Assessment of a new self-rating scale for post-traumatic stress disorder

Changes in Trauma-Related Emotions Following Treatment With Dialectical Behavior Therapy for Posttraumatic Stress Disorder After Childhood Abuse

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.

Associations Between Sexual Assault Severity and Psychological and Physical Health Outcomes: Similarities and Differences Among African American and Caucasian Survivors

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.

Gendered racial microaggressions predict posttraumatic stress disorder symptoms and cognitions among Black women living with HIV

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).

Neuropsychological Findings in Gulf War Illness: A Review

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.

Post-Traumatic Growth and Resilience Among Medical Students After the March 2011 Disaster in Fukushima, Japan

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.

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

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.

Multiple session early psychological interventions for the prevention of post-traumatic stress disorder

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.

Correlates of sedentary behaviour among adolescents and adults with hazardous, harmful or dependent drinking in South Africa

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.

A realist review of which advocacy interventions work for which abused women under what circumstances

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.

Maternal Tobacco use during Pregnancy in South Africa: Results from a National Population-based Survey

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.

Insecure adult attachment style is associated with elevated psychological symptoms in early adjustment to severe burn: A cross-sectional study

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.

The Relationships Among Symptom Distress, Posttraumatic Stress Symptoms, and Depression in Patients With Female-specific Cancers

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.

Endometriosis as a Comorbid Condition in Chronic Fatigue Syndrome (CFS): Secondary Analysis of Data From a CFS Case-Control Study

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.

Posttraumatic stress symptoms in people exposed to the 2017 earthquakes in Mexico

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.

Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life: A Randomized Clinical Trial

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.

Playing to live: outcome evaluation of a community-based psychosocial expressive arts program for children during the Liberian Ebola epidemic

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.

TRR's Warrior Camp: An Intensive Treatment Program for Combat Trauma in Active Military and Veterans of All Eras

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.

Posttraumatic stress disorder and traumatic brain Injury: Sex differences in veterans

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.

Experience coercion, post-traumatic stress, and satisfaction with treatment associated with different coercive measures during psychiatric hospitalization

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.

Relationship of symptoms associated with ICU-survivorship: An integrative literature review

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.

Increased recruitment of cognitive control in the presence of traumatic stimuli in complex PTSD

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.

The Effects of a Supportive Care Program on the Posttraumatic Stress Symptoms of Patients With Oral Cancer After Surgery

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.

Psychological and Brain Connectivity Changes Following Trauma-Focused CBT and EMDR Treatment in Single-Episode PTSD Patients

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.

Cognitive Behavioral Treatment for Acute Posttrauma Distress: A Randomized, Controlled Proof-of-Concept Study Among Hospitalized Adults With Burns

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.

Protective factors that buffer against the intergenerational transmission of trauma from mothers to young children: A replication study of angels in the nursery

This 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.

Validation of a short version of the Coercion Experience Scale (CES-18): Psychometric characteristics in a Spanish sample

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.

Maternal alcohol use during pregnancy in a general national population in South Africa

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.

The Electrical Aftermath: Brain Signals of Posttraumatic Stress Disorder Filtered Through a Clinical Lens

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.

Prevalence, and social and health correlates of insomnia among persons 15 years and older in South Africa

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.

Medical Student Reactions to Disaster after the 2011 Great East Japan Earthquake: Motivation and Posttraumatic Growth

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.

Posttraumatic Stress Disorder Symptom Network Analysis in U.S. Military Veterans: Examining the Impact of Combat Exposure

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.

Correlates of Perinatal Post-Traumatic Stress among Culturally Diverse Women with Depressive Symptomatology

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.

Incidence and Persistence of Depression Among Women Living with and Without HIV in South Africa: A Longitudinal Study

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.

Posttraumatic Stress Symptoms and Emerging Adult Sexual Minority Men: Implications for Assessment and Treatment of Childhood Sexual Abuse

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.

Generalisation of fear in PTSD related to prolonged childhood maltreatment: an experimental study

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.

The Indirect Effect of Posttraumatic Stress Disorder Symptoms on Current Alcohol Use Through Negative Cognitions in Sexual Minority Men

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.

Examination of the indirect effects of combat exposure on suicidal behavior in veterans

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.

Social welfare of workers affected by a chronic lung disease

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. 

Sex differences in traumatic events and psychiatric morbidity associated to probable posttraumatic stress disorder among Latino prisoners

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.

Application of data pooling to longitudinal studies of early post-traumatic stress disorder (PTSD): the International Consortium to Predict PTSD (ICPP) project

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.

Traumatic stress and accelerated DNA methylation age: A meta-analysis

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.

Assessment and Management of Posttraumatic Stress Disorder

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.

Self-Reported Pain in Male and Female Iraq/Afghanistan-Era Veterans: Associations with Psychiatric Symptoms and Functioning

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.

Behavioral and Health Outcomes Associated With Deployment and Nondeployment Acquisition of Traumatic Brain Injury in Iraq and Afghanistan Veterans

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.