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Görg N, Böhnke JR, Priebe K, Rausch S, Wekenmann S, Ludäscher P, Bohus M, Kleindienst N. Changes in Trauma-Related Emotions Following Treatment With Dialectical Behavior Therapy for Posttraumatic Stress Disorder After Childhood Abuse. J Trauma Stress 2019; 32:764-773. [PMID: 31476252 DOI: 10.1002/jts.22440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 03/11/2019] [Accepted: 03/16/2019] [Indexed: 01/13/2023]
Abstract
Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) is a trauma-focused therapy shown to reduce core PTSD symptoms, such as intrusions, hyperarousal, and avoidance. Preliminary data indicate effects on elevated trauma-related emotions (e.g., guilt and shame) and possibly radical acceptance of the traumatic event. However, it is unclear if improvements in these variables are significant after controlling for changes in core PTSD symptoms and to what extent nonclinical levels are obtained. In the current study, 42 individuals who met criteria for PTSD after childhood abuse and were participating in a 3-month residential DBT-PTSD program were evaluated at the start of the exposure phase of DBT-PTSD and the end of treatment; a nonclinical sample with a history of childhood abuse was the reference group. Multivariate analyses of variance and multivariate analyses of covariance controlling for change in core PTSD symptoms were used to evaluate changes in several elevated trauma-related emotions (fear, anger, guilt, shame, disgust, sadness, and helplessness) and in radical acceptance. In a repeated measures multivariate analyses of variance, both elevated trauma-related emotions and radical acceptance significantly improved during DBT-PTSD, λ = 0.34, p < .001; η2 = .56; t(40) = -5.66, p < .001, SMD = 0.88, even after controlling for changes in PTSD symptoms, λ = 0.35, p < .001, η2 = .65; Λ = 0.86, p = .018, η2 = .14, respectively. Posttreatment, 31.0% (for acceptance) to 76.2% (for guilt) of participants showed nonclinical levels of the investigated outcomes, suggesting that both trauma-related emotions and radical acceptance changed after the 3-month residential DBT-PTSD program.
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Affiliation(s)
- Nora Görg
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany.,Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University, Frankfurt am Main, Germany
| | - Jan R Böhnke
- Dundee Centre for Health and Related Research, School of Nursing and Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Kathlen Priebe
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
| | - Sophie Rausch
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
| | - Stefanie Wekenmann
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Petra Ludäscher
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany.,Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
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152
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Pegram SE, Abbey A. Associations Between Sexual Assault Severity and Psychological and Physical Health Outcomes: Similarities and Differences Among African American and Caucasian Survivors. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:4020-4040. [PMID: 27754921 PMCID: PMC7019196 DOI: 10.1177/0886260516673626] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
There are well-established associations between sexual assault victimization and deleterious psychological and physical health outcomes. The present study contributes to the emerging health disparities literature by examining similarities and differences in relationships between the severity of the sexual assault and health in a community sample of African American and Caucasian survivors. Although the overall pattern of relationships was expected to be comparable for all survivors, some associations were hypothesized to be stronger for African American survivors as compared with Caucasian survivors based on theories of chronic stress. Single, African American, and Caucasian women were recruited for a study of dating experiences through random digit dialing in one large metropolitan area. Participants who experienced a sexual assault since age 14 were included in this study (121 African American and 100 Caucasian women). Multigroup path analyses indicated that for both African American and Caucasian survivors, sexual assault severity was significantly positively associated with posttraumatic stress disorder (PTSD) symptoms, and depressive symptoms were significantly positively associated with physical health symptoms. Among African American survivors, sexual assault severity affected physical health symptoms indirectly through its impact on depressive symptoms, and assault severity indirectly affected drinking problems through its impact on PTSD symptoms; these relationships were not found for Caucasian survivors. These findings highlight the need for additional research that focuses on health disparities in sexual assault survivors' recovery process, so that treatment programs address culturally relevant issues.
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153
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Dale SK, Safren SA. Gendered racial microaggressions predict posttraumatic stress disorder symptoms and cognitions among Black women living with HIV. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2019; 11:685-694. [PMID: 31033304 PMCID: PMC6889033 DOI: 10.1037/tra0000467] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Gendered racial microaggression (GRM) experienced by Black women living with HIV (BWLWH) is a potentially important variable for posttraumatic stress disorder (PTSD) symptomatology in this population. GRM refers to everyday insults experienced by Black women on the basis of being both Black and female (e.g., comments about Black women's hair and body). We investigated the associations between GRM, race- and HIV-related discrimination, and trauma symptoms among BWLWH and explored whether gendered racial microaggressions contributed uniquely to trauma symptoms above the contribution of race- and HIV-related discrimination. METHOD One-hundred BWLWH in the U.S. completed baseline measures on GRM (frequency and appraisal), racial discrimination, HIV-related discrimination, PTSD symptoms, and posttraumatic cognitions. RESULTS Hierarchical multiple linear regressions controlling for age, education, and income indicated that higher GRM and HIV-related discrimination predicted higher total PTSD symptoms, and higher GRM and racial discrimination predicted higher posttraumatic cognitions. Hierarchical multiple linear regressions with all predictors entered together revealed that only GRM contributed uniquely to both total PTSD symptoms and total posttraumatic cognitions. Analyses between GRM subscales and subscales of PTSD symptoms and posttraumatic cognitions indicated that GRM about beauty/sexual objectification and the strong Black women stereotype contributed uniquely and in interesting ways to PTSD symptoms and posttraumatic cognitions. CONCLUSIONS Our findings highlight the importance of addressing intersectional adversities such as GRM for BWLWH, as well as recognizing the role that GRM may play in mental health symptoms for Black women. Future research and intervention efforts aimed at improving the well-being of BWLWH should address GRM. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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154
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Jeffrey MG, Krengel M, Kibler JL, Zundel C, Klimas NG, Sullivan K, Craddock TJA. Neuropsychological Findings in Gulf War Illness: A Review. Front Psychol 2019; 10:2088. [PMID: 31616335 PMCID: PMC6775202 DOI: 10.3389/fpsyg.2019.02088] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 08/28/2019] [Indexed: 12/11/2022] Open
Abstract
This review paper summarizes the accumulation of research investigating neuropsychological outcomes in veterans with Gulf War illness (GWI). Earlier research focused on Gulf War veterans (GW) who were deployed versus non-deployed, as well as those who were symptomatic versus asymptomatic, or compared neuropsychological test results to published norms. Further research became more sophisticated, investigating specific GWI criteria, as well as the result of neurotoxicant exposure and the relationship to possible neurocognitive outcomes. As the early research supported both psychological and physiological effects on GWI; current research as summarized in this literature review supports the presence of neuropsychological deficits, particularly in the domains of attention, executive functioning, memory, and motor functioning related to chemical exposures that can be exacerbated by comorbid mood-related conditions. The same test battery has not been used consistently making it difficult to compare results among studies. Therefore, researchers created a resource to provide recommendations for the recently listed Neuropsychological Tests for Common Data Elements (CDEs) for use in all future GWI studies. Future research is necessary to further understand patterns of neuropsychological test data and how these decrements may relate to immunological or other biological markers, and the impact of trauma from physical and psychological stressors. In conclusion, there is consistent evidence that GWI is characterized by neuropsychological decrements - with future research these findings may aid in the diagnosis and assessment of treatment trial efficacy of GW veterans.
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Affiliation(s)
- Mary G. Jeffrey
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | | | - Jeffrey L. Kibler
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Clara Zundel
- VA Boston Healthcare System, Boston, MA, United States
| | - Nancy G. Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
- Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, United States
- Miami VA Medical Center, Miami, FL, United States
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Travis J. A. Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
- Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, United States
- Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, United States
- Department of Computer Science, Nova Southeastern University, Fort Lauderdale, FL, United States
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155
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Pengpid S, Peltzer K. Correlates of physical activity among adults with anxiety symptoms in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2019. [DOI: 10.1080/14330237.2019.1648725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand
- Deputy Vice Chancellor Research and Innovation Office, North West University, Potchefstroom, South Africa
| | - Karl Peltzer
- Deputy Vice Chancellor Research and Innovation Office, North West University, Potchefstroom, South Africa
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156
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Kaye-Kauderer HP, Levine J, Takeguchi Y, Machida M, Sekine H, Taku K, Yanagisawa R, Katz C. Post-Traumatic Growth and Resilience Among Medical Students After the March 2011 Disaster in Fukushima, Japan. Psychiatr Q 2019; 90:507-518. [PMID: 31098921 DOI: 10.1007/s11126-019-09646-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In March of 2011, an earthquake, tsunami, and nuclear accident struck northern Japan causing profound damage to the surrounding area and lasting effects to all those who lived there. Fukushima Medical University (FMU), the closest hospital that remained open during the disaster, was greatly impacted and its students rallied to help the cause. Many of them were directly affected as their neighborhoods were ruined and family and friends were injured or killed. Our study sought to better understand how this disaster impacted their posttraumatic growth and resilience in the wake of the disaster and today, 8 years later. There were three goals of this study. First, we aimed to replicate previous research that showed positive effects of disaster volunteerism on medical students' posttraumatic growth. Second, we sought to better understand the role of resilience in the wellbeing of these students. Finally, we wanted to explore the advantages to our newly created 10-Factor Resilience Behavioral Scale, which we used alongside the Davidson Trauma Scale (DTS), Posttraumatic Growth Inventory (PTGI-X), and Connor-Davidson Resilience Scale (CD-RISC). Overall, 579 responses were collected (response rate of 71.9%). Volunteers continued to show greater PTG as well as greater overall resilience. Furthermore, there were positive correlations between students' feelings of confusion, anger, sadness, guilt or anxiety and their sense of resilience, both at the time of the disaster and in the most recent month, suggesting that within Japanese culture difficult emotions may promote resilient behaviors and actions.
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Affiliation(s)
- Halley P Kaye-Kauderer
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jake Levine
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Hideharu Sekine
- International Exchange Affairs, Fukushima Medical University, Fukushima, Japan
| | - Kanako Taku
- Department of Psychology, Oakland University, Rochester, MI, USA
| | - Robert Yanagisawa
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Craig Katz
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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157
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O'Cleirigh C, Safren SA, Taylor SW, Goshe BM, Bedoya CA, Marquez SM, Boroughs MS, Shipherd JC. Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial. AIDS Behav 2019; 23:2421-2431. [PMID: 30993478 PMCID: PMC7271561 DOI: 10.1007/s10461-019-02482-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To address childhood sexual abuse (CSA) related distress and HIV risk in men who have sex with men (MSM) using cognitive-behavioral therapy for trauma and self-care (CBT-TSC), which is a novel intervention integrating HIV risk reduction with modified cognitive and behavioral therapy strategies for post-traumatic stress. We compared CBT-TSC to HIV voluntary counseling and testing (VCT)-only in an initial 2-arm RCT in 43 HIV-negative MSM at with a history of CSA and HIV risk. Serodiscordant condomless anal/vaginal sex (CAS; CAS with HIV-postive or HIV unknown status partners) and posttraumatic stress disorder (PTSD) symptoms (Davidson Trauma Scale: total score and avoidance, intrusions, hyperarousal subscales) were outcomes immediately post-treatment, and at 6- and 9-month follow-up. At post-treatment, CBT-TSC had decreased odds (approximately 60%) of any CAS and greater reductions in CAS compared to VCT-only. Additionally, the CBT-TSC condition experienced greater reductions in total PTSD and avoidance symptoms. At the follow-up visits, CBT-TSC condition had significant reductions in the odds of any CAS and reductions in CAS. However, for PTSD symptoms, only the avoidance subscale remained significantly different compared to VCT-only. CBT-TSC is a potentially efficacious approach to address HIV risk in MSM with a CSA history, with replication and extension in a larger trial needed. This proof-of-concept trial is the first to integrate the treatment of a commonly occurring mental-health syndemic problem in MSM with a health psychology approach to self-care in MSM.Trial Registration Clinicaltrials.gov NCT01266122.
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Affiliation(s)
- Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
- The Fenway Institute of Fenway Health, Boston, MA, USA.
| | - Steven A Safren
- The Fenway Institute of Fenway Health, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - S Wade Taylor
- The Fenway Institute of Fenway Health, Boston, MA, USA
- School of Social Work, Boston University, Boston, MA, USA
| | - Brett M Goshe
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - C Andres Bedoya
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Samantha M Marquez
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- The Fenway Institute of Fenway Health, Boston, MA, USA
| | | | - Jillian C Shipherd
- VA Boston Healthcare System, Boston, MA, USA
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- Department of Veterans Affairs, LGBT Health Program, Washington, DC, USA
- Boston University School of Medicine, Boston, MA, USA
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158
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Roberts NP, Kitchiner NJ, Kenardy J, Robertson L, Lewis C, Bisson JI. Multiple session early psychological interventions for the prevention of post-traumatic stress disorder. Cochrane Database Syst Rev 2019; 8:CD006869. [PMID: 31425615 PMCID: PMC6699654 DOI: 10.1002/14651858.cd006869.pub3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The prevention of long-term psychological distress following traumatic events is a major concern. Systematic reviews have suggested that individual psychological debriefing is not an effective intervention at preventing post-traumatic stress disorder (PTSD). Over the past 20 years, other forms of intervention have been developed with the aim of preventing PTSD. OBJECTIVES To examine the efficacy of psychological interventions aimed at preventing PTSD in individuals exposed to a traumatic event but not identified as experiencing any specific psychological difficulties, in comparison with control conditions (e.g. usual care, waiting list and no treatment) and other psychological interventions. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO and ProQuest's Published International Literature On Traumatic Stress (PILOTS) database to 3 March 2018. An earlier search of CENTRAL and the Ovid databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to May 2016). We handsearched reference lists of relevant guidelines, systematic reviews and included study reports. Identified studies were shared with key experts in the field.We conducted an update search (15 March 2019) and placed any new trials in the 'awaiting classification' section. These will be incorporated into the next version of this review, as appropriate. SELECTION CRITERIA We searched for randomised controlled trials of any multiple session (two or more sessions) early psychological intervention or treatment designed to prevent symptoms of PTSD. We excluded single session individual/group psychological interventions. Comparator interventions included waiting list/usual care and active control condition. We included studies of adults who experienced a traumatic event which met the criterion A1 according to the Diagnostic and Statistical Manual (DSM-IV) for PTSD. DATA COLLECTION AND ANALYSIS We entered data into Review Manager 5 software. We analysed categorical outcomes as risk ratios (RRs), and continuous outcomes as mean differences (MD) or standardised mean differences (SMDs), with 95% confidence intervals (CI). We pooled data with a fixed-effect meta-analysis, except where there was heterogeneity, in which case we used a random-effects model. Two review authors independently assessed the included studies for risk of bias and discussed any conflicts with a third review author. MAIN RESULTS This is an update of a previous review.We included 27 studies with 3963 participants. The meta-analysis included 21 studies of 2721 participants. Seventeen studies compared multiple session early psychological intervention versus treatment as usual and four studies compared a multiple session early psychological intervention with active control condition.Low-certainty evidence indicated that multiple session early psychological interventions may be more effective than usual care in reducing PTSD diagnosis at three to six months' follow-up (RR 0.62, 95% CI 0.41 to 0.93; I2 = 34%; studies = 5; participants = 758). However, there was no statistically significant difference post-treatment (RR 1.06, 95% CI 0.85 to 1.32; I2 = 0%; studies = 5; participants = 556; very low-certainty evidence) or at seven to 12 months (RR 0.94, 95% CI 0.20 to 4.49; studies = 1; participants = 132; very low-certainty evidence). Meta-analysis indicated that there was no statistical difference in dropouts compared with usual care (RR 1.34, 95% CI 0.91 to 1.95; I2 = 34%; studies = 11; participants = 1154; low-certainty evidence) .At the primary endpoint of three to six months, low-certainty evidence indicated no statistical difference between groups in reducing severity of PTSD (SMD -0.10, 95% CI -0.22 to 0.02; I2 = 34%; studies = 15; participants = 1921), depression (SMD -0.04, 95% CI -0.19 to 0.10; I2 = 6%; studies = 7; participants = 1009) or anxiety symptoms (SMD -0.05, 95% CI -0.19 to 0.10; I2 = 2%; studies = 6; participants = 945).No studies comparing an intervention and active control reported outcomes for PTSD diagnosis. Low-certainty evidence showed that interventions may be associated with a higher dropout rate than active control condition (RR 1.61, 95% CI 1.11 to 2.34; studies = 2; participants = 425). At three to six months, low-certainty evidence indicated no statistical difference between interventions in terms of severity of PTSD symptoms (SMD -0.02, 95% CI -0.31 to 0.26; I2 = 43%; studies = 4; participants = 465), depression (SMD 0.04, 95% CI -0.16 to 0.23; I2 = 0%; studies = 2; participants = 409), anxiety (SMD 0.00, 95% CI -0.19 to 0.19; I2 = 0%; studies = 2; participants = 414) or quality of life (MD -0.03, 95% CI -0.06 to 0.00; studies = 1; participants = 239).None of the included studies reported on adverse events or use of health-related resources. AUTHORS' CONCLUSIONS While the review found some beneficial effects of multiple session early psychological interventions in the prevention of PTSD, the certainty of the evidence was low due to the high risk of bias in the included trials. The clear practice implication of this is that, at present, multiple session interventions aimed at everyone exposed to traumatic events cannot be recommended. There are a number of ongoing studies, demonstrating that this is a fast moving field of research. Future updates of this review will integrate the results of these new studies.
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Affiliation(s)
- Neil P Roberts
- Cardiff University School of MedicineDivision of Psychological Medicine and Clinical NeurosciencesHadyn Ellis BuildingMaindy RoadCardiffUKCF24 4HQ
| | - Neil J Kitchiner
- Cardiff & Vale, University Health BoardVeterans' NHS WalesGlobal LinkDunleavy DriveCardiffUKCF11 0SN
| | - Justin Kenardy
- The University of QueenslandSchool of MedicineHerston RoadHerstonAustralia4006
| | - Lindsay Robertson
- University of YorkCochrane Common Mental DisordersHeslingtonYorkUKYO10 5DD
| | - Catrin Lewis
- Cardiff University School of MedicineDivision of Psychological Medicine and Clinical NeurosciencesHadyn Ellis BuildingMaindy RoadCardiffUKCF24 4HQ
| | - Jonathan I Bisson
- Cardiff University School of MedicineDivision of Psychological Medicine and Clinical NeurosciencesHadyn Ellis BuildingMaindy RoadCardiffUKCF24 4HQ
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159
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Peltzer K, Phaswana-Mafuya N, Pengpid S. Correlates of sedentary behaviour among adolescents and adults with hazardous, harmful or dependent drinking in South Africa. S Afr J Psychiatr 2019; 25:1217. [PMID: 31308972 PMCID: PMC6620553 DOI: 10.4102/sajpsychiatry.v25i0.1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/28/2019] [Indexed: 11/01/2022] Open
Abstract
Background There is lack of information on the correlates of sedentary behaviour among persons with alcohol use disorders. The study aimed to examine socio-demographic and health correlates among adolescents and adults with hazardous, harmful or probable dependent alcohol use (= problem drinking). Method Data from the cross-sectional South African National Health and Nutrition Examination Survey (SANHANES-1) 2011-12 were analysed. From a total sample of 15 085 persons aged 15 years and older, 2849 adolescents and adults (mean age = 37.1 years, standard deviation [s.d.] = 15.1) were identified as problem drinkers, based on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Multivariable logistic and linear regression were used to determine the associations between socio-demographic characteristics, health variables and high sedentary behaviour (≥8 h/day) and total minutes of sedentary behaviour a day. Results The prevalence of high sedentary behaviour (≥ 8 h/day) was 11.9% overall (11.9% among men and 12.1% among women), and the mean (s.d.) duration of sedentary behaviour was 263 (169) min/day. In bivariate analysis, older age, population group, functional disability, cognitive impairment, having hypertension, having had a stroke and posttraumatic symptoms were correlated with high sedentary behaviour. In adjusted logistic regression analysis, older age and being Indian or Asian were positively, and having been diagnosed with angina was negatively, associated with high sedentary behaviour. In linear regression analysis, older age, not employed and having had a stroke were positively, and being of mixed race and having angina were negatively, associated with total minutes (up to 960 min/day) of sedentary behaviour in a day. Conclusion The study provides socio-demographic and health correlates of sedentary behaviour among problem drinkers. This information can guide possible future interventions in reducing sedentary behaviour among problem drinkers.
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Affiliation(s)
- Karl Peltzer
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Vietnam.,Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | | | - Supa Pengpid
- Research and Innovation Office, North West University, Potchefstroom, South Africa.,ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
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160
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Rivas C, Vigurs C, Cameron J, Yeo L. A realist review of which advocacy interventions work for which abused women under what circumstances. Cochrane Database Syst Rev 2019; 6:CD013135. [PMID: 31254283 PMCID: PMC6598804 DOI: 10.1002/14651858.cd013135.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Intimate partner abuse (including coercive control, physical, sexual, economic, emotional and economic abuse) is common worldwide. Advocacy may help women who are in, or have left, an abusive intimate relationship, to stop or reduce repeat victimisation and overcome consequences of the abuse. Advocacy primarily involves education, safety planning support and increasing access to different services. It may be stand-alone or part of other services and interventions, and may be provided within healthcare, criminal justice, social, government or specialist domestic violence services. We focus on the abuse of women, as interventions for abused men require different considerations. OBJECTIVES To assess advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances. SEARCH METHODS In January 2019 we searched CENTRAL, MEDLINE, 12 other databases, two trials registers and two relevant websites. The search had three phases: scoping of articles to identify candidate theories; iterative recursive search for studies to explore and fill gaps in these theories; and systematic search for studies to test, confirm or refute our explanatory theory. SELECTION CRITERIA Empirical studies of any advocacy or multi-component intervention including advocacy, intended for women aged 15 years and over who were experiencing or had experienced any form of intimate partner abuse, or of advocates delivering such interventions, or experiences of women who were receiving or had received such an intervention. Partner abuse encompasses coercive control in the absence of physical abuse. For theory development, we included studies that did not strictly fit our original criteria but provided information useful for theory development. DATA COLLECTION AND ANALYSIS Four review authors independently extracted data, with double assessment of 10% of the data, and assessed risk of bias and quality of the evidence. We adopted RAMESES (Realist and meta-narrative evidence syntheses: evolving standards) standards for reporting results. We applied a realist approach to the analysis. MAIN RESULTS We included 98 studies (147 articles). There were 88 core studies: 37 focused on advocates (4 survey-based, 3 instrument development, 30 qualitative focus) and seven on abused women (6 qualitative studies, 1 survey); 44 were experimental intervention studies (some including qualitative evaluations). Ten further studies (3 randomised controlled trials (RCTs), 1 intervention process evaluation, 1 qualitative study, 2 mixed methods studies, 2 surveys of women, and 1 mixed methods study of women and staff) did not fit the original criteria but added useful information, as befitting a realist approach. Two studies are awaiting classification and three are ongoing.Advocacy interventions varied considerably in contact hours, profession delivering and setting.We constructed a conceptual model from six essential principles based on context-mechanism-outcome (CMO) patterns.We have moderate and high confidence in evidence for the importance of considering both women's vulnerabilities and intersectionalities and the trade-offs of abuse-related decisions in the contexts of individual women's lives. Decisions should consider the risks to the woman's safety from the abuse. Whether actions resulting from advocacy increase or decrease abuse depends on contextual factors (e.g. severity and type of abuse), and the outcomes the particular advocacy intervention is designed to address (e.g. increasing successful court orders versus decreasing depression).We have low confidence in evidence regarding the significance of physical dependencies, being pregnant or having children. There were links between setting (high confidence), and potentially also theoretical underpinnings of interventions, type, duration and intensity of advocacy, advocate discipline and outcomes (moderate and low confidence). A good therapeutic alliance was important (high confidence); this alliance might be improved when advocates are matched with abused women on ethnicity or abuse experience, exercise cultural humility, and remove structural barriers to resource access by marginalised women. We identified significant challenges for advocates in inter-organisational working, vicarious traumatisation, and lack of clarity on how much support to give a woman (moderate and high confidence). To work effectively, advocates need ongoing training, role clarity, access to resources, and peer and institutional support.Our provisional model highlights the complex way that factors combine and interact for effective advocacy. We confirmed the core ingredients of advocacy according to both women and advocates, supported by studies and theoretical considerations: education and information on abuse; rights and resources; active referral and liaising with other services; risk assessment and safety planning. We were unable to confirm the impact of complexity of the intervention (low confidence). Our low confidence in the evidence was driven mostly by a lack of relevant studies, rather than poor-quality studies, despite the size of the review. AUTHORS' CONCLUSIONS Results confirm the core ingredients of advocacy and suggest its use rests on sound theoretical underpinnings. We determined the elements of a good therapeutic alliance and how it might be improved, with a need for particular considerations of the factors affecting marginalised women. Women's goals from advocacy should be considered in the contexts of their personal lives. Women's safety was not necessarily at greatest risk from staying with the abuser. Potentially, if undertaken for long enough, advocacy should benefit an abused woman in terms of at least one outcome providing the goals are matched to each woman's needs. Some outcomes may take months to be determined. Where abuse is severe, some interventions may increase abuse. Advocates have a challenging role and must be supported emotionally, through provision of resources and through professional training, by organisations and peers.Future research should consider the different principles identified in this review, and study outcomes should be considered in relation to the mechanisms and contexts elucidated. More longitudinal evidence is needed. Single-subject research designs may help determine exactly when effect no longer increases, to determine the duration of longitudinal work, which will likely differ for vulnerable and marginalised women. Further work is needed to ascertain how to tailor advocacy interventions to cultural variations and rural and resource-poor settings. The methods used in the included studies may, in some cases, limit the applicability and completeness of the data reported. Economic analyses are required to ascertain if resources devoted to advocacy interventions are cost-effective in healthcare and community settings.
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Affiliation(s)
- Carol Rivas
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Carol Vigurs
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Jacqui Cameron
- The University of MelbourneDepartment of Social Work, Melbourne School of Health SciencesMelbourneVICAustralia
- Finders UniversityNational Centre for Education and Training on Addiction (NCETA)AdelaideSouth AustraliaAustralia
| | - Lucia Yeo
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
- KK Women's and Children's HospitalDepartment of Child DevelopmentSingaporeSingapore229899
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Phaswana-Mafuya N, Peltzer K, Pengpid S. Maternal Tobacco use during Pregnancy in South Africa: Results from a National Population-based Survey. Int J Prev Med 2019; 10:99. [PMID: 31360346 PMCID: PMC6592098 DOI: 10.4103/ijpvm.ijpvm_212_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 10/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Tobacco use in pregnancy is linked with various negative health effects. The aim of this study was to examine the prevalence of maternal tobacco use during pregnancy and sociodemographic and health correlates. Methods: Data of ever pregnant women from the cross-sectional “South African National Health and Nutrition Examination Survey (SANHANES-1) 2011-12” were analyzed. The sample included 5089 adolescents and adult women aged 15–55 years. They responded to questions on tobacco use, sociodemographic and health indicators. Results: Results indicate that 5.0% [95% confidence interval (CI) = 4.3, 5.9] of South African women had engaged in tobacco use during their pregnancy. In adjusted analysis, being Colored and White population groups, poor self-rated health status, and having chronic medical conditions were associated with tobacco use during pregnancy. Conclusions: Findings suggest links between sociodemographic and health variables and prenatal tobacco use, which may have public health policy implications.
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Affiliation(s)
- Nancy Phaswana-Mafuya
- Deputy Vice Chancellor Research and Innovation Office, North West University, South Africa.,HIV/AIDS/STI/TB Research Programme, Human Sciences Research Council, South Africa
| | - Karl Peltzer
- Deputy Vice Chancellor Research and Innovation Office, North West University, South Africa.,HIV/AIDS/STI/TB Research Programme, Human Sciences Research Council, South Africa
| | - Supa Pengpid
- Deputy Vice Chancellor Research and Innovation Office, North West University, South Africa.,ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand
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Holt R, Kornhaber R, Kwiet J, Rogers V, Shaw J, Law J, Proctor MT, Vandervord J, Streimer J, Visentin D, Cleary M, McLean L. Insecure adult attachment style is associated with elevated psychological symptoms in early adjustment to severe burn: A cross-sectional study. Burns 2019; 45:1359-1366. [PMID: 31160134 DOI: 10.1016/j.burns.2019.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 02/06/2019] [Accepted: 03/03/2019] [Indexed: 12/28/2022]
Abstract
Research into recovery and adjustment after burn injury has indicated a link between psychopathological symptoms including traumatic stress, distress, depression and anxiety, and worse psychosocial and physical outcomes. The severity of psychological symptoms does not always correlate with that of the burn injury, and symptoms can be ongoing in certain patients for extensive periods, leading to a need for early screening in burns patients for psychological vulnerabilities. One potential factor influencing recovery from the psychological impact of burn injury is adult attachment style, specifically secure and insecure attachment, as this describes how an individual organizes their stress regulation. This cross-sectional study measured: (a) attachment style (via the Relationship Questionnaire [RQ]): (b) negative psychological symptoms (via the Depression Anxiety and Stress Scale [DASS]); and, (c) post-traumatic symptoms (via the Davidson Trauma Scale [DTS]) in a cohort of burns patients (n = 104, 51 analysed) in a severe burns unit in Australia during the acute phase of their recovery. Secure attachment style was inversely related to psychopathological symptoms. Secure participants scored significantly lower scores on the DASS (M = 17.63, SD = 17.07) compared to self-rated insecure participants [(M = 42.38, SD = 34.69), p < .01] and on the DTS (M = 14.22, SD = 15.42) compared to insecure participants [(M = 40.54, SD = 35.72), p < .01]. Similar results were found in analyses controlling for covariates of gender, age and burn severity as potential confounders. This research suggests attachment style may play an important role in psychosocial recovery from severe burn injury.
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Affiliation(s)
- Rachael Holt
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Rachel Kornhaber
- College of Health and Medicine, University of Tasmania, Sydney Campus, Australia; National Burns Center, Sheba Medical Center, Israel
| | - Julia Kwiet
- Severe Burns Injury Unit (SBIU), Royal North Shore Hospital, St Leonards, Sydney, Australia; Social Work, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Vanessa Rogers
- Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Australia; Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Joanne Shaw
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Jeremy Law
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | | | - John Vandervord
- Severe Burns Injury Unit (SBIU), Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Jeffrey Streimer
- Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Australia; Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Denis Visentin
- College of Health and Medicine, University of Tasmania, Sydney Campus, Australia
| | - Michelle Cleary
- College of Health and Medicine, University of Tasmania, Sydney Campus, Australia
| | - Loyola McLean
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia; Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Sydney, Australia; Westmead Psychotherapy Program for Complex Traumatic Disorders, Western Sydney Local Health District, Parramatta, Australia.
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163
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Trivedi MS, Abreu MM, Sarria L, Rose N, Ahmed N, Beljanski V, Fletcher MA, Klimas NG, Nathanson L. Alterations in DNA Methylation Status Associated with Gulf War Illness. DNA Cell Biol 2019; 38:561-571. [DOI: 10.1089/dna.2018.4469] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Malav S. Trivedi
- Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida
| | - Maria M. Abreu
- Miami VAMC, Miami, Florida
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - Leonor Sarria
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - Natasha Rose
- Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida
| | - Nida Ahmed
- Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida
| | - Vladimir Beljanski
- Cell Therapy Institute, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - Mary A. Fletcher
- Miami VAMC, Miami, Florida
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - Nancy G. Klimas
- Miami VAMC, Miami, Florida
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - Lubov Nathanson
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
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The Relationships Among Symptom Distress, Posttraumatic Stress Symptoms, and Depression in Patients With Female-specific Cancers. Cancer Nurs 2019; 41:181-188. [PMID: 28151832 DOI: 10.1097/ncc.0000000000000479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Previous studies have demonstrated that posttraumatic stress symptoms (PTSS) affect women with breast cancer. However, few studies have explored the relationships among PTSS, symptom distress, and depression in association with cancers specific to women in Taiwan. OBJECTIVE The aim of this study was to explore the relationships among symptom distress, PTSS, and depression in women given a diagnosis of female-specific cancers. METHODS A cross-sectional design was used, and 220 women given a diagnosis of female-specific cancer were recruited from a general hospital in southern Taiwan. The outcome measures included the subjects' scores on a symptom distress scale, the Chinese Davidson Trauma Scale, and the Center for Epidemiologic Studies-Depressive Scale; their personal characteristics; and disease-related variables. RESULTS There were significant positive relationships among the frequency of PTSS, the severity of PTSS, symptom distress, and depressive symptoms. Logistic regression analysis demonstrated that educational level, symptom distress, and the frequency of PTSS were significant predictors of depression. CONCLUSIONS The study demonstrated a high prevalence of depression in women with female-specific cancer, and the results confirm the relationship between PTSS and depression. In addition, educational level and physical distress were also found to be predictors of depression. IMPLICATIONS FOR PRACTICE Screening for depressive symptoms should be a component of routine screening in women with female-specific cancer. Oncology nurses should be aware of the distress symptoms experienced by these women and recognize PTSS in patients who are given a diagnosis of female-specific cancer. Awareness will reduce the multiple risks of posttraumatic stress disorder and depression and decrease the depressive symptoms of women after surviving cancer.
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165
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Boneva RS, Lin JMS, Wieser F, Nater UM, Ditzen B, Taylor RN, Unger ER. Endometriosis as a Comorbid Condition in Chronic Fatigue Syndrome (CFS): Secondary Analysis of Data From a CFS Case-Control Study. Front Pediatr 2019; 7:195. [PMID: 31179251 PMCID: PMC6537603 DOI: 10.3389/fped.2019.00195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 04/25/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Endometriosis (EM) is a recognized co-morbid condition in women with chronic fatigue syndrome (CFS). This analysis evaluates the impact of EM on the health of women with CFS by comparing selected health characteristics and laboratory parameters in women with CFS with and without EM (CFS+EM and CFS-only). Methods: This secondary analysis included all 36 women with CFS from a cross-sectional study of CFS in Wichita, KS, conducted between 2002 and 2003. The health characteristics and laboratory parameters of interest included functioning, fatigue, CFS-related symptoms, gynecologic history, routine laboratory parameters, inflammatory markers, cortisol levels, allostatic load, and sleep parameters (overnight polysomnography). We used parametric or non-parametric tests to compare group differences in the selected health characteristics and laboratory parameters. For examining the association between EM and variables of interest, logistic regression models were performed and odds ratios (OR) with 95% confidence intervals (CI) were reported for the magnitude of associations. Statistical significance was set at 0.05 (two-sided). Results: The mean age of this study sample was 50.9 years. Of women with CFS, 36.1% reported having EM. Age and body mass index (BMI) did not differ between CFS+EM and CFS-only groups. When examining the impact of EM, compared to women with CFS-only, women with both CFS and EM were more likely to report chronic pelvic pain [OR = 9.00 (95% CI, 1.47-55.25)] and hysterectomy [OR = 10.3 (1.82-58.39)], had more CFS symptoms (6.8 ± 0.3 vs. 5.5 ± 0.3, p = 0.02), younger mean age at menopause onset (36.4 ± 3.0 vs. 47.0 ± 2.7 years, p = 0.03), higher mean number of obstructive apnea episodes per hour (20.3 vs. 4.4, p = 0.05) and reported more negative life events (15.8 vs. 4.4, p = 0.05). Other parameters did not differ significantly between the two groups. Conclusions: We found more than a third of women with CFS reported endometriosis as a comorbid condition. The endometriosis comorbidity was associated with chronic pelvic pain, earlier menopause, hysterectomy, and more CFS-related symptoms. However, endometriosis in women with CFS did not appear to further impact functioning, fatigue, inflammatory markers, or other laboratory parameters. Further investigations including younger women are warranted.
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Affiliation(s)
- Roumiana S. Boneva
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jin-Mann S. Lin
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Friedrich Wieser
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Urs M. Nater
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Beate Ditzen
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Robert N. Taylor
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Elizabeth R. Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Russell DN, Morey LC. Use of Validity Indicators on the Personality Assessment Inventory to Detect Feigning of Post-traumatic Stress Disorder. PSYCHOLOGICAL INJURY & LAW 2019. [DOI: 10.1007/s12207-019-09349-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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167
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Zuñiga RAA, Reyes GG, Murrieta JIS, Villoria RAMG. Posttraumatic stress symptoms in people exposed to the 2017 earthquakes in Mexico. Psychiatry Res 2019; 275:326-331. [PMID: 30954842 DOI: 10.1016/j.psychres.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022]
Abstract
This is the first study to produce a reliable valid measure of the symptoms of Posttraumatic Stress Disorders (PTSD) in Mexico, which has a high incidence of disasters, and has not had a measurement of PTSD frequency in the population. The objective was to analyze the prevalence of PTSD symptoms in persons who experienced the 2017 earthquakes in Mexico. A probabilistic sample of 1539 participants from Mexico City, the State of Mexico, Chiapas, Puebla, Morelos and Oaxaca during November and December of 2017 was screened using the Davidson Trauma Scale (DTS) for symptoms of post-traumatic stress. The prevalence of PTSD symptoms was 34.6%, with greater effects on the inhabitants of Oaxaca, Morelos and Puebla, women, indigenous people and people who experienced damage to their homes (p = 0.001). The DTS had a moderate negative correlation with the RS-14 and a Cronbach's alpha coefficient of 0.957. The confirmatory factor analysis generated four factors that explain 50% of the variance, compatible with a Dysphoria model. We can conclude that one in three people exposed to earthquakes had symptoms of post-traumatic stress.
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168
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Jack SM, Boyle M, McKee C, Ford-Gilboe M, Wathen CN, Scribano P, Davidov D, McNaughton D, O’Brien R, Johnston C, Gasbarro M, Tanaka M, Kimber M, Coben J, Olds DL, MacMillan HL. Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life: A Randomized Clinical Trial. JAMA 2019; 321:1576-1585. [PMID: 31012933 PMCID: PMC6487547 DOI: 10.1001/jama.2019.3211] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Intimate partner violence (IPV) is a public health problem with significant adverse consequences for women and children. Past evaluations of a nurse home visitation program for pregnant women and first-time mothers experiencing social and economic disadvantage have not consistently shown reductions in IPV. OBJECTIVE To determine the effect on maternal quality of life of a nurse home visitation program augmented by an IPV intervention, compared with the nurse home visitation program alone. DESIGN, SETTING, AND PARTICIPANTS Cluster-based, single-blind, randomized clinical trial at 15 sites in 8 US states (May 2011-May 2015) enrolling 492 socially disadvantaged pregnant women (≥16 years) participating in a 2.5-year nurse home visitation program. INTERVENTIONS In augmented program sites (n = 229 participants across 7 sites), nurses received intensive IPV education and delivered an IPV intervention that included a clinical pathway to guide assessment and tailor care focused on safety planning, violence awareness, self-efficacy, and referral to social supports. The standard program (n = 263 participants across 8 sites) included limited questions about violence exposure and information for abused women but no standardized IPV training for nurses. MAIN OUTCOMES AND MEASURES The primary outcome was quality of life (WHOQOL-BREF; range, 0-400; higher score indicates better quality of life) obtained through interviews at baseline and every 6 months until 24 months after delivery. From 17 prespecified secondary outcomes, 7 secondary end points are reported, including scores on the Composite Abuse Scale, SPAN (Startle, Physiological Arousal, Anger, and Numbness), Prime-MD Patient Health Questionnaire, TWEAK (Tolerance/Worry About Drinking/Eye-Opener/Amnesia/C[K]ut Down on Drinking), Drug Abuse Severity Test, and the 12-Item Short-Form Health Survey (physical and mental health), version 2. RESULTS Among 492 participants enrolled (mean age, 20.4 years), 421 (86%) completed the trial. Quality of life improved from baseline to 24 months in both groups (change in WHOQOL-BREF scores from 299.5 [SD, 54.4] to 308.2 [SD, 52.6] in the augmented program group vs from 293.6 [SD, 56.4] to 316.4 [SD, 57.5] in the standard program group). Based on multilevel growth curve analysis, there was no statistically significant difference between groups (modeled score difference, -4.9 [95% CI, -16.5 to 6.7]). There were no statistically significant differences between study groups in any of the secondary participant end points. There were no adverse events recorded in either group. CONCLUSIONS AND RELEVANCE Among pregnant women experiencing social and economic disadvantage and preparing to parent for the first time, augmentation of a nurse home visitation program with a comprehensive IPV intervention, compared with the home visitation program alone, did not significantly improve quality of life at 24 months after delivery. These findings do not support the use of this intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01372098.
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Affiliation(s)
- Susan M. Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Michael Boyle
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Christine McKee
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - C. Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- Faculty of Information and Media Studies, Western University, London, Ontario, Canada
| | - Philip Scribano
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Danielle Davidov
- Department of Emergency Medicine, West Virginia University, Morgantown
- School of Public Health, West Virginia University, Morgantown
| | - Diane McNaughton
- Department of Community, Systems, and Mental Health Nursing, Rush University Medical Center, Chicago, Illinois
| | - Ruth O’Brien
- College of Nursing, University of Colorado Anschutz Medical Campus, Denver
| | - Carolyn Johnston
- Nurse-Family Partnership National Service Office, Denver, Colorado
| | - Mariarosa Gasbarro
- Department of Pediatrics, University of Colorado School of Medicine, Denver
| | - Masako Tanaka
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Kimber
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Coben
- School of Public Health, West Virginia University, Morgantown
| | - David L. Olds
- Department of Pediatrics, University of Colorado School of Medicine, Denver
| | - Harriet L. MacMillan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Decosimo CA, Hanson J, Quinn M, Badu P, Smith EG. Playing to live: outcome evaluation of a community-based psychosocial expressive arts program for children during the Liberian Ebola epidemic. Glob Ment Health (Camb) 2019; 6:e3. [PMID: 31143464 PMCID: PMC6521133 DOI: 10.1017/gmh.2019.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 03/14/2019] [Accepted: 03/26/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This paper reviews the efficacy of a community psychosocial arts program focused on building mental health capacity within post-Ebola Liberia. The aim of this paper was to evaluate the outcome effects of two groups using pre- and post-treatment data. We hypothesized that there would be a difference in symptoms pre- and post-treatment, and the longer program would yield more significant results. METHODS There was a total of 870 child participants. Of 40 sites, 24 were selected for a 5-month treatment (TG1) while the remaining 16 sites received 3 months of treatment (TG2). Paired t tests and a mixed-model analysis of variance (ANOVA) were used to analyse pre- and post-psychological stress symptoms (PSS) for samples from both groups. RESULTS Separately, treatment group 1 (TG1) and treatment group 2's (TG2) paired t test yielded significant results (p < 0.001) for the decrease of PSS. The mixed-model ANOVA found that there were significant differences in total pre- and post-test PSS and a significant difference in PSS means over time. CONCLUSIONS Results indicated that there was a statistically significant decrease in reported symptoms in both treatment groups pre- to post-intervention and a significant difference in total symptoms over time. However, the findings do not indicate that the longer programming was statistically different compared to the shorter programming. The study presented had gaps in data, largely due to limits in research during the crisis. However, this paper provides a unique case study for challenges that can be faced for project evaluation in emergency settings.
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Affiliation(s)
- C. A Decosimo
- Playing to Live, East Tennessee State University, Johnson City, TN, USA
| | - J. Hanson
- University of Pittsburg, Pittsburgh, PA, USA
| | - M. Quinn
- East Tennessee State University, Johnson City, TN, USA
| | - P. Badu
- Playing to Live, Renewed Energy Serving Humanity, Paynesville, Liberia
| | - E. G. Smith
- Renewed Energy Serving Humanity, Monrovia, Liberia
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170
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Steele E, Wood DS, J Usadi E, Applegarth DM. TRR's Warrior Camp: An Intensive Treatment Program for Combat Trauma in Active Military and Veterans of All Eras. Mil Med 2019; 183:403-407. [PMID: 29635563 DOI: 10.1093/milmed/usx153] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Indexed: 11/13/2022] Open
Abstract
Effective treatments for combat trauma in military service members exist, but barriers to care abound, including poor access, stigma, and dropout. Although the effects of post-traumatic stress disorder (PTSD) can be severe, recovery is possible when proper treatment is implemented. Trauma and Resiliency Resources, Inc.'s Warrior Camp (WC) program is designed to address the effects of combat trauma in military service members and veterans. This intensive, 7-d treatment incorporates eye movement desensitization and reprocessing therapy, equine-assisted psychotherapy, yoga, and narrative writing in context of community. This single-group pretest-posttest design included paired t-tests and effect size analyses for 85 participants of WC. Outcome measures included the Mississippi Scale for Combat-related PTSD, the Patient Health Questionnaire, the Revised Adult Attachment Scales, and the Moral Injury Events Scale. Clinician-administered measures included the Davidson Trauma Scale and the Dissociative Experiences Scale. All measures showed statistically significant reductions in distress. The effect sizes ranged from small to large. Results suggest that WC participants experienced significant improvement in PTSD, depression, moral injury, dissociation and adult attachment. Clinicians should consider the potential benefits of this short-term, intensive treatment when addressing combat-related PTSD among military service members and veterans.
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Affiliation(s)
- Emily Steele
- School of Social Work, Brigham Young University, 2190 JFSB, Provo, UT 84602
| | - David S Wood
- School of Social Work, Brigham Young University, 2190 JFSB, Provo, UT 84602.,Utah Army National Guard, 17800 Camp Williams Road, Bluffdale, UT 84065
| | - Eva J Usadi
- Trauma and Resiliency Resources, Inc., 26 West 9th Street, Suite 5-E, New York, NY 10011
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Epstein EL, Martindale SL, Va Mid-Atlantic Mirecc Workgroup, Miskey HM. Posttraumatic stress disorder and traumatic brain Injury: Sex differences in veterans. Psychiatry Res 2019; 274:105-111. [PMID: 30784779 DOI: 10.1016/j.psychres.2019.01.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
Around half of Iraq and Afghanistan war veterans with traumatic brain injury (TBI) have co-occurring posttraumatic stress disorder (PTSD). Research on the differences between male and female veterans with co-occurring PTSD/TBI is sparse. This study evaluated behavioral health differences between sexes with these conditions. Veterans (N = 1577) completed a structured psychiatric interview, TBI interview, and self-report interviews assessing sleep quality, alcohol use, substance use, pain, depression symptoms, PTSD symptoms, and combat exposure. Groups depended on the presence/absence of a lifetime PTSD diagnosis and history of TBI. Among veterans with PTSD and TBI, males and females were equally likely to meet criteria for current PTSD, and in the PTSD only group, male veterans were more likely to have current PTSD. Male veterans with PTSD were also more likely to meet criteria for lifetime alcohol and substance use disorders (AUD and SUD), and mild TBI. Although TBI severity did not differ between sexes in the TBI only group, female veterans were more likely to have a moderate/severe TBI among veterans with co-occurring PTSD. Female veterans without PTSD and TBI were more likely to have major depressive disorder (MDD). Significant sex differences were found for AUD, MDD, current PTSD, and TBI severity.
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Affiliation(s)
- Erica L Epstein
- Salisbury VA Health Care System, 1601 Brenner Ave, Salisbury, NC 28144, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), 508 Fulton St, Durham, NC 27705, USA; Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Sarah L Martindale
- Salisbury VA Health Care System, 1601 Brenner Ave, Salisbury, NC 28144, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), 508 Fulton St, Durham, NC 27705, USA; Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | | | - Holly M Miskey
- Salisbury VA Health Care System, 1601 Brenner Ave, Salisbury, NC 28144, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), 508 Fulton St, Durham, NC 27705, USA; Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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172
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Guzmán-Parra J, Aguilera-Serrano C, García-Sanchez JA, García-Spínola E, Torres-Campos D, Villagrán JM, Moreno-Küstner B, Mayoral-Cleries F. Experience coercion, post-traumatic stress, and satisfaction with treatment associated with different coercive measures during psychiatric hospitalization. Int J Ment Health Nurs 2019; 28:448-456. [PMID: 30239098 DOI: 10.1111/inm.12546] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 01/04/2023]
Abstract
Coercive measures are frequently used in psychiatric hospitalization. However, there are few studies that analyse perceived coercion, post-traumatic stress, and subjective satisfaction with the hospitalization treatment associated with different types of coercive measures. The sample consisted of 111 patients admitted to two psychiatric units and divided into three groups based on the measure applied: involuntary medication (N = 41), mechanical restraint (N = 32), and combined measures (mechanical restraint and involuntary medication; N = 38). The outcome variables were perceived coercion evaluated with the Coercion Experience Scale (CES), post-traumatic stress evaluated with the Davidson Trauma Scale (DTS), and satisfaction with the treatment evaluated with the Client's Assessment of Treatment (CAT). The results found higher levels of perceived coercion associated with the use of mechanical restraint (P = 0.002) and combined measures (P < 0.001) in comparison with involuntary medication. Additionally, in relation to post-traumatic stress, mechanical restraint (P = 0.013) and combined measures (P = 0.004) were more stressful compared to involuntary medication. Finally, the use of combined measures was associated with lower satisfaction with inpatient psychiatric treatment compared to the use of involuntary medication (P = 0.006). The following recommendation would be consistent with the results found: if a patient does not specify a preference for some type of measure, involuntary medication could be used and mechanical restraint avoided, especially when used in combination with involuntary medication.
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Affiliation(s)
- José Guzmán-Parra
- Department of Mental Health, Biomedical Research Institute of Malaga (IBIMA), University General Hospital of Málaga, Málaga, Spain
| | - Carlos Aguilera-Serrano
- Department of Mental Health, Biomedical Research Institute of Malaga (IBIMA), University General Hospital of Málaga, Málaga, Spain.,Andalucía Tech, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Juan Antonio García-Sanchez
- Department of Mental Health, Biomedical Research Institute of Malaga (IBIMA), University General Hospital of Málaga, Málaga, Spain
| | | | | | | | - Berta Moreno-Küstner
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Grupo GAP, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Fermín Mayoral-Cleries
- Department of Mental Health, Biomedical Research Institute of Malaga (IBIMA), University General Hospital of Málaga, Málaga, Spain
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173
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Proffitt T, Menzies V. Relationship of symptoms associated with ICU-survivorship: An integrative literature review. Intensive Crit Care Nurs 2019; 53:60-67. [PMID: 30878537 DOI: 10.1016/j.iccn.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/23/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The number of adults who survive a critical illness involving admission to an intensive care unit is increasing. These survivors have an increased risk of developing impairments in cognition, physical function and psychological health. OBJECTIVE This integrative literature review examined the literature for studies exploring the relationships among two or more of the variables of interest, i.e. cognitive, physical, and psychological symptoms (depressive, anxiety, or posttraumatic stress) in intensive care unit survivors post-hospital discharge. METHODS A literature search was conducted using PubMed, CINHAL and PsycINFO databases. FINDINGS While all 13 studies included in the review explored some aspect of a relationship among the variables of interest, none explored associations among all three variables. Five studies explored physical function and psychological symptoms, four studies explored cognitive impairment and psychological symptoms and five studies explored the association among different psychological symptoms. Inconsistencies were found in the study designs, follow-up time frames, patient populations and measures used. CONCLUSIONS Further research using well-designed methodologies and standardized instruments is warranted. Gaining a better understanding of the relationships among these impairments has the potential to contribute to the development of screening guidelines, preventative strategies, and treatments.
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Affiliation(s)
- Tracye Proffitt
- Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, Box 980567, Richmond, VA 23298-0567, United States.
| | - Victoria Menzies
- Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, Box 980567, Richmond, VA 23298-0567, United States
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174
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Herzog JI, Niedtfeld I, Rausch S, Thome J, Mueller-Engelmann M, Steil R, Priebe K, Bohus M, Schmahl C. Increased recruitment of cognitive control in the presence of traumatic stimuli in complex PTSD. Eur Arch Psychiatry Clin Neurosci 2019; 269:147-159. [PMID: 28712089 DOI: 10.1007/s00406-017-0822-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/09/2017] [Indexed: 12/31/2022]
Abstract
A neurocircuitry model of post-traumatic stress disorder (PTSD) suggests increased amygdala responses to emotional stimuli, coupled with hypoactivation of prefrontal regions associated with cognitive control. However, results are heterogenous across different subsamples of PTSD as well as different paradigms. We investigated cognitive control in a classic and emotional Stroop task in 28 female patients with complex PTSD (cPTSD), 28 female trauma-exposed healthy controls (TCs) and 28 female non-trauma-exposed healthy controls (HCs) using functional neuroimaging. Afterwards, we assessed memory function in a spontaneous free recall and recognition task. Patients with cPTSD displayed significantly greater Stroop interference with trauma-related words (as reflected in slower reaction times and increased errors) compared to the other conditions and compared to the TC and HC groups. Moreover, patients with cPTSD showed increased activation in the context of trauma-related words in brain regions associated with cognitive control (dlPFC, vmPFC, dACC) compared to both control groups, and a trend for increased activation in the insula compared to the HC group. Increased recruitment of regions contributing to cognitive control in patients with cPTSD, together with a lack of amygdala response may point to efforts to compensate for emotional distraction caused by the trauma-related words.
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Affiliation(s)
- Julia I Herzog
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Sophie Rausch
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Janine Thome
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Meike Mueller-Engelmann
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany
| | - Regina Steil
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany
| | - Kathlen Priebe
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
- Department of Psychology, Faculty of Life Sciences, Humboldt-Universitaet zu Berlin, Unter den Linden 6, 10999, Berlin, Germany
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
- Faculty of Health, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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175
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Hwang TZ, Lin YH, Liu CY, Kao CC, Huang PC. The Effects of a Supportive Care Program on the Posttraumatic Stress Symptoms of Patients With Oral Cancer After Surgery. Clin Nurs Res 2019; 29:598-606. [PMID: 30808207 DOI: 10.1177/1054773819831444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to estimate the effects of a supportive care program on the posttraumatic stress symptoms (PTSSs) of patients with oral cancer after surgery. Participants were divided into two groups. Outcome measurements included the Chinese version of the Davidson trauma scale to examine PTSSs at a clinical follow-up 1 week (T0), 1 month (T1), and 3 months (T2) after hospital discharge. The results indicated that the frequency and severity mean scores of PTSSs for the two groups at T0 were significantly higher than those at T1 and T2. Both the groups and times were significantly different; moreover, the supported group's PTSS score decreased more than that of the nonsupported group. These findings supported the effects of the supportive care program. Health care staff should be aware of the PTSS status of patients with oral cancer who undergo surgery and consider these issues in combination with patients' discharge care plans.
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176
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Santarnecchi E, Bossini L, Vatti G, Fagiolini A, La Porta P, Di Lorenzo G, Siracusano A, Rossi S, Rossi A. Psychological and Brain Connectivity Changes Following Trauma-Focused CBT and EMDR Treatment in Single-Episode PTSD Patients. Front Psychol 2019; 10:129. [PMID: 30858808 PMCID: PMC6397860 DOI: 10.3389/fpsyg.2019.00129] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/14/2019] [Indexed: 11/13/2022] Open
Abstract
Among the different therapeutic alternatives for post-traumatic stress disorder (PTSD), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) Therapy have shown promising results in helping patients cope with PTSD symptoms. However, given the different theoretical and methodological substrate of TF-CBT and EMDR, a potentially different impact on the brain for the two interventions could be hypothesized, as well as an interaction between trauma-specific PTSD symptomatology and response to a given psychotherapy. In this study, we monitored psychological and spontaneous functional connectivity fMRI patterns in two groups of PTSD patients who suffered by the same traumatic event (i.e., natural disaster), before and after a cycle of psychotherapy sessions based on TF-CBT and EMDR. Thirty-seven (37) PTSD patients were enrolled from a larger sample of people exposed to a single, acute psychological stress (i.e., 2002 earthquake in San Giuliano di Puglia, Italy). Patients were randomly assigned to TF-CBT (n = 14) or EMDR (n = 17) psychotherapy. Clinical assessment was performed using the Clinician-Administered PTSD Scale (CAPS), the Davidson Trauma Scale (DTS) and the Work and Social Adjustment Scale (WSAS), both at baseline and after treatment. All patients underwent a fMRI data acquisition session before and after treatment, aimed at characterizing their functional connectivity (FC) profile at rest, as well as potential connectivity changes associated with the clinical impact of psychotherapy. Both EMDR and TF-CBT induced statistically significant changes in clinical scores, with no difference in the clinical impact of the two treatments. Specific changes in FC correlated with the improvement at the different clinical scores, and differently for EMDR and TF-CBT. However, a similarity in the connectivity changes associated with changes in CAPS in both groups was also observed. Specifically, changes at CAPS in the entire sample correlated with an (i) increase in connectivity between the bilateral superior medial frontal gyrus and right temporal pole, and a (ii) decrease in connectivity between left cuneus and left temporal pole. Results point to a similar, beneficial psychological impact of EMDR and TF-CBT for treatment of natural-disaster PTSD patients. Neuroimaging data suggest a similar neurophysiological substrate for clinical improvement following EMDR and TF-CBT, involving changes affecting bilateral temporal pole connectivity.
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Affiliation(s)
- Emiliano Santarnecchi
- Siena Brain Investigation & Neuromodulation Lab, Neurology and Clinical Neurophysiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | | | - Giampaolo Vatti
- Siena Brain Investigation & Neuromodulation Lab, Neurology and Clinical Neurophysiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | | | - Giorgio Di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Tor Vergata University of Rome Fondazione Policlinico Tor Vergata Roma, Rome, Italy
| | - Alberto Siracusano
- Laboratory of Psychophysiology and Cognitive Neuroscience, Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Tor Vergata University of Rome Fondazione Policlinico Tor Vergata Roma, Rome, Italy
| | - Simone Rossi
- Siena Brain Investigation & Neuromodulation Lab, Neurology and Clinical Neurophysiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Alessandro Rossi
- Department of Medicine, Surgery and Neuroscience, School of Medicine, University of Siena, Siena, Italy
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177
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Fauerbach JA, Gehrke AK, Mason ST, Gould NF, Milner SM, Caffrey J. Cognitive Behavioral Treatment for Acute Posttrauma Distress: A Randomized, Controlled Proof-of-Concept Study Among Hospitalized Adults With Burns. Arch Phys Med Rehabil 2019; 101:S16-S25. [PMID: 30776324 DOI: 10.1016/j.apmr.2018.11.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 09/14/2018] [Accepted: 11/04/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE (1) To evaluate the feasibility of conducting a randomized controlled trial (RCT) of the Safety, Meaning, Activation and Resilience Training (SMART) intervention vs nondirective supportive psychotherapy (NDSP) in an acutely hospitalized adult survivor of burn injury sample; and (2) to assess the preliminary effect of SMART on acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) symptom reduction as secondary prevention. DESIGN Proof-of-concept, parallel group RCT design. SETTING Regional burn center. PARTICIPANTS Acutely injured, hospitalized adult survivors of burn injury (N=50) were randomly assigned to SMART (n=28) or nondirective supportive psychotherapy (n=22). Due to dropout and missing data, final sample size was 40, SMART (n=21) and nondirective supportive psychotherapy (n=19). INTERVENTIONS SMART is a manualized, 4-session cognitive behavioral therapy-based psychological intervention targeting ASD, PTSD, and MDD symptoms. NDSP is a manualized, 4-session protocol. MAIN OUTCOME MEASURES Davidson Trauma Scale ([DTS]; diagnostic proxy for ASD and PTSD; clinical cutoff=40, with higher score=higher severity) and the Patient Health Questionnaire-9 ([PHQ-9]; diagnostic proxy for MDD; clinical cutoff=10, with higher score=higher severity) at pretreatment, immediate posttreatment, and 1 month posttreatment. RESULTS At baseline, median DTS scores and PHQ-9 scores were above clinical cutoffs and did not differ across groups. At 1 week and 1 month posttreatment, median DTS and PHQ-9 scores were beneath clinical cutoffs in the SMART group; scores remained above clinical cutoffs in the NDSP group at these time points. CONCLUSIONS It is feasible to conduct an RCT of SMART in hospitalized adult survivors of burn injury. SMART has the potential to yield clinically significant outcomes. Additional studies are needed to replicate and extend these findings.
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Affiliation(s)
- James A Fauerbach
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Amanda K Gehrke
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shawn T Mason
- Johnson and Johnson Health and Wellness Solutions, New Brunswick, New Jersey
| | - Neda F Gould
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen M Milner
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Surgery, Division of Plastics and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie Caffrey
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Surgery, Division of Plastics and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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178
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Protective factors that buffer against the intergenerational transmission of trauma from mothers to young children: A replication study of angels in the nursery. Dev Psychopathol 2019; 31:173-187. [DOI: 10.1017/s0954579418001530] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis replication study examined protective effects of positive childhood memories with caregivers (“angels in the nursery”) against lifespan and intergenerational transmission of trauma. More positive, elaborated angel memories were hypothesized to buffer associations between mothers’ childhood maltreatment and their adulthood posttraumatic stress disorder (PTSD) and depression symptoms, comorbid psychopathology, and children's trauma exposure. Participants were 185 mothers (M age = 30.67 years, SD = 6.44, range = 17–46 years, 54.6% Latina, 17.8% White, 10.3% African American, 17.3% other; 24% Spanish speaking) and children (M age = 42.51 months; SD = 15.95, range = 3–72 months; 51.4% male). Mothers completed the Angels in the Nursery Interview (Van Horn, Lieberman, & Harris, 2008), and assessments of childhood maltreatment, adulthood psychopathology, children's trauma exposure, and demographics. Angel memories significantly moderated associations between maltreatment and PTSD (but not depression) symptoms, comorbid psychopathology, and children's trauma exposure. For mothers with less positive, elaborated angel memories, higher levels of maltreatment predicted higher levels of psychopathology and children's trauma exposure. For mothers with more positive, elaborated memories, however, predictive associations were not significant, reflecting protective effects. Furthermore, protective effects against children's trauma exposure were significant only for female children, suggesting that angel memories may specifically buffer against intergenerational trauma from mothers to daughters.
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179
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Aguilera-Serrano C, Guzmán-Parra J, Miranda-Paez J, García-Spínola E, Torres-Campos D, Villagrán-Moreno JM, Moreno-Küstner B, García-Sanchez JA, Mayoral-Cleries F. Validation of a short version of the Coercion Experience Scale (CES-18): Psychometric characteristics in a Spanish sample. Psychiatry Res 2019; 272:284-289. [PMID: 30594761 DOI: 10.1016/j.psychres.2018.12.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/23/2018] [Accepted: 12/23/2018] [Indexed: 11/17/2022]
Abstract
The Coercion Experience Scale (CES) is a questionnaire that evaluates the subjective experience of coercion during psychiatric hospitalization. This study aimed to assess a short version of the Coercion Experience Scale (CES-18) in a Spanish Sample (N = 114). Two authors independently selected the items, choosing those that could also be applied to the experience of coercion after the use of forced medication. Reliability was estimated using internal consistency coefficients. Internal validity was assessed by means of a factorial analysis based on the method of extraction of main components and using orthogonal rotation VARIMAX. Convergent and discriminatory validity was evaluated by correlation between the total score of the CES-18 with the original CES and a Visual Analogue Scale, The Davidson Trauma Scale and the Client Assessment of Treatment Scale. The CES-18 showed adequate internal consistency (Cronbach α = 0.940). Factor analysis resulted in a two-factor solution (Coercion and Humiliation and Fear) explaining 64.2% of the total variance. The correlation between the original CES and CES-18 was adequate (r = 0.968). The scores suggested good divergent and convergent validity. The Spanish language CES-18 demonstrated adequate psychometric proprieties in order to assess perceived coercion during psychiatric hospitalization.
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Affiliation(s)
- Carlos Aguilera-Serrano
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain; University of Málaga, Andalucía Tech, Faculty of Psychology, Málaga, Spain
| | - José Guzmán-Parra
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain.
| | - Jesús Miranda-Paez
- University of Málaga, Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Faculty of Psychology, Málaga, Spain
| | | | | | | | - Berta Moreno-Küstner
- University of Málaga, Departamento de Personalidad, Evaluación y Tratamiento Psicológico. Grupo GAP, Faculty of Psychology, Málaga, Spain
| | - Juan Antonio García-Sanchez
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
| | - Fermín Mayoral-Cleries
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
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180
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Peltzer K, Pengpid S. Maternal alcohol use during pregnancy in a general national population in South Africa. S Afr J Psychiatr 2019; 25:1236. [PMID: 30899583 PMCID: PMC6424534 DOI: 10.4102/sajpsychiatry.v25i0.1236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/29/2018] [Indexed: 11/28/2022] Open
Abstract
Objective Alcohol use in pregnancy is linked with various negative health effects on the infant. The aim of this study was to examine the prevalence of maternal alcohol use during pregnancy and socio-demographic and health correlates. Methods Data of ever-pregnant women from the cross-sectional ‘South African National Health and Nutrition Examination Survey (SANHANES-1) 2011–2012’ were analysed. The sample included 5089 adolescents and adult women aged 15–55 years. They responded to questions on alcohol use, socio-demographic and health indicators. Results The results indicated that 3.7% (95.0% confidence interval [CI] = 3.1, 4.5) of South African women had engaged in alcohol use during their pregnancy. In adjusted analysis, being mixed race, not employed, poor self-rated health status, ever been diagnosed with tuberculosis and having partial post-traumatic stress disorder were found to be associated with alcohol use during pregnancy. Conclusions The study findings suggest links between socio-demographic and health variables and prenatal alcohol use, which may have public health policy implications.
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Affiliation(s)
- Karl Peltzer
- HIV/AIDS/STIs and TB (HAST), Human Sciences Research Council, South Africa.,Department of Research Innovation and Development, University of Limpopo, South Africa
| | - Supa Pengpid
- Department of Research Innovation and Development, University of Limpopo, South Africa.,ASEAN Institute for Health Development, Mahidol University, Thailand
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181
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Butt M, Espinal E, Aupperle RL, Nikulina V, Stewart JL. The Electrical Aftermath: Brain Signals of Posttraumatic Stress Disorder Filtered Through a Clinical Lens. Front Psychiatry 2019; 10:368. [PMID: 31214058 PMCID: PMC6555259 DOI: 10.3389/fpsyt.2019.00368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/13/2019] [Indexed: 12/14/2022] Open
Abstract
This review aims to identify patterns of electrical signals identified using electroencephalography (EEG) linked to posttraumatic stress disorder (PTSD) diagnosis and symptom dimensions. We filter EEG findings through a clinical lens, evaluating nuances in findings according to study criteria and participant characteristics. Within the EEG frequency domain, greater right than left parietal asymmetry in alpha band power is the most promising marker of PTSD symptoms and is linked to exaggerated physiological arousal that may impair filtering of environmental distractors. The most consistent findings within the EEG time domain focused on event related potentials (ERPs) include: 1) exaggerated frontocentral responses (contingent negative variation, mismatch negativity, and P3a amplitudes) to task-irrelevant distractors, and 2) attenuated parietal responses (P3b amplitudes) to task-relevant target stimuli. These findings suggest that some individuals with PTSD suffer from attention dysregulation, which could contribute to problems concentrating on daily tasks and goals in lieu of threatening distractors. Future research investigating the utility of alpha asymmetry and frontoparietal ERPs as diagnostic and predictive biomarkers or intervention targets are recommended.
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Affiliation(s)
- Mamona Butt
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States
| | - Elizabeth Espinal
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
| | - Valentina Nikulina
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States.,Department of Psychology, The Graduate Center, City University of New York, New York, NY, United States
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
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182
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Schuman DL, Bricout J, Peterson HL, Barnhart S. A systematic review of the psychosocial impact of emotional numbing in US combat veterans. J Clin Psychol 2018; 75:644-663. [DOI: 10.1002/jclp.22732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/04/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Donna L. Schuman
- College of Social Work; University of Kentucky; Lexington Kentucky
| | - John Bricout
- School of Social Work; University of Minnesota; Minneapolis Minnesota
| | | | - Sheila Barnhart
- College of Social Work; University of Kentucky; Lexington Kentucky
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183
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Peltzer K, Pengpid S. Prevalence, and social and health correlates of insomnia among persons 15 years and older in South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1177/0081246318818623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study aims to investigate the prevalence, and social and health correlates of insomnia symptoms in a national population sample in South Africa. Data were analysed from the cross-sectional ‘South African National Health and Nutrition Examination Survey (SANHANES-1)’ 2012, using a sample of 15,133 individuals (mean age = 36.9, SD = 16.5). Measures included information on insomnia, sociodemographics, health status, health risk behaviour, and mental health. Results indicate that the overall prevalence of insomnia symptoms was 7.1%, with 3.5% among 15- to 24-year-olds and 20.5% among 65 years and older participants. In the adjusted logistic regression analysis, poorer health status (self-rated health, functional disability and cognitive impairment), having bodily pain, having experienced three or more traumatic events, and having psychological distress and partial Posttraumatic Stress Disorder were positively associated with insomnia. A significant proportion of South Africans have insomnia symptoms and several risk factors were identified that can help in guiding interventions.
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Affiliation(s)
- Karl Peltzer
- HIV/AIDS, STIs and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
- Department of Research Innovation and Development, University of Limpopo, Sovenga, South Africa
| | - Supa Pengpid
- Department of Research Innovation and Development, University of Limpopo, Sovenga, South Africa
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
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184
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Taku K, Prioleau PG, Anderson DS, Takeguchi Y, Sekine H, Maeda M, Yabe H, Yanagisawa RT, Katz CL. Medical Student Reactions to Disaster after the 2011 Great East Japan Earthquake: Motivation and Posttraumatic Growth. Psychiatr Q 2018; 89:1007-1018. [PMID: 30145770 DOI: 10.1007/s11126-018-9601-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Medical students often become involved as post-disaster emergency responders despite incomplete training, and in doing so may suppress their immediate experiences as victims and survivors. This experience, however, may lead them to increase their motivation to help others. We examined how cognitive and emotional reactions to disaster correlated with posttraumatic growth (PTG) in medical students in Fukushima, Japan after the Great East Japan Earthquake of March 11, 2011. To date, Fukushima continues to suffer from radiation concerns following the nuclear power plant meltdown. In a survey three years after the onset of a long-term disaster, with a cross-sectional research design, medical students (N = 494) reported their negative post-disaster reactions, desire to help, and demonstrations of capability, and completed the Posttraumatic Growth Inventory (PTGI). We conducted hierarchical regression analyses and found that the addition of variables pertaining to negative post-disaster reactions (e.g. confusion, anger, and sadness) led to the largest increase in predictive value for PTGI scores; students reporting a past traumatic experience were also more likely to experience PTG. Our results indicate that weathering stressful disaster circumstances created opportunities for positive personal growth and reinforcement at a crucial time in medical students' professional development.
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Affiliation(s)
- Kanako Taku
- Department of Psychology, Oakland University, 654 Pioneer Drive, 123 Pryale Hall, Rochester, MI, 48309-4401, USA.
| | - Phoebe G Prioleau
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - David S Anderson
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Yuzo Takeguchi
- School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, 960-1295, Japan
| | - Hideharu Sekine
- International Exchange Affairs, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, 960-1295, Japan
| | - Masaharu Maeda
- Department of Disaster Psychiatry, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, 960-1295, Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, 960-1295, Japan
| | - Robert T Yanagisawa
- Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Craig L Katz
- Medical Education, and Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box, New York, NY, 1257, USA
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185
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Phillips RD, Wilson SM, Sun D, Morey R. Posttraumatic Stress Disorder Symptom Network Analysis in U.S. Military Veterans: Examining the Impact of Combat Exposure. Front Psychiatry 2018; 9:608. [PMID: 30519198 PMCID: PMC6259007 DOI: 10.3389/fpsyt.2018.00608] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/30/2018] [Indexed: 01/18/2023] Open
Abstract
Recent work inspired by graph theory has begun to conceptualize mental disorders as networks of interacting symptoms. Posttraumatic stress disorder (PTSD) symptom networks have been investigated in clinical samples meeting full diagnostic criteria, including military veterans, natural disaster survivors, civilian survivors of war, and child sexual abuse survivors. Despite reliable associations across reported networks, more work is needed to compare central symptoms across trauma types. Additionally, individuals without a diagnosis who still experience symptoms, also referred to as subthreshold cases, have not been explored with network analysis in veterans. A sample of 1,050 Iraq/Afghanistan-era U.S. military veterans (851 males, mean age = 36.3, SD = 9.53) meeting current full-criteria PTSD (n = 912) and subthreshold PTSD (n = 138) were assessed with the Structured Clinical Interview for DSM-IV Disorders (SCID). Combat Exposure Scale (CES) scores were used to group the sample meeting full-criteria into high (n = 639) and low (n = 273) combat exposure subgroups. Networks were estimated using regularized partial correlation models in the R-package qgraph, and robustness tests were performed with bootnet. Frequently co-occurring symptom pairs (strong network connections) emerged between two avoidance symptoms, hypervigilance and startle response, loss of interest and detachment, as well as, detachment and restricted affect. These associations replicate findings reported across PTSD trauma types. A symptom network analysis of PTSD in a veteran population found significantly greater overall connectivity in the full-criteria PTSD group as compared to the subthreshold PTSD group. Additionally, novel findings indicate that the association between intrusive thoughts and irritability is a feature of the symptom network of veterans with high levels of combat exposure. Mean node predictability is high for PTSD symptom networks, averaging 51.5% shared variance. With the tools described here and by others, researchers can help refine diagnostic criteria for PTSD, develop more accurate measures for assessing PTSD, and eventually inform therapies that target symptoms with strong network connections to interrupt interconnected symptom complexes and promote functional recovery.
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Affiliation(s)
- Rachel D. Phillips
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, United States
- Mental Illness Research, Education and Clinical Centers MIRECC (VA), Durham VA Medical Center, Durham, NC, United States
| | - Sarah M. Wilson
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, United States
| | - Delin Sun
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, United States
- Mental Illness Research, Education and Clinical Centers MIRECC (VA), Durham VA Medical Center, Durham, NC, United States
| | - Rajendra Morey
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, United States
- Mental Illness Research, Education and Clinical Centers MIRECC (VA), Durham VA Medical Center, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, United States
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186
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Peltzer K, Pengpid S. Post-traumatic stress disorder and health risk behaviour among persons 15 years and older in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2018. [DOI: 10.1080/14330237.2018.1501912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Karl Peltzer
- HIV/AIDS/STIs and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
- Department of Research Innovation and Development, University of Limpopo, Turfloop Campus, Sovenga, South Africa
| | - Supa Pengpid
- Department of Research Innovation and Development, University of Limpopo, Turfloop Campus, Sovenga, South Africa
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
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187
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Vignato J, Connelly CD, Bush RA, Georges JM, Semino-Asaro S, Calero P, Horwitz SM. Correlates of Perinatal Post-Traumatic Stress among Culturally Diverse Women with Depressive Symptomatology. Issues Ment Health Nurs 2018; 39:840-849. [PMID: 30277842 PMCID: PMC6397067 DOI: 10.1080/01612840.2018.1488313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
Post-traumatic stress disorder (PTSD) is an important and often neglected comorbidity of pregnancy; left untreated, it can lead to serious health complications for the mother and developing fetus. Structured interviews were conducted to identify risk factors of PTSD among culturally diverse women with depressive symptomatology receiving perinatal services at community obstetric/gynecologic clinics. Women abused as adults, with two or more instances of trauma, greater trauma severity, insomnia, and low social support were more likely to present perinatal PTSD symptoms. Perinatal PTSD is prevalent and has the potential for chronicity. It is imperative healthcare providers recognize salient risk factors and integrate culturally sensitive screening, appropriate referral, and treatment services for perinatal PTSD.
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Affiliation(s)
- Julie Vignato
- College of Nursing, University of Iowa, 305 College of Nursing Building, 50 Newton Road, Iowa City, IA 52242, USA
| | - Cynthia D. Connelly
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Ruth A. Bush
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Jane M. Georges
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Semira Semino-Asaro
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Patricia Calero
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, 1 Park Avenue, 8 Floor, New York, NY 10016, USA
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188
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Spies G, Konkiewitz EC, Seedat S. Incidence and Persistence of Depression Among Women Living with and Without HIV in South Africa: A Longitudinal Study. AIDS Behav 2018; 22:3155-3165. [PMID: 29476437 PMCID: PMC8850942 DOI: 10.1007/s10461-018-2072-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Depression and trauma are common among women living with HIV. This is the first study to track the longitudinal course of depression and examine the relationship between depression and trauma over time among women in South Africa. HIV-infected and uninfected women (N = 148) were assessed at baseline and one year later. Results of a path analysis show the multi-directional and entwined influence of early life stress, other life-threatening traumas across the lifespan, depression and PTSD over the course of HIV. We also observed higher rates of depressive symptomatology and more persistent cases among infected women compared to uninfected women, as well as a more consistent and enduring relationship between childhood trauma and depression among women living with HIV. The present study is unique in documenting the course of untreated depression and PTSD in women with and without HIV infection with a high prevalence of early childhood trauma.
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Affiliation(s)
- Georgina Spies
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | - Elisabete Castelon Konkiewitz
- Faculdade de Ciências Médicas e da Saúde, Universidade Federal da Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Soraya Seedat
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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189
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Boroughs MS, Ehlinger PP, Batchelder AW, Safren SA, O’Cleirigh C. Posttraumatic Stress Symptoms and Emerging Adult Sexual Minority Men: Implications for Assessment and Treatment of Childhood Sexual Abuse. J Trauma Stress 2018; 31:665-675. [PMID: 30338584 PMCID: PMC6557140 DOI: 10.1002/jts.22335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 05/24/2018] [Accepted: 06/06/2018] [Indexed: 11/09/2022]
Abstract
Emerging adulthood (EA) is a developmental period marked by unique challenges that affect health including burgeoning occupational, relational, and financial stability; and increased risk taking in terms of sexual behavior(s) and substance use. Data were collected from 296 HIV-uninfected sexual minority men with childhood sexual abuse (CSA) histories. We analyzed baseline assessment data from a multisite randomized controlled trial that tested the efficaciousness of an experimental psychosocial treatment and examined vulnerabilities known to be linked with CSA. Our analyses compared EA sexual minority men, aged 18-29, with older sexual minority men (OSMM) on posttraumatic stress disorder (PTSD) and other mental health and substance use outcomes. We found higher odds of PTSD, odds ratio (OR) = 0.57, 95% CI [0.33, 0.96]; panic disorder or panic disorder with agoraphobia, OR = 0.36, 95% CI [0.16, 0.85]; and cocaine use, OR = 0.50, 95% CI [0.25, 0.97], among OSMM and higher odds of alcohol intoxication, OR = 5.60, 95% CI [3.20, 9.82]; cannabis use, OR = 3.09, 95% CI [1.83, 5.21]; and non-HIV sexually transmitted infections, OR = 3.03, 95% CI [1.29, 7.13], among the EA men. These results present a complex picture of health risks among sexual minority men in general and EA sexual minority men in particular. HIV seroconversion linked health risk behaviors, among sexual minority men, may be better addressed via increased attention to treating trauma and comorbid mental health and substance use problems using evidence-based psychosocial assessments and integrated treatment platforms that are tailored to this population.
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Affiliation(s)
- Michael S. Boroughs
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada,The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
| | - Peter P. Ehlinger
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, Oregon, USA
| | - Abigail W. Batchelder
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA,Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven A. Safren
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA,Department of Psychology, University of Miami, Miami, Florida, USA
| | - Conall O’Cleirigh
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA,Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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190
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Thome J, Hauschild S, Koppe G, Liebke L, Rausch S, Herzog JI, Müller-Engelmann M, Steil R, Priebe K, Hermans D, Schmahl C, Bohus M, Lis S. Generalisation of fear in PTSD related to prolonged childhood maltreatment: an experimental study. Psychol Med 2018; 48:2223-2234. [PMID: 29282161 DOI: 10.1017/s0033291717003713] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Fear responses are particularly intense and persistent in post-traumatic stress disorder (PTSD), and can be evoked by unspecific cues that resemble the original traumatic event. Overgeneralisation of fear might be one of the underlying mechanisms. We investigated the generalisation and discrimination of fear in individuals with and without PTSD related to prolonged childhood maltreatment. METHODS Sixty trauma-exposed women with (N = 30) and without (N = 30) PTSD and 30 healthy control participants (HC) underwent a fear conditioning and generalisation paradigm. In a contingency learning procedure, one of two circles of different sizes was associated with an electrical shock (danger cue), while the other circle represented a safety cue. During generalisation testing, online risk ratings, reaction times and fear-potentiated startle were measured in response to safety and danger cues as well as to eight generalisation stimuli, i.e. circles of parametrically varying size creating a continuum of similarity between the danger and safety cue. RESULTS The increase in reaction times from the safety cue across the different generalisation classes to the danger cue was less pronounced in PTSD compared with HC. Moreover, PTSD participants expected higher risk of an aversive event independent of stimulus types and task. CONCLUSIONS Alterations in generalisation constitute one part of fear memory alterations in PTSD. Neither the accuracy of a risk judgement nor the strength of the induced fear was affected. Instead, processing times as an index of uncertainty during risk judgements suggested a reduced differentiation between safety and threat in PTSD.
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Affiliation(s)
- Janine Thome
- Institute for Psychiatric and Psychosomatic Psychotherapy,Central Institute of Mental Health Mannheim,Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
| | - Sophie Hauschild
- Institute for Psychiatric and Psychosomatic Psychotherapy,Central Institute of Mental Health Mannheim,Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
| | - Georgia Koppe
- Department of Theoretical Neuroscience,Central Institute of Mental Health Mannheim,Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
| | - Lisa Liebke
- Institute for Psychiatric and Psychosomatic Psychotherapy,Central Institute of Mental Health Mannheim,Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
| | - Sophie Rausch
- Institute for Psychiatric and Psychosomatic Psychotherapy,Central Institute of Mental Health Mannheim,Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
| | - Julia I Herzog
- Department of Psychosomatic Medicine and Psychotherapy,Central Institute of Mental Health Mannheim,Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Intervention,Institute of Psychology,Goethe University Frankfurt,Frankfurt,Germany
| | - Regina Steil
- Department of Clinical Psychology and Intervention,Institute of Psychology,Goethe University Frankfurt,Frankfurt,Germany
| | - Kathlen Priebe
- Department of Psychology,Faculty of Life Sciences,Humboldt University Berlin,Berlin,Germany
| | - Dirk Hermans
- Faculty of Psychology and Educational Sciences,Leuven University,Leuven,Belgium
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy,Central Institute of Mental Health Mannheim,Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
| | - Martin Bohus
- Institute for Psychiatric and Psychosomatic Psychotherapy,Central Institute of Mental Health Mannheim,Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
| | - Stefanie Lis
- Institute for Psychiatric and Psychosomatic Psychotherapy,Central Institute of Mental Health Mannheim,Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
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191
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Phaswana-Mafuya N, Peltzer K, Pengpid S. Concurrent tobacco use and risky drinking in South Africa: Results from the South African National Health and Nutrition Examination Survey. JOURNAL OF PSYCHOLOGY IN AFRICA 2018. [DOI: 10.1080/14330237.2018.1507330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nancy Phaswana-Mafuya
- Deputy Vice Chancellor Research and Innovation Office, North West University, Potchefstroom, South Africa
- HIV/AIDS/STI/TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Karl Peltzer
- Deputy Vice Chancellor Research and Innovation Office, North West University, Potchefstroom, South Africa
- HIV/AIDS/STI/TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand
- Department of Research and Innovation, University of Limpopo, Turfloop, South Africa
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192
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Banerjee N, Ironson G, Fitch C, Boroughs MS, Safren SA, Powell A, O’Cleirigh C. The Indirect Effect of Posttraumatic Stress Disorder Symptoms on Current Alcohol Use Through Negative Cognitions in Sexual Minority Men. J Trauma Stress 2018; 31:602-612. [PMID: 30028033 PMCID: PMC6286675 DOI: 10.1002/jts.22304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/06/2022]
Abstract
Self-medication theory posits that some trauma survivors use alcohol to cope with posttraumatic stress disorder (PTSD) symptoms, but the role of negative posttraumatic cognitions in this relationship is not well defined. We examined associations among PTSD symptoms, posttraumatic cognitions, and alcohol intoxication frequency in 290 men who have sex with men (MSM), who reported a history of childhood sexual abuse (CSA). Using a bootstrap approach, we examined the indirect effects of PTSD symptoms on alcohol intoxication frequency through posttraumatic cognitions regarding the self, world, and self-blame. In separate regression models, higher levels of PTSD symptoms and posttraumatic cognitions were each associated with more frequent intoxication, accounting for 2.6% and 5.2% of the variance above demographics, respectively. When examined simultaneously, posttraumatic cognitions remained significantly correlated with intoxication frequency whereas PTSD symptoms did not. Men reporting elevated posttraumatic cognitions faced increased odds for current alcohol dependence, odds ratio (OR) = 2.19, 95% CI [1.13, 4.22], compared with men reporting low posttraumatic cognitions, independent of current PTSD diagnosis. A higher level of PTSD symptom severity was indirectly associated with more frequent alcohol intoxication through cognitions about the self and world; the indirect to total effect ratios were 0.74 and 0.35, respectively. Negative posttraumatic cognitions pertaining to individuals' self-perceptions and appraisals of the world as dangerous may play a role in self-medication with alcohol among MSM with a history of CSA. Interventions targeting these cognitions may offer potential for reducing alcohol misuse in this population, with possible broader implications for HIV-infection risk.
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Affiliation(s)
- Nikhil Banerjee
- Department of Psychology, University of Miami, Coral
Gables, Florida, USA
| | - Gail Ironson
- Department of Psychology, University of Miami, Coral
Gables, Florida, USA
| | - Calvin Fitch
- Department of Psychology, University of Miami, Coral
Gables, Florida, USA
| | | | - Steven A. Safren
- Department of Psychology, University of Miami, Coral
Gables, Florida, USA
| | - Alexis Powell
- Miller School of Medicine, University of Miami, Miami,
Florida, USA
| | - Conall O’Cleirigh
- Department of Psychiatry, Harvard Medical
School/Massachusetts General Hospital, Boston, Massachusetts, USA
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193
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Dillon KH, Cunningham KC, Neal JM, Wilson SM, Dedert EA, Elbogen EB, Calhoun PS, Beckham JC, Kimbrel NA. Examination of the indirect effects of combat exposure on suicidal behavior in veterans. J Affect Disord 2018; 235:407-413. [PMID: 29677605 PMCID: PMC8954689 DOI: 10.1016/j.jad.2018.04.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/06/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Researchers have theorized that increased rates of suicide in the military are associated with combat exposure; however, this hypothesis has received inconsistent support in the literature, potentially because combat exposure may be indirectly related to suicide risk through its influence on posttraumatic stress disorder (PTSD) and depressive symptoms. The current study tested the hypothesis that combat exposure has a significant indirect effect on suicidal behavior among Iraq/Afghanistan-era veterans through its effects on PTSD-depressive symptomatology. METHODS Iraq/Afghanistan-era veterans (N = 3,238) participated in a cross-sectional, multi-site study of post-deployment mental health consisting of clinical interviews and self-report questionnaires. Structural equation modeling (SEM) was used to examine direct and indirect relationships between three latent variables: combat exposure, PTSD-depression, and suicidal behavior (past attempts and current ideation, intent, and preparation). RESULTS A partial mediation model was the best-fitting model for the data. Combat exposure was significantly associated with PTSD-depression (β = 0.50, p < .001), which was in turn associated with suicidal behavior (β = 0.62, p < .001). As expected, the indirect effect between combat exposure and suicidal behavior was statistically significant, β = 0.31, p < .001. LIMITATIONS Data were cross-sectional, and suicidal behavior was measured via self-report. CONCLUSIONS Results indicated that combat exposure was indirectly related to suicidal behavior via PTSD-depressive symptomatology. Findings lend support for a higher-order combined PTSD-depression latent factor and suggest that Iraq/Afghanistan-era veterans with high levels of PTSD-depressive symptoms are at increased risk for suicidal behavior.
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Affiliation(s)
- Kirsten H. Dillon
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Katherine C. Cunningham
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Julia M. Neal
- Duke University Medical Center, Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Sarah M. Wilson
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA,VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | - Eric A. Dedert
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Eric B. Elbogen
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Patrick S. Calhoun
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA,VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | - Jean C. Beckham
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | | | - Nathan A. Kimbrel
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA,Correspondence concerning this article should be sent to: Dr. Nathan A. Kimbrel, VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, 3022 Croasdaile Drive, Durham, NC, 27705,
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194
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Reig-Botella A, Clemente M. Social welfare of workers affected by a chronic lung disease. REVISTA DE ESTUDIOS E INVESTIGACIÓN EN PSICOLOGÍA Y EDUCACIÓN 2018. [DOI: 10.17979/reipe.2018.5.1.3343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We try to verify if there are variables of social welfare able to differentiate chronically ill patients affected by asbestos poisoning from healthy people. We used the scale of Hahn, Cella, Bode and Hanharan, developed to measure the social welfare. After reviewing the literature we intend to verify first the psychometric properties of the previously mentioned scale by using a sample of patients affected, 110, as well as a comparison group of 70 people matched by age and gender blocks, who have been employees of the largest Spanish naval organization. The results indicate a very high reliability of the instrument, and a high concurrent validity of the questionnaire SCL-90. Next an Anova is performed obtaining that, contrary to expectations from the literature, only a variation occurs in three variables: negative social companionship, limitations, and satisfaction. This research opens the possibility for future research studying the age variable as a mediator of social welfare. Finally, the limitations of the study and possible future projects are discussed.
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195
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Pérez-Pedrogo C, Martínez-Taboas A, González RA, Caraballo JN, Albizu-García CE. Sex differences in traumatic events and psychiatric morbidity associated to probable posttraumatic stress disorder among Latino prisoners. Psychiatry Res 2018; 265:208-214. [PMID: 29738944 PMCID: PMC6016368 DOI: 10.1016/j.psychres.2018.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 03/01/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
Latinos comprised 17.1% of the U.S. population and 33.1% of US prisoners, yet they are underrepresented in the psychopathology literature. Despite higher rates of trauma among incarcerated individuals than in the general population, most of the previous research in this area focused primarily on women samples, and very few studies examined sex differences in PTSD and traumatic experiences. In addition, there is a need for research assessing traumatic experiences and probable PTSD in men and women Latino inmates to inform culturally competent care and sex sensitive care for this vulnerable and underserved population. Our study examined whether men and women Latino inmates with probable Posttraumatic Stress Disorder (PTSD), based on the cut off 40 or more symptoms on the Davidson Trauma Scale (DTS), differed significantly by the number of event types experienced, the type of potentially traumatizing event, and in co-occurring psychiatric conditions. A multi-stage sample design was used to select a probabilistic sample of 1,331 inmates from 26 penal institutions in PR of which 1179 participated in the study. Bivariate associations were calculated for each type of traumatic event and probable PTSD. Mean number of types of potentially traumatizing event experienced was comparable for both sexes (F = 3.83, M = 3.74) yet sex differences were found in the nature of the event. Women with probable PTSD had higher rates of experiencing rape and sexual abuse. Men had higher rates of experiencing combat in war, a life-threatening accident, of witnessing violence, and being threatened with a weapon. Men with significant ADHD symptoms in childhood and with Generalized Anxiety Disorder (GAD) during adulthood were almost 5 and 7 times as likely to score above threshold on the DTS whereas women were >3 times as likely in the presence of ADHD symptoms in childhood or depression during adulthood. This study underscores the need to improve understanding of the clinical manifestations of trauma and co-occurring psychiatric conditions for appropriate sex sensitive interventions targeting Latinos living in prisons.
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Affiliation(s)
- Coralee Pérez-Pedrogo
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico; Carlos Albizu University, San Juan Campus, San Juan, Puerto Rico.
| | | | - Rafael A González
- East London NHS Foundation Trust, Child and Adolescent Mental Health Service (CAMHS), London, UK; Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
| | - José N Caraballo
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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Qi W, Ratanatharathorn A, Gevonden M, Bryant R, Delahanty D, Matsuoka Y, Olff M, deRoon-Cassini T, Schnyder U, Seedat S, Laska E, Kessler RC, Koenen K, Shalev A. Application of data pooling to longitudinal studies of early post-traumatic stress disorder (PTSD): the International Consortium to Predict PTSD (ICPP) project. Eur J Psychotraumatol 2018; 9:1476442. [PMID: 29938009 PMCID: PMC6008580 DOI: 10.1080/20008198.2018.1476442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Understanding the development of post-traumatic stress disorder (PTSD) is a precondition for efficient risk assessment and prevention planning. Studies to date have been site and sample specific. Towards developing generalizable models of PTSD development and prediction, the International Consortium to Predict PTSD (ICPP) compiled data from 13 longitudinal, acute-care based PTSD studies performed in six different countries. Objective: The objectives of this study were to describe the ICPP's approach to data pooling and harmonization, and present cross-study descriptive results informing the longitudinal course of PTSD after acute trauma. Methods: Item-level data from 13 longitudinal studies of adult civilian trauma survivors were collected. Constructs (e.g. PTSD, depression), measures (questions or scales), and time variables (days from trauma) were identified and harmonized, and those with inconsistent coding (e.g. education, lifetime trauma exposure) were recoded. Administered in 11 studies, the Clinician Administered PTSD Scale (CAPS) emerged as the main measure of PTSD diagnosis and severity. Results: The pooled data set included 6254 subjects (39.9% female). Studies' average retention rate was 87.0% (range 49.1-93.5%). Participants' baseline assessments took place within 2 months of trauma exposure. Follow-up durations ranged from 188 to 1110 days. Reflecting studies' inclusion criteria, the prevalence of baseline PTSD differed significantly between studies (range 3.1-61.6%), and similar differences were observed in subsequent assessments (4.3-38.2% and 3.8-27.0% for second and third assessments, respectively). Conclusion: Pooling data from independently collected studies requires careful curation of individual data sets for extracting and optimizing informative commonalities. However, it is an important step towards developing robust and generalizable prediction models for PTSD and can exceed findings of single studies. The large differences in prevalence of PTSD longitudinally cautions against using any individual study to infer trauma outcome. The multiplicity of instruments used in individual studies emphasizes the need for common data elements in future studies.
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Affiliation(s)
- Wei Qi
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Andrew Ratanatharathorn
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York , USA
| | - Martin Gevonden
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Richard Bryant
- Faculty of Science, University of New South Wales School of Psychology, Kensington, Australia
| | - Douglas Delahanty
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Yutaka Matsuoka
- Division of Health Care Research, National Cancer Center, Center for Public Health Sciences, Tokyo, Japan
| | - Miranda Olff
- Department of Psychiatry, University of Amsterdam Academic Medical Center, Amsterdam-Zuidoost, The Netherlands
| | | | - Ulrich Schnyder
- Department of Psychiatry, University of Zurich School of Medicine, Zurich, Switzerland
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University School of Medicine and Health Sciences, Cape Town, South Africa
| | - Eugene Laska
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan Koenen
- Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Arieh Shalev
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
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197
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Wolf EJ, Maniates H, Nugent N, Maihofer AX, Armstrong D, Ratanatharathorn A, Ashley-Koch AE, Garrett M, Kimbrel NA, Lori A, Aiello AE, Baker DG, Beckham JC, Boks MP, Galea S, Geuze E, Hauser MA, Kessler RC, Koenen KC, Miller MW, Ressler KJ, Risbrough V, Rutten BP, Stein MB, Ursano RJ, Vermetten E, Vinkers CH, Uddin M, Smith AK, Nievergelt CM, Logue MW. Traumatic stress and accelerated DNA methylation age: A meta-analysis. Psychoneuroendocrinology 2018; 92:123-134. [PMID: 29452766 PMCID: PMC5924645 DOI: 10.1016/j.psyneuen.2017.12.007] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/07/2017] [Accepted: 12/12/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent studies examining the association between posttraumatic stress disorder (PTSD) and accelerated aging, as defined by DNA methylation-based estimates of cellular age that exceed chronological age, have yielded mixed results. METHODS We conducted a meta-analysis of trauma exposure and PTSD diagnosis and symptom severity in association with accelerated DNA methylation age using data from 9 cohorts contributing to the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (combined N = 2186). Associations between demographic and cellular variables and accelerated DNA methylation age were also examined, as was the moderating influence of demographic variables. RESULTS Meta-analysis of regression coefficients from contributing cohorts revealed that childhood trauma exposure (when measured with the Childhood Trauma Questionnaire) and lifetime PTSD severity evidenced significant, albeit small, meta-analytic associations with accelerated DNA methylation age (ps = 0.028 and 0.016, respectively). Sex, CD4T cell proportions, and natural killer cell proportions were also significantly associated with accelerated DNA methylation age (all ps < 0.02). PTSD diagnosis and lifetime trauma exposure were not associated with advanced DNA methylation age. There was no evidence of moderation of the trauma or PTSD variables by demographic factors. CONCLUSIONS Results suggest that traumatic stress is associated with advanced epigenetic age and raise the possibility that cells integral to immune system maintenance and responsivity play a role in this. This study highlights the need for additional research into the biological mechanisms linking traumatic stress to accelerated DNA methylation age and the importance of furthering our understanding of the neurobiological and health consequences of PTSD.
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Affiliation(s)
- Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | | | - Nicole Nugent
- Bradley Hasbro Children’s Research Center, Rhode Island Hospital,Departments of Psychiatry and Human Behavior and Pediatrics, Brown Medical School
| | | | - Don Armstrong
- University of Illinois Urbana-Champaign, Carl R. Woese Institute for Genomic Biology
| | | | | | - Melanie Garrett
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center
| | - Nathan A. Kimbrel
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center,VA Mid-Atlantic, Mental Illness Research, Education, and Clinical Center,Durham VA Medical Center
| | - Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University
| | | | - Allison E. Aiello
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health
| | - Dewleen G. Baker
- University of California San Diego, Department of Psychiatry,Veterans Affairs San Diego Healthcare System,Veterans Affairs Center of Excellence for Stress and Mental Health
| | - Jean C. Beckham
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center,VA Mid-Atlantic, Mental Illness Research, Education, and Clinical Center,Durham VA Medical Center
| | - Marco P. Boks
- University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht the Netherlands
| | | | - Elbert Geuze
- University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht the Netherlands,Ministry of Defence, Military Mental Healthcare, Utrecht the Netherlands
| | - Michael A. Hauser
- Duke Molecular Physiology Institute, Duke University School of Medicine
| | | | - Karestan C. Koenen
- Harvard T.H. Chan School of Public Health, Department of Epidemiology,Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Department of Psychiatry
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Victoria Risbrough
- University of California San Diego, Department of Psychiatry,Veterans Affairs San Diego Healthcare System,Veterans Affairs Center of Excellence for Stress and Mental Health
| | - Bart P.F. Rutten
- School for Mental Health and Neuroscience and the European Graduate School of Neuroscience (EURON), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Murray B. Stein
- University of California San Diego, Department of Psychiatry,Veterans Affairs San Diego Healthcare System,University of California San Diego, Department of Family Medicine and Public Health
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences
| | - Eric Vermetten
- University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht the Netherlands,Ministry of Defence, Military Mental Healthcare, Utrecht the Netherlands,Arq Psychotrauma Expert Group
| | - Christiaan H. Vinkers
- University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht the Netherlands
| | - Monica Uddin
- University of Illinois Urbana-Champaign, Carl R. Woese Institute for Genomic Biology,University of Illinois Urbana-Champaign, Department of Psychology
| | - Alicia K. Smith
- Department of Psychiatry and Behavioral Sciences, Emory University,Department of Gynecology and Obstetrics, Emory University
| | - Caroline M. Nievergelt
- University of California San Diego, Department of Psychiatry,Veterans Affairs San Diego Healthcare System,Veterans Affairs Center of Excellence for Stress and Mental Health
| | - Mark W. Logue
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine,Biomedical Genetics, Boston University School of Medicine
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198
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Ellis J, Zaretsky A. Assessment and Management of Posttraumatic Stress Disorder. ACTA ACUST UNITED AC 2018; 24:873-892. [PMID: 29851883 DOI: 10.1212/con.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The goal of this article is to increase clinicians' understanding of posttraumatic stress disorder (PTSD) and improve skills in assessing risk for and diagnosing PTSD. The importance and sequelae of lifetime trauma burden are discussed, with reference to trends in prevention, early intervention, and treatment. RECENT FINDINGS PTSD has different clinical phenotypes, which are reflected in the changes in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. PTSD is almost always complicated by comorbidity. Treatment requires a multimodal approach, usually including medication, different therapeutic techniques, and management of comorbidity. Interest is growing in the neurobiology of childhood survivors of trauma, intergenerational transmission of trauma, and long-term impact of trauma on physical health. Mitigation of the risk of PTSD pretrauma in the military and first responders is gaining momentum, given concerns about the cost and disability associated with PTSD. Interest is also growing in screening for PTSD in medical populations, with evidence of improved clinical outcomes. Preliminary research supports the treatment of PTSD with repetitive transcranial magnetic stimulation. SUMMARY PTSD is a trauma-related disorder with features of fear and negative thinking about the trauma and the future. Untreated, it leads to ongoing disruption of life due to avoidance, impaired vocational and social functioning, and other symptoms, depending on the phenotype. Despite a theoretical understanding of underlying mechanisms, PTSD remains challenging to treat, although evidence exists for benefit of pharmacologic agents and trauma-focused therapies. A need still remains for treatments that are more effective and efficient, with faster onset.
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Naylor JC, Ryan Wagner H, Brancu M, Shepherd-Banigan M, Elbogen E, Kelley M, Fecteau T, Goldstein K, Kimbrel NA, Marx CE, Strauss JL. Self-Reported Pain in Male and Female Iraq/Afghanistan-Era Veterans: Associations with Psychiatric Symptoms and Functioning. PAIN MEDICINE 2018; 18:1658-1667. [PMID: 28122941 DOI: 10.1093/pm/pnw308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective To examine pain symptoms and co-occurring psychiatric and functional indices in male and female Iraq/Afghanistan-era veterans. Design Self-reported data collection and interviews of Iraq/Afghanistan-era veterans who participated in a multisite study of postdeployment mental health. Setting Veterans were enrolled at one of four participating VA sites. Subjects Two thousand five hundred eighty-seven male and 662 female Iraq/Afghanistan-era veterans. Methods Nonparametric Wilcoxon rank tests examined differences in pain scores between male and female veterans. Chi-square tests assessed differences between male and female veterans in the proportion of respondents endorsing moderate to high levels of pain vs no pain. Multilevel regression analyses evaluated the effect of pain on a variety of psychiatric and functional measures. Results Compared with males, female veterans reported significantly higher mean levels of headache ( P < 0.0001), muscle soreness ( P < 0.008), and total pain ( P < 0.0001), and were more likely to report the highest levels of headache ( P < 0.0001) and muscle soreness ( P < 0.0039). The presence of pain symptoms in Iraq/Afghanistan-era veterans was positively associated with psychiatric comorbidity and negatively associated with psychosocial functioning. There were no observed gender differences in psychiatric and functional indices when levels of pain were equated. Conclusions Although female Iraq/Afghanistan-era veterans reported higher levels of pain than male veterans overall, male and female veterans experienced similar levels of psychiatric and functional problems at equivalent levels of reported pain. These findings suggest that pain-associated psychological and functional impacts are comparable and consequential for both male and female veterans.
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Affiliation(s)
- Jennifer C Naylor
- Research and Development.,Mental Health Service Line.,Department of Psychiatry and Behavioral Sciences.,VA Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, North Carolina
| | - H Ryan Wagner
- Department of Psychiatry and Behavioral Sciences.,VA Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Mira Brancu
- Department of Psychiatry and Behavioral Sciences.,VA Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Megan Shepherd-Banigan
- Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Eric Elbogen
- Mental Health Service Line.,Department of Psychiatry and Behavioral Sciences.,VA Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Michelle Kelley
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | | | - Karen Goldstein
- Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, North Carolina.,Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nathan A Kimbrel
- Research and Development.,Department of Psychiatry and Behavioral Sciences.,VA Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Christine E Marx
- Research and Development.,Mental Health Service Line.,Department of Psychiatry and Behavioral Sciences.,VA Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, North Carolina
| | | | | | - Jennifer L Strauss
- Department of Psychiatry and Behavioral Sciences.,Department of Veterans Affairs, Mental Health Services, Washington, DC, USA
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Behavioral and Health Outcomes Associated With Deployment and Nondeployment Acquisition of Traumatic Brain Injury in Iraq and Afghanistan Veterans. Arch Phys Med Rehabil 2018; 99:2485-2495. [PMID: 29859179 DOI: 10.1016/j.apmr.2018.04.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To characterize behavioral and health outcomes in veterans with traumatic brain injury (TBI) acquired in nondeployment and deployment settings. DESIGN Cross-sectional assessment evaluating TBI acquired during and outside of deployment, mental and behavioral health symptoms, and diagnoses. SETTING Veterans Affairs Medical Centers. PARTICIPANTS Iraq and Afghanistan veterans who were deployed to a warzone (N=1399). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Comprehensive lifetime TBI interview, Structured Clinical Interview for DSM-IV Disorders, Combat Exposure Scale, and behavioral and health measures. RESULTS There was a main effect of deployment TBI on depressive symptoms, posttraumatic stress symptoms, poor sleep quality, substance use, and pain. Veterans with deployment TBI were also more likely to have a diagnosis of bipolar, major depressive, alcohol use, and posttraumatic stress disorders than those who did not have a deployment TBI. CONCLUSIONS TBIs acquired during deployment are associated with different behavioral and health outcomes than TBI acquired in nondeployment environments. The presence of TBI during deployment is associated with poorer behavioral outcomes, as well as a greater lifetime prevalence of behavioral and health problems in contrast to veterans without deployment TBI. These results indicate that problems may persist chronically after a deployment TBI and should be considered when providing care for veterans. Veterans with deployment TBI may require treatment alterations to improve engagement and outcomes.
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