A comparison of the SPRINT and CAPS assessment scales for posttraumatic stress disorder

Prevalence and Correlates of Complicated Grief in Military Primary Care: Implications for Healthcare Providers

Grief is a universal experience, but for approximately 1 in 10 individuals, grief can become impairing. Despite servicemembers' frequent exposure to death, research on grief in the military remains limited. The purpose of the study was to explore the prevalence and correlates of complicated grief (CG) in military primary care. A quantitative survey was conducted with 161 non-treatment-seeking service members, veterans, and their dependents, of whom 138 reported a significant loss. Results revealed that 35% of the respondents who were bereaved met the cut-off score of 25 on the Inventory of Complicated Grief (ICG). Furthermore, 10% met the cut-off score of 30 on the Prolonged Grief Disorder-13-Revised Scale (PG-13-R). Importantly, death by suicide and pre-existing mental health conditions were associated with greater symptom severity. These findings have important implications for primary care providers and other clinicians working with military populations.

Evaluating effects of burn injury characteristics on quality of life in pediatric burn patients and caregivers

OBJECTIVES

The purpose of this study was to evaluate pediatric burn patients' and caregivers' quality of life (QoL), while identifying clinical characteristics correlated with psychological stress.

METHODS

Pediatric burn patients at an ABA-verified institution from November 2019-January 2021 were included. Caregivers of patients 0-4 years completed the Infant's Dermatology QoL Index (IDQOL). Patients> 4-16 years completed the Children's Dermatology Life Quality Index (CDLQI). The Short Post-Traumatic Stress Disorder Rating Interview (SPRINT) measured caregivers' stress. Generalized linear mixed models evaluated associations between assessment scores and burn characteristics.

RESULTS

Overall, 27.3% (39/143) of IDQOL and 53.1.% (41/96) of CDLQI scores indicated that patients' burns caused moderate to extremely large effects on QoL. In caregivers, 4.5% (7/159) scored> 14 on the SPRINT, warranting further PTSD evaluation. For the IDQOL, each additional 1% TBSA burn was associated with a 2.75-point increase (p = 0.05), and patients sustaining 2nd degree deep partial thickness burns scored an average of 3.3 points higher compared to 2nd degree superficial partial thickness burns (P < 0.01). CLDQI and SPRINT scores demonstrated a similar pattern.

CONCLUSIONS

QoL is impacted in a substantial proportion of pediatric burn patients. Larger TBSA and increased burn depths cause significantly more psychological stress in children, and caregivers may require more extensive psychological evaluation.

Parent Traumatic Stress After Minor Pediatric Burn Injury

Parents are at increased risk for psychological sequelae following their child's burn injury which has demonstrated negative impacts on the child. The current study sought to address gaps in the literature on risk factors for parental distress by examining the relationships among demographic variables, burn characteristics, and child functioning after burn injury, with parent post-traumatic stress symptoms (PTSS). Participants included parents of 660 pediatric burn patients from a regional burn clinic. Parents completed measures during their initial visit to the burn clinic. Additional demographic and burn data were retrospectively collected by medical chart review. Fifteen percent of parents reported at-risk levels of parent PTSS. Parent PTSS was independently associated with child burn characteristics of total body surface area (TBSA) affected by the burn, required hospitalization, number of nights hospitalized, and number of ambulatory burn appointments attended. Minority race was associated with higher parent PTSS than non-minority race status, with Asian parents endorsing the highest scores. Furthermore, when considered simultaneously, impaired child quality of life (QOL), a higher number of ambulatory burn appointments attended, and racial minority status were associated with higher parent PTSS. These findings highlight the need for routine parent trauma screening in pediatric burn clinics, while additionally identifying a feasible screening measure.

Trauma-informed Collaborative Care for African American Primary Care Patients in Federally Qualified Health Centers: A Pilot Randomized Trial

BACKGROUND

African Americans have nearly double the rate of posttraumatic stress disorder (PTSD) compared with other racial/ethnic groups.

OBJECTIVE

To understand whether trauma-informed collaborative care (TICC) is effective for improving PTSD among African Americans in New Orleans who receive their care in Federally Qualified Health Centers (FQHCs).

DESIGN AND METHOD

In this pilot randomized controlled trial, we assigned patients within a single site to either TICC or to enhanced usual care (EUC). We performed intent to treat analysis by nonparametric exact tests for small sample sizes.

PARTICIPANTS

We enrolled 42 patients from October 12, 2018, through July 2, 2019. Patients were eligible if they considered the clinic their usual source of care, had no obvious physical or cognitive obstacles that would prevent participation, were age 18 or over, self-identified as African American, and had a provisional diagnosis of PTSD.

MEASURES

Our primary outcome measures were PTSD measured as both a symptom score and a provisional diagnosis based on the PTSD Checklist for DSM-5 (PCL-5).

KEY RESULTS

Nine months following baseline, both PTSD symptom scores and provisional PTSD diagnosis rates decreased substantially more for patients in TICC than in EUC. The decreases were by 26 points in EUC and 36 points in TICC for symptoms (P=0.08) and 33% in EUC and 57% in TICC for diagnosis rates (P=0.27). We found no effects for mediator variables.

CONCLUSIONS

TICC shows promise for addressing PTSD in this population. A larger-scale trial is needed to fully assess the effectiveness of this approach in these settings.

Aggression towards clinicians within Opiate Substitution Treatment (OST) services: A survey of service providers

Background

High levels of aggression towards staff in healthcare settings have been reported. It seems likely that workers in Opioid Substitution Therapy (OST) would be at increased risk of adverse events and their consequences.

Objectives

This study aimed to establish if practitioners who provide OST are experiencing negative outcomes, specifically aggression, distress, and burnout, and to identify if workload and professional affiliation were associated with these risks.

Methods

A survey was conducted of OST practitioners in a single geographical region of New Zealand (population approx. 344,000). The survey asked for demographics (including caseloads), Perception of Patient Aggression Scale New Zealand Revision (POPAS-NZ), Kessler 10 (K10), Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), and Abbreviated Maslach Burnout Inventory (aMBI) and two qualitative questions asking about the best and worst aspects of working in OST.

Results

All recorded OST workers in the region (n = 181) were invited to participate, 95 practitioners responded to the survey (52.4%). This group included pharmacists, doctors, nurses, social workers and addiction workers. Results indicated aggression, distress, and burnout were being experienced by practitioners. Number of patients seen by a practitioner significantly increased risk of aggression (F(1,90) = 14.14, p < 0.001). Psychiatrists were the most at risk profession (p = 0.016). Burnout responses were high for around 20% of practitioners, with low numbers meeting criteria for distress and PTSD. Positive things about working in OST were relationships with patients, appreciating patient outcomes and positive team environments. Negative aspects were patient behaviours, maintaining empathy, and, administration tasks.

Conclusions

Aggression was a workplace hazard for OST clinicians. Low rates of distress and PTSD symptoms were reported and some evidence of practitioner burnout. Practitioners reported positive relationships, making a difference and teamwork may have been improving this area of mental health work.

Mental health benefits of a 1-week intensive multimodal group program for adolescents with multiple adverse childhood experiences

BACKGROUND

Adverse childhood experiences (ACEs) are associated with a wide range of diseases, unsafe behavior and shorter life expectancy. However, there is scarce evidence on effective interventions for children or adolescents who report multiple ACEs, including abuse, neglect and household dysfunction.

OBJECTIVE

The aim of this study was to evaluate the mental health outcomes of a multimodal program designed for adolescents with multiple ACEs.

PARTICIPANTS

Forty-four girls (aged 13-16 years, mean ACE score > 5) were randomized to an intervention group or a care-as-usual control group.

METHODS

The intervention included mindfulness-based practices, expressive arts and EMDR (Eye Movement Desensitization and Reprocessing Integrative) group treatment. We used questionnaires for adolescents to assess trauma (SPRINT, CPSS) and attention/awareness-related outcomes (MAAS-A) at baseline (T1), post-intervention (T2) and two-months post-discharge (T3).

RESULTS

Linear mixed effects model analyses showed significant Group by Time interactions on all the scales (F = 11.0, p = 0.015; F = 12.5 p < 0.001; and F = 6.4, p = 0.001, for SPRINT, CPSS and MAAS-A, respectively). After completing the program, the intervention group showed significant reduction in trauma-related outcomes (SPRINT, Δ%_(T2-T1) = -73%, p < 0.001; CPSS, Δ%_(T2-T1) = -26%, p < 0.001) while attention/awareness-related outcomes were improved by 57% (p < 0.001). These changes remained stable two months after discharge. SPRINT and CPSS scales were highly correlated (r = 0.833, p < 0.001) and outcomes from both trauma-related scales negatively correlated with mindfulness scores (MAAS-A/SPRINT, r = -0.515, p = 0.007; MAAS-A/CPSS, r = -0.553, p < 0.001).

CONCLUSIONS

Results presented here support this multimodal group intervention as a feasible and promising program for reducing the psychological burden in adolescents with a history of multiple ACEs.

Pilot Research Study on the Provision of the Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol With Female Cancer Patients

The purpose of this research is to evaluate the effectiveness of the eye movement desensitization and reprocessing (EMDR) Integrative Group Treatment Protocol (EMDR-IGTP) in reducing posttraumatic stress disorder (PTSD) symptoms related to the diagnosis and treatment of different types of cancer in adult women. EMDR-IGTP intensive therapy was administered for 3 consecutive days, twice daily, to 24 adult women diagnosed with different types of cancer (cervical, breast, colon, bladder, and skin) who had PTSD symptoms related to their diagnosis and treatment. The data was analyzed using factorial ANOVA with the effects of the EMDR-IGTP evaluated with the Short PTSD Rating Interview as dependent variable and group (two groups of patients: active phase and follow-up phase of cancer treatment) and time (four time points) as independent variables. Post hoc analyses were carried out. Results showed significant main effects for time and group. No significant interaction was found. Results also showed an overall subjective improvement in the participants. This pilot study suggests that intensive administration of the EMDR-IGTP can be a valuable support for cancer patients with PTSD symptoms related to their diagnosis and treatment. Further research with randomized controlled studies is needed to demonstrate the effectiveness of EMDR-IGTP in this population.

EMDR Protocol for Recent Critical Incidents: A Randomized Controlled Trial in a Technological Disaster Context

This research evaluated the effectiveness of the Eye Movement Desensitization and Reprocessing (EMDR) Protocol for Recent Critical Incidents (EMDR-PRECI) in reducing posttraumatic stress symptoms related to the explosion in an explosives manufacturing factory north of Mexico City that killed 7 employees. The EMDR-PRECI was administered on 2 consecutive days to 25 survivors who had posttraumatic stress symptoms related to the critical incident. Participants’ mean score on the Short PTSD Rating Interview (SPRINT) was 22, well above the clinical cutoff of 14. They were randomly assigned to immediate and waitlist/delayed treatment conditions and therapy was provided within 15 days of the explosion. Results showed significant main effects for the condition factor, F(1, 80) = 67.04, p < .000. SPRINT scores were significantly different across time showing the effects of the EMDR therapy through time, F(3, 80) = 150.69, p < .000. There was also a significant interaction effect, condition by time, F(2, 80) = 55.45, p < .001. There were significant differences between the two treatment conditions at Time 2 (post-immediate treatment vs. post-waitlist/delayed), t(11) = −10.08, p < .000. Treatment effects were maintained at 90-day follow-up. Results also showed an overall subjective improvement in the participants. This randomized controlled trial provides evidence for the efficacy of EMDR-PRECI in reducing posttraumatic stress symptoms after a technological disaster.

The sleep effects of tiagabine on the first night of treatment predict post-traumatic stress disorder response at three weeks

INTRODUCTION

We sought to test the hypothesis that improvements in sleep might mediate treatment-related improvements in daytime symptoms of post-traumatic stress disorder (PTSD). We evaluated whether changes in sleep occurring on the first night of tiagabine (a gamma-amino butyric acid (GABA) reuptake inhibitor) administration predicted subsequent PTSD response.

METHODS

This was an open-label three-week polysomnographic (PSG) study of nightly treatment with tiagabine dosing from 2-12 mg including 20 adults with PTSD with ≥30 min of self-reported and PSG wake time after sleep onset (WASO).

RESULTS

A treatment night 1 decrease in self-reported and PSG WASO and an increase in slow-wave sleep (SWS) accounted for 94% of the variance in week 3 Short PTSD Rating Interview (SPRINT) score, the primary outcome measure (p<0.001). Increased night 1 SWS also accounted for 91% of the variance in Work/School Impairment and 45% of the variance in Social Life Impairment as measured with the Sheehan Disability Scale (p<0.001). These relationships were much stronger correlates of three-week outcome than three-week sleep effects.

CONCLUSIONS

The initial sleep response to tiagabine may mediate or be an indicator of the subsequent PTSD response. The findings highlight the importance of sleep maintenance and SWS in the treatment of PTSD and also suggest a potential relationship between SWS and daytime function.

EMDR Therapy Humanitarian Trauma Recovery Interventions in Latin America and the Caribbean

This article presents an overview of the eye movement desensitization and reprocessing (EMDR) Humanitarian Trauma Recovery Interventions in Latin America and the Caribbean and provides the reader with clinical stories from the front lines. During our many years working in the field, we have observed that psychological trauma is a challenging consequence of the multifaceted situations confronting individuals and communities after disasters. In this article, we describe the EMDR humanitarian interventions provided since 1998 in Latin America and the Caribbean to address survivors’ psychological distress after natural disasters (e.g., flooding, landslides, earthquakes), man-made disasters, human massacre, and severe interpersonal violence. Treatment has been provided to child, adolescent, and adult survivors, often in community settings, and to first responders and cancer patients. The EMDR early intervention protocols are brief effective interventions that can be used in the field or emergency situations; there is a body of research supporting the use of modified EMDR therapy protocols to treat acute trauma in both group and individual formats (Jarero, Artigas, & Luber, 2011).

The Provision of an EMDR-Based Multicomponent Trauma Treatment With Child Victims of Severe Interpersonal Trauma

This study evaluated a multicomponent phase–based trauma treatment approach for 34 children who were victims of severe interpersonal trauma (e.g., rape, sexual abuse, physical and emotional violence, neglect, abandonment). The children attended a week-long residential psychological recovery camp, which provided resource building experiences, the Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol (EMDR-IGTP), and one-on-one EMDR intervention for the resolution of traumatic memories. The individual EMDR sessions were provided for 26 children who still had some distress about their targeted memory following the EMDR-IGTP. Results showed significant improvement for all the participants on the Child’s Reaction to Traumatic Events Scale (CRTES) and the Short PTSD Rating Interview (SPRINT), with treatment results maintained at follow-up. More research is needed to assess the EMDR-IGTP and the one-on-one EMDR intervention effects as part of a multimodal approach with children who have suffered severe interpersonal trauma.

EMDR Individual Protocol for Paraprofessional Use: A Randomized Controlled Trial With First Responders

The eye movement desensitization and reprocessing (EMDR) individual protocol for paraprofessional use in acute trauma situations (EMDR-PROPARA) is part of a project developed at the initiative of Dr. Francine Shapiro. This randomized clinical trial examined the effectiveness of the protocol administered by experienced EMDR therapists. There were 39 traumatized first responders on active duty randomly assigned to receive two 90-min sessions of either EMDR-PROPARA or of supportive counseling. Participants in the EMDR-PROPARA group showed benefits immediately after treatment, with their scores on the Short PTSD Rating Interview (SPRINT) showing further decreases at 3-month follow-up. In comparison, supportive counseling participants experienced a nonsignificant decrease after treatment and an increase in the SPRINT scores at the second follow-up. The significant difference between the two treatments provides preliminary support for EMDR-PROPARA’s effectiveness in reducing severity of posttraumatic symptoms and subjective global improvement. More controlled research is recommended to evaluate further the efficacy of this intervention.

Effects of pre- and post-Katrina nonviolent and violent experiences on male veterans' psychological functioning

BACKGROUND

Identifying individuals at risk for mental health problems after a disaster often involves assessing potentially traumatic exposures inherent to the disaster. Survivors of disasters also may have been exposed, both before and during the event, to trauma not directly related to the disaster. A substantial literature suggests exposure to interpersonal violence may have more severe negative outcomes than exposure to non-violent events; however, it is unclear whether violent vs nonviolent exposures before and during a disaster have differential effects on postdisaster psychological functioning.

METHODS

We examined the associations of violent and nonviolent exposures before and during Hurricane Katrina with postdisaster psychological functioning in a sample of male military veterans.

RESULTS

Violent and nonviolent exposures post-Hurricane Katrina as well as pre-Katrina violent exposures were significantly associated with symptoms of posttraumatic stress disorder, panic, and generalized anxiety disorder more than 2 years after the storm. Moreover, veterans who reported violent exposures pre-Katrina were more than 4 times more likely to have reexperienced interpersonal violence during Katrina than those who did not report such exposures.

CONCLUSIONS

Results suggest assessing disaster-specific experiences in addition to predisaster interpersonal violence may be important for identifying and triaging individuals at risk for postdisaster mental health problems.

The EMDR Protocol for Recent Critical Incidents: Follow-Up Report of an Application in a Human Massacre Situation

This article reports the follow-up results of our field study (Jarero & Uribe, 2011) that investigated the application of the eye movement desensitization and reprocessing (EMDR) Protocol for Recent Critical Incidents (EMDR-PRECI) in a human massacre situation. A single individual session was provided to 32 forensic personnel of the State Attorney General in the Mexican state of Durango who were working with 258 bodies recovered from clandestine graves. Pre-post results showed significant improvement for both immediate treatment and waitlist/delayed treatment groups on the Impact of Event Scale (IES) and Short PTSD Rating Interview (SPRINT). In this study, we report the follow-up assessment, which was conducted, at 3 and 5 months posttreatment. Follow-up scores showed that the original treatment results were maintained, with a further significant reduction of self-reported symptoms of posttraumatic stress and PTSD between posttreatment and follow-up. During the follow-up period, the employees continued to work with the recovered corpses and were continually exposed to horrific emotional stressors, with ongoing threats to their own safety. This suggests that EMDR-PRECI was an effective early intervention, reducing traumatic stress for a group of traumatized adults continuing to work under extreme stressors in a human massacre situation. It appears that the treatment may have helped to prevent the development of chronic PTSD and to increase psychological and emotional resilience.

The Combat Experience Log: a web-based system for the in theater assessment of war zone stress

This article presents preliminary data on the Combat Experience Log (CEL)--a web-based prospective data collection system for the in theater assessment of war zone stressors and stress reactions. 177 U.S. Army soldiers deployed to Iraq took part in the study. The overall response rate was 90.1% and the majority of CEL responders perceived the CEL system to be quite easy and convenient to use, and relevant to their war-zone experiences. Preliminary data on stress reactions, CEL utilization and soldier satisfaction are encouraging and suggest that the CEL assessment system offers a potentially useful assessment tool for enhancing our understanding of war-zone stress experiences and their contribution to PTSD and other combat stress disorders.

The EMDR Protocol for Recent Critical Incidents: Brief Report of an Application in a Human Massacre Situation

This ongoing field study was conducted subsequent to the discovery of clandestine graves with 218 bodies recovered in the Mexican state of Durango in April 2011. A preliminary psychometric assessment was conducted with the 60 State Attorney General employees who were working with the corpses to establish a triage criterion and provide baseline measures. The Impact of Event Scale (IES) and the short posttraumatic stress disorder (PTSD) rating interview were administered, and the 32 individuals whose scores indicated moderate-to-severe posttraumatic stress and PTSD symptoms were treated with the eye movement desensitization and reprocessing (EMDR) Protocol for Recent Critical Incidents (EMDR-PRECI). Participants were assigned to two groups: immediate treatment (severe scores) and waitlist/delayed treatment (moderate scores). Each individual client session lasted between 90 and 120 minutes. Results showed that one session of EMDR-PRECI produced significant improvement on self-report measures of posttraumatic stress and PTSD symptoms for both the immediate treatment and waitlist/delayed treatment groups. This study provides preliminary evidence in support of the protocol’s efficacy in a natural setting of a human massacre situation to a group of traumatized adults working under extreme stressors. More controlled research is recommended to evaluate further the protocol’s efficacy.

Psychometric properties of the Korean version of the Short Post-Traumatic Stress Disorder Rating Interview (K-SPRINT)

AIMS

The Short Post-traumatic Stress Disorder (PTSD) Rating Interview (SPRINT) is a validated, eight-item, brief global assessment scale for PTSD. This report investigated the psychometric properties of the Korean version of the SPRINT (K-SPRINT).

METHODS

Eighty-seven PTSD patients, 47 other psychiatric patients, and 63 healthy control subjects were enrolled in the study. All subjects completed a psychometric assessment package that included the K-SPRINT and the Korean versions of the Clinician-Administered PTSD Scale (CAPS), the Beck Depression Inventory (BDI), and the State Trait Anxiety Inventory (STAI).

RESULTS

The K-SPRINT showed good internal consistency (Cronbach's alpha = 0.86) and test-retest reliability (r = 0.82). K-SPRINT showed moderatecorrelations with CAPS (r = 0.71). An exploratory factor analysis produced one K-SPRINT factor. The optimal diagnostic efficiency (91.9%) of the K-SPRINT was found at a total score of 15, at which point the sensitivity and specificity were 90.8% and 92.7%, respectively.

CONCLUSIONS

The present findings demonstrate that the K-SPRINT had good psychometric properties and can be used as a reliable and valid instrument for the assessment of PTSD.

Rating scales for anxiety/anxiety disorders

This article reviews new developments in rating scales for anxiety/anxiety disorders. Several new rating instruments have been developed. These instruments could be useful in various areas, such as research of anxiety disorders or in assessment of anxiety in patients with various somatic diseases (dyspnea, pain, chronic illnesses such as diabetes or cancer). Some of the existing instruments have been modified, shortened, or translated into other languages. Finally, psychometric properties of various rating scales for anxiety/anxiety disorders continue to be examined in various conditions and populations. In spite of all the development, there is no established standard in the area of measuring anxiety. However, a number of rating scales have become validated for measurement of severity of anxiety disorders.