Trauma exposure and posttraumatic reactions in a community sample of Bedouin members of the Israel Defense Forces

Pregnancy complications and intimate partner violence: The moderating role of prenatal posttraumatic stress symptoms

Intimate partner violence (IPV) and posttraumatic stress disorder increase the risk of poor pregnancy outcomes, but associations among IPV exposure, mental health, and pregnancy complications remain underexplored. This study assessed the interaction between three types of IPV exposure (i.e., physical, sexual, psychological) and posttraumatic stress symptoms (PTSS) on prenatal complications (e.g., preeclampsia, gestational diabetes) among pregnant women exposed to IPV. Participants included 137 IPV-exposed pregnant women (M_age = 27.29, SD = 6.00; 66.9% African American/Black). Three regression models were run to test the main effect of each type of IPV and PTSS on pregnancy complications, and the moderating effect of PTSS on the association between IPV and pregnancy complications, controlling for socioeconomic status, gestational age, and childhood trauma. Main effects were observed for sexual coercion, β = .32, p = .010, R² _part = .050, and PTSS, β = 0.19, p = .039, R² _part = .026, with more frequent sexual IPV and higher levels of PTSS associated with more pregnancy complications. Moderating effects were also evident, with the IPV x PTSS interaction significant for all three IPV domains: psychological aggression, f² = .046; sexual coercion, f² = .079; and physical assault, f² = .048. PTSS strengthened the positive association between psychological and sexual IPV and pregnancy complications. Physical IPV and pregnancy complications were inversely related for participants with low-level PTSS. Results provide novel information on how IPV types and PTSS function together during pregnancy. Findings highlight the need for evidence-based prenatal interventions that successfully address both IPV exposure and PTSS severity.

Functional impairment in Posttraumatic Stress Disorder: A systematic review and meta-analysis

Posttraumatic Stress Disorder (PTSD) is a serious and debilitating condition often associated with significant impairments in daily functioning. To date, research on the complexity of functional impairment in individuals with PTSD is scarce and only limited. Yet, a quantitative synthesis and comprehensive review of existing evidence is needed to better characterize the magnitude of functional impairment in PTSD in distinct domains. We conducted a systematic literature search including observational studies comparing functioning of individuals with and without PTSD. Random effects meta-analyses were performed for the different functional domains according to the WHO International Classification of Functioning, Disability and Health (ICF). The protocol followed the MOOSE guidelines for systematic reviews. A total of thirty-four studies comprising 14 206 participants were included in the study. Compared to healthy individuals, subjects with PTSD showed significant (ps < 0.001) impairments with large to very large effect sizes (ds > 1) in all domains. Subjects with, compared to without, PTSD showed significant (ps < 0.001) impairments with medium to large effect sizes (ds > 0.5) in the domains General Tasks and Demands, Mobility, Self Care, Domestic Life, Interpersonal Interactions and Relationships, Major Life Areas and Community, Social and Civic Life. Significant impairments with small to medium effect sizes in the same domains were observed comparing PTSD to other mental disorders. In conclusion, PTSD has a significant impact on most areas of daily functioning as conceptualized in the International Classification of Functioning, Disability and Health (ICF) of the WHO. Early detection and targeted treatment of functional deficits is warranted in this patient population.

Psychometric Properties of the Online Arabic Versions of BDI-II, HSCL-25, and PDS

Abstract. The Beck Depression Inventory (BDI-II), Hopkins Symptom Checklist (HSCL-25), and Posttraumatic Diagnostic Scale (PDS) are three widely applied clinical instruments for assessing depression, anxiety, and posttraumatic stress symptoms, respectively. Use of online-based psychological help and assessment is rapidly growing which necessitates the need for the validation of online assessment. To address these needs, data from 1,544 Arabic mother tongue treatment-seeking participants, who filled in the Arabic versions of these instruments online, was analyzed in two steps. In the first step, exploratory structural equation modeling (ESEM) was used to scrutinize factorial validity and eliminate items. In the second step, we examined the interrelationships between the latent factors (dimensions) using confirmatory factor analysis (CFA) of multitrait-multimethod (MTMM) data. Results show an acceptable to good fit of the hypothesized model, providing some first insights into the factorial and construct validity of the Arabic versions of BDI-II, HSCL-25, and PDS under consideration of cultural-specific aspects. Present evidence speaks for construct validity of the three instruments and the reliability and usefulness of online assessment.

Cultural Perspectives on the Aftereffects of Combat Trauma: Review of a Community Study of Bedouin IDF Servicemen and Their Families

Combat trauma may affect servicemen from indigenous, traditional communities in ways that warrant special attention. The Bedouins, who enlist in the Israel Defense Forces (IDF) voluntarily, represent a unique, closed, collectivist cultural minority, potentially in a predicament in light of ongoing sociopolitical events. This paper summarizes findings and lessons learned from a community study of Bedouin IDF servicemen and their families residing in Israel's Western Galilee. This is the only research endeavor to have addressed trauma exposure and posttraumatic reactions in this community. The sampling strategies and interview schedule were designed in consideration of participation barriers typical of hard-to-reach populations. Data collection followed an extended phase of liaising with key informants and building trust. Study limitations are discussed in terms of the challenges presented by this type of research. Interviews conducted with 317 men, 129 wives, and 67 mothers revealed high levels of trauma exposure and posttraumatic stress disorder (PTSD) in the men, and related distress in wives and mothers, but not in the children. The role of aggression in mediating the impact of PTSD and concepts such as shame, the loss of personal resources, and beliefs about retribution are highlighted as key issues for a culturally relevant understanding of traumatized indigenous communities.

Association of PTSD symptoms with asthma attacks among hurricane Katrina survivors

The relationship between posttraumatic stress disorder (PTSD) and asthma in the wake of natural disasters is poorly understood. Using pre- and postdisaster data (N = 405) from the Resilience in Survivors of Katrina (RISK) project, we examined associations between PTSD symptoms, measured by the Impact of Event Scale-Revised (IES-R), and self-reported postdisaster asthma attacks. A 1-point increase in the IES-R avoidance score, which corresponded to one standard deviation change in this sample, was associated with double the odds of reporting an asthma attack or episode since the hurricane, 95% CI Revise spacing among characters: [1.22, 4.16]. Association with hyperarousal and intrusion symptoms was null. Further research using objective measures of asthma morbidity is needed; nevertheless, these findings may help inform postdisaster health services delivery and predisaster mitigation planning.

A systematic review of the comorbidity between PTSD and alcohol misuse

PURPOSE

This systematic review aimed to assess (1) the level of comorbidity of post-traumatic stress disorder (PTSD) and alcohol misuse reported in research studies since 2007 and (2) any associations found between specific PTSD symptom clusters and alcohol misuse.

METHODS

A literature search was carried out to capture any papers published from 2007 to the end of July 2012. Six hundred and twenty abstracts were identified and reviewed, and 42 papers were included in the final review after applying inclusion and exclusion criteria.

RESULTS

The prevalence of comorbid alcohol misuse in those with PTSD ranged from 9.8 to 61.3 %. The prevalence of comorbid PTSD in those with alcohol misuse ranged from 2.0 to 63.0 %, and the majority of prevalence rates were over 10.0 %. Almost all of the odds ratios representing the strength of association between the conditions across a variety of populations were significant, and those ranged from 1.1 to 4.87. Of the different PTSD symptom clusters, this review found most evidence for associations between alcohol misuse and both avoidance/numbing symptoms and hyperarousal symptoms.

CONCLUSIONS

Given that comorbidity appears to be common, the evidence from this systematic review supports the use of routine screening for comorbidity in populations who are known to have PTSD or alcohol misuse.

Lifetime mania is related to post-traumatic stress symptoms in high school students exposed to the 2009 L'Aquila earthquake

BACKGROUND

Bipolar patients seem to be at high risk of trauma exposure and, when exposed, of PTSD. When comorbid, PTSD has shown a negative impact on the course of the bipolar illness. Conversely, a correlation between even manic symptoms and an increased risk for suicide has also been reported in PTSD patients. The aim of this study was to investigate the relationships between lifetime mood spectrum symptoms and PTSD in a sample of earthquake survivors.

METHODS

A total of 475 young adults who survived the L'Aquila 2009 earthquake, 21months earlier, were assessed by the Moods Spectrum-Self Report (MOODS-SR) and the Trauma and Loss Spectrum Self Report (TALS-SR).

RESULTS

Significantly higher MOODS-SR and TALS-SR domain scores were found in PTSD survivors compared to those without. The mood depressive (O.R.=1.17, 95% CI: 1.10-1.25), cognition depressive (O.R.=1.07, 95% CI: 1.01-1.14) and energy manic (O.R.=1.13, 95% CI: 1.02-1.25) MOODS-SR domains were significantly associated with an increased likelihood of PTSD.

CONCLUSIONS

Our data corroborate the strong relationship between mood disorder and PTSD highlighting a relationship between lifetime depressive and manic symptoms and PTSD, with a particular impact of the latter on the number of traumatic exposures and maladaptive behaviors.

The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review

The present meta-analysis systematically examined associations between physical health and posttraumatic stress disorder (PTSD)/PTSD symptoms (PTSS), as well as moderators of this relationship. Literature searches yielded 62 studies examining the impact of PTSD/PTSS on physical health-related quality of life (HR-QOL), general health symptoms, general medical conditions, musculoskeletal pain, cardio-respiratory (CR) symptoms, and gastrointestinal (GI) health. Sample-specific and methodological moderators were also examined. Results revealed significantly greater general health symptoms, general medical conditions, and poorer HR-QOL for PTSD and high PTSS individuals. PTSD/PTSS was also associated with greater frequency and severity of pain, CR, and GI complaints. Results of moderation analyses were mixed. However, consistent relationships emerged regarding PTSD assessment method, such that effect sizes were largest for self-reported PTSD/PTSS and all but one health outcome. Results highlight the need for prospective longitudinal examination of physical health shortly following trauma, and suggest variables to consider in the design of such studies.

Epidemiology of comorbid substance use and psychiatric disorders in Asia

PURPOSE OF REVIEW

Studying comorbidities between substance use disorders (SUDs) and psychiatric disorders in different regions is important from public health and heuristic perspectives. In this study we review recent studies conducted in Asian countries on these comorbidities.

RECENT FINDINGS

Comprehensive and methodologically sound studies conducted with focus on comorbidity between SUDs and psychiatric disorders are few and far between in Asian countries. Studies differ widely in their focus and methodological rigor. Some studies from China, Japan and Taiwan report fairly low rates of comorbidity of SUDs, particularly with illicit substances, among individuals with psychiatric disorders. Similar findings exist for rates of psychiatric disorders among those with SUDs. Recent research is lacking in several Asian countries on the issue of comorbidity.

SUMMARY

Interesting regional differences exist in the rates of comorbidity both across the Asian countries and between these countries and the west. Genetic and socio-cultural differences may be responsible for these differences. Methodologically sound, multicenter studies, involving several Asian countries, specifically examining the epidemiology of comorbidity between SUDs and psychiatric disorders, will have the potential to provide useful insights in this regard.

Political violence, psychological distress, and perceived health: A longitudinal investigation in the Palestinian Authority

One thousand one hundred and ninety six Palestinian adults living in the West Bank, Gaza Strip, and East Jerusalem were interviewed beginning in September 2007 and again at 6- and 12-month intervals. Using structural equation modeling, we focused on the effects of exposure to political violence, psychosocial and economic resource loss, and social support, on psychological distress, and the association of each of these variables on subjective health. Our proposed mediation model was partially supported. Exposure to political violence, psychosocial resource loss, and social support were related to subjective health, fully mediated by their relationship with psychological distress. Female sex and being older were also directly related to poorer subjective health and partially mediated via psychological distress. Greater economic resource loss, lower income, and poorer education were directly related to poor subjective health. An alternative model exploring subjective health as a mediator of psychological distress revealed that subjective health partially mediated the relationship between resource loss and psychological distress. The associate between female sex, education, income, and age on psychological distress were fully mediated by subjective health. Social support and exposure to political violence were directly related to psychological distress. These results were discussed in terms of the importance of resource loss on both mental and physical health in regions of chronic political violence and potential intervention strategies.

The association of traumatic experiences and posttraumatic stress disorder with health care utilization in the elderly - a German population based study

OBJECTIVE

Traumatic experiences (TE) and posttraumatic stress disorder (PTSD) are related to impaired mental and physical health and to increased health care utilization (HCU). However, general population studies simultaneously investigating the association of TE and PTSD with HCU in the elderly are lacking to date.

METHODS

A representative sample of 1456 people aged 60-85 years from the German general population was examined using self-rating instruments for TE, PTSD, HCU and physical health (PH).

RESULTS

In regression analyses including age and gender, TE are significantly associated with increased probability of visits to specialists and to mental health professionals, and of hospitalization, but not with the frequency of HCU. Current PTSD is significantly associated with increased probability of visits to mental health professionals and of hospitalization, and with increased frequency of general practitioner visits, of specialist visits, and of visits to mental health professionals. In two mediation models, the relationships between TE and PTSD, respectively, with HCU were weakened but remained significant after including PTSD and physical morbidity, respectively.

CONCLUSION

These results indicate that both trauma and PTSD are positively associated to some indicators of HCU. Posttraumatic stress disorder has a weak mediating role in the association of TE and HCU. Physical health has a weak mediating role in the association of PTSD and HCU.

Resource loss and posttraumatic responses in Bedouin members of the Israeli Defense Forces

This study examined the impact of exposure to traumatizing events in an ethnic minority group of Bedouin members of the Israel Defense Forces (N = 317). Guided by the conservation of resources (COR) theory (Hobfoll, 1988), the authors hypothesized that loss of resources would mediate the relationship between trauma and posttraumatic responses. We found that loss of personal resources (e.g., self-esteem, self-mastery) was the best predictor of psychological distress among traumatized Bedouin servicemen. Our findings suggest the significance of personal resources within collectivist communities in coping with trauma and maintaining resilience. This study contributes to the understanding of the ethnocultural aspects of trauma and the potential interventions that may be tailored for minority groups.

Bedouin wives on the home front: living with men serving in the Israel Defense Forces

This community-based study examined emotional and somatic symptoms of 129 Bedouin women whose husbands serve in the Israel Defense Forces. Wives of men diagnosed with posttraumatic stress disorder (PTSD) reported more symptoms than wives of men diagnosed with other disorders and wives of men with no diagnosis. Findings indicate that not only was PTSD in Bedouin servicemen positively associated with their wives' symptoms of posttraumatic stress and depression and somatic complaints, but that this relationship was fully mediated by husbands' aggression. Unraveling the special circumstances of women from traditional backgrounds faced with the devastating effects of husbands' combat-related posttraumatic pathology may inform an approach to the concept of vicarious trauma that is more specific to non-Western societies.