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Post-traumatic cognitions and quality of life in terrorism victims: the role of well-being in indirect versus direct exposure. Health Qual Life Outcomes 2018; 16:96. [PMID: 29764432 PMCID: PMC5952590 DOI: 10.1186/s12955-018-0923-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/02/2018] [Indexed: 02/05/2023] Open
Abstract
Background The effect of indirect (versus direct) exposure to a traumatic event on the quality of life of terrorist attack victims has received considerable attention in the literature. However, more research is required to examine whether the symptoms and underlying processes caused by both types of exposure are equivalent. Our main hypothesis is that well-being plays a different role depending on indirect vs. direct trauma exposure. Methods In this cross-sectional study, eighty direct victims of 11-M terrorist attacks (people who were traveling in trains where bombs were placed) and two-hundred indirect victims (individuals highly exposed to the 11-M terrorist attacks through communications media) voluntarily participated without compensation. To test our hypothesis regarding the mediating role of indirect exposure, we conducted a biased corrected bootstrapping procedure. To test our hypothesis regarding the moderating role of direct exposure, data were subjected to a hierarchical regression analysis. Results As predicted, for indirect trauma exposure, well-being mediated the relationship between post-traumatic dysfunctional cognitions and trauma symptoms. However, for direct trauma exposure, well-being moderated the relationship between post-traumatic dysfunctional cognitions and trauma symptoms. Conclusions The results of our study indicate that the different role of well-being found between indirect (causal factor) and direct exposure (protective factor) should be taken into consideration in interventions designed to improve victims’ health.
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202
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Acute Intermittent Porphyria in the North of China: The Acute Attack Effect on Quality of Life and Psychological Condition. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3216802. [PMID: 29862261 PMCID: PMC5976947 DOI: 10.1155/2018/3216802] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 02/22/2018] [Accepted: 04/08/2018] [Indexed: 12/24/2022]
Abstract
Background Acute intermittent porphyria (AIP) is an autosomal recessive disorder with intermittent attacks. Patients with AIP are susceptible to impaired quality of life and psychological distress. Objectives To document the clinical features of AIP and its impact on SF-36 and IES scores of AIP patients in China and to explore the variables associated with SF-36 and IES scores. Methods A single investigator collated data related to treatments and outcomes in 27 patients with AIP of PUMCH. A cross-sectional questionnaire survey including the SF-36, the IES-R, and demographic questions was conducted in the north of China. Differences in the QoL scale/summary scores and proportions in the QoL dimensions between patients and the general population were analyzed. Independent effects of chronic conditions and demographic variables on the SF-36 and IES-R were analyzed. Results AIP patients had considerably lower SF-36 scores than the general population (the PF score and MH were lower than normal, P < 0.05). Working had higher RP than staying at home (P = 0.02); “without acute attack” had higher PF and BP scores and PCS composite score (P = 0.001). The mean IES-R score of AIP was higher than normal (36.7 ± 11.8 points, P < 0.001), “without acute attack” had lower intrusion score than “with acute attack” (P = 0.03). Conclusion AIP patients in China had impaired quality of life, especially in terms of physical health. The acute attacks coursed the posttraumatic stress disorder-related symptoms.
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Van Voorhees EE, Wagner HR, Beckham JC, Bradford DW, Neal LC, Penk WE, Elbogen EB. Effects of social support and resilient coping on violent behavior in military veterans. Psychol Serv 2018; 15:181-190. [PMID: 29723020 DOI: 10.1037/ser0000187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Violence toward others has been identified as a serious postdeployment adjustment problem in a subset of Iraq- and Afghanistan-era veterans. In the current study, we examined the intricate links between posttraumatic stress disorder (PTSD), commonly cited psychosocial risk and protective factors, and violent behavior using a national randomly selected longitudinal sample of Iraq- and Afghanistan-era United States veterans. A total of 1,090 veterans from the 50 United States and all United States military branches completed 2 waves of self-report survey-data collection 1 year apart (retention rate = 79%). History of severe violent behavior at Wave 1 was the most substantial predictor of subsequent violence. In bivariate analyses, high correlations were observed among risk and protective factors, and between risk and protective factors and severe violence at both time points. In multivariate analyses, baseline violence (OR = 12.43, p < .001), baseline alcohol misuse (OR = 1.06, p < .05), increases in PTSD symptoms between Waves 1 and 2 (OR = 1.01, p < .05), and decreases in social support between Waves 1 and 2 (OR = .83, p < .05) were associated with increased risk for violence at Wave 2. Our findings suggest that rather than focusing specifically on PTSD symptoms, alcohol use, resilience, or social support in isolation, it may be more useful to consider how these risk and protective factors work in combination to convey how military personnel and veterans are managing the transition from wartime military service to civilian life, and at what point it might be most effective to intervene. (PsycINFO Database Record
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Affiliation(s)
- Elizabeth E Van Voorhees
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - H Ryan Wagner
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - Jean C Beckham
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - Daniel W Bradford
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Lydia C Neal
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - Walter E Penk
- Psychiatry and Behavioral Sciences, Texas A&M College of Medicine
| | - Eric B Elbogen
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
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204
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Hughes JM, Ulmer CS, Gierisch JM, Howard MO. Single-Item Measures for Detecting Sleep Problems in United States Military Veterans. J Gen Intern Med 2018; 33:698-704. [PMID: 29362959 PMCID: PMC5910336 DOI: 10.1007/s11606-017-4250-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/05/2017] [Accepted: 11/22/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND As many as two-thirds of post-9/11 military veterans complain of sleep problems, including insomnia-like symptoms. Left untreated, chronic sleep problems increase the risk for a range of negative outcomes, including incident mental health disorders. However, sleep problems remain overlooked in primary care settings. To date, no brief sleep screeners have been developed or validated. Items assessing insomnia and poor sleep are often embedded into commonly used psychological assessments, and may serve as a viable first step in screening. OBJECTIVE The objective of this study was to examine the utility of three single items (i.e., trouble falling asleep, awakening in the early morning, and sleep that is restless or disturbed) embedded into the Symptom Checklist-90-Revised (SCL) for identifying two outcomes of interest, poor sleep and probable insomnia. DESIGN Data were drawn from the cross-sectional Post-Deployment Mental Health Study, hosted by the Mid-Atlantic VA Mental Illness Research, Education, and Clinical Center. Item performance was evaluated using sensitivity, specificity, and predictive value calculations, along with receiver operating characteristic (ROC) curves. PARTICIPANTS Post-9/11 U.S. military veterans with one or more overseas deployments and with no current DSM Axis I mental health disorder (N = 1118). MAIN MEASURES An in-person health and sleep questionnaire, including the Pittsburgh Sleep Quality Index (PSQI) and the Symptom Checklist (SCL). KEY RESULTS Using an item response of 1, all three items demonstrated moderate sensitivity (0.70-0.78) and acceptable rates of false positives and false negatives (0.23-0.48 and 0.11-0.42, respectively) in predicting both outcomes, poor sleep and probable insomnia. CONCLUSIONS Our initial findings suggest that existing items in the SCL may serve as a first step in screening for sleep problems. Early detection and treatment of sleep problems might prevent or ameliorate several negative outcomes, including incident mental health disorders.
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Affiliation(s)
- Jaime M Hughes
- Center for Health Services Research in Primary Care, Durham VA Medical Center, 508 Fulton St (152), Durham, NC, 27705, USA.
| | - Christi S Ulmer
- Center for Health Services Research in Primary Care, Durham VA Medical Center, 508 Fulton St (152), Durham, NC, 27705, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC, USA
| | - Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham VA Medical Center, 508 Fulton St (152), Durham, NC, 27705, USA.,Division of General Internal Medicine, Duke University Medical School, Durham, NC, USA
| | | | - Matthew O Howard
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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205
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Garcia AF, Berzins T, Acosta M, Pirani S, Osman A. The Anxiety Depression Distress Inventory-27 (ADDI-27): New Evidence of Factor Structure, Item-Level Measurement Invariance, and Validity. J Pers Assess 2018; 100:321-332. [PMID: 28494161 PMCID: PMC5681894 DOI: 10.1080/00223891.2017.1318888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Three studies examining the factor structure and psychometric properties of the Anxiety Depression Distress Inventory-27 (ADDI-27) extended the initial instrument development studies for this recently introduced inventory. The ADDI-27 is an empirically derived short form of the Mood and Anxiety Questionaire-90 (MASQ-90) comprising three scales: Positive Affect, Somatic Anxiety, and General Distress. The main objectives of Study 1 (N = 700) were to examine the factor structure of the ADDI-27 and its measurement invariance across gender at the item level. The objective of Study 2 (N = 538) was to examine evidence for the convergent and discriminant validity of scores on the ADDI-27. The objective of Study 3 (N = 240) was to assess further evidence for the nomological network and convergent and discriminant validity of the ADDI-27 scores. Results of exploratory structural equation modeling yielded strong support for a 3-factor model, with approximate fit indexes meeting or exceeding the conventional cutoffs. With p ≤ .001 as the criterion for detecting noninvariance, results of measurement invariance analysis suggested that all of the ADDI-27 items were invariant across gender. Results of multivariate validity analyses across 2 studies provided support for the convergent and discriminant validity of scores on the ADDI-27 scales.
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Affiliation(s)
| | | | - Melina Acosta
- Department of Psychology, The University of Texas at San Antonio
| | - Saifa Pirani
- Department of Psychology, The University of Texas at San Antonio
| | - Augustine Osman
- Department of Psychology, The University of Texas at San Antonio
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206
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Mujezinovic A, Kwiet J, Kornhaber R, Holt R, Streimer J, Vandervord J, Rogers V, Shaw J, Law J, Cleary M, McLean L. Type-D Personality and Elevated Psychological Symptoms In Early Adjustment of Severe Burn Injury Patients. Issues Ment Health Nurs 2018; 39:337-343. [PMID: 29436882 DOI: 10.1080/01612840.2017.1416506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Severe burn injuries are highly traumatic requiring lengthy recovery. High levels of distress in the early stages of treatment have been associated with poor physical and psychosocial recovery outcomes. Identifying traits relating to distress and personal coping styles may aid screening. Type-D, or 'distressed', personality may be such a trait. Type-D personality refers to an ongoing personality organization defined by a tendency to experience greater negative emotions and thoughts while simultaneously socially inhibiting their expression (Denollet et al., 1996 . Type-D has been linked to poor health outcomes in those with cardiovascular disease as well as other populations and has been found to be associated with elevated psychological symptoms. Currently, there are no investigations in the literature looking at Type-D in the severe burns injury population. This study aimed to investigate Type-D in severe burn injury patients, specifically regarding the presence of psychological symptoms in early treatment, using data gathered during a pilot study conducted at a severe burn injury unit. The DS-16, Davidson Trauma scale and Depression Anxiety and Stress Scale scores were analysed along with demographic and clinical data in 54 participants (40 males, 14 females). Participants who were found to have Type-D displayed significantly higher levels of psychopathology. Additionally, Type-D was found to be a significant predictor of psychological symptoms.
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Affiliation(s)
- Ajdin Mujezinovic
- a The University of Sydney, Brain and Mind Centre , Sydney , NSW , Australia
| | - Julia Kwiet
- b Severe Burns Injury Unit (SBIU), Royal North Shore Hospital , Sydney , NSW , Australia.,c Social Work, Royal North Shore Hospital , Sydney , NSW , Australia
| | - Rachel Kornhaber
- d University of Tasmania, School of Health Sciences, College of Health and Medicine , Sydney , NSW , Australia
| | - Rachael Holt
- a The University of Sydney, Brain and Mind Centre , Sydney , NSW , Australia
| | - Jeffrey Streimer
- e Consultation-Liaison Psychiatry, Royal North Shore Hospital , Sydney , NSW , Australia.,f The University of Sydney , Sydney , NSW , Australia.,g RANZCP , Australia
| | - John Vandervord
- b Severe Burns Injury Unit (SBIU), Royal North Shore Hospital , Sydney , NSW , Australia
| | - Vanessa Rogers
- e Consultation-Liaison Psychiatry, Royal North Shore Hospital , Sydney , NSW , Australia.,h The University of Sydney, Northern Clinical School , Sydney , NSW , Australia
| | - Joanne Shaw
- i The University of Sydney, Psycho-Oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science , Sydney , NSW , Australia
| | - Jeremy Law
- a The University of Sydney, Brain and Mind Centre , Sydney , NSW , Australia
| | - Michelle Cleary
- d University of Tasmania, School of Health Sciences, College of Health and Medicine , Sydney , NSW , Australia
| | - Loyola McLean
- a The University of Sydney, Brain and Mind Centre , Sydney , NSW , Australia.,e Consultation-Liaison Psychiatry, Royal North Shore Hospital , Sydney , NSW , Australia.,j The University of Sydney, Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School , Sydney , New South Wales , Australia.,k Cumberland Hospital, Western Sydney Local Health District, Sydney West and Greater Southern Psychiatry Training Network, Sydney , New South Wales , Australia
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207
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Gapen M, van der Kolk BA, Hamlin E, Hirshberg L, Suvak M, Spinazzola J. A Pilot Study of Neurofeedback for Chronic PTSD. Appl Psychophysiol Biofeedback 2018; 41:251-61. [PMID: 26782083 DOI: 10.1007/s10484-015-9326-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
EEG Biofeedback (also known as neurofeedback) has been in use as a clinical intervention for well over 30 years; however, it has made very little impact on clinical care. One reason for this has been the difficulty in designing research to measure clinical change in the real world. While substantial evidence exists for its efficacy in treating attention deficit/hyperactivity disorder, relatively little evidence exists for its utility in other disorders including posttraumatic stress disorder (PTSD). The current study represents a "proof-of-concept" pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. Participants completed 40 sessions of neurofeedback training two times per week with sensors randomly assigned (by the study coordinator, who was not blind to condition) to sensor placements of either T4-P4 or T3-T4. We found that neurofeedback significantly reduced PTSD symptoms (Davidson Trauma Scale scores averaged 69.14 at baseline to 49.26 at termination), and preceded gains in affect regulation (Inventory of Altered Self-Capacities-Affect Dysregulation scores averaged 23.63 at baseline to 17.20 at termination). We discuss a roadmap for future research.
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Affiliation(s)
- Mark Gapen
- Trauma Center at Justice Resource Institute (JRI), 1269 Beacon Street, Brookline, MA, 02446, USA. .,Community Services Institute, Inc., 1695 Main St, Springfield, MA, 01103, USA.
| | - Bessel A van der Kolk
- Trauma Center at Justice Resource Institute (JRI), 1269 Beacon Street, Brookline, MA, 02446, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,National Child Traumatic Stress Network, Durham, NC, USA
| | - Ed Hamlin
- Center for the Advancement of Human Potential, Institute for Applied Neuroscience, 31 College Place, Building B, Suite 218, Asheville, NC, 28801, USA.,Department of Psychology, Western Carolina University, Cullowhee, NC, USA.,Department of Psychiatry, University of North Carolina Medical School, Chapel Hill, NC, USA
| | - Laurence Hirshberg
- The NeuroDevelopment Center, Providence, RI, USA.,Alpert Medical School, Brown University, Providence, RI, USA
| | - Michael Suvak
- National Center for PTSD, Boston, MA, USA.,Department of Psychology, Suffolk University, Boston, MA, USA
| | - Joseph Spinazzola
- Trauma Center at Justice Resource Institute (JRI), 1269 Beacon Street, Brookline, MA, 02446, USA.,National Child Traumatic Stress Network, Durham, NC, USA
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208
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Van Voorhees EE, Dennis PA, Elbogen EB, Fuemmeler B, Neal LC, Calhoun PS, Beckham JC. Characterizing anger-related affect in individuals with posttraumatic stress disorder using ecological momentary assessment. Psychiatry Res 2018; 261:274-280. [PMID: 29329048 PMCID: PMC6341481 DOI: 10.1016/j.psychres.2017.12.080] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 12/13/2017] [Accepted: 12/30/2017] [Indexed: 11/30/2022]
Abstract
This study employed secondary analyses of existing ecological momentary assessment (EMA) data to characterize hostile and irritable affect in the day-to-day experience of 52 smokers with, and 65 smokers without, posttraumatic stress disorder (PTSD). EMA monitoring occurred over a mean of 8.2 days, and participants responded to an average of 2.8 random prompts/day. Analyses included Wilcoxon rank sum tests of group differences, and path analyses of cross-lagged multilevel models. Participants with PTSD endorsed a significantly higher proportion of total EMA entries indicating hostile affect and irritable affect than did individuals without PTSD. Cross-lagged analyses indicated that over a period of hours, PTSD symptoms significantly predicted subsequent hostile and irritable affect, but hostile and irritable affect did not predict subsequent PTSD symptoms. Findings suggest that day-to-day exposure to PTSD-related trauma cues may contribute to chronically elevated levels of anger-related affect. Such heightened affective arousal may, in turn, underlie an increased risk for verbal or physical aggression, as well as other health and quality-of-life related impairments associated with PTSD. Clinical implications include conceptualizing anger treatment in the broader context of trauma history and symptoms, and specifically targeting physiological arousal and maladaptive hostile cognitions triggered by trauma reminders in patients with PTSD.
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Affiliation(s)
- Elizabeth E. Van Voorhees
- Durham Veterans Affairs Medical Center, United States,VISN 6, Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States,Corresponding author at: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States. , (E.E. Van Voorhees)
| | - Paul A. Dennis
- Durham Veterans Affairs Medical Center, United States,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Eric B. Elbogen
- Durham Veterans Affairs Medical Center, United States,VISN 6, Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Bernard Fuemmeler
- Department of Health Behavior and Policy School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Lydia C. Neal
- Durham Veterans Affairs Medical Center, United States,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Patrick S. Calhoun
- Durham Veterans Affairs Medical Center, United States,VISN 6, Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Jean C. Beckham
- Durham Veterans Affairs Medical Center, United States,VISN 6, Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
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209
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Teche SP, Barros AJS, Rosa RG, Guimarães LP, Cordini KL, Goi JD, Hauck S, Freitas LH. Association between resilience and posttraumatic stress disorder among Brazilian victims of urban violence: a cross-sectional case-control study. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 39:116-123. [PMID: 28700041 DOI: 10.1590/2237-6089-2016-0070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 04/10/2017] [Indexed: 11/21/2022]
Abstract
Introduction This study investigated the association between resilience and posttraumatic stress disorder (PTSD) among Brazilian victims of urban violence. It also compared defense mechanisms, parental bonding, and childhood trauma between those who developed PTSD and those who did not. Methods This cross-sectional case-control study included 66 adult subjects exposed to recent urban violence in southern Brazil - 33 with PTSD and 33 healthy controls matched by sex and age - who were administered the Resilience Scale, Defense Style Questionnaire, Parental Bonding Instrument, and Childhood Trauma Questionnaire. The statistical tests used were the McNemar test for categorical variables, the Wilcoxon signed-rank test for continuous asymmetric variables, and the paired Student t-test for continuous symmetric variables. Results The PTSD group showed lower total Resilience Scale scores compared with controls (128.4±20.7 vs. 145.8±13.1, respectively; p = 0.01), along with a lower ability to solve situations and lower personal values that give meaning to life (p = 0.019). They also had lower rates of mature defense mechanisms (p < 0.001) and higher rates of emotional (p = 0.001) and physical (p = 0.003) abuse during childhood. Conclusion Lower levels of resilience, especially the ability to solve situations and having personal values that give meaning to life, immature defense mechanisms, and emotional and physical abuse in childhood are associated with PTSD in adult Brazilian victims of urban violence.
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Affiliation(s)
- Stefania Pigatto Teche
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Alcina Juliana Soares Barros
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Regis Goulart Rosa
- Programa de Pós-Graduação em Ciências Médicas, UFRGS, Porto Alegre, RS, Brazil
| | | | - Kariny Larissa Cordini
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Julia Domingues Goi
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Simone Hauck
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Lucia Helena Freitas
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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210
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Rodríguez-Rey R, Alonso-Tapia J, Colville G. Prediction of parental posttraumatic stress, anxiety and depression after a child's critical hospitalization. J Crit Care 2018; 45:149-155. [PMID: 29477091 DOI: 10.1016/j.jcrc.2018.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 02/03/2018] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To study the role of parental resilience, emotions accessed during admission and perceived stress in predicting the degree of parental posttraumatic stress disorder (PTSD), anxiety and depression symptoms after a child's treatment in intensive care. METHODS This was prospective longitudinal cohort study. A total of 196 parents of pediatric intensive care survivors completed questionnaires assessing resilience, perceived stress, emotions experienced during admission, 48h post-discharge (T0). Sociodemographic and medical data were also collected. Main outcomes were anxiety, depression and PTSD, three (T1) and six (T2) months later. RESULTS At T2, 23% of parents reported clinically significant levels of symptoms of PTSD, 21% reported moderate-severe anxiety, and 9% reported moderate-severe depression. These rates were not statistically different to rates at T1. Path analyses indicated that 47% of the variance in psychopathology symptoms at T2 could be predicted from the variables assessed at T0. Resilience was a strong negative predictor of psychopathology symptoms, but this effect was mostly indirect, mediated by the stress that parents perceive during their child's critical hospitalization. CONCLUSIONS Mobilizing coping in order to maintain resilience and to decrease their perceived stress levels could improve parents' mental health outcomes following their child's intensive care treatment.
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Affiliation(s)
- Rocío Rodríguez-Rey
- European University of Madrid, School of Biomedical Sciences, Department of Psychology, Spain.
| | - Jesús Alonso-Tapia
- Universidad Autónoma de Madrid, School of Psychology, Department of Biological and Health Psychology, Spain.
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211
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Chmitorz A, Wenzel M, Stieglitz RD, Kunzler A, Bagusat C, Helmreich I, Gerlicher A, Kampa M, Kubiak T, Kalisch R, Lieb K, Tüscher O. Population-based validation of a German version of the Brief Resilience Scale. PLoS One 2018; 13:e0192761. [PMID: 29438435 PMCID: PMC5811014 DOI: 10.1371/journal.pone.0192761] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 01/30/2018] [Indexed: 12/13/2022] Open
Abstract
Smith and colleagues developed the Brief Resilience Scale (BRS) to assess the individual ability to recover from stress despite significant adversity. This study aimed to validate the German version of the BRS. We used data from a population-based (sample 1: n = 1.481) and a representative (sample 2: n = 1.128) sample of participants from the German general population (age ≥ 18) to assess reliability and validity. Confirmatory factor analyses (CFA) were conducted to compare one- and two-factorial models from previous studies with a method-factor model which especially accounts for the wording of the items. Reliability was analyzed. Convergent validity was measured by correlating BRS scores with mental health measures, coping, social support, and optimism. Reliability was good (α = .85, ω = .85 for both samples). The method-factor model showed excellent model fit (sample 1: χ2/df = 7.544; RMSEA = .07; CFI = .99; SRMR = .02; sample 2: χ2/df = 1.166; RMSEA = .01; CFI = 1.00; SRMR = .01) which was significantly better than the one-factor model (Δχ2(4) = 172.71, p < .001) or the two-factor model (Δχ2(3) = 31.16, p < .001). The BRS was positively correlated with well-being, social support, optimism, and the coping strategies active coping, positive reframing, acceptance, and humor. It was negatively correlated with somatic symptoms, anxiety and insomnia, social dysfunction, depression, and the coping strategies religion, denial, venting, substance use, and self-blame. To conclude, our results provide evidence for the reliability and validity of the German adaptation of the BRS as well as the unidimensional structure of the scale once method effects are accounted for.
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Affiliation(s)
- Andrea Chmitorz
- Deutsches Resilienz Zentrum (DRZ), University Medical Center Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Mario Wenzel
- Health Psychology, Institute for Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Angela Kunzler
- Deutsches Resilienz Zentrum (DRZ), University Medical Center Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Christiana Bagusat
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Isabella Helmreich
- Deutsches Resilienz Zentrum (DRZ), University Medical Center Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Anna Gerlicher
- Deutsches Resilienz Zentrum (DRZ), University Medical Center Mainz, Mainz, Germany
- Neuroimaging Center (NIC) Mainz, University Medical Center Mainz, Mainz, Germany
| | - Miriam Kampa
- Deutsches Resilienz Zentrum (DRZ), University Medical Center Mainz, Mainz, Germany
- Neuroimaging Center (NIC) Mainz, University Medical Center Mainz, Mainz, Germany
| | - Thomas Kubiak
- Health Psychology, Institute for Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Raffael Kalisch
- Deutsches Resilienz Zentrum (DRZ), University Medical Center Mainz, Mainz, Germany
- Neuroimaging Center (NIC) Mainz, University Medical Center Mainz, Mainz, Germany
| | - Klaus Lieb
- Deutsches Resilienz Zentrum (DRZ), University Medical Center Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Oliver Tüscher
- Deutsches Resilienz Zentrum (DRZ), University Medical Center Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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212
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Hagan MJ, Gentry M, Ippen CG, Lieberman AF. PTSD with and without dissociation in young children exposed to interpersonal trauma. J Affect Disord 2018; 227:536-541. [PMID: 29169122 DOI: 10.1016/j.jad.2017.11.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 11/12/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND A Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) was added to the DSM-5, but little is known about this symptom pattern in young children exposed to trauma. Tailoring treatment to traumatized young children requires understanding the different patterns of trauma-related symptomatology and important correlates. The current study tested the hypothesis that type and number of child traumatic events, caregiver trauma exposure, and caregiver symptomatology would predict whether traumatized young children presented with PTSD, PTSD with clinical dissociation, or non-clinical trauma symptoms. METHODS A multinomial regression was conducted using data collected from an ethnically and economically diverse sample of 297 trauma-exposed children between the ages of 3 and 6 and their caregivers. Based on parent-report on a well-validated measure of trauma symptoms, children were categorized into three groups: non-clinical (n = 128), PTSD only (n = 104), or PTSD with dissociation (PTSD-DISS; n = 65). Predictors included trauma exposure, parent trauma symptoms, and child sex. RESULTS Girls were twice more likely than boys to be in the PTSD-DISS group; sexually abused children were almost three times as likely to be in the PTSD-DISS group; and, for every unit increase in parent avoidance symptoms or number of traumatic events, the odds of being in the PTSD-DISS group increased significantly. LIMITATIONS Given the cross-sectional study design, conclusions cannot be drawn regarding causality. Measures were completed by a single reporter. CONCLUSIONS Findings suggest that subgroups of children may be especially vulnerable to comorbid PTSD and dissociation. Implications for treatment are discussed.
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Affiliation(s)
- Melissa J Hagan
- Department of Psychology, San Francisco State University, United States; Department of Psychiatry, University of California, San Francisco, United States.
| | - Miya Gentry
- Department of Psychology, San Francisco State University, United States
| | - Chandra Ghosh Ippen
- Child Trauma Research Program, Department of Psychiatry, University of California, San Francisco, United States
| | - Alicia F Lieberman
- Child Trauma Research Program, Department of Psychiatry, University of California, San Francisco, United States
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213
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Brewin CR, Rose S, Andrews B, Green J, Tata P, McEvedy C, Turner S, Foa EB. Brief screening instrument for post-traumatic stress disorder. Br J Psychiatry 2018. [PMID: 12151288 DOI: 10.1192/bjp.181.2.158] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundBrief screening instruments appear to be a viable way of detecting post-traumatic stress disorder (PTSD) but none has yet been adequately validated.AimsTo test and cross-validate a brief instrumentthat is simple to administer and score.MethodForty-one survivors of a rai l crash were administered a questionnaire, followed by a structured clinical interview 1 week later.ResultsExcellent prediction of a PTSD diagnosis was provided by respondents endorsing at least six re-experiencing or arousal symptoms, in any combination. The findings were replicated on data from a previous study of 157 crime victims.ConclusionsPerformance of the new measure was equivalent to agreement achieved between two full clinical interviews.
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215
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Furuta M, Horsch A, Ng ESW, Bick D, Spain D, Sin J. Effectiveness of Trauma-Focused Psychological Therapies for Treating Post-traumatic Stress Disorder Symptoms in Women Following Childbirth: A Systematic Review and Meta-Analysis. Front Psychiatry 2018; 9:591. [PMID: 30515108 PMCID: PMC6255986 DOI: 10.3389/fpsyt.2018.00591] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/25/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Approximately 3% of women in community samples develop posttraumatic stress disorder (PTSD) after childbirth. Higher prevalence rates are reported for high risk samples. Postpartum PTSD can adversely affect women's wellbeing, mother-infant relationships and child development. This study aims to examine the effectiveness of trauma-focused psychological interventions (TFPT), for postnatal women. Methods: We conducted a systematic review and meta-analysis including all clinical trials which reported post-traumatic stress symptoms for both the intervention and control groups or at least two time-points, pre- and post-intervention. We searched four databases: CENTRAL, MEDLINE, PsycINFO, and OpenGrey. Screening of search results, data extraction, and risk of bias assessment were undertaken independently by two reviewers. Results: Eleven studies, reported in 12 papers, involving 2,677 postnatal women were included. All were RCTs, bar one case series. Interventions varied in modality, duration and intensity, and included exposure therapy, trauma-focused cognitive behavioral therapy, eye movement desensitization and reprocessing and other psychological approaches. Participants had experienced uncomplicated births, emergency cesarean sections and/or preterm births. Results suggest that TFPT are effective for reducing PTSD symptoms in the short term (up to 3 months postpartum [4 RCTs, n = 301, SMD = -0.50, 95% CI = -0.73 to -0.27]), and medium term (i.e., 3-6 months postpartum [2 RCTs, n = 174, SMD = -1.87, 95% CI = -2.60 to -1.13]). However, there is no robust evidence to suggest whether TFPT can also improve women's recovery from clinically significant PTSD symptoms. Conclusion: Further larger studies, distinguishing between low and high risk groups, and with adequate follow-up, are needed to establish which TFPT are most effective and acceptable for treating postnatal PTSD.
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Affiliation(s)
- Marie Furuta
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Antje Horsch
- Institute of Higher Education in Healthcare Research, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.,Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Edmond S W Ng
- Director's Office, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Debra Bick
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Debbie Spain
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jacqueline Sin
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom.,Berkshire Traumatic Stress Service, Berkshire Healthcare NHS Foundation Trust, Bracknell, United Kingdom
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216
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Rosellini AJ, Dussaillant F, Zubizarreta JR, Kessler RC, Rose S. Predicting posttraumatic stress disorder following a natural disaster. J Psychiatr Res 2018; 96:15-22. [PMID: 28950110 PMCID: PMC5726547 DOI: 10.1016/j.jpsychires.2017.09.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/23/2017] [Accepted: 09/07/2017] [Indexed: 01/16/2023]
Abstract
Earthquakes are a common and deadly natural disaster, with roughly one-quarter of survivors subsequently developing posttraumatic stress disorder (PTSD). Despite progress identifying risk factors, limited research has examined how to combine variables into an optimized post-earthquake PTSD prediction tool that could be used to triage survivors to mental health services. The current study developed a post-earthquake PTSD risk score using machine learning methods designed to optimize prediction. The data were from a two-wave survey of Chileans exposed to the 8.8 magnitude earthquake that occurred in February 2010. Respondents (n = 23,907) were interviewed roughly three months prior to and again three months after the earthquake. Probable post-earthquake PTSD was assessed using the Davidson Trauma Scale. We applied super learning, an ensembling machine learning method, to develop the PTSD risk score from 67 risk factors that could be assessed within one week of earthquake occurrence. The super learner algorithm had better cross-validated performance than the 39 individual algorithms from which it was developed, including conventional logistic regression. The super learner also had a better area under the receiver operating characteristic curve (0.79) than existing post-disaster PTSD risk tools. Individuals in the top 5%, 10%, and 20% of the predicted risk distribution accounted for 17.5%, 32.2%, and 51.4% of all probable cases of PTSD, respectively. In addition to developing a risk score that could be implemented in the near future, these results more broadly support the utility of super learning to develop optimized prediction functions for mental health outcomes.
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Affiliation(s)
- Anthony J Rosellini
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA.
| | | | - José R Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; Division of Decision, Risk and Operations, and Department of Statistics, Columbia University, New York, NY, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Sherri Rose
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Kyriazos TA, Stalikas A, Prassa K, Galanakis M, Yotsidi V, Lakioti A. Psychometric Evidence of the Brief Resilience Scale (BRS) and Modeling Distinctiveness of Resilience from Depression and Stress. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/psych.2018.97107] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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218
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Jacobs S, Moxley K, Womersley JS, Spies G, Hemmings SM, Seedat S. HPA-axis genes as potential risk variants for neurocognitive decline in trauma-exposed, HIV-positive females. Neuropsychiatr Dis Treat 2018; 14:2497-2504. [PMID: 30319260 PMCID: PMC6167976 DOI: 10.2147/ndt.s166992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Previous studies have independently provided evidence for the effects of HIV infection, hypothalamic-pituitary-adrenal (HPA) axis dysfunction and early life trauma on neurocognitive impairment (NCI). This study examined the interaction between single-nucleotide polymorphisms (SNPs) of two HPA axis genes, corticotrophin-releasing hormone receptor 1 (CRHR1; rs110402, rs242924, rs7209436, and rs4792888) and corticotrophin-releasing hormone-binding protein (CRHBP; rs32897, rs10062367, and rs1053989), childhood trauma, and HIV-associated NCI. PATIENTS AND METHODS The sample comprised 128 HIV-positive Xhosa females of whom 88 (69%) had a history of childhood trauma. NCI was assessed using a battery of 17 measures sensitive to the effects of HIV, and the history of childhood trauma was assessed using the validated retrospective Childhood Trauma Questionnaire-Short Form. Generalized linear regression models were used to compare allelic distribution by trauma status and global NCI. The association between genotype, childhood trauma, and cognitive scores was also evaluated using generalized linear regression models, assuming additive models for the SNPs, and ANOVA. RESULTS Of the seven polymorphisms assessed, only the rs10062367 variant of CRHBP was significantly associated with global NCI (P=0.034), independent of childhood trauma. This polymorphism was not significantly associated with z-scores on any specific cognitive domain. The interaction of childhood trauma and variants of CRHR1 was associated with poorer learning (rs110402) and/or recall (rs110402 and rs4792888). CONCLUSION These findings suggest that CRHBP rs10062367 A allele is a possible risk variant for NCI in HIV, independent of childhood trauma. Furthermore, results show that the interaction of childhood trauma with variants of CRHR1, rs110402 and rs4792888, confer added vulnerability to NCI in HIV-infected individuals in cognitive domains that are known to be impacted by HIV. While these findings need independent replication in larger samples, it adds CRHBP and CRHR1 to the list of known genes linked to HIV- and childhood trauma-associated neurocognitive phenotypes.
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Affiliation(s)
- Sean Jacobs
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
| | - Karis Moxley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
| | - Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
| | - Georgina Spies
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
| | - Sian Mj Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
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219
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Maternal Experience of Neonatal Intensive Care Unit Hospitalization: Trauma Exposure and Psychosocial Responses. MOTHERHOOD IN THE FACE OF TRAUMA 2018. [DOI: 10.1007/978-3-319-65724-0_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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220
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Steil R, Dittmann C, Müller-Engelmann M, Dyer A, Maasch AM, Priebe K. Dialectical behaviour therapy for posttraumatic stress disorder related to childhood sexual abuse: a pilot study in an outpatient treatment setting. Eur J Psychotraumatol 2018; 9:1423832. [PMID: 29372016 PMCID: PMC5774406 DOI: 10.1080/20008198.2018.1423832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/18/2017] [Indexed: 11/08/2022] Open
Abstract
Background: Dialectical behaviour therapy for posttraumatic stress disorder (DBT-PTSD), which is tailored to treat adults with PTSD and co-occurring emotion regulation difficulties, has already demonstrated its efficacy, acceptance and safety in an inpatient treatment setting. It combines elements of DBT with trauma-focused cognitive behavioural interventions. Objective: To investigate the feasibility, acceptance and safety of DBT-PTSD in an outpatient treatment setting by therapists who were novice to the treatment, we treated 21 female patients suffering from PTSD following childhood sexual abuse (CSA) plus difficulties in emotion regulation in an uncontrolled clinical trial. Method: The Clinician Administered PTSD Symptom Scale (CAPS), the Davidson Trauma Scale (DTS), the Borderline Section of the International Personality Disorder Examination (IPDE) and the Borderline Symptom List (BSL-23) were used as primary outcomes. For secondary outcomes, depression and dissociation were assessed. Assessments were administered at pretreatment, post-treatment and six-week follow-up. Results: Improvement was significant for PTSD as well as for borderline personality symptomatology, with large pretreatment to follow-up effect sizes for completers based on the CAPS (Cohens d = 1.30), DTS (d = 1.50), IPDE (d = 1.60) and BSL-23 (d = 1.20). Conclusion: The outcome suggests that outpatient DBT-PTSD can safely be used to reduce PTSD symptoms and comorbid psychopathology in adults who have experienced CSA.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University, Frankfurt Main, Germany
| | - Clara Dittmann
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University, Frankfurt Main, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University, Frankfurt Main, Germany
| | - Anne Dyer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | | | - Kathlen Priebe
- Department of Psychotherapy and Somatopsychology, Humboldt University, Berlin, Germany
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221
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Gross GM, Cunningham KC, Moore DA, Naylor JC, Brancu M, Wagner HR, Elbogen EB, Calhoun PS, Kimbrel NA. Does Deployment-Related Military Sexual Assault Interact with Combat Exposure to Predict Posttraumatic Stress Disorder in Female Veterans? TRAUMATOLOGY 2018; May 2018:325827753. [PMID: 30202245 PMCID: PMC6128291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objective of the present research was to expand upon previous findings indicating that military sexual trauma interacts with combat exposure to predict PTSD among female Iraq/Afghanistan-era veterans. Three hundred and thirty female veterans completed self-report measures of combat experiences, military sexual assault (MSA) experiences, and PTSD symptoms as well as structured diagnostic interviews for PTSD. A significant strength of the present research was the use of PTSD diagnosis as an outcome measure. Consistent with prior research, both combat exposure and MSA were significant predictors of PTSD symptoms (linear regression) and PTSD diagnoses (logistic regression). Specifically, participants who experienced deployment-related MSA had approximately six times the odds of developing PTSD compared to those who had not experienced deployment-related MSA, over and above the effects of combat exposure. Contrary to expectations, the hypothesized interaction between MSA and combat exposure was not significant in any of the models. The low base rate of MSA may have limited power to find a significant interaction; however, these findings are also consistent with other recent studies that have failed to find support for the hypothesized interaction. Thus, whereas the majority of available evidence indicates that MSA increases risk for PTSD among veterans over and above the effects of combat, there is presently only limited support for the hypothesized MSA x combat interaction. These findings highlight the continued need for prevention and treatment of MSA in order to improve veterans' long-term mental health and well-being.
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Affiliation(s)
- Georgina M. Gross
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Katherine C. Cunningham
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
| | | | - Jennifer C. Naylor
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Mira Brancu
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - H. Ryan Wagner
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Eric B. Elbogen
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
- VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | | | - Nathan A. Kimbrel
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
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222
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Dale SK, Safren SA. Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV. COGNITIVE AND BEHAVIORAL PRACTICE 2017; 25:361-376. [PMID: 30147289 DOI: 10.1016/j.cbpra.2017.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.
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223
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Sloand E, Killion C, Yarandi H, Sharps P, Lewis-O'Connor A, Hassan M, Gary F, Cesar NM, Campbell D. Experiences of violence and abuse among internally displaced adolescent girls following a natural disaster. J Adv Nurs 2017; 73:3200-3208. [PMID: 28398661 PMCID: PMC5636658 DOI: 10.1111/jan.13316] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 11/27/2022]
Abstract
AIM To describe the physical, psychological and sexual violence among internally displaced adolescent girls following the 2010 Haiti earthquake and related risk factors, health concerns and cultural norms. BACKGROUND Thousands of adolescents were displaced following the earthquake, leaving them vulnerable to abuse and violence. Displaced survivors are disproportionately vulnerable to violence after natural and man-made disasters. DESIGN A descriptive-correlational design was used to: (1) describe the extent of violence, health risks and concerns in the displaced adolescent girls; and (2) identify correlations in the strength and magnitude of relationships between selected variables including demographics, risk factors and cultural tolerance of violence. METHODS Data were collected from participants using computer-assisted self-interviews between 2011-2013 including demographics, pre- and post-earthquake violence, perpetrators, risk factors and health consequences. Analysis included frequency, logistic regression and multiple regression. RESULTS/FINDINGS A majority reported physical, psychological, or sexual abuse both pre- (59%) and post- (64.1%) earthquake. Pre-earthquake, abused adolescents reported the perpetrator as a boyfriend (50%) or family member (30%). Post-earthquake, 20.5% of physical abuse perpetrators were family members. Pre- and post-earthquake physical and sexual abuse did not change. The risk of being sexually abused post-earthquake increased after controlling for age and education. CONCLUSION Displaced adolescent girls reported similar rates of physical and sexual abuse pre- and post-earthquake. These findings show the importance of preventive policies for adolescent girls in disaster situations in countries with low resources. Social and cultural change is critically needed since abuse was at an unacceptably high rate prior to the earthquake.
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Affiliation(s)
- Elizabeth Sloand
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Cheryl Killion
- Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | | | - Phyllis Sharps
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Mona Hassan
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Faye Gary
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Nicole Muller Cesar
- Institut Universitaire de Formation des Cadres (INUFOCAD), Port au Prince, Haiti
| | - Doris Campbell
- Caribbean Exploratory Research Center of Excellence, University of the Virgin Islands School of Nursing, Saint Thomas, Virgin Islands (U.S.A.)
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224
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Choi KW, Batchelder AW, Ehlinger PP, Safren SA, O’Cleirigh C. Applying network analysis to psychological comorbidity and health behavior: Depression, PTSD, and sexual risk in sexual minority men with trauma histories. J Consult Clin Psychol 2017; 85:1158-1170. [PMID: 29189032 PMCID: PMC5724394 DOI: 10.1037/ccp0000241] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE High rates of depression and posttraumatic stress disorder (PTSD) contribute to sexual risk, particularly in men who have sex with men (MSM) who have experienced childhood sexual abuse. The comorbidity between depression and PTSD and mechanisms by which they contribute to sexual risk in MSM remain unclear. This study sought to demonstrate the feasibility and utility of a network approach to (a) characterize symptom interconnections between depression and PTSD in MSM, (b) identify specific symptoms related to sexual risk behavior, and (c) compare symptom networks across groups at different levels of risk. METHOD Cross-sectional baseline data were collected from 296 HIV-negative urban MSM as part of a multisite randomized intervention trial. Symptoms of depression and PTSD were self-reported along with sexual risk behavior. Analyses were performed in R using regularized partial correlation network modeling. RESULTS Network analyses revealed complex associations between depression and PTSD symptoms and in relation to sexual risk behavior. While symptoms clustered within their respective disorders, depression and PTSD were connected at key symptom nodes (e.g., sleep, concentration). Specific symptoms (e.g., avoiding thoughts and feelings) were linked to sexual risk behavior. Network comparisons across risk groups suggested avoidant processes could be more readily activated in higher-risk individuals, whereas hyperarousal symptoms may be more salient and protective for lower-risk individuals. CONCLUSIONS This study is one of the earliest network analyses of depression and PTSD, and first to extend this inquiry to health behavior. Symptom-level investigations may clarify mechanisms underlying psychological comorbidity and behavioral risk in MSM and refine targets for intervention/prevention. (PsycINFO Database Record
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Affiliation(s)
- Karmel W. Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Community Health, Boston, MA
| | | | - Steven A. Safren
- The Fenway Institute, Fenway Community Health, Boston, MA
- University of Miami, Miami, FL
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Community Health, Boston, MA
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225
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Hagan MJ, Browne DT, Sulik M, Ippen CG, Bush N, Lieberman AF. Parent and Child Trauma Symptoms During Child-Parent Psychotherapy: A Prospective Cohort Study of Dyadic Change. J Trauma Stress 2017; 30:690-697. [PMID: 29131408 DOI: 10.1002/jts.22240] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/05/2017] [Accepted: 08/11/2017] [Indexed: 11/07/2022]
Abstract
Five randomized controlled trials have shown that child-parent psychotherapy (CPP) improves trauma symptoms in children. Less is known about parent symptoms or moderators of symptom change. In a sample of 199 parent (81% biological mother; 54% Latina/o) and child (aged 2 to 6 years; 52% male; 49% Latina/o) dyads who participated in an open treatment study of CPP, this study investigated whether parent and child symptoms similarly decreased during treatment and whether improvement was moderated by parent, child, and treatment characteristics. Parents completed baseline and posttreatment interviews regarding exposure to traumatic events, posttraumatic stress symptomatology (PTSS), and other mental health indices. Latent difference score analysis showed that PTSS significantly decreased by more than 0.5 SD for parents and children. The PTSS improvement in parents was associated with reductions in child avoidance, r = .19, p = .040, and hyperarousal, r = .33, p < .001. Girls showed a greater reduction than boys in reexperiencing, β = -.13, p = .018, and hyperarousal, β = -.20, p = .001. Contrary to expectations, parent and child improvement in PTSS was greater for those with fewer parental lifetime stressors, βrange = .15 to .33, and for those who participated in fewer treatment sessions, βrange = .15 to .21. The extent of improvement in parent PTSS varied based on clinician expertise, β = -.20, p = .009. Significant reductions in parent and child PTSS were observed during community-based treatment, with CPP and symptom improvement varying according to child, parent, and treatment characteristics.
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Affiliation(s)
- Melissa J Hagan
- Department of Psychology, College of Science and Engineering, San Francisco State University, San Francisco, California, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Dillon T Browne
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Michael Sulik
- Graduate School of Education, Stanford University, Stanford, California, USA
| | - Chandra Ghosh Ippen
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Nicole Bush
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.,Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Alicia F Lieberman
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
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226
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Genome-wide association study of subcortical brain volume in PTSD cases and trauma-exposed controls. Transl Psychiatry 2017; 7:1265. [PMID: 29187748 PMCID: PMC5802459 DOI: 10.1038/s41398-017-0021-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 08/18/2017] [Accepted: 09/13/2017] [Indexed: 12/13/2022] Open
Abstract
Depending on the traumatic event, a significant fraction of trauma survivors subsequently develop PTSD. The additional variability in PTSD risk is expected to arise from genetic susceptibility. Unfortunately, several genome-wide association studies (GWAS) have failed to identify a consistent genetic marker for PTSD. The heritability of intermediate phenotypes such as regional brain volumes is often 80% or higher. We conducted a GWAS of subcortical brain volumes in a sample of recent military veteran trauma survivors (n = 157), grouped into PTSD (n = 66) and non-PTSD controls (n = 91). Covariates included PTSD diagnosis, sex, intracranial volume, ancestry, childhood trauma, SNP×PTSD diagnosis, and SNP×childhood trauma. We identified several genetic markers in high linkage disequilibrium (LD) with rs9373240 (p = 2.0 × 10-7, FDR q = 0.0375) that were associated with caudate volume. We also observed a significant interaction between rs9373240 and childhood trauma (p-values = 0.0007-0.002), whereby increased trauma exposure produced a stronger association between SNPs and increased caudate volume. We identified several SNPs in high LD with rs34043524, which is downstream of the TRAM1L1 gene that were associated with right lateral ventricular volume (p = 1.73 × 10-7; FDR q = 0.032) and were also associated with lifetime alcohol abuse or dependence (p = 2.49 × 10-7; FDR q = 0.0375). Finally, we identified several SNPs in high LD with rs13140180 (p = 2.58 × 10-7; FDR q = .0016), an intergenic region on chromosome 4, and several SNPs in the TMPRSS15 associated with right nucleus accumbens volume (p = 2.58 × 10-7; FDR q = 0.017). Both TRAM1L1 and TMPRSS15 have been previously implicated in neuronal function. Key results survived genome-wide multiple-testing correction in our sample. Leveraging neuroimaging phenotypes may offer a shortcut, relative to clinical phenotypes, in mapping the genetic architecture and neurobiological pathways of PTSD.
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Humphreys KL, Weems CF, Scheeringa MS. The Role of Anxiety Control and Treatment Implications of Informant Agreement on Child PTSD Symptoms. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2017; 46:903-914. [PMID: 26645622 PMCID: PMC4899315 DOI: 10.1080/15374416.2015.1094739] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The goal of this study is to examine parent and child agreement of child posttraumatic stress disorder (PTSD) symptoms pre- and posttreatment, as well as potential moderators of agreement including treatment responder status, child anxiety control, and parent self-reported PTSD symptoms. We examined child self-reported and parent-reported child PTSD symptoms from the Diagnostic Interview Schedule for Children. Of the 141 parent-child pairs, the mean age of children was 12.72 (SD = 3.40), 53% were female, and 54% were Black. A subsample of participants (n = 47) was assessed after completion of a cognitive behavioral therapy treatment for PTSD. Moderate levels of agreement were found at baseline, though Criterion D (increased arousal) symptoms had lower levels of agreement than the other symptom clusters. Symptom agreement was lower at posttreatment. Treatment responders had higher levels of baseline informant agreement than treatment nonresponders. Child perceived anxiety control significantly moderated informant agreement, such that pairs with children who had high levels of perceived control of their anxiety had lower PTSD symptom agreement where children reported lower symptoms relative to their parents. Contrary to expectations, parent self-reported PTSD did not moderate parent-child symptom agreement. Factors associated with higher parent-child agreement of child PTSD symptoms were being a PTSD treatment responder and children with lower perceived anxiety control. These findings have potential implications for determining those who may benefit from greater symptom monitoring over the course of intervention and potential alternative intervention approaches.
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228
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Chivukula U, Hariharan M, Rana S, Thomas M, Andrew A. Enhancing Hospital Well-being and Minimizing Intensive Care Unit Trauma: Cushioning Effects of Psychosocial Care. Indian J Crit Care Med 2017; 21:640-645. [PMID: 29142374 PMCID: PMC5672668 DOI: 10.4103/ijccm.ijccm_468_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Hospitalization has the potential to induce hospital anxiety, while admission in the Intensive Care Unit (ICU) is found to surpass the anxiety and result in what is termed as "ICU Trauma." AIMS This study aimed to determine the impact of psychosocial care and quality of ICU on ICU trauma and hospital well-being in patients who underwent coronary artery bypass grafting (CABG). SETTINGS AND DESIGN This correlational study involved 250 CABG patients, who were recruited from five major corporate hospitals. PARTICIPANTS AND METHODS The ICU Psychosocial Care Scale, Hospital Wellbeing Scale, and ICU Trauma Scale were used. Each of the participants was assessed individually. The ICU Practices Checklist was used to assess the environment of the ICU in the hospital. STATISTICAL ANALYSIS USED Descriptive statistics, correlation, and simple and multiple linear regression analyses were done. RESULTS The results revealed the significant contribution of psychosocial care in ICU in enhancing hospital well-being as well as minimizing ICU trauma of patients who underwent CABG. The results of multiple regressions clearly indicated that psychosocial care was a powerful predictor of hospital well-being and ICU trauma. CONCLUSIONS Although psychosocial care was not a component of hospital well-being and had a negative correlation with ICU trauma, it contributed significantly with a cushioning effect to minimize trauma and helped enhance the feelings and experiences of well-being among patients in ICU.
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Affiliation(s)
- Usha Chivukula
- Centre for Health Psychology, University of Hyderabad, Hyderabad, Telangana, India
| | - Meena Hariharan
- Centre for Health Psychology, University of Hyderabad, Hyderabad, Telangana, India
| | - Suvashisa Rana
- Centre for Health Psychology, University of Hyderabad, Hyderabad, Telangana, India
| | - Marlyn Thomas
- Centre for Health Psychology, University of Hyderabad, Hyderabad, Telangana, India
| | - Asher Andrew
- Centre for Health Psychology, University of Hyderabad, Hyderabad, Telangana, India
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229
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Carter JM, Arentsen TJ, Cordova MJ, Ruzek J, Reiser R, Suppes T, Ostacher MJ. Increased Suicidal Ideation in Patients with Co-Occurring Bipolar Disorder and Post-Traumatic Stress Disorder. Arch Suicide Res 2017; 21:621-632. [PMID: 27310106 DOI: 10.1080/13811118.2016.1199986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Suicide risk increases for those with Bipolar Disorder or PTSD, however little research has focused on risk for co-occurring Bipolar Disorder and PTSD. The aim of this article was to evaluate increased suicide risk in co-occurring disorders, and differences in suicide risk for patients with Bipolar I versus Bipolar II. This study evaluated suicide risk in patients with co-occurring PTSD and Bipolar Disorder (n = 3,158), using the MADRS and Suicide Questionnaire. Those with history of PTSD had significantly higher suicidal ideation than those without (U = 1063375.00, p < .0001). Those with Bipolar I had higher risk than those with Bipolar II. Patients with Bipolar I and PTSD were at higher risk for suicidal ideation, implying the importance of diagnosis and risk assessment.
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230
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Abrahams N, Seedat S, Lombard C, Kengne AP, Myers B, Sewnath A, Mhlongo S, Ramjee G, Peer N, Garcia-Moreno C, Jewkes R. Study protocol for a longitudinal study evaluating the impact of rape on women's health and their use of health services in South Africa. BMJ Open 2017; 7:e017296. [PMID: 28965098 PMCID: PMC5640088 DOI: 10.1136/bmjopen-2017-017296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION South Africa is a country known for its high levels of HIV infection and sexual violence. Although the interface between gender-based violence, HIV and mental health has been described, there are substantial gaps in knowledge of the medium-term and long-term health impact. The 2010 Global Burden of Disease study excluded many health outcomes associated with rape and other forms of gender-based violence because systematic reviews revealed huge gaps in data and poor evidence of health effects. This study aims to describe the incidence and attributable burden of physical and mental health problems (including HIV acquisition) in adult women over a 2-year postrape period, through comparison with a cohort of women who have not been raped. The study will substantially advance our understanding of the impact of rape and will generate robust data to assist in the development of postrape health services and the delivery of evidence-based care. METHODS AND ANALYSIS This longitudinal study seeks to recruit 1008 rape-exposed and 1008 rape non-exposed women. Women were recruited from health services, and assessments were carried out at baseline, 3, 6, 9, 12, 18 and 24 months. Outcome measures include exposure to risk factors; mental health status; cardio-metabolic risks; and biomarkers for HIV, sexually transmitted infections, pregnancy and stress. The primary analysis will be to compare HIV incidence in the two groups using log-rank tests. Appropriate models to predict health outcomes over time will also be applied. ETHICS AND DISSEMINATION The South African Medical Research Council's Ethics Committee approved the study. As rape is a key element of the study, the safety and protection of participants guides the research process. We will adopt a research uptake strategy to ensure dissemination to policy makers, service providers and advocacy groups. Peer-reviewed journal articles will be published.
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Affiliation(s)
- Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Soraya Seedat
- Anxiety and Stress Disorder Unit, University of Stellenbosch, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Alesha Sewnath
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nasheeta Peer
- Non-Communicable Disease Research Unit, South African Medical Research Council, Durban, South Africa
| | - Claudia Garcia-Moreno
- Department of Reproductive Health and Research, World Health Organisation, Geneva, Switzerland
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
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231
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Müller-Engelmann M, Wünsch S, Volk M, Steil R. Mindfulness-Based Stress Reduction (MBSR) as a Standalone Intervention for Posttraumatic Stress Disorder after Mixed Traumatic Events: A Mixed-Methods Feasibility Study. Front Psychol 2017; 8:1407. [PMID: 28928678 PMCID: PMC5591787 DOI: 10.3389/fpsyg.2017.01407] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 08/03/2017] [Indexed: 12/03/2022] Open
Abstract
Objectives: There is promising evidence that mindfulness-based interventions are effective in reducing the symptoms of posttraumatic stress disorder (PTSD). However, until now, studies have often lacked a full clinical PTSD assessment, and interventions are often administered in addition to other interventions. This study examined the feasibility of mindfulness-based stress reduction (MBSR) as a standalone intervention in patients with PTSD who have experienced mixed traumatic events. Method: Fourteen patients participated in 8 weeks of MBSR. The patients were assessed prior to treatment, post-treatment and at a 1-month follow-up through self-ratings (e.g., the Davidson Trauma Scale) and the Clinician-Administered PTSD Scale to determine the effects of the intervention. Furthermore, after the intervention, the patients participated in qualitative interviews regarding their experiences with MBSR and their ideas for future improvements. Results: Nine patients finished the program, and these patients considered the exercises to be applicable and helpful. In the Clinician-Administered PTSD Scale, we found large effects regarding the reduction of PTSD symptoms among completers (Cohen's d = 1.2). In the Davidson Trauma Scale, the effect sizes were somewhat lower (Cohen's d = 0.6) but nevertheless confirmed the efficacy of MBSR in reducing PTSD symptoms. In the qualitative interviews, the patients reported an augmentation of wellbeing and improvement regarding the handling of difficult situations and more distance from the traumatic event. Conclusion: Despite the large effects, the high dropout rates and the results of the post-treatment interviews suggest that the intervention should be better adapted to the needs of PTSD patients, e.g., by giving more information regarding the exercises and by including shorter exercises to manage acute distress.
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Affiliation(s)
- Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University FrankfurtFrankfurt, Germany
| | - Susanne Wünsch
- Trauma-und Opferzentrum Frankfurt e.V.Frankfurt, Germany
| | - Marina Volk
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University FrankfurtFrankfurt, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University FrankfurtFrankfurt, Germany
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232
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Rodríguez-Rey R, Alonso-Tapia J. Relation between parental psychopathology and posttraumatic growth after a child's admission to intensive care: Two faces of the same coin? Intensive Crit Care Nurs 2017; 43:156-161. [PMID: 28882361 DOI: 10.1016/j.iccn.2017.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 06/06/2017] [Accepted: 08/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Confronted with the potentially traumatic experience of a child's admission to a paediatric intensive care unit, parents may experience psychopathological post-trauma symptoms as well as posttraumatic growth. The aim of this cross-sectional study was to explore the relation between psychopathology symptoms, namely, posttraumatic stress disorder), anxiety and depression, as well as post traumatic growth in parents following their child's hospitalisation in a paediatric intensive care unit. METHODS Six months after their child's discharge, 143 parents completed the questionnaire, which assessed post traumatic growth (Posttraumatic Growth Inventory), post traumatic stress disorder (Davidson Trauma Scale), depression and anxiety (Hospital Anxiety and Depression Scale). RESULTS Of the 143 parents, 23.1% reported symptoms of post traumatic stress disorder, 21% reported symptoms of moderate to severe anxiety, 9.1% reported symptoms of moderate to severe depression and 37.1% reported at least a medium degree of post traumatic growth. There was a moderate, direct association between post traumatic stress disorder, depression and anxiety with post traumatic growth. Higher scores in anxiety, depression and post traumatic stress disorder were associated with higher levels of post traumatic growth, contradicting the notion of an inverted U-shaped relationship between psychopathology symptoms and post traumatic growth. CONCLUSIONS Given that positive and negative outcomes after a child's critical admission tend to co-occur, it is surmised that parents who indicate post traumatic growth do not deny the difficulties. While not negating the negative impact on the mental health of a parent with a child admitted to intensive care, including the assessment of post traumatic growth as an outcome following this event has important implications for research and clinical practice.
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Affiliation(s)
- Rocío Rodríguez-Rey
- European University of Madrid, School of Biomedical Sciences, Department of Psychology.
| | - Jesús Alonso-Tapia
- Universidad Autónoma de Madrid, Department of Biological and Health Psychology, Spain.
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233
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Graziano R, Elbogen EB. Improving Mental Health Treatment Utilization in Military Veterans: Examining the Effects of Perceived Need for Care and Social Support. MILITARY PSYCHOLOGY 2017; 29:359-369. [PMID: 29335663 PMCID: PMC5766283 DOI: 10.1037/mil0000169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Many veterans with mental health problems do not adequately utilize needed care. Research has focused on identifying barriers to mental health care in veterans. METHOD The current study adds to existing literature by examining whether perceived need for treatment and social support affect treatment utilization in a national longitudinal survey of Iraq and Afghanistan veterans (n = 1090). RESULTS The Health Beliefs Model (HBM) postulates that a key reason why patients fail to obtain needed care is their belief "it's up to me to handle my own problems." This view was endorsed by 42% in the current national sample of veterans and was found in multivariate analysis to predict less treatment seeking in the next year. Mediation analysis revealed that veterans with higher ratings of social support were less likely to believe they needed to solve mental health problems on their own, indirectly equating to higher odds of treatment use. Simultaneously, findings indicated that posttraumatic stress disorder (PTSD) had a direct effect on more mental health visits but was also associated with higher endorsement that one needed to handle one's own problems and thus had an indirect effect of reducing mental health visits. CONCLUSION Both social support and PTSD affected veterans' perceptions of needing to solve one's own problems, significantly predicted follow-up with mental health care. As a result, the findings indicate that clinicians' should explore veterans' belief systems about perceived treatment need as well as investigate the role of social support to improve mental health treatment utilization.
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Affiliation(s)
| | - Eric B Elbogen
- University of North Carolina at Chapel Hill. Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
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234
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Kevan B. Consistency and factorial invariance of the Davidson trauma scale in heterogeneous populations: results from the 2010 Chilean earthquake. Int J Methods Psychiatr Res 2017; 26:e1516. [PMID: 27453581 PMCID: PMC5637937 DOI: 10.1002/mpr.1516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 11/26/2022] Open
Abstract
This investigation seeks to validate an application of a standardized post-traumatic stress symptom self-report survey, the Davidson Trauma Scale (DTS), with a large, heterogeneous population of earthquake victims. While previous studies have focused primarily on small samples, this investigation uses a unique dataset to assess the validity of this application of the DTS while accounting for heterogeneity and sample size. We use concurrent validity and reliability analysis tests to confirm the validity of the scale. Further, confirmatory factor analysis is used to test the fit of the data's factor structure against previously established trauma models. Finally, these fit tests are repeated across different mutually exclusive vulnerability subsets of the data in order to investigate how the invariance of the scale is affected by sample heterogeneity. We find that this particular application of the scale is, on the whole, reliable and valid, showing good concurrent validity. However, evidence of variability is found across specific vulnerability subsets, indicating that a heterogeneous sample can have a measurable impact on model fit. © 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd.
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235
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Florez IA, Allbaugh LJ, Harris CE, Schwartz AC, Kaslow NJ. Suicidal ideation and hopelessness in PTSD: spiritual well-being mediates outcomes over time. ANXIETY STRESS AND COPING 2017; 31:46-58. [PMID: 28846030 DOI: 10.1080/10615806.2017.1369260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background There is an increased interest in understanding the mechanisms through which post-traumatic stress disorder (PTSD) relates with hopelessness and suicidal ideation. Spiritual well-being could help explain the link between PTSD and both hopelessness and suicidal ideation in African Americans. However, no study has examined the mediational role of existential and religious well-being among these variables. Objectives To examine if initial levels of existential and religious well-being mediated the relation between levels of PTSD symptoms and prospective levels of hopelessness and suicidal ideation in a sample of African American females. Design The study used a longitudinal design with a 10-week time interval. Methods The sample comprised of 113 disadvantaged African American women survivors of a recent suicide attempt recruited from a southern hospital. Self-report measures of PTSD symptoms, hopelessness, suicidal ideation, and spiritual well-being were administered to examine the variables of interest. Bootstrapping techniques were used to test the mediational models. Results Existential, but not religious well-being, mediated the relationship between levels of PTSD symptoms severity and both levels of hopelessness and suicidal ideation over time. Conclusions Existential well-being appears to play a promising protective role against the negative effects of PTSD on both hopelessness and suicidal ideation.
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Affiliation(s)
- Ivonne Andrea Florez
- a Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine , Atlanta , GA , USA
| | - Lucy J Allbaugh
- a Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine , Atlanta , GA , USA
| | - Catherine E Harris
- a Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine , Atlanta , GA , USA
| | - Ann C Schwartz
- a Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine , Atlanta , GA , USA
| | - Nadine J Kaslow
- a Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine , Atlanta , GA , USA
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DeFraia GS. Workplace Disruption following Psychological Trauma: Influence of Incident Severity Level on Organizations' Post-Incident Response Planning and Execution. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2017; 7:75-86. [PMID: 27112716 PMCID: PMC6816515 DOI: 10.15171/ijoem.2016.746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/08/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Psychologically traumatic workplace events (known as critical incidents), which occur globally, are increasing in prevalence within the USA. Assisting employers in their response is a growing practice area for occupational medicine, occupational social work, industrial psychology and other occupational health professions. Traumatic workplace events vary greatly in their level of organizational disruption. OBJECTIVE To explore whether extent of workplace disruption influences organizations' decisions for post-incident response planning and plan execution. METHODS Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring extent of workplace disruption associated with organizational decisions regarding post-incident response. RESULTS The more severe and disruptive the incident, the more likely organizations planned for and followed through to deliver on-site interventions. Following more severe incidents, organizations were also more likely to deliver group sessions and to complete follow-up consultations to ensure ongoing worker recovery. CONCLUSION Increasing occupational health practitioners' knowledge of varying levels of organizational disruption and familiarity with a range of organizational response strategies improves incident assessment, consultation and planning, and ensures interventions delivered are consistent with the level of assistance needed on both worker and organizational levels.
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Affiliation(s)
- G S DeFraia
- Adjunct Professor, Adelphi University, New York, USA.
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Dennis PA, Kimbrel NA, Sherwood A, Calhoun PS, Watkins LL, Dennis MF, Beckham JC. Trauma and Autonomic Dysregulation: Episodic-Versus Systemic-Negative Affect Underlying Cardiovascular Risk in Posttraumatic Stress Disorder. Psychosom Med 2017; 79:496-505. [PMID: 28570433 PMCID: PMC5466498 DOI: 10.1097/psy.0000000000000438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) has been linked to elevated heart rate (HR) and reduced heart rate variability (HRV) in cross-sectional research. Recent evidence suggests that this link may be driven by individual differences in autonomic arousal associated with momentary negative affect (NA). Using ecological momentary assessment (EMA) of NA and minute-to-minute HR/HRV monitoring, we examined whether NA-related HR/HRV mediated the association of PTSD symptom severity with 24-hour HRV and endothelial functioning. METHODS One hundred ninety-seven young adults (18-39 years), 93 with PTSD, underwent 1 day of Holter monitoring while concurrently reporting NA levels via EMA. Two noninvasive measures of endothelial functioning-flow-mediated dilation and hyperemic flow-were also collected. Multilevel modeling was used to assess the associations of momentary NA with HR and low- and high-frequency HRV during the 5-minute intervals after each EMA reading. Latent variable modeling was then used to determine whether individual differences in these associations mediated the association of PTSD symptom severity with 24-hour HRV, flow-mediated dilation, and hyperemic flow. RESULTS PTSD symptom severity was positively associated with NA-related autonomic arousal (β = .21, p < .001), which significantly mediated the association of PTSD symptom severity with 24-hour HRV and hyperemic flow, accounting for 62% and 34% of their associations, respectively, while overshadowing the influence of smoking, lifetime alcohol dependence, sleep duration, mean NA, and episodes of acute NA. CONCLUSIONS Results suggest that NA-related autonomic arousal is both a primary factor driving cardiovascular risk in PTSD and a potential point of intervention.
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Affiliation(s)
- Paul A. Dennis
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Nathan A. Kimbrel
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA,Durham Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA
| | - Lana L. Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | | | - Jean C. Beckham
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
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238
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The Stanford-ReSurge Burn Scar Contracture Scale for Neck: Development and Initial Validation for Burn Scar Contracture. Plast Reconstr Surg 2017; 138:896e-902e. [PMID: 27783006 DOI: 10.1097/prs.0000000000002840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Burn contractures can cause significant disability, particularly in patients in resource-limited settings. However, a gap exists in our ability to measure outcomes in patients with burn contractures of the neck. The objective of this study was to develop and validate the Stanford-ReSurge Burn Scar Contracture Scale-Neck to longitudinally assess functional status and measure functional improvement following contracture release of the neck. METHODS A literature review was performed to identify scales used in neck assessment and burn assessment. Items were then removed from the pool based on redundancy, feasibility, cultural appropriateness, and applicability to patients in international resource-limited environments. Remaining items were administered to patients with burn contracture of the neck. RESULTS The initial literature review found 33 scales that were combined to create an initial pool of 714 items, which was first reduced to 40 items. Feedback from field testing then yielded a 20-item outcome tool to assess appearance, activities of daily living, somatosensation, satisfaction, and range of motion, with a floor of 20 and a ceiling score of 100 points. Preliminary testing with 10 patients showed an average preoperative score of 58 points and an average 1-month postoperative score of 42 points. CONCLUSIONS The authors have created an outcome tool for measuring functional status following burn contracture release of the neck, which can easily be implemented in resource-limited settings where the burden of burn injuries and morbidities is disproportionately high. Ongoing work includes a multicountry study to evaluate validity and reliability.
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Lin YH, Kao CC, Wu SF, Hung SL, Yang HY, Tung HY. Risk factors of post-traumatic stress symptoms in patients with cancer. J Clin Nurs 2017; 26:3137-3143. [PMID: 27875034 DOI: 10.1111/jocn.13662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 10/20/2022]
Abstract
AIMS AND OBJECTIVES To determine the level of post-traumatic stress symptoms and to identify demographics, disease history and clinical symptoms that were associated with post-traumatic stress symptoms among patients with gynaecological, breast or colorectal cancer in Taiwan. BACKGROUND Literature indicated that 7·3-35·2% of patients with cancer had experienced level of post-traumatic stress symptoms. However, the post-traumatic stress symptoms among patients with cancer in Taiwan was not documented. DESIGN A cross-sectional study. METHODS A total of 347 participants recruited from two general hospitals in southern Taiwan. They completed the Chinese version of Davidson Trauma Scale and a profile describing their demographics and clinical symptoms. Disease history was collected from medical records. RESULTS Approximately 21·6% of participants reported higher score on Chinese version of Davidson Trauma Scale (Mean ± SD = 22·85 ± 24·12). The top four scores on Chinese version of Davidson Trauma Scale were painful memories, insomnia, shortened lifespan and flashbacks. The risk factors of post-traumatic stress symptoms were suicidal intention (OR = 2·29, 95% CI = 1·86-2·82), chemotherapy (OR = 2·13, 1·18-3·84), metastasis (OR = 2·07, 1·29-3·34), cancer-specific symptoms (OR = 1·21, 1·15-1·27) and high education (OR = 1·75, 1·10-2·78). CONCLUSION To prevent post-traumatic stress symptoms, patients with cancer should be routinely screened by psychiatrists for post-traumatic stress symptoms, for ongoing symptom control and suicidal intention. Patients with cancer who are at risk of suicidal behaviour should be enrolled in suicide prevention programmes. RELEVANCE TO CLINICAL PRACTICE Nurses need to assess post-traumatic stress symptoms of patients with cancer, particularly those who with high education, suffered from complications of chemotherapy, metastasis and cancer-specific symptoms and suicidal intention.
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Affiliation(s)
- Yu-Hua Lin
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | - Chia-Chan Kao
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Fen Wu
- Anesthesiology Department, E-Da Hospital, Kaohsiung, Taiwan
| | - Shu-Ling Hung
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Hsing-Yu Yang
- Department of Nursing, Mackay Medical College, Taipei, Taiwan
| | - Hong-Yi Tung
- Surgical Department, Yuan's General Hospital, Kaohsiung, Taiwan
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240
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Psychological and behavioral moderators of the relationship between trauma severity and HIV transmission risk behavior among MSM with a history of childhood sexual abuse. J Behav Med 2017; 40:794-802. [PMID: 28396969 DOI: 10.1007/s10865-017-9848-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
Childhood sexual abuse (CSA) is associated with post-traumatic stress disorder (PTSD), which can be associated with condomless sex among men who have sex with men (MSM). However, the impact of moderating factors on the relationship between PTSD symptom severity and condomless sex is poorly understood. We examined whether PTSD symptom severity was associated with condomless sex among MSM with CSA histories, and whether substance dependence, self-esteem, and distress tolerance moderated that relationship (n = 288). Notably, no direct relationship between PTSD symptom severity and condomless sex was found. Adjusted models indicated that condomless sex was differentially impacted by PTSD symptom severity among those without substance dependence (ΔR2 = 0.03, p = 0.034) and, counterintuitively, those with high self-esteem (ΔR2 = 0.07, p = 0.005). PTSD symptom severity was associated with condomless sex across levels of distress tolerance. Findings indicate that substance use, self-esteem, and distress tolerance should be targeted in high-risk MSM with CSA even if they do not have PTSD.
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241
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Teche SP, Rovaris DL, Aguiar BW, Hauck S, Vitola ES, Bau CHD, Freitas LH, Grevet EH. Resilience to traumatic events related to urban violence and increased IL10 serum levels. Psychiatry Res 2017; 250:136-140. [PMID: 28160656 DOI: 10.1016/j.psychres.2017.01.072] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 12/13/2016] [Accepted: 01/25/2017] [Indexed: 01/16/2023]
Abstract
The exposition to traumatic events related to urban violence is epidemic in Brazil, with rate of 80% in the general population, and is becoming a major cause of post-traumatic stress disorder (PTSD). The objective of the study was to compare serum levels of pro-inflammatory interleukin-6 (IL-6) and anti-inflammatory interleukin-10 (IL-10) in PTSD and resilient individuals. We hypothesized that resilient individuals present an attenuated pro-inflammatory and enhanced anti-inflammatory state. We conducted a case-control study comparing 30 resilient individuals and 30 PTSD patients exposed to traumatic events related to urban violence. The groups were evaluated using Self-Report Questionnaire (SRQ-20), Mini-International Neuropsychiatric Interview (MINI) and the Davidson Trauma Scale. For all individuals, blood samples were collected to determine IL-6, IL-10 and cortisol serum levels. All samples were frozen at -80°C until the assay and were analyzed with the same immunoassay kit and in duplicates. The resilient group presented higher IL-10 levels than PTSD patients [mean (CI95%); 1.03 (0.52-2.08) pg/mL vs. 0.29 (0.20-0.43) pg/mL; P=0.002]. There were no differences in terms of IL-6 or cortisol levels. The results provided evidence for increased levels of IL-10 in resilient individuals when compared to PTSD patients, probably conferring them a better anti-inflammatory response after exposition.
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Affiliation(s)
- Stefania P Teche
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Brazil; PTSD Outpatient program (NET-Trauma), Hospital de Clínicas de Porto Alegre, Brazil
| | - Diego L Rovaris
- Department of Genetics, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bianca W Aguiar
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Brazil
| | - Simone Hauck
- Department of Psychiatry, Faculty of Medicine (FAMED), Federal University at Rio Grande do Sul, Brazil; PTSD Outpatient program (NET-Trauma), Hospital de Clínicas de Porto Alegre, Brazil
| | - Eduardo S Vitola
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Brazil
| | - Claiton H D Bau
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Brazil; Department of Genetics, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucia H Freitas
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Brazil; Department of Psychiatry, Faculty of Medicine (FAMED), Federal University at Rio Grande do Sul, Brazil; PTSD Outpatient program (NET-Trauma), Hospital de Clínicas de Porto Alegre, Brazil
| | - Eugenio H Grevet
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Brazil; Department of Psychiatry, Faculty of Medicine (FAMED), Federal University at Rio Grande do Sul, Brazil; PTSD Outpatient program (NET-Trauma), Hospital de Clínicas de Porto Alegre, Brazil.
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242
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Kontoangelos K, Tsiori S, Poulakou G, Protopapas K, Katsarolis I, Sakka V, Kavatha D, Papadopoulos A, Antoniadou A, Papageorgiou CC. Reliability, Validity and Psychometric Properties of the Greek Translation of the Posttraumatic Stress Disorder Scale. Ment Illn 2017; 9:6832. [PMID: 28479971 PMCID: PMC5399537 DOI: 10.4081/mi.2017.6832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 11/22/2022] Open
Abstract
The Greek version of the Davidson Trauma Scale (DTS) was developed to respond to the need of Greek-speaking individuals. The translated questionnaire was administered to 128 HIV outpatients (aged 37.1±9.1) and 166 control patients (aged 32.4±13.4). In addition to the DTS Greek scale, subjects were assessed with two other scales useful for assessing validity. For each factor analyses two components were extracted, based on Cattell’s scree test. The two components solution accounted for 55.34% of the total variation in case of frequency variables and 61.45% in case of severity variables. The Cronbach’s alpha coefficient and Guttman split-half coefficient of the DTS scale were 0.93 and 0.88 respectively. The test-retest reliability of the Greek version of DTS scale proved to be satisfactory. Individual items had good intra-class correlation coefficients higher than 0.5, which means that all questions have high levels of external validity. The psychometric strength of interview for posttraumatic stress disorder-Greek version it’s reliable for its future use, particularly for screening subjects with possible diagnosis of posttraumatic stress disorder.
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Affiliation(s)
- Konstantinos Kontoangelos
- First Department of Psychiatry, Eginition Hospital, School of Medicine, University of Athens, Athens, Greece.,University Mental Health Research Institute, Athens, Greece
| | - Sofia Tsiori
- First Department of Psychiatry, Eginition Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Garyfalia Poulakou
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | | | - Ioannis Katsarolis
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Vissaria Sakka
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Dimitra Kavatha
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | | | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Charalambos C Papageorgiou
- First Department of Psychiatry, Eginition Hospital, School of Medicine, University of Athens, Athens, Greece.,University Mental Health Research Institute, Athens, Greece
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243
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Predicting Posttraumatic Stress Symptom Prevalence and Local Distribution after an Earthquake with Scarce Data. Prehosp Disaster Med 2017; 32:357-367. [PMID: 28318470 DOI: 10.1017/s1049023x17000206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND After a major earthquake, the assignment of scarce mental health emergency personnel to different geographic areas is crucial to the effective management of the crisis. The scarce information that is available in the aftermath of a disaster may be valuable in helping predict where are the populations that are in most need. OBJECTIVE The objectives of this study were to derive algorithms to predict posttraumatic stress (PTS) symptom prevalence and local distribution after an earthquake and to test whether there are algorithms that require few input data and are still reasonably predictive. METHODS A rich database of PTS symptoms, informed after Chile's 2010 earthquake and tsunami, was used. Several model specifications for the mean and centiles of the distribution of PTS symptoms, together with posttraumatic stress disorder (PTSD) prevalence, were estimated via linear and quantile regressions. The models varied in the set of covariates included. RESULTS Adjusted R2 for the most liberal specifications (in terms of numbers of covariates included) ranged from 0.62 to 0.74, depending on the outcome. When only including peak ground acceleration (PGA), poverty rate, and household damage in linear and quadratic form, predictive capacity was still good (adjusted R2 from 0.59 to 0.67 were obtained). CONCLUSIONS Information about local poverty, household damage, and PGA can be used as an aid to predict PTS symptom prevalence and local distribution after an earthquake. This can be of help to improve the assignment of mental health personnel to the affected localities. Dussaillant F , Apablaza M . Predicting posttraumatic stress symptom prevalence and local distribution after an earthquake with scarce data. Prehosp Disaster Med. 2017;32(4):357-367.
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244
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Johnson JE, Schonbrun YC, Anderson B, Kurth M, Timko C, Stein M. Study protocol: Community Links to Establish Alcohol Recovery (CLEAR) for women leaving jail. Contemp Clin Trials 2017; 55:39-46. [PMID: 28185995 DOI: 10.1016/j.cct.2017.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 01/30/2017] [Accepted: 02/04/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE This article describes the protocol for a randomized effectiveness trial of a method to link alcohol use disordered women who are in pretrial jail detention with post-release 12-step mutual help groups. BACKGROUND Jails serve 15 times more people per year than do prisons and have very short stays, posing few opportunities for treatment or treatment planning. Alcohol use is associated with poor post-jail psychosocial and health outcomes including sexually transmitted diseases and HIV, especially for women. At least weekly 12-step self-help group attendance in the months after release from jail has been associated with improvements in alcohol use and alcohol-related consequences. Linkage strategies improve 12-step attendance and alcohol outcomes among outpatients, but have not previously been tested in criminal justice populations. DESIGN In the intervention condition, a 12-step volunteer meets once individually with an incarcerated woman while she is in jail and arranges to be in contact after release to accompany her to 12-step meetings. The control condition provides schedules for local 12-step meetings. Outcomes include percent days abstinent from alcohol (primary), 12-step meeting involvement, and fewer unprotected sexual occasions (secondary) after release from jail. We hypothesize that (Minton, 2015) 12-step involvement will mediate the intervention's effect on alcohol use, and (O'Brien, 2001) percent days abstinent will mediate the intervention's effect on STI/HIV risk-taking outcomes. Research methods accommodate logistical and philosophical hurdles including rapid turnover of commitments and unpredictable release times at the jail, possible post-randomization ineligibility due to sentencing, 12-step principles such as Nonaffiliation, and use of volunteers as interventionists.
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Affiliation(s)
- Jennifer E Johnson
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1st St Room 367, Flint, MI 48503, United States.
| | - Yael Chatav Schonbrun
- Butler Hospital, Warren Alpert Medical School of Brown University, 345 Blackstone Blvd, Providence, RI 02906, United States.
| | - Bradley Anderson
- Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, United States.
| | - Megan Kurth
- Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, United States.
| | - Christine Timko
- Department of Veterans Affairs, Stanford University School of Medicine, 795 Willow Rd., Menlo Park, CA 94025, United States.
| | - Michael Stein
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States.
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245
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Liaveri PG, Dikeos D, Ilias I, Lygkoni EP, Boletis IN, Skalioti C, Paparrigopoulos T. Quality of sleep in renal transplant recipients and patients on hemodialysis. J Psychosom Res 2017; 93:96-101. [PMID: 28107900 DOI: 10.1016/j.jpsychores.2016.12.013] [Citation(s) in RCA: 28] [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] [Received: 06/07/2016] [Revised: 11/22/2016] [Accepted: 12/23/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sleep disorders are very common in patients with chronic kidney disease and they may not always subside after kidney transplantation. AIM AND METHODS The aim of this cross-sectional study was to evaluate the self-reported quality of sleep, insomnia problems in particular, and examine the factors that disturb sleep of kidney transplant recipients (KTx: n=152) in comparison to age- and sex-matched patients on dialysis (HD: n=67) and participants with normal renal function (NOR: n=49), through the administration of the Athens Insomnia Scale (AIS) at least six months after transplantation. Clinical and laboratory data, as well as health-related quality of life, depression, anxiety, post-traumatic stress symptoms, and the presence of restless legs syndrome (RLS) and pruritus were investigated in relation to sleep problems. RESULTS The highest mean AIS score was observed in the transplant patients (KTx: 4.6±13.3 vs. HD: 3.8±8.1 vs. NOR: 2.4±10.2); both KTx and HD patients had a lower quality of sleep compared to participants with normal renal function. Multiple linear regression analysis showed that the determinants of the total AIS score were the frequency of post-traumatic stress symptoms, depression, RLS, diastolic blood pressure, and pain (all p<0.0001). CONCLUSION Although amelioration of renal function post-transplantation improves several aspects of quality of life, it does not seem to have a beneficial effect on self-reported sleep.
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Affiliation(s)
| | - Dimitris Dikeos
- Sleep Research Unit, First Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, "Eginition" Hospital, Athens, Greece
| | - Ioannis Ilias
- Endocrine Unit, "Elena Venizelou" Hospital, Athens, Greece
| | - Eirini P Lygkoni
- School of Applied Mathematics and Physical Science, National Technical University of Athens, Athens, Greece
| | - Ioannis N Boletis
- Nephrology Department, Renal Transplantation Unit, "Laikon" Hospital, Athens, Greece
| | - Chryssanthi Skalioti
- Nephrology Department, Renal Transplantation Unit, "Laikon" Hospital, Athens, Greece
| | - Thomas Paparrigopoulos
- Sleep Research Unit, First Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, "Eginition" Hospital, Athens, Greece
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246
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Peters ME, Rao V, Bechtold KT, Roy D, Sair HI, Leoutsakos JM, Diaz-Arrastia R, Stevens RD, Batty DS, Falk H, Fernandez C, Ofoche U, Vassila A, Hall AJ, Anderson B, Bessman E, Lyketsos CG, Everett AD, Van Eyk J, Korley FK. Head injury serum markers for assessing response to trauma: Design of the HeadSMART study. Brain Inj 2017; 31:370-378. [PMID: 28140672 PMCID: PMC6438171 DOI: 10.1080/02699052.2016.1231344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/29/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Accurate diagnosis and risk stratification of traumatic brain injury (TBI) at time of presentation remains a clinical challenge. The Head Injury Serum Markers for Assessing Response to Trauma study (HeadSMART) aims to examine blood-based biomarkers for diagnosing and determining prognosis in TBI. METHODS HeadSMART is a 6-month prospective cohort study comparing emergency department patients evaluated for TBI (exposure group) to (1) emergency department patients evaluated for traumatic injury without head trauma and (2) healthy persons. Study methods and characteristics of the first 300 exposure participants are discussed. RESULTS Of the first 300 participants in the exposure arm, 70% met the American Congress of Rehabilitation Medicine criteria for TBI, with the majority (80.1%) classified as mild TBI. The majority of subjects in the exposure arm had Glasgow Coma Scale scores of 13-15 (98.0%), normal head computed tomography (81.3%) and no prior history of concussion (71.7%). CONCLUSION With systematic phenotyping, HeadSMART will facilitate diagnosis and risk-stratification of the heterogeneous group of individuals currently diagnosed with TBI.
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Affiliation(s)
| | - Vani Rao
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Durga Roy
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haris I. Sair
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - Hayley Falk
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Uju Ofoche
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Anna J. Hall
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Braden Anderson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward Bessman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Jennifer Van Eyk
- The Heart Institute, Department of Medicine, Cedars-Sinai, Los Angeles, CA, USA
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247
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Madhombiro M, Dube-Marimbe B, Dube M, Chibanda D, Zunza M, Rusakaniko S, Stewart D, Seedat S. A cluster randomised controlled trial protocol of an adapted intervention for alcohol use disorders in people living with HIV and AIDS: impact on alcohol use, general functional ability, quality of life and adherence to HAART. BMC Psychiatry 2017; 17:44. [PMID: 28129756 PMCID: PMC5273845 DOI: 10.1186/s12888-017-1208-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/17/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Interventions for alcohol use disorders (AUDs) in HIV infected individuals have been primarily targeted at HIV risk reduction and improved antiretroviral treatment adherence. However, reduction in alcohol use is an important goal. Alcohol use affects other key factors that may influence treatment course and outcome. In this study the authors aim to administer an adapted intervention for AUDs to reduce alcohol use in people living with HIV/AIDS (PLWHA). METHODS This study is a cluster randomised controlled trial at 16 HIV care clinics. A motivational interviewing and cognitive behavioural therapy based intervention for AUDs, developed through adaptation and piloted in Zimbabwe, will be administered to PLWHA with AUDs recruited at HIV clinics. The intervention will be administered over 16 sessions at 8 HIV clinics. This intervention will be compared with an equal attention control in the form of the World Health Organization Mental Health Gap Action Programme (WHO mhGAP) guide, adapted for the Zimbabwean context. General function, quality of life, and adherence to highly active antiretroviral treatment (HAART) will be secondary outcomes. Booster sessions will be administered to both groups at 3 and 6 months respectively. The primary outcome measure will be the Alcohol Use Disorder Identification Test (AUDIT) score. The World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0), World Health Organisation Quality of Life (WHOQoL) HIV, viral load, and CD4 counts will be secondary outcome measures. Outcome assessments will be administered at baseline, 3, 6, and 12 months. Moderating factors such as perceived social support, how people cope with difficult situations and post-traumatic exposure and experience will be assessed at baseline. Trained research assistants will recruit participants. The outcome assessors who will be trained in administering the outcome and moderating tools will be blinded to the treatment arms allocated to the participants. However, the principal investigator, participants and intervention staff will be unblinded. Data will be analysed using STATA Version 14. Primary and secondary outcomes will be measured at four time points that is; at baseline, 3, 6, and 12 months respectively. All participants will be included in the analysis of primary and secondary outcome measures. The mean AUDIT scores will be compared between groups using student t-tests. Multilevel logistic regression analysis will be performed for binominal variables and multilevel linear regression for continuous variables. Descriptive statistics will be computed for baseline and follow-up assessments. DISCUSSION The study will be the first to address problematic alcohol use in PLWHA in Zimbabwe. It seeks to use local resources in delivering a modified, brief, evidence-based, and culturally contextualised intervention. The study results will determine the effectiveness of adapting psychological interventions for AUDs in HIV infected adults using a task-sharing framework. TRIAL REGISTRATION Pan African Clinical Trial Registry, PACTR201509001211149 . Registered 22 July 2015.
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Affiliation(s)
- Munyaradzi Madhombiro
- Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare, Zimbabwe. .,Harare Central Hospital, Psychiatric Unit, Southerton, Harare, Zimbabwe.
| | - Bazondlile Dube-Marimbe
- 0000 0004 0572 0760grid.13001.33Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe
| | - Michelle Dube
- 0000 0004 0572 0760grid.13001.33Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe
| | - Dixon Chibanda
- 0000 0004 0572 0760grid.13001.33Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe ,Harare Central Hospital, Psychiatric Unit, Southerton, Harare Zimbabwe
| | - Moleen Zunza
- 0000 0001 2214 904Xgrid.11956.3aStellenbosch University, Faculty of Medicine and Health Sciences, Biostatistics Unit, Tygerberg Campus, Parow, Cape Town, South Africa
| | - Simbarashe Rusakaniko
- 0000 0004 0572 0760grid.13001.33Department of Community Medicine Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe
| | - David Stewart
- Department of Psychology, Seattle Pacific University, 3rd Avenue W Seattle 206-281-2000, Washington, 3307 USA
| | - Soraya Seedat
- 0000 0001 2214 904Xgrid.11956.3aDepartment of Psychiatry, Stellenbosch University, Faculty of Medicine and Health Sciences, Tygerberg Campus, Parow, Cape Town, South Africa
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248
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Price M, Spinazzola J, Musicaro R, Turner J, Suvak M, Emerson D, van der Kolk B. Effectiveness of an Extended Yoga Treatment for Women with Chronic Posttraumatic Stress Disorder. J Altern Complement Med 2017; 23:300-309. [PMID: 28121466 DOI: 10.1089/acm.2015.0266] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Yoga has been found to be an effective posttraumatic stress disorder (PTSD) treatment for a variety of trauma survivors, including females with chronic PTSD. Aim/Purpose: The current study builds on extant research by examining an extended trauma-sensitive yoga treatment for women with chronic PTSD. The study sought to optimize the results of a treatment protocol examined in a recent randomized controlled trial with a shorter duration and without assignment or monitoring of home practice. MATERIALS AND METHODS The authors examined a 20-week trauma-sensitive yoga treatment in a non-randomized single-group treatment feasibility study for women with chronic treatment-resistant PTSD (N = 9). The authors examined PTSD and dissociation symptom reduction over several assessment periods. RESULTS The results indicate that participants experienced significant reductions in PTSD and dissociative symptomatology above and beyond similar treatments of a shorter duration. CONCLUSIONS The findings suggest that more intensive trauma-sensitive yoga treatment characterized by longer duration and intentional assignment and monitoring of home practice may be more advantageous for individuals with severe and chronic PTSD. The implications of the findings for the potentially more substantial role of yoga as an intervention for a subset of adults with chronic treatment-resistant PTSD are discussed.
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Affiliation(s)
- Maggi Price
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA.,2 Department of Counseling, Developmental, and Educational Psychology, Boston College , Newton, MA
| | - Joseph Spinazzola
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA.,3 Department of Psychology, Suffolk University , Boston, MA
| | - Regina Musicaro
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA.,3 Department of Psychology, Suffolk University , Boston, MA
| | - Jennifer Turner
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA
| | - Michael Suvak
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA.,3 Department of Psychology, Suffolk University , Boston, MA
| | - David Emerson
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA
| | - Bessel van der Kolk
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA.,4 Department of Psychiatry, Boston University School of Medicine , Boston, MA
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Nyssen OP, Taylor SJC, Wong G, Steed E, Bourke L, Lord J, Ross CA, Hayman S, Field V, Higgins A, Greenhalgh T, Meads C. Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations. Health Technol Assess 2017; 20:vii-xxxvii, 1-367. [PMID: 27071807 DOI: 10.3310/hta20270] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Writing therapy to improve physical or mental health can take many forms. The most researched model of therapeutic writing (TW) is unfacilitated, individual expressive writing (written emotional disclosure). Facilitated writing activities are less widely researched. DATA SOURCES Databases, including MEDLINE, EMBASE, PsycINFO, Linguistics and Language Behaviour Abstracts, Allied and Complementary Medicine Database and Cumulative Index to Nursing and Allied Health Literature, were searched from inception to March 2013 (updated January 2015). REVIEW METHODS Four TW practitioners provided expert advice. Study procedures were conducted by one reviewer and checked by a second. Randomised controlled trials (RCTs) and non-randomised comparative studies were included. Quality was appraised using the Cochrane risk-of-bias tool. Unfacilitated and facilitated TW studies were analysed separately under International Classification of Diseases, Tenth Revision chapter headings. Meta-analyses were performed where possible using RevMan version 5.2.6 (RevMan 2012, The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark). Costs were estimated from a UK NHS perspective and three cost-consequence case studies were prepared. Realist synthesis followed Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. OBJECTIVES To review the clinical effectiveness and cost-effectiveness of TW for people with long-term conditions (LTCs) compared with no writing, or other controls, reporting any relevant clinical outcomes. To conduct a realist synthesis to understand how TW might work, and for whom. RESULTS From 14,658 unique citations, 284 full-text papers were reviewed and 64 studies (59 RCTs) were included in the final effectiveness reviews. Five studies examined facilitated TW; these were extremely heterogeneous with unclear or high risk of bias but suggested that facilitated TW interventions may be beneficial in individual LTCs. Unfacilitated expressive writing was examined in 59 studies of variable or unreported quality. Overall, there was very little or no evidence of any benefit reported in the following conditions (number of studies): human immunodeficiency virus (six); breast cancer (eight); gynaecological and genitourinary cancers (five); mental health (five); asthma (four); psoriasis (three); and chronic pain (four). In inflammatory arthropathies (six) there was a reduction in disease severity [n = 191, standardised mean difference (SMD) -0.61, 95% confidence interval (CI) -0.96 to -0.26] in the short term on meta-analysis of four studies. For all other LTCs there were either no data, or sparse data with no or inconsistent, evidence of benefit. Meta-analyses conducted across all of the LTCs provided no evidence that unfacilitated emotional writing had any effect on depression at short- (n = 1563, SMD -0.06, 95% CI -0.29 to 0.17, substantial heterogeneity) or long-term (n = 778, SMD -0.04 95% CI -0.18 to 0.10, little heterogeneity) follow-up, or on anxiety, physiological or biomarker-based outcomes. One study reported costs, no studies reported cost-effectiveness and 12 studies reported resource use; and meta-analysis suggested reduced medication use but no impact on health centre visits. Estimated costs of intervention were low, but there was insufficient evidence to judge cost-effectiveness. Realist synthesis findings suggested that facilitated TW is a complex intervention and group interaction contributes to the perception of benefit. It was unclear from the available data who might benefit most from facilitated TW. LIMITATION Difficulties with developing realist synthesis programme theory meant that mechanisms operating during TW remain obscure. CONCLUSIONS Overall, there is little evidence to support the therapeutic effectiveness or cost-effectiveness of unfacilitated expressive writing interventions in people with LTCs. Further research focused on facilitated TW in people with LTCs could be informative. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003343. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de la Princesa, Instituto de Investigación, Sanitaria Princesa (IP), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Steed
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Liam Bourke
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - Joanne Lord
- Southampton Health Technology Assessment Centre, University of Southampton, Southampton, UK
| | - Carol A Ross
- Cumbria Partnership NHS Foundation Trust, Penrith, UK
| | - Sheila Hayman
- Medical Foundation for the Care of Victims of Torture, London, UK
| | - Victoria Field
- Freelance experienced therapeutic writing practitioner, International Federation for Biblio/Poetry Therapy, Steamboat Springs, CO, USA
| | - Ailish Higgins
- Health Economics Research Group, Brunel University, London, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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A Systematic Review of Patient-Reported Outcome Measures Used in Adult Burn Research. J Burn Care Res 2017; 38:e521-e545. [DOI: 10.1097/bcr.0000000000000474] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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