Posttraumatic stress disorder in the World Mental Health Surveys

Trauma exposure and post-traumatic stress disorder in a cohort of pregnant Peruvian women

Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak during the reproductive years. PTSD during pregnancy adversely impacts maternal and infant health outcomes. The objectives of this study were to estimate the prevalence of antepartum PTSD symptoms in a population of pregnant Peruvian women and to examine the impact of number of traumatic events and type of trauma experienced. The Traumatic Events Questionnaire was used to collect data about traumatic exposures. The Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) was used to assess PTSD. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Three thousand three hundred seventy-two pregnant women were interviewed. Of the 2920 who reported experiencing one or more traumatic events, 41.8% met criteria for PTSD (PCL-C score ≥ 26). A quarter of participants had experienced four or more traumas, and 60.5% of those women had PTSD. Interpersonal trauma was most strongly associated with PTSD (aOR, 3.20; 95% CI, 2.74-3.74), followed by unspeakable trauma (aOR, 2.87; 95% CI, 2.35-3.50), and structural trauma (aOR, 1.39; 95% CI, 1.15-1.67). These findings indicate the high prevalence of PTSD during pregnancy in the Peruvian population, which is relevant to other countries suffering from terrorism, war, or high rates of violence. This underscores the importance of screening for PTSD in pregnancy.

Well-Being and Functioning at Work Following Thefts and Robberies: A Comparative Study

Thefts and robberies may be traumatizing experiences for employees. The aim of this study is to explore to what extent experiencing robberies and/or thefts at work affect workers' mental health, coping-self-efficacy, social support seeking, workload and job satisfaction. Drawing on Conservation of Resources theory, this research contributes to our understanding of the psychological sequelae of robbery and theft for employees working in small businesses. The few studies on the effects of robberies and thefts in the past have predominantly focused on bank employees. A sample of Italian tobacconists and jewelers completed an anonymous self-report questionnaire examining the experience of robbery and/or theft, social support seeking (Coping Orientation to Problem Experienced scale, COPE-IV), psycho-somatic well-being (General Health Questionnaire, GHQ-12), job satisfaction (a single item). Victims of thefts and/or robberies reported their PTSD symptoms (Impact of Event- Revised 6, IES-R-6) and trauma-related coping self-efficacy (Coping Self-Efficacy scale, CSE-7), based on the last event (N = 319). Descriptive analyses, ANOVA, ANCOVA and multiple regressions analyses have been carried out. The results indicated that victims of thefts and robberies experienced greater workload, higher psycho-physical complaints and greater tendency to seek social support in comparison with their non-affected counterparts. They additionally experienced more post-traumatic symptomatology and perceived lower coping self-efficacy, when compared to those who experienced thefts “only.” Multiple regression analyses revealed that CSE was positively related to job satisfaction, although the presence of psycho-physical symptoms was the main predictor of job satisfaction among both non-affected and affected employees. PTSD was not an independent predictor of job satisfaction. In sum, robberies and/or thefts exposure undermines differently workers' well-being.

PTSD Coach around the world

Posttraumatic stress disorder (PTSD) is a global public health problem. Unfortunately, many individuals with PTSD do not receive professional care due to a lack of available providers, stigma about mental illness, and other concerns. Technology-based interventions, including mobile phone applications (apps) may be a viable means of surmounting such barriers and reaching and helping those in need. Given this potential, in 2011 the U.S Veterans Affairs National Center for PTSD released PTSD Coach, a mobile app intended to provide psycho-education and self-management tools for trauma survivors with PTSD symptoms. Emerging research on PTSD Coach demonstrates high user satisfaction, feasibility, and improvement in PTSD symptoms and other psychosocial outcomes. A model of openly sharing the app's source code and content has resulted in versions being created by individuals in six other countries: Australia, Canada, The Netherlands, Germany, Sweden, and Denmark. These versions are described, highlighting their significant adaptations, enhancements, and expansions to the original PTSD Coach app as well as emerging research on them. It is clear that the sharing of app source code and content has benefited this emerging PTSD Coach community, as well as the populations they are targeting. Despite this success, challenges remain especially reaching trauma survivors in areas where few or no other mental health resources exist.

Posttraumatic stress disorder in patients who rule out versus rule in for acute coronary syndrome

OBJECTIVE

Many patients who present to the emergency department (ED) with acute coronary syndromes (ACS) develop posttraumatic stress disorder (PTSD) due to the experience. Less is known about risk for PTSD in patients who rule out for ACS. Our objective was to compare the risk of developing PTSD among patients who rule out versus rule in for ACS.

METHODS

We enrolled a consecutive sample of 1000 patients presenting to an emergency department (ED) with symptoms of a probable ACS. We assessed presenting ACS symptoms in the ED. We determined whether presenting symptoms were due to a confirmed ACS or another etiology by chart review. We assessed PTSD by telephone 1 month after discharge using the PTSD Checklist specific for the suspected ACS event (PCL-S). We used logistic regression to determine the association of ruling out versus ruling in for ACS with a positive PTSD screen (PCL-S ≥ 32), adjusting for demographics, comorbidities, depression, trauma history, and pre-existing PTSD.

RESULTS

Approximately two-thirds of patients (68.2%) ruled out for ACS. Compared to confirmed ACS patients, patients who ruled out had similar presenting symptoms, and similar risk of screening positive for PTSD (18.9% versus 16.8%; p = 0.47; adjusted OR 1.18, 95% CI 0.69-2.00; p = 0.55).

CONCLUSIONS

ED presentation with ACS symptoms was sufficient to trigger a positive PTSD screen whether the etiology was due to a life-threatening ACS or another etiology. Patients who present with ACS symptoms should be considered for interventions to prevent PTSD after hospitalization, regardless of symptom etiology.

Innovations in digital interventions for psychological trauma: harnessing advances in cognitive science

A range of digital psychological interventions have demonstrated a positive impact on trauma-related problems in controlled trials, but there is room for further improvements in their form, reach and impact. Most to date have been adaptions of established face-to-face treatments. In this paper, we highlight a complementary emerging route to their development, which draws on advances in cognitive science theory and research and applies them to clinical contexts. Three examples are given regarding laboratory research with potential applications to digital interventions for trauma-related mental health problems: a digital game to reduce intrusive memories of trauma, novel cognitive techniques for worry, and digitally supported mental imagery to enhance motivation for functional behavior change. Much of this research is still at an early stage, meriting a balance of optimism and caution. However, even if only a few digital applications of cognitive science constitute substantial improvements to complement current treatments, their potential for large-scale use at low unit cost may provide significant benefits across populations.

A DRD2/ANNK1-COMT Interaction, Consisting of Functional Variants, Confers Risk of Post-traumatic Stress Disorder in Traumatized Chinese

Objective: Post-traumatic stress disorder (PTSD) is a trauma- and stress-related psychiatric syndrome that occurs after exposure to extraordinary stressors. The neurotransmitter dopamine (DA) plays important roles in neurobiological processes like reward and stress, and a link between PTSD and the dopaminergic system has been reported. Thus, the investigation of an association between PTSD and gene-gene interaction (epistasis) within dopaminergic genes could uncover the genetic basis of dopamine-related PTSD symptomatology and contribute to precision medicine. Methods: We genotyped seven single nucleotide polymorphisms (SNPs) of three dopaminergic genes DRD2/ANNK1 (rs1800497 and rs1801028), COMT (rs6269, rs4633, rs4818 and rs4680) and DBH (rs1611115), in a Chinese predominantly adult cohort that had been exposed to an earthquake (156 PTSD cases and 978 controls). Results: Statistical genetics analysis identified a DRD2/ANNK1-COMT interaction (rs1800497 × rs6269), which is associated with PTSD diagnosis (P_interaction = 0.0008055 and P_corrected = 0.0169155). Single-variant and haplotype-based subset analyses showed that rs1800497 modulates the association directions of both the rs6269 G allele and the rs6269-rs4633-rs4818-rs4680 haplotype G-C-G-G. The interaction (rs1800497 × rs6269) was replicated in a Chinese young female cohort (32 cases and 581 controls, P_interaction = 0.01329). Conclusions: Rs1800497 is related to the DA receptor D2 density and rs6269-rs4633-rs4818-rs4680 haplotypes affect the catechol O-methyltransferase level and enzyme activity. Thus, the interaction was inferred to be at protein-protein and DA activity level. The genotype combinations of the two SNPs indicate a potential origin of DA homeostasis abnormalities in PTSD development.

Mothers and fathers of children with epilepsy: gender differences in post-traumatic stress symptoms and correlations with mood spectrum symptoms

BACKGROUND

Post-traumatic stress disorder (PTSD) and post-traumatic stress spectrum have been recently applied to understand the impact of life-threatening disease or injury in one's child; nevertheless, scant data are available on a particular chronic illness such as epilepsy whose phenotypic expression is seizures, which are acute, sudden, and unpredictable manifestations. Subjects with bipolar disorders or with mood spectrum symptoms demonstrated to be more vulnerable to develop PTSD in the aftermath of a trauma.

OBJECTIVES

The main aim of this study was to evaluate post-traumatic symptoms among 134 parents of children with a diagnosis of epilepsy, followed at the outpatient neurologic unit of Department of Pediatrics in Santa Chiara Hospital in Pisa, as well as gender differences. The second aim of this study was to estimate the impact of lifetime mood spectrum on post-traumatic stress symptoms in the same study sample after fulfillment of the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Mood Spectrum-Self Report (MOODS-SR) lifetime version.

RESULTS

Results showed 10.4% and 37.3% of PTSD full and partial, respectively. Demographic characteristics and clinical features of the study sample did not show any impact on stress symptomatology. Mothers presented higher rates at all Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 PTSD symptoms' clusters except avoidance. Nevertheless, noteworthy correlations between post-traumatic symptomatology and mood spectrum symptoms detected with the self-report tools, emerged only in the subgroup of the fathers.

CONCLUSION

These findings corroborate the need to provide assistance to caregivers of pediatric patients and confirm the hypothesis that lifetime mood spectrum may have an impact on reaction to traumas.

Prevalence and predictors of posttraumatic stress disorder and depressive symptoms among burn survivors two years after the 2015 Formosa Fun Coast Water Park explosion in Taiwan

Background: Posttraumatic stress disorder (PTSD) and depressive symptoms are relatively common in burn survivors. Several previously reported risk factors (e.g. burn severity) have not consistently predicted psychological adjustment post-burn. Empirically-derived risk factors of PTSD from the meta-analysis and theory-derived cognitive variables may be of great predictive value. Objective: This study investigated the prevalence of probable DSM-5 PTSD and major depression (MDD) and the predictors of PTSD and depressive symptoms in burn survivors of the 2015 Formosa Fun Coast Water Park explosion. Three sets of predictors were examined: (a) burn-related variables; (b) empirically-derived risk factors from the meta-analysis; and (c) theory-derived cognitive variables. Method: Participants were 116 burn survivors of the Formosa Fun Coast Water Park explosion. The mean age at the disaster was 22.3 ± 4.2 years; the average total body surface area burned (TBSA) was 49.5%. Results: Of our participants, 12.9 and 20.7% met DSM-5 probable PTSD and MDD two years after the Formosa Fun Coast Water Park explosion. No gender differences were observed. For the prediction of PTSD symptoms post-burn, theory-derived cognitive variables (adjusted R² = .562, 95% CI [.423, .638]) performed best and provided significantly better prediction than empirically-derived risk factors from the meta-analysis (adjusted R² = .337, 95% CI [.180, .412]) and burn-related variables (adjusted R² = .313, 95% CI [.156, .389]). In contrast, the three sets of variables examined provided similar predictions for depressive symptoms post-burn (adjusted R² = .267-.295). Random forest regression revealed that theory-derived cognitive variables, particularly negative appraisal of symptoms and maladaptive cognitive coping, were considered the most important predictors of PTSD symptoms post-burn. Conclusion: The prevalence of probable PTSD and MDD were relatively higher in burn survivors. Theory-derived cognitive variables substantially improve predictions for PTSD symptoms post-burn.

Potentially traumatic events have negative and positive effects on loneliness, depending on PTSD-symptom levels: evidence from a population-based prospective comparative study

PURPOSE

Examine to what extent adults affected by recent potentially traumatic events (PTE) with different PTSD-symptom levels are more at risk for post-event loneliness than non-affected adults are in the same study period.

METHODS

We extracted data from the Dutch longitudinal LISS panel to measure pre-event loneliness (2011) and post-event loneliness (2013 and 2014), pre-event mental health problems (2011), PTE and PTSD symptoms (2012). This panel is based on a traditional random sample drawn from the population register by Statistics Netherlands.

RESULTS

Results of the multinomial logistic regression analyses showed that affected adults with high levels of PTSD symptoms were more at risk for high levels of post-event loneliness than affected adults with very low PTSD-symptom levels and non-affected adults, while controlling for pre-event loneliness, pre-event mental health problems and demographics. However, affected adults with very low levels of PTSD symptoms compared to non-affected adults were less at risk for medium and high levels of post-event loneliness while controlling for the same variables. Yet, pre-event loneliness appeared to be the strongest independent predictor of loneliness at later stages: more than 80% with high pre-event levels had high post-event levels at both follow-ups.

CONCLUSIONS

Remarkably, potentially traumatic events have depending on PTSD-symptom levels both negative and positive effects on post-event loneliness in favor of affected adults with very low PTSD symptoms levels. However, post-event levels at later stages are predominantly determined by pre-event loneliness levels.

Integrating Endocannabinoid Signaling and Cannabinoids into the Biology and Treatment of Posttraumatic Stress Disorder

Exposure to stress is an undeniable, but in most cases surmountable, part of life. However, in certain individuals, exposure to severe or cumulative stressors can lead to an array of pathological conditions including posttraumatic stress disorder (PTSD), characterized by debilitating trauma-related intrusive thoughts, avoidance behaviors, hyperarousal, as well as depressed mood and anxiety. In the context of the rapidly changing political and legal landscape surrounding use of cannabis products in the USA, there has been a surge of public and research interest in the role of cannabinoids in the regulation of stress-related biological processes and in their potential therapeutic application for stress-related psychopathology. Here we review the current state of knowledge regarding the effects of cannabis and cannabinoids in PTSD and the preclinical and clinical literature on the effects of cannabinoids and endogenous cannabinoid signaling systems in the regulation of biological processes related to the pathogenesis of PTSD. Potential therapeutic implications of the reviewed literature are also discussed. Finally, we propose that a state of endocannabinoid deficiency could represent a stress susceptibility endophenotype predisposing to the development of trauma-related psychopathology and provide biologically plausible support for the self-medication hypotheses used to explain high rates of cannabis use in patients with trauma-related disorders.

DSM-5 posttraumatic stress symptom dimensions and health-related quality of life among Chinese earthquake survivors

It has been well-documented that posttraumatic stress symptoms cause impairments in health-related quality of life (HRQoL). Until now we have little data on how DSM-5 PTSD symptom dimensions relate to different aspects of HRQoL. Clarifying this question would be informative to improve the quality of life of PTSD patients. This study aimed to investigate the effects of dimensions of a well-supported seven-factor model of DSM-5 PTSD symptoms on physical and psychosocial HRQoL. A total of 1063 adult survivors of the 2008 Wenchuan earthquake took part in this study nine years after the disaster. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). HRQoL was measured by the Medical Outcomes Survey Short Form-36 (SF-36). The associations between PTSD symptom dimensions and HRQoL were examined using structural equation models. Dysphoric arousal symptoms were found to significantly relate to physical HRQoL. Other symptom dimensions were not associated with HRQoL. Our findings contribute to the relationship between DSM-5 PTSD and HRQoL, and carry implications for further clinical practice and research on trauma-exposed individuals.

If we build it, will they come? Issues of engagement with digital health interventions for trauma recovery

Exposure to traumatic events is extremely common with nearly 75% reported to have experienced one or more traumatic events worldwide. A significant number of those exposed will develop posttraumatic stress disorder (PTSD) along with depression, anxiety, and substance use disorders. Globally, trauma-related mental health disorders are the leading cause of global disability burden, and many of these disorders are caused, or worsened, by exposure to wars, natural and human-caused disasters, and other traumatic events. Significant barriers to treatment exist including logistical, geographical, financial, stigma, and other attitudinal challenges. One opportune approach to overcoming these barriers is the provision of mental health interventions via technology that can be readily standardized for wide dissemination of evidence-based care. However, engagement with technology-based interventions is a concern and limited participation and high attrition rates are common. This may be especially true for trauma survivors who often experience symptoms of avoidance and hyperarousal. Engagement is regarded as an essential component of intervention efficacy and has been demonstrated to be associated with more positive clinical outcomes, yet theoretically based research in this area is sparse. This review focuses on the complex issue of engagement with digital health interventions (DHIs). Specifically, we review the conceptualization and measurement of engagement, predictors of engagement, and importantly, the relationship of engagement with intervention effectiveness. Finally, a theoretically based model of engagement is proposed that considers the unique challenges of trauma recovery. This review is not intended to provide a systematic or exhaustive set of recommendations, rather it is intended to highlight the challenges of engagement research including its definition, measurement, and modeling. Future engagement research that includes valid and reliable measures of engagement will enable consistent exploration of engagement predictors that can then inform methods for increasing engagement and, ultimately, intervention effectiveness.

Trauma and PTSD in the WHO World Mental Health Surveys

Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their 'worst.' Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD. Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the 'worst' lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk. Conclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.

Proton pump inhibitors and the risk of severe cognitive impairment: The role of posttraumatic stress disorder

Introduction

Proton pump inhibitors (PPIs), a common treatment for gastroesophageal reflux disease (GERD), were recently associated with increased risk of dementia. However, severe or chronic stress including, for example, posttraumatic stress disorder (PTSD) was not accounted for. This study examined whether PPI use was associated with severe cognitive impairment (SCI) and whether PTSD explained this association in a cohort of World Trade Center (WTC) responders.

Method

A prospective cohort study of 3779 WTC responders attending a university-based monitoring and treatment program. Prescriptions for PPIs and SCI determined using the Montreal Cognitive Assessment were the focus of the analysis.

Results

Overall, 1451 (38.4%) responders were dispensed PPIs, and 83 (2.2%) had SCI. Bivariable analyses revealed significant associations between being-dispensed PPIs in relation to SCI. After adjusting for PTSD, major depressive disorder, WTC exposures, age, and sex, being-dispensed PPIs were significantly associated with odds of SCI (adjusted odds ratio = 1.67 95% confidence interval = 1.054–2.643).

Conclusions

Being-dispensed PPIs were associated with SCI in this analysis of WTC responders. Results suggest that clinicians treating GERD seek to both understand patients' mental health history and monitor cognitive functioning when designing treatment routines. Overall, results confirmed that this is an important area of investigation with potential direct clinical implications.