28 studies of postpartum PTSD (where 4 studies provided prevalence of PTSD in pregnancy and postpartum). In community samples the mean prevalence of prenatal PTSD was 3.3% (95%, CI 2.44-4.54). The majority of postpartum studies measured PTSD in relation to childbirth with a mean prevalence of 4.0% (95%, CI 2.77-5.71) in community samples. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95%, CI 10.62-31.43) in pregnancy and 18.5% (95%, CI 10.6-30.38) after birth. Using clinical interviews was associated with lower prevalence rates in pregnancy and higher prevalence rates postpartum. LIMITATIONS Limitations include use of stringent diagnostic criteria, wide variability of PTSD rates, and inadequacy of studies on prenatal PTSD measured in three trimesters. CONCLUSIONS PTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended.
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Affiliation(s)
- Pelin Dikmen Yildiz
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.
| | - Louise Phillips
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
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Spagnolo PA, Ramchandani VA, Schwandt ML, Kwako LE, George DT, Mayo LM, Hillard CJ, Heilig M. FAAH Gene Variation Moderates Stress Response and Symptom Severity in Patients with Posttraumatic Stress Disorder and Comorbid Alcohol Dependence. Alcohol Clin Exp Res 2016; 40:2426-2434. [PMID: 27716956 DOI: 10.1111/acer.13210] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 04/21/2016] [Accepted: 07/30/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND A common single nucleotide polymorphism (C385A) in the human fatty acid amide hydrolase (FAAH) gene has been associated with decreased distress responses in healthy volunteers, but its role in psychiatric disorders remains unknown. Here, we obtained genotypes and carried out a secondary analysis of subjects from a trial of comorbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD). We evaluated the effects of C385A variation on behavioral and biochemical biomarkers of distress responses. METHODS Forty-nine patients with PTSD and AD were admitted for 4 weeks to an experimental medicine unit at the National Institutes of Health Clinical Center. Following detoxification, stress reactivity and peripheral endocannabinoid (eCB) levels were assessed in response to a challenge session using personalized auditory guided imagery. Over the course of the study, subjects were also evaluated for changes in PTSD symptom severity. RESULTS FAAH C385A allele carriers showed a marked increase in serum anandamide levels at baseline and throughout the stress challenge procedure compared with C allele homozygotes, while levels of eCBs primarily metabolized through other enzymatic activity, such as 2-arachidonoylglycerol, did not differ between genotype groups. FAAH C385A carriers also had decreased subjective anxiety responses to the stress challenge. Similar effects of FAAH C385A genotype were found at the level of clinical PTSD symptom severity, in particular in the arousal domain. CONCLUSIONS This is to our knowledge the first study showing that FAAH C385A variation modulates stress responses in subjects with disorders characterized by increased stress reactivity. These findings point to the eCB pathway as a promising target for future antistress therapeutics.
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Affiliation(s)
- Primavera A Spagnolo
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland
| | - Vijay A Ramchandani
- Section on Human Psychopharmacology, Division of Intramural Clinical and Biomedical Research, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland
| | - Melanie L Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland
| | - Laura E Kwako
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland
| | - David T George
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland
| | - Leah M Mayo
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Cecilia J Hillard
- Department of Pharmacology and Toxicology, Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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15
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Naderi M, Firouzkoohi Moghadam M, Hamzenejad M, Emamdadi A, Karami H. Post-traumatic stress disorder and related factors in parents of children with cancer in South-East of iran. Iran Red Crescent Med J 2013; 14:776-81. [PMID: 23483014 PMCID: PMC3587866 DOI: 10.5812/ircmj.2163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 01/11/2012] [Accepted: 06/25/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) comprises a collection of symptoms following exposure to injury-causing accidents of life. It is estimated that the prevalence of PTSD in children with malignancy and their parents is between 10-30% and even several years after treatment of malignancy this disorderremain in 20-20% of these patients. OBJECTIVES This study investigated the prevalence of post-traumatic stress disorder in parents of children with cancer. MATERIALS AND METHODS In this analytic-descriptive study, 256parents of children with cancer (mean age: 30.06 ± 14.6 years-old) that their children treated in pediatric hematology ward of Ali ebn-e Abitaleb (AS) teaching hospital of Zahedan city (south east of Iran) at 2009-2010 were evaluated. The demographic data and symptoms of PTSD were collected by standard questionnaire (based on DSM-IV). After data analysis was performed using statistical software SPSS (version 18). RESULTS All parents who were studied had PTSD. The severity of PTSD in 111 of parents was mild, in 103 (40.2%) moderate and in 42 (16.4%) parents was severe. Furthermore, there were a significant correlation between the severity of PTSD with number of children, age of parents, gender, literacy, religion and economic state (P = 0.001). CONCLUSIONS Our results showed that factors such as age, sex, number of children, educational state and religion of parents with economic state of the family can effect on the severity of PTSD. As for role of parents of children with chronic disease especially malignancy diseases on decline of psycho-social disorders with mental and physical supports of their children should be given the necessary recommendations and educations regarding PTSD.
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Affiliation(s)
- Majid Naderi
- Children and Adolescent Hygiene Research Center (CAHRC) & Clinical Research Development Center (CRDC), Ali ebn-e Abitaleb (AS) Teaching Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Mahboubeh Firouzkoohi Moghadam
- Bahran Psychiatry Teaching Hospital, Children and Adolescent Hygiene Research Center (CAHRC), Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding author:Mahboubeh Firouzkoohi Moghadam, Bahran Psychiatry Teaching Hospital, Children and Adolescent Hygiene Research Center (CAHRC), Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel.: +98-5413414103, Fax: +98-5413414103, E-mail:
| | - Mahdiyeh Hamzenejad
- Clinical Research Development Center (CRDC) & Medical Students' Research Committee (MSRC), Ali ebn-e Abitaleb (AS) Teaching Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Abolfazl Emamdadi
- Clinical Research Development Center (CRDC) & Medical Students' Research Committee (MSRC), Ali ebn-e Abitaleb (AS) Teaching Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Hossein Karami
- Thalassemia Research Center (TRC), Mazandaran University of Medical Sciences, Mazandaran, IR Iran
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Omidi A, Mohammadi A, Zargar F, Akbari H. Efficacy of mindfulness-based stress reduction on mood States of veterans with post-traumatic stress disorder. Arch Trauma Res 2013; 1:151-4. [PMID: 24396769 PMCID: PMC3876494 DOI: 10.5812/atr.8226] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/09/2013] [Accepted: 01/14/2013] [Indexed: 11/26/2022]
Abstract
Background: Mood and negative emotional states and their regulation in patients with post-traumatic stress disorder have family, social and employment problems. Practices that could be helpful in this area are highly important. Objectives: The current study aimed to investigate the influence of mindfulness-based stress reduction (MBSR) in improving mood state of combat veterans. Patients and Methods: In this randomized clinical trial study, participants were selected from the patients referring to the counseling center of the veterans. The participants had post-traumatic stress disorder according to diagnostic and statistical manual of mental disorders, fourth edition, text review (DSM-IV-TR). Sixty- two patients were randomly assigned into 2 groups: (31 for MBSR and 31 for the control group). Results: Analysis showed that there were no significant differences between the groups at baseline (P < 0.05). Comparison of the results between the two groups before the two-step test showed that anger and vitality scales between the two groups have no significant differences, but on the other scales (depression, dizziness, fatigue and tension), differences between pre and post-test groups were significant in the two groups. Conclusions: It was concluded that mindfulness-based stress reduction is a useful method to regulate the mood state in veterans with post-traumatic stress disorder (PTSD) who have difficulties in mood and emotions in Kashan.
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Affiliation(s)
- Abdollah Omidi
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Abolfazl Mohammadi
- Department of Clinical Psychology, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Abolfazl Mohammadi, Department of Clinical Psychology, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.: +98-2615551112, Fax: +98-2615551112, E-mail:
| | - Fatemeh Zargar
- Department of Clinical Psychology, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Hossein Akbari
- Department of Public Health, Kashan University of Medical Sciences, Kashan, IR Iran
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Maercker A, Horn AB. A socio-interpersonal perspective on PTSD: the case for environments and interpersonal processes. Clin Psychol Psychother 2012; 20:465-81. [PMID: 22730216 DOI: 10.1002/cpp.1805] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [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: 11/01/2010] [Revised: 05/15/2012] [Accepted: 05/17/2012] [Indexed: 12/30/2022]
Abstract
UNLABELLED Post-traumatic stress disorder (PTSD) is a common reaction to traumatic experiences. We propose a socio-interpersonal model of PTSD that complements existing models of post-traumatic memory processes or neurobiological changes. The model adds an interpersonal perspective to explain responses to traumatic stress. The framework draws from lifespan psychology, cultural psychology and research into close relationships and groups. Additionally, clinical knowledge about PTSD is incorporated. This involves knowledge about shame, guilt, estrangement feelings and protective factors, such as social support and forgiveness. Three levels are proposed at which relevant interpersonal processes can be situated and should be adequately researched. First, the individual level comprises social affective states, such as shame, guilt, anger and feelings of revenge. Second, at the close relationship level, social support, negative exchange (ostracism and blaming the victim), disclosure and empathy are proposed as dyadic processes relevant to PTSD research and treatment. Third, the distant social level represents culture and society, in which the collectivistic nature of trauma, perceived injustice, and social acknowledgement are concepts that predict the response trajectories to traumatic stress. Research by the current authors and others is cited in an effort to promote future investigation based on the current model. Methodological implications, such as multi-level data analyses, and clinical implications, such as the need for couple, community or larger-level societal interventions, are both outlined. KEY PRACTITIONER MESSAGE The socio-interpersonal model proposes an interpersonal view of the processes that occur in the aftermath of a traumatic experience. At the individual level, the model integrates the social affective phenomena that clinical research identifies in PTSD patients, including shame, guilt, anger, revenge and the urges or reluctance to disclose. At the level of close relationships, there is an emphasis on the role of the individuals' partner, family or social support in the development or maintenance of PTSD and its recovery. At the distant social level, societal and cultural factors, e.g., individualistic versus collectivistic or other human value orientations, are acknowledged as contributing to the severity and course of PTSD. Increasing attention should be given to new approaches of PTSD treatment that refer to an interpersonal view of PTSD, e.g., communication training, PTSD-specific couples' therapy or community programs.
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Affiliation(s)
- Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
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