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Yang XJ, Meng XX, Zhang LB, Wang LL, Deng H, Yang YC, Zhou SJ. Mediating effects of insomnia and resilience on COVID-19-related post-traumatic stress disorder and quality of life in adolescents. Sci Rep 2024; 14:17969. [PMID: 39095413 DOI: 10.1038/s41598-024-69093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 07/31/2024] [Indexed: 08/04/2024] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has impaired the quality of life (QoL) for many due to its extensive impacts. However, few studies have addressed the specific impact of COVID-19 on the mental health of adolescents, particularly post-traumatic stress disorder (PTSD). This study considered the impact of COVID-19-related PTSD on the QoL of adolescents in China, the mediating effects of insomnia, and the moderating effects of resilience. Participants included 50,666 adolescents aged 12-18 years selected using a comprehensive sampling method. We performed data collection from January 8th to January 18th, 2023, using the Children's Revised Impact of Event Scale, Pittsburgh Sleep Quality Index, Ten-item Connor-Davidson Resilience Scale, and Screening for and Promotion of Health-related QoL in Children and Adolescents Questionnaire for data collection. Male adolescents exhibited significantly lower levels of PTSD and insomnia compared to females and scored significantly higher in psychological resilience and overall QoL. Insomnia played a mediating role between PTSD and QoL. Psychological resilience moderated the impact of COVID-19-related stress on adolescents' QoL through its influence on insomnia. PTSD resulting from the COVID-19 pandemic affects the QoL of adolescents through the presence of insomnia. Psychological resilience plays a moderating role in this process. Cultivating psychological resilience in adolescents can effectively enhance their ability to cope with the impacts of sudden public events.
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Affiliation(s)
- Xing-Jie Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China
| | - Xue-Xue Meng
- School of Psychology and Mental Health, North China University of Science and Technology, Hebei, China
| | - Li-Bin Zhang
- Collaborative Innovation Center of Assessment for Basic Education Quality, Beijing Normal University, Beijing, China
| | - Lei-Lei Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China
| | - Hu Deng
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China
| | - Yu-Chun Yang
- Faculty of Education, Beijing Normal University, Beijing, 100875, China.
| | - Shuang-Jiang Zhou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China.
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2
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Scheeringa MS. Is factor analysis useful for revising diagnostic criteria for PTSD? A systematic review of five issues ten years after DSM-5. J Psychiatr Res 2024; 176:98-107. [PMID: 38850584 DOI: 10.1016/j.jpsychires.2024.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Based on factor analysis research, DSM-5 revised the diagnostic criteria for posttraumatic stress disorder (PTSD) by increasing symptom clusters from three to four. AIMS To question whether that is an appropriate use of factor analysis. METHODS Reviewed the literature on five issues of factor analysis relevant to diagnostic criteria: (1) discovery of factors identical to symptom clusters, (2) consensus about the number of factors in best-fitting models, (3) configural variance between subpopulations to explain inconsistent model results, (4) methods to externally validate factors after discovery, and (5) treatment response of symptom clusters to externally validate factors. Two hundred four articles using DSM-IV or DSM-5 symptoms were included. RESULTS Two of four DSM-5 clusters were discovered with exploratory factor analysis. Support for a best-fitting model was inconsistent. Models with the highest number of factors were the best mathematical fit 87% of the time. Subpopulations did not reveal a pattern of configural variance to explain inconsistent findings. External validation of factors relied entirely on questionnaires. A review of 143 randomized controlled trials did not reveal differential treatment response of any symptom cluster. CONCLUSION Findings did not support the usefulness of factor analysis because the findings are too disparate to be helpful.
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Affiliation(s)
- Michael S Scheeringa
- Adjunct, Tulane University School of Medicine, Department of Psychiatry and Behavioral Sciences, New Orleans, LA, USA.
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3
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Levin-Aspenson HF, Greene AL. Rethinking trauma-related psychopathology in the Hierarchical Taxonomy of Psychopathology (HiTOP). J Trauma Stress 2024; 37:361-371. [PMID: 38270594 DOI: 10.1002/jts.23014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/17/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024]
Abstract
Research on trauma exposure and its consequences has made tremendous progress in elucidating the role of traumatic life events in the development and maintenance of psychopathology as well as in evaluating interventions aimed at addressing the personal and public burden of trauma-related psychopathology. However, there is growing concern that problems with predominant definitions of posttraumatic syndrome (e.g., content coverage and scope, within-category heterogeneity, excessive diagnostic comorbidity) limit further efforts to fully conceptualize trauma-related psychopathology and deliver appropriate, personalized interventions. As demonstrated by an impressive body of research over the past several years, the Hierarchical Taxonomy of Psychopathology (HiTOP) presents a compelling alternative to traditional nosologies in terms of empirically based characterizations of psychopathology phenotypes, with evidence of strong utility for research and clinical applications. However, HiTOP's primary focus on descriptive psychopathology has resulted in an unacceptable gap regarding the conceptualization of trauma-related psychopathology from a dimensional, transdiagnostic perspective. We see an important opportunity to clarify what HiTOP can offer the field of traumatic stress research and articulate a future for trauma-related psychopathology within HiTOP. We argue for disaggregating psychopathology symptoms from their purported causes and, instead, developing a detailed taxonomy of traumatic events alongside an ever-evolving HiTOP model. Doing so will help identify empirically based phenotypes of trauma-related psychopathology that (a) go beyond the traditional PTSD criterion sets and (b) allow for the possibility that different features of traumatic experiences (e.g., type, duration, subjective meaning) may be associated with different symptom sequelae across different psychopathology spectra.
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Affiliation(s)
| | - Ashley L Greene
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
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4
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Eilers R, Ertl V, Kasparik B, Kost A, Rosner R. [Posttraumatic stress disorder in children and adolescents: results of a cross-sectional study on the effects of the newly formulated PTSD and CPTSD diagnoses in the ICD-11]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:409-418. [PMID: 38498186 PMCID: PMC10995073 DOI: 10.1007/s00103-024-03860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND ICD-11 presents narrowed criteria for posttraumatic stress disorder (PTSD) and introduces complex PTSD (CPTSD) with additional difficulties in self-organization (DSO). These changes can have significant effects on the frequency of the diagnosis. The aim of this study was to investigate which ICD-11 symptom clusters cause children and adolescents to miss the diagnosis and whether caregivers are more likely to attribute changes in DSO to developmental level or to the traumatic event, and how these attributions are in turn related to symptom severity. METHODS N = 88 German-speaking children and adolescents (age: 7-17 years) after traumatic events and N = 79 caregivers participated between September 2019 and November 2020 in a survey on PTSD symptom severity (CATS-2) and attribution of DSO symptoms (caregiver questionnaire). RESULTS The ICD-11 criteria (CATS‑2 and a developmentally adapted version) showed lower frequency rates for PTSD as compared to DSM‑5 and ICD-10. The ICD-11 clusters re-experiencing and hyperarousal were met the least often. Changes in DSO symptoms were predominantly rated as event-related. This attribution was associated with higher PTSD and DSO symptom severity in caregiver reports. The age-related attribution was associated with higher DSO-symptom severity, but not PTSD symptom severity in caregiver reports. DISCUSSION In the context of the diagnostic process and the revision of diagnostic instruments for ICD-11 (C)PTSD, development-specific symptoms should be taken into account. The trauma-related differentiation of DSO symptom changes as compared to development-related fluctuations is challenging and therefore requires several sources of information.
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Affiliation(s)
- Rebekka Eilers
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Verena Ertl
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland.
- Katholische Universität Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Deutschland.
| | - Barbara Kasparik
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Anne Kost
- Altonaer Kinderkrankenhaus, Kinder- und Jugendsomatik, Hamburg, Deutschland
| | - Rita Rosner
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
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5
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Guo J, Orgeta V, Olivé I, Hoff E, Huntley J, Olff M, Sobczak S. Biomarkers associated with cognitive impairment in post-traumatic stress disorder: A systematic review of current evidence. Ageing Res Rev 2024; 95:102198. [PMID: 38237700 DOI: 10.1016/j.arr.2024.102198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This systematic review aimed at synthesizing current evidence on biomarkers associated with cognitive impairment (CI) in Post-Traumatic Stress Disorder (PTSD). METHODS A systematic literature search was conducted for studies assessing biomarkers associated with CI in PTSD. RESULTS Of the 10,149 titles screened, 8 studies met our inclusion criteria. In a single longitudinal study, MRI volumes, Aβ and tau accumulation were not associated with CI in PTSD. Studies on structural imaging reported no significant association between morphological changes and CI. Two studies on diffusion neuroimaging showed abnormalities in white matter tracts which were cross-sectionally associated with CI in PTSD. Similarly, lower resting-state functional connectivity in neocortical networks, and elevated tau in the neocortex were also cross sectionally associated with CI. Two single studies on biochemical biomarkers showed that sixteen novel plasma proteins and lower BDNF, indicative of genetic vulnerabilities associated with neural and synaptic dysfunctions commonly observed in neurodegeneration, were cross-sectionally associated with CI in PTSD. Overall, evidence is of low quality. CONCLUSIONS Longitudinal research utilizing large representative samples of trauma exposed populations are needed to establish the utility of specific biomarkers in monitoring cognitive decline in PTSD.
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Affiliation(s)
- Junling Guo
- Division of Psychiatry, University College London, London, United Kingdom
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, United Kingdom.
| | - Isadora Olivé
- Division of Psychiatry, University College London, London, United Kingdom
| | - Erik Hoff
- Department of Neurology, Zuyderland Medical Center, Heerlen, Sittard, the Netherlands
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, United Kingdom
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Neuroscience, & Amsterdam Public Health, Amsterdam, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | - Sjacko Sobczak
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Mondriaan Mental Health Center, Heerlen, Maastricht, the Netherlands; Rotterdam University of Applied Sciences (RUAS), Research Center Innovations in Care, Rotterdam, the Netherlands
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6
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Klein AB, Schnurr PP, Bovin MJ, Friedman MJ, Keane TM, Marx BP. An empirical investigation of definitions of subthreshold posttraumatic stress disorder. J Trauma Stress 2024; 37:113-125. [PMID: 37937636 DOI: 10.1002/jts.22987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
Subthreshold posttraumatic stress disorder (PTSD) has long been recognized as an important construct that identifies a subgroup of individuals who report significant PTSD symptoms and associated disability but do not endorse enough symptoms to meet the criteria for a full PTSD diagnosis. Different investigators have defined subthreshold PTSD in various ways, making it difficult to interpret findings across studies. To address this problem, we systematically compared individuals who met criteria for nine different subthreshold PTSD definitions with individuals diagnosed with either full PTSD or no PTSD (i.e., failed to meet the criteria for a subthreshold definition) with respect to prevalence and associated clinical outcomes of interest. Participants were 1,082 veterans enrolled in the Veterans After Discharge Longitudinal Registry. PTSD and subthreshold PTSD diagnostic status were determined using the Structured Clinical Interview for DSM-5 (SCID-5) and validated self-report instruments were used to assess clinical outcomes. Across outcomes, subthreshold definitions generally identified a group of participants that was distinguishable from participants in both the PTSD and no PTSD groups, rs = .02-.47. We discuss the benefits and drawbacks of various subthreshold definitions and highlight the need for additional work evaluating these definitions across additional outcomes and samples. In the interim, we propose a working case definition of subthreshold PTSD as meeting any three of the four DSM-5 symptom criteria (i.e., Criteria B, C, D, and E) along with Criterion A and Criteria F-H. The results suggest subthreshold PTSD is a clinically meaningful construct.
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Affiliation(s)
- Alexandra B Klein
- Mental Health Service, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, California, USA
| | - Paula P Schnurr
- Executive Division, National Center for PTSD, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Michelle J Bovin
- Behavioral Sciences Division, National Center for PTSD, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Matthew J Friedman
- Executive Division, National Center for PTSD, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Terence M Keane
- Behavioral Sciences Division, National Center for PTSD, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Brian P Marx
- Behavioral Sciences Division, National Center for PTSD, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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7
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Marx BP, Hall-Clark B, Friedman MJ, Holtzheimer P, Schnurr PP. The PTSD Criterion A debate: A brief history, current status, and recommendations for moving forward. J Trauma Stress 2024; 37:5-15. [PMID: 38123526 DOI: 10.1002/jts.23007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
Posttraumatic stress disorder (PTSD) Criterion A, also known as the "stressor criterion," has been a major source of debate ever since PTSD was added to the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM) in 1980. Since then, the traumatic stress field has held an ongoing debate about how to best define Criterion A and the events that it covers. Because of the COVID-19 pandemic and recent race-based incidents, the Criterion A debate has been reinvigorated. In this paper, we review briefly the history of Criterion A and changes in its language across different editions of the DSM. We then describe the four main positions held by scholars involved in the Criterion A debate and carefully examine the support for those positions. We conclude by offering recommendations for moving forward.
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Affiliation(s)
- Brian P Marx
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Brittany Hall-Clark
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
- National Center for PTSD, Executive Division, White River Junction, Vermont, USA
| | - Matthew J Friedman
- National Center for PTSD, Executive Division, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, USA
| | - Paul Holtzheimer
- National Center for PTSD, Executive Division, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, USA
| | - Paula P Schnurr
- National Center for PTSD, Executive Division, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, USA
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8
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Suarez-Jimenez B, Lazarov A, Zhu X, Zilcha-Mano S, Kim Y, Marino CE, Rjabtsenkov P, Bavdekar SY, Pine DS, Bar-Haim Y, Larson CL, Huggins AA, Terri deRoon-Cassini, Tomas C, Fitzgerald J, Kennis M, Varkevisser T, Geuze E, Quidé Y, El Hage W, Wang X, O’Leary EN, Cotton AS, Xie H, Shih C, Disner SG, Davenport ND, Sponheim SR, Koch SB, Frijling JL, Nawijn L, van Zuiden M, Olff M, Veltman DJ, Gordon EM, May G, Nelson SM, Jia-Richards M, Neria Y, Morey RA. Intrusive Traumatic Re-Experiencing Domain: Functional Connectivity Feature Classification by the ENIGMA PTSD Consortium. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:299-307. [PMID: 38298781 PMCID: PMC10829610 DOI: 10.1016/j.bpsgos.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 02/02/2024] Open
Abstract
Background Intrusive traumatic re-experiencing domain (ITRED) was recently introduced as a novel perspective on posttraumatic psychopathology, proposing to focus research of posttraumatic stress disorder (PTSD) on the unique symptoms of intrusive and involuntary re-experiencing of the trauma, namely, intrusive memories, nightmares, and flashbacks. The aim of the present study was to explore ITRED from a neural network connectivity perspective. Methods Data were collected from 9 sites taking part in the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) PTSD Consortium (n= 584) and included itemized PTSD symptom scores and resting-state functional connectivity (rsFC) data. We assessed the utility of rsFC in classifying PTSD, ITRED-only (no PTSD diagnosis), and trauma-exposed (TE)-only (no PTSD or ITRED) groups using a machine learning approach, examining well-known networks implicated in PTSD. A random forest classification model was built on a training set using cross-validation, and the averaged cross-validation model performance for classification was evaluated using the area under the curve. The model was tested using a fully independent portion of the data (test dataset), and the test area under the curve was evaluated. Results rsFC signatures differentiated TE-only participants from PTSD and ITRED-only participants at about 60% accuracy. Conversely, rsFC signatures did not differentiate PTSD from ITRED-only individuals (45% accuracy). Common features differentiating TE-only participants from PTSD and ITRED-only participants mainly involved default mode network-related pathways. Some unique features, such as connectivity within the frontoparietal network, differentiated TE-only participants from one group (PTSD or ITRED-only) but to a lesser extent from the other group. Conclusions Neural network connectivity supports ITRED as a novel neurobiologically based approach to classifying posttrauma psychopathology.
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Affiliation(s)
- Benjamin Suarez-Jimenez
- Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Amit Lazarov
- Department of Clinical Psychology, School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York
| | - Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York
| | - Sigal Zilcha-Mano
- Department of Psychology, University of Haifa, Mount Carmel, Haifa, Israel
| | - Yoojean Kim
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Claire E. Marino
- Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Pavel Rjabtsenkov
- Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Shreya Y. Bavdekar
- Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Daniel S. Pine
- Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, Maryland
| | - Yair Bar-Haim
- Department of Clinical Psychology, School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | - Mitzy Kennis
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tim Varkevisser
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elbert Geuze
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yann Quidé
- School of Psychology, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Wissam El Hage
- Unité Mixte de Recherche 1253, Institut National de la Santé et de la Recherche Médicale, Université de Tours, Tours, France
- Centre d'investigation Clinique 1415, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Xin Wang
- University of Toledo, Toledo, Ohio
| | | | | | - Hong Xie
- University of Toledo, Toledo, Ohio
| | | | - Seth G. Disner
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | | | | | - Saskia B.J. Koch
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Jessie L. Frijling
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Laura Nawijn
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | - Dick J. Veltman
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Evan M. Gordon
- Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Geoffery May
- VISN 17 Center of Excellence for Research on Returning War Veterans, U.S. Department of Veterans Affairs, Waco, Texas
| | - Steven M. Nelson
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | | | - Yuval Neria
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York
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9
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Dyab R, Zuccarella-Hackl C, Princip M, Sivakumar S, Meister-Langraf RE, Znoj H, Schmid JP, Barth J, Schnyder U, von Känel R, Gidron Y. Role of Heart Rate Variability in the Association between Myocardial Infarction Severity and Post-Myocardial Infarction Distress. Life (Basel) 2023; 13:2266. [PMID: 38137867 PMCID: PMC10744743 DOI: 10.3390/life13122266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Myocardial infarction (MI) results in mental health consequences, including depression and post-traumatic stress disorder (PTSD). The risk and protective factors of such mental consequences are not fully understood. This study examined the relation between MI severity and future mental health consequences and the moderating role of vagal nerve activity. METHODS In a reanalysis of data from the Myocardial Infarction-Stress Prevention Intervention (MI-SPRINT) study, 154 post-MI patients participated. MI severity was measured by the Killip Scale and by troponin levels. Depression and PTSD symptoms were assessed with valid questionnaires, both at 3 and 12 months. Vagal nerve activity was indexed by the heart rate variability (HRV) parameter of the root-mean square of successive R-R differences (RMSSD). Following multivariate analyses, the association between MI severity and distress was examined in patients with low and high HRV (RMSSD = 30 ms). RESULTS In the full sample, the Killip index predicted post-MI distress only at 3 months, while troponin predicted distress at 3- and 12-months post-MI. However, HRV moderated the effects of the Killip classification; Killip significantly predicted symptoms of depression and PTSD at 3- and 12-months post-MI, but only in patients with low HRV. Such moderation was absent for troponin. CONCLUSION MI severity (Killip classification) predicted post-MI depression and PTSD symptoms, but only in patients with low HRV, suggesting that the vagal nerve is a partial protective (moderating) factor in the relation between Killip score and post-MI distress.
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Affiliation(s)
- Reham Dyab
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, The University of Haifa, Haifa 3498838, Israel
- Lady Davis Carmel Medical Center, Haifa 3436212, Israel
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
| | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
| | - Sinthujan Sivakumar
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
| | - Rebecca E. Meister-Langraf
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
- Faculty of Medicine, University of Zürich, 8006 Zurich, Switzerland;
- Clienia Schlössli AG, 8618 Oetwil am See, Switzerland
| | - Hansjörg Znoj
- Department of Clinical Psychology and Psychotherapy, University of Bern, 3012 Bern, Switzerland;
| | - Jean-Paul Schmid
- Department of Internal Medicine and Cardiology, Clinic Gais AG, 9056 Gais, Switzerland;
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zürich, University of Zürich, 8006 Zurich, Switzerland;
| | - Ulrich Schnyder
- Faculty of Medicine, University of Zürich, 8006 Zurich, Switzerland;
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
- Faculty of Medicine, University of Zürich, 8006 Zurich, Switzerland;
| | - Yori Gidron
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, The University of Haifa, Haifa 3498838, Israel
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van Sleeuwen C, van Zuiden M, Koch SBJ, Frijling JL, Veltman DJ, Olff M, Nawijn L. How does it feel? An exploration of neurobiological and clinical correlates of alexithymia in trauma-exposed police-officers with and without PTSD. Eur J Psychotraumatol 2023; 14:2281187. [PMID: 38154073 PMCID: PMC10990451 DOI: 10.1080/20008066.2023.2281187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/25/2023] [Indexed: 12/30/2023] Open
Abstract
Background: Alexithymia, an inability to recognise one's emotions, has been associated with trauma-exposure and posttraumatic stress disorder (PTSD). Previous research suggests involvement of the oxytocin system, and socio-emotional neural processes. However, the paucity of neurobiological research on alexithymia, particularly in trauma-exposed populations, warrants further investigation.Objective: Explore associations between alexithymia, endogenous oxytocin levels, and socio-emotional brain function and morphometry in a trauma-exposed sample.Method: Dutch trauma-exposed police officers with (n = 38; 18 females) and without PTSD (n = 40; 20 females) were included. Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20). Endogenous salivary oxytocin was assessed during rest, using radioimmunoassay. Amygdala and insula reactivity to socio-emotional stimuli were assessed with functional MRI, amygdala and insula grey matter volume were derived using Freesurfer.Results: Alexithymia was higher in PTSD patients compared to trauma-exposed controls (F(1,70) = 54.031, p < .001). Within PTSD patients, alexithymia was positively associated with PTSD severity (ρ(36) = 0.497, p = .002). Alexithymia was not associated with childhood trauma exposure (β = 0.076, p = .509), police work-related trauma exposure (β = -0.107, p = .355), oxytocin levels (β = -0.164, p = .161), insula (β = -0.170, p = .158) or amygdala (β = -0.175, p = .135) reactivity, or amygdala volume (β = 0.146, p = .209). Insula volume was positively associated with alexithymia (β = 0.222, p = .016), though not significant after multiple testing corrections. Bayesian analyses supported a lack of associations.Conclusions: No convincing neurobiological correlates of alexithymia were observed with any of the markers included in the current study. Yet, the current study confirmed high levels of alexithymia in PTSD patients, independent of trauma-exposure, substantiating alexithymia's relevance in the clinical phenotype of PTSD.
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Affiliation(s)
- Cindy van Sleeuwen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Saskia B. J. Koch
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Jessie L. Frijling
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, the Netherlands
| | - Dick J. Veltman
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Arq National Psychotrauma Centre, Diemen, the Netherlands
| | - Laura Nawijn
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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11
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Sawalma AS, Kiefer CM, Boers F, Shah NJ, Khudeish N, Neuner I, Herzallah MM, Dammers J. The effects of trauma on feedback processing: an MEG study. Front Neurosci 2023; 17:1172549. [PMID: 38027493 PMCID: PMC10651751 DOI: 10.3389/fnins.2023.1172549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The cognitive impact of psychological trauma can manifest as a range of post-traumatic stress symptoms that are often attributed to impairments in learning from positive and negative outcomes, aka reinforcement learning. Research on the impact of trauma on reinforcement learning has mainly been inconclusive. This study aimed to circumscribe the impact of psychological trauma on reinforcement learning in the context of neural response in time and frequency domains. Two groups of participants were tested - those who had experienced psychological trauma and a control group who had not - while they performed a probabilistic classification task that dissociates learning from positive and negative feedback during a magnetoencephalography (MEG) examination. While the exposure to trauma did not exhibit any effects on learning accuracy or response time for positive or negative feedback, MEG cortical activity was modulated in response to positive feedback. In particular, the medial and lateral orbitofrontal cortices (mOFC and lOFC) exhibited increased activity, while the insular and supramarginal cortices showed decreased activity during positive feedback presentation. Furthermore, when receiving negative feedback, the trauma group displayed higher activity in the medial portion of the superior frontal cortex. The timing of these activity changes occurred between 160 and 600 ms post feedback presentation. Analysis of the time-frequency domain revealed heightened activity in theta and alpha frequency bands (4-10 Hz) in the lOFC in the trauma group. Moreover, dividing the two groups according to their learning performance, the activity for the non-learner subgroup was found to be lower in lOFC and higher in the supramarginal cortex. These differences were found in the trauma group only. The results highlight the localization and neural dynamics of feedback processing that could be affected by exposure to psychological trauma. This approach and associated findings provide a novel framework for understanding the cognitive correlates of psychological trauma in relation to neural dynamics in the space, time, and frequency domains. Subsequent work will focus on the stratification of cognitive and neural correlates as a function of various symptoms of psychological trauma. Clinically, the study findings and approach open the possibility for neuromodulation interventions that synchronize cognitive and psychological constructs for individualized treatment.
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Affiliation(s)
- Abdulrahman S. Sawalma
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
| | - Christian M. Kiefer
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Mathematics, Computer Science and Natural Sciences, RWTH Aachen University, Aachen, Germany
| | - Frank Boers
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - N. Jon Shah
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Institute of Neuroscience and Medicine (INM-11), Jülich Aachen Research Alliance (JARA), Forschungszentrum Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)-Brain – Translational Medicine, Aachen, Germany
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Nibal Khudeish
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Irene Neuner
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)-Brain – Translational Medicine, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Mohammad M. Herzallah
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, United States
| | - Jürgen Dammers
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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12
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Russell JD, Heyn SA, Herringa RJ. Through a Developmental Lens: Emerging Insights to Understand and Treat Pediatric PTSD. Am J Psychiatry 2023; 180:636-644. [PMID: 37654114 PMCID: PMC10636806 DOI: 10.1176/appi.ajp.20230523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Justin D Russell
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
| | - Sara A Heyn
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
| | - Ryan J Herringa
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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13
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Joshi SA, Aupperle RL, Khalsa SS. Interoception in Fear Learning and Posttraumatic Stress Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:266-277. [PMID: 37404967 PMCID: PMC10316209 DOI: 10.1176/appi.focus.20230007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a psychiatric condition characterized by sustained symptoms, including reexperiencing, hyperarousal, avoidance, and mood alterations, following exposure to a traumatic event. Although symptom presentations in PTSD are heterogeneous and incompletely understood, they likely involve interactions between neural circuits involved in memory and fear learning and multiple body systems involved in threat processing. PTSD differs from other psychiatric conditions in that it is a temporally specific disorder, triggered by a traumatic event that elicits heightened physiological arousal, and fear. Fear conditioning and fear extinction learning have been studied extensively in relation to PTSD, because of their central role in the development and maintenance of threat-related associations. Interoception, the process by which organisms sense, interpret, and integrate their internal body signals, may contribute to disrupted fear learning and to the varied symptom presentations of PTSD in humans. In this review, the authors discuss how interoceptive signals may serve as unconditioned responses to trauma that subsequently serve as conditioned stimuli, trigger avoidance and higher-order conditioning of other stimuli associated with these interoceptive signals, and constitute an important aspect of the fear learning context, thus influencing the specificity versus generalization of fear acquisition, consolidation, and extinction. The authors conclude by identifying avenues for future research to enhance understanding of PTSD and the role of interoceptive signals in fear learning and in the development, maintenance, and treatment of PTSD.
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Affiliation(s)
- Sonalee A Joshi
- Laureate Institute for Brain Research, Tulsa, Oklahoma (all authors); Department of Psychology, University of Michigan, Ann Arbor (Joshi); Oxley College of Health Sciences, School of Community Medicine, University of Tulsa, Tulsa (Aupperle, Khalsa)
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, Oklahoma (all authors); Department of Psychology, University of Michigan, Ann Arbor (Joshi); Oxley College of Health Sciences, School of Community Medicine, University of Tulsa, Tulsa (Aupperle, Khalsa)
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma (all authors); Department of Psychology, University of Michigan, Ann Arbor (Joshi); Oxley College of Health Sciences, School of Community Medicine, University of Tulsa, Tulsa (Aupperle, Khalsa)
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14
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Grzymała-Moszczyńska H, Różańska-Mglej M. Challenges for the Mental Health of Refugee Artists: Perspectives of the ADAPT Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095694. [PMID: 37174214 PMCID: PMC10178664 DOI: 10.3390/ijerph20095694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
This study aimed to address the mental health challenges faced by refugee artists who are grantees of ICORN-the International Cities of Refuge Network-from the perspective of the extended conceptual ADAPT model. The study employed exploratory qualitative research, and data were collected through semi-structured interviews with ICORN artists in Poland, Norway, and Sweden. For data analysis, Interpretive Phenomenological Analysis (IPA) was used, whereas for the presentation of the results, the framework of the ADAPT model was applied. The results showed that the super-ordinate themes that emerged from the IPA analysis related directly to the ADAPT model and could mostly be assigned to its basic pillars: (1) Security; (2) Bonds and Networks; (3) Justice; (4) Roles and Identities; and (5) Existential Meaning. However, the model was insufficient for capturing the full diversity of experiences described by the respondents. Therefore, an extension of the model in the form of two additional pillars, Art and Body and Mind, was proposed. The findings confirm that the ADAPT model is adequate for systematizing and depicting in detail the experiences of migrants/refugees. However, further modifications of the model are necessary, particularly the additional pillar Body and Mind, which has the potential to become a separate category in other migrants'/refugees' assessment frameworks. Moreover, Art itself could be seen as a universal bridging factor between the refugee and the host population, contributing to the refugees' adaptation to the host society.
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Affiliation(s)
- Halina Grzymała-Moszczyńska
- Department for the Psychology of Religion and Spirituality, Institute of Psychology, Jesuit University Ignatianum, 31-501 Kraków, Poland
| | - Małgorzata Różańska-Mglej
- Faculty of Philosophy, Institute of Religious Studies, Jagiellonian University, 31-044 Kraków, Poland
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15
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Yimer GM, Adem YF, Haile Y. Determinants of post-traumatic stress disorder among survivors of road traffic accidents in dessie comprehensive specialized hospital North-East Ethiopia. BMC Psychiatry 2023; 23:218. [PMID: 36997932 PMCID: PMC10064700 DOI: 10.1186/s12888-023-04673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/12/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder is the most common mental disorder occurring among survivors of road traffic accidents. However, it remains under-explored and is not taken into account in the health policies of Ethiopia. Therefore, this study aimed to identify determinant factors of post-traumatic stress disorder among survivors of road traffic accident patients in Dessie Comprehensive Specialized Hospital, North-East Ethiopia. METHODS A facility-based unmatched case-control study design was employed from February 15 to April 25, 2021, in Dessie Comprehensive Specialized Hospital, with a total sample size of 139 cases and 280 controls selected by using a simple random sampling technique. Data were collected by pretested, interview with a structured questionnaire. The data were entered using Epi-Info, then exported and analyzed using STATA. The bi-variable and multivariable binary logistic regression model was used to identify determinant factors of post-traumatic stress disorder among survivors of road traffic accident. Adjusted odds ratio with a 95% confidence level was used as a measure of association. Variables with a p-value less than 0.05 were considered as statistically significant. RESULT A total of 135 cases and 270 controls participated in this study, with a response rate of 97% and 96%, respectively. In the final multivariable analysis, being male [AOR = 0.43, 95% CI: 0.32-0.99], primary educational status [AOR = 3.4, 95% CI: 1.04-11], presence of personal psychiatric history [AOR = 2.12, 95% CI: 1.17-3.92], presence of fracture [AOR = 2.41, 95% CI: 1.2-4.8], witness of death [AOR = 2.25, 95% CI: 1.26-4.30], presence of comorbidity [AOR = 2.29, 95% CI: 1.28-4], good social support [AOR = 0.71, 95% CI: 0.12-0.68] were significantly associated with post-traumatic stress disorder among survivors of road traffic accident patients. CONCLUSION PTSD following road traffic accidents is common. A multi-disciplinary approach was therefore essential in the management of road traffic accident survivors at the orthopedic and trauma clinics. Patients with poor social support, bone fracture, witnessed death, comorbidity, and females should be routinely screened for post-traumatic stress disorder in all road traffic accident survivors.
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Affiliation(s)
- Geleta Mussa Yimer
- Department of Epidemiology and Biostatics', School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yonas Fissha Adem
- Department of Public Health, Dessie College of Health Sciences, P.O.Box: 1212, Dessie, Ethiopia.
| | - Yosef Haile
- Department of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
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16
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Li Q, Wang C, Hu J, Jiao W, Tang Z, Song X, Wu Y, Dai J, Gao P, Du L, Jin Y. Cannabidiol-loaded biomimetic macrophage membrane vesicles against post-traumatic stress disorder assisted by ultrasound. Int J Pharm 2023; 637:122872. [PMID: 36958611 DOI: 10.1016/j.ijpharm.2023.122872] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/03/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
Post-traumatic stress disorder (PTSD), which normally follows psychological trauma, has been increasingly studied as a brain disease. However, the blood-brain barrier (BBB) prevents conventional drugs for PTSD from entering the brain. Our previous studies proved the effectiveness of cannabidiol (CBD) against PTSD, but low water solubility, low brain targeting efficiency and poor bioavailability restricted its applications. Here, a bionic delivery system, camouflage CBD-loaded macrophage-membrane nanovesicles (CMNVs), was constructed via co-extrusion of CBD with macrophage membranes, which had inflammatory and immune escape properties. In vitro anti-inflammatory, cellular uptake and pharmacokinetic experiments respectively verified the anti-inflammatory, inflammatory targeting and immune escape properties of CMNVs. Brain targeting and excellent anti-PTSD effects of CMNVs had been validated in vivo by imaging and pharmacodynamics studies. In our study, the potential of ultrasound to open BBBs and improve the brain-targeted delivery of CBD was evaluated. In conclusion, this cell membrane bionic delivery system assisted with ultrasound had good therapeutic effect against PTSD mice, which is expected to help convey CBD to inflammatory areas within the brain and alleviate the symptoms of PTSD.
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Affiliation(s)
- Qi Li
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, China; Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Chunqing Wang
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, China; Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Jinglu Hu
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, China; Pharmaceutical College, Henan University, Kaifeng 475004, China
| | - Wencheng Jiao
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, China; Pharmaceutical College, Hebei University, Baoding 071000, China
| | - Ziyan Tang
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Xingshuang Song
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, China; Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Yanping Wu
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, China; Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Jing Dai
- Information Department, General Hospital of Western Theater Command, Chengdu 610083, China
| | - Peng Gao
- R&D Institute, Shandong University of Traditional Chinese Medicine, Jinan 250355, China.
| | - Lina Du
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, China; Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; Pharmaceutical College, Henan University, Kaifeng 475004, China; Pharmaceutical College, Hebei University, Baoding 071000, China.
| | - Yiguang Jin
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; Pharmaceutical College, Henan University, Kaifeng 475004, China
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17
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TRAUMA AND THE DISRUPTION OF TEMPORAL EXPERIENCE: A PSYCHOANALYTICAL AND PHENOMENOLOGICAL PERSPECTIVE. Am J Psychoanal 2023; 83:36-55. [PMID: 36918715 DOI: 10.1057/s11231-023-09395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
A deep understanding of the subjective experience of time in traumatized individuals may require a comprehensive framework that takes into account both psychoanalytic and phenomenological contributions. Referring to the retroactive interpretation of past experiences, the concept of Nachträglichkeit is critical to analyze how trauma can be signified in the form of the après-coup, in which the original traces of traumatic experiences are signified only at a later time. Trauma alters the temporal sequence of past, present, and future, thus leaving the psyche in a time-shifted dimension, where the shadow of the past extends over the present, and the unbearable present hinders growth and development. A clinical vignette is presented to illustrate how trauma can disrupt the temporal nature of subjective experience by reshaping the meaning of psychic events. Ultimately, trauma treatment aims at inscribing the person's experience into a unified and coherent self-narrative.
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18
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Forkus SR, Raudales AM, Rafiuddin HS, Weiss NH, Messman BA, Contractor AA. The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5: A Systematic Review of Existing Psychometric Evidence. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2023; 30:110-121. [PMID: 37378352 PMCID: PMC10292741 DOI: 10.1037/cps0000111] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
The PTSD Checklist for DSM-5 (PCL-5) is a widely used self-rated measure of DSM-5 PTSD symptoms. The goal of this systematic review was to synthesize research on the psychometric properties of the PCL-5 to guide clinical and research applications. We focused on reliability, validity, factor structure, optimal cutoff scores, and sensitivity to clinical change indices. A systematic review of the literature following PRISMA guidelines was conducted using PubMed, PsycINFO, CINAHL, and PTSDpubs with search terms capturing selected psychometric indices of the PCL-5. The inclusion criteria were: peer-reviewed publication in English; primary focus on the PCL-5 psychometrics; empirical study; and study with adult samples. The search yielded 265 studies; 56 papers (amounting to 64 studies) met inclusion criteria and were reviewed. Findings generally indicated evidence for: acceptable internal consistency and test-retest reliability; construct validity; a 7-factor Hybrid Model; recommended cutoff scores between 31-33; and ability to index sensitivity to clinical change. To further advance knowledge and applications of the PCL-5, we need more research on abbreviated versions of the PCL-5, bifactor modeling as applied to the PCL-5, as well as on PCL-5 item difficulty estimates, discrimination parameters, and clinical change score estimates.
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Affiliation(s)
| | | | | | - Nicole H. Weiss
- Department of Psychology, University of Rhode Island, RI, USA
| | - Brett A. Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
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Matson LA, Moeck EK, Takarangi MKT. Disgust and fear reactions uniquely affect intrusions and posttraumatic stress symptoms. J Anxiety Disord 2023; 95:102683. [PMID: 36870275 DOI: 10.1016/j.janxdis.2023.102683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/23/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023]
Abstract
Disgust reactions commonly occur during/following trauma and predict posttraumatic stress (PTS) symptoms. Yet, disgust is not mentioned in DSM-5 PTSD criteria. To investigate disgust's clinical significance in PTSD, we measured the relationship between disgust (and fear) reactions to a personal trauma, and problematic intrusion characteristics (e.g., distress) and intrusion symptom severity. We focused on intrusions because they are a transdiagnostic PTSD symptom, though we also measured overall PTS symptoms to replicate prior work. Participants (N = 471) recalled their most traumatic/stressful event from the past six months. They then rated disgust and fear reactions to this event and completed the Posttraumatic Stress Disorder Checklist-5. Participants who had experienced intrusions about their event in the past month (n = 261) rated these intrusions on several characteristics (e.g., distress, vividness). We found stronger traumatic event-related disgust reactions were associated with more problematic intrusion characteristics, higher intrusion symptom severity, and higher overall PTS symptom severity. Notably, disgust reactions uniquely predicted these variables after statistically controlling for fear reactions. We conclude disgust reactions to trauma may be similarly pathological to fear reactions for intrusion and broader PTS symptoms. Therefore, PTSD diagnostic manuals and treatments should recognize disgust as a trauma-relevant emotion.
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Affiliation(s)
- Lucy A Matson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Ella K Moeck
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melanie K T Takarangi
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.
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20
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Leung T, Yang T, Xiao L, Xu C, Zhu C. Effects of Mobile Mindfulness Meditation on the Mental Health of University Students: Systematic Review and Meta-analysis. J Med Internet Res 2023; 25:e39128. [PMID: 36596239 PMCID: PMC9856434 DOI: 10.2196/39128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Mobile mindfulness meditation (MMM) is a mindfulness meditation intervention implemented using mobile devices such as smartphones and apps. MMM has been used to help manage the mental health of university students. OBJECTIVE This study aims to evaluate the effectiveness of MMM on the mental health of university students in the areas of stress, anxiety, depression, mindfulness, well-being, and resilience. METHODS We conducted a systematic review and meta-analysis of the effectiveness of MMM on the mental health of university students. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic literature search was performed on PubMed, Web of Science, EBSCO, Cochrane Library, and Embase databases, from inception to July 16, 2021. This study was conducted to identify studies that reported the effects of MMM on the primary outcomes including stress, anxiety, and depression, and on the secondary outcomes including mindfulness, well-being, and resilience. Two reviewers retrieved articles, evaluated quality, and extracted data independently. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Standardized mean differences (SMDs) for continuous outcomes and risk ratios for dichotomous outcomes were calculated. Sensitivity analyses and subgroup analyses were performed for results with high heterogeneity. The RevMan version 5.3 was used to perform meta-analysis. RESULTS A total of 10 studies, including 958 university students, were selected for this meta-analysis. Results of the primary outcome showed that the MMM groups were more effective than the control groups in decreasing stress (SMD -0.41, 95% CI -0.59 to -0.23; P<.001) and alleviating anxiety (SMD -0.29, 95% CI -0.50 to -0.09; P=.004). However, there was no difference between the MMM groups and the control groups in depression (SMD -0.14, 95% CI -0.30 to 0.03; P=.11). The use of either waitlist control or traditional face-to-face intervention in the control group was identified as the source of heterogeneity. Specifically, the waitlist control subgroup (SMD -0.33, 95% CI -0.53 to -0.13; P=.002) was superior when compared with the face-to-face subgroup (SMD 0.29, 95% CI -0.01 to 0.59; P=.06). Results of the secondary outcome showed that the MMM groups were more effective than the control groups in enhancing well-being (SMD 0.30, 95% CI 0.11-0.50; P=.003) and improving mindfulness (SMD 2.66, 95% CI 0.77-4.55; P=.006). Whether commercial sponsorship was obtained was considered as the source of heterogeneity. The "without company support" group (SMD 17.60, 95% CI 11.32-23.87; P<.001) was superior to the "with company support" group (SMD 1.17, 95% CI -0.82 to 3.15; P=.25) in raising the level of mindfulness. However, there was no difference between the MMM and control groups in resilience (SMD -0.06, 95% CI -0.26 to 0.15; P=.59). The evidence level of the results from the 10 studies was determined to be moderate to low. CONCLUSIONS MMM was an effective method to reduce stress and anxiety, and to increase the well-being and mindfulness of university students. However, further studies are needed to confirm our findings. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022303585; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=303585.
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Affiliation(s)
| | - Ting Yang
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Lei Xiao
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Changxia Xu
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chunqin Zhu
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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21
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Rossi AA, Panzeri A, Taccini F, Parola A, Mannarini S. The Rising of the Shield hero. Development of the Post-Traumatic Symptom Questionnaire (PTSQ) and Assessment of the Protective Effect of self-esteem from trauma-related Anxiety and Depression. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 17:1-19. [PMID: 36532142 PMCID: PMC9734448 DOI: 10.1007/s40653-022-00503-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
Background Adverse life events such as life-threatening accidents, domestic and/or sexual violence, organic diseases (i.e., cancer), or COVID-19 can have a strong traumatic impact - generating reactions as intrusive thoughts, hyperarousal, and avoidance. Indeed, the traumatic impact of COVID-19 seems to lead individuals to experience anxiety and depression. However, the Anxiety-Buffer Hypothesis suggests that self-esteem could be considered a shield (buffer) against traumatic experiences and their outcomes (i.e., anxiety and depression). The present study has two objectives. First, to develop a measure of the impact of the traumatic event considering the aforementioned reactions. Second, to test the process - triggered by COVID19-related traumatic experience - in which self-esteem buffers the path that leads to anxiety and depression. Method In Study 1 (N = 353), the Post-Traumatic Symptom Questionnaire (PTSQ) was developed and a deep investigation of its psychometric properties was conducted. In Study 2 (N = 445), a structural equation model with latent variables was performed to assess the buffering effect of self-esteem. Results The PTSQ has excellent fit indices and psychometric properties. According to the ABH, results confirm the buffering effect of self-esteem in the relationships between traumatic symptoms and both anxiety and depression. Conclusion On the one hand, the PTSQ is a solid and reliable instrument. On the other hand, that self-esteem is a protective factor against anxiety and depression related to a traumatic experience - such as COVID-19. Targeted psychological interventions should be implemented to minimize the psychological burden of the illness while promoting adaptation and positive aspects of oneself. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-022-00503-z.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
- Interdepartmental Center for Family Research, University of Padova, Padova, Italy
| | - Anna Panzeri
- Department of General Psychology, University of Padova, Padova, Italy
| | - Federica Taccini
- Interdepartmental Center for Family Research, University of Padova, Padova, Italy
- Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy
| | - Anna Parola
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
- Interdepartmental Center for Family Research, University of Padova, Padova, Italy
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22
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Leinweber J, Fontein-Kuipers Y, Thomson G, Karlsdottir SI, Nilsson C, Ekström-Bergström A, Olza I, Hadjigeorgiou E, Stramrood C. Developing a woman-centered, inclusive definition of traumatic childbirth experiences: A discussion paper. Birth 2022; 49:687-696. [PMID: 35403241 DOI: 10.1111/birt.12634] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Many women experience giving birth as traumatic. Although women's subjective experiences of trauma are considered the most important, currently there is no clear inclusive definition of a traumatic birth to help guide practice, education, and research. AIM To formulate a woman-centered, inclusive definition of a traumatic childbirth experience. METHODS After a rapid literature review, a five-step process was undertaken. First, a draft definition was created based on interdisciplinary experts' views. The definition was then discussed and reformulated with input from over 60 multidisciplinary clinicians and researchers during a perinatal mental health and birth trauma research meeting in Europe. A revised definition was then shared with consumer groups in eight countries to confirm its face validity and adjusted based on their feedback. RESULTS The stepwise process confirmed that a woman-centered and inclusive definition was important. The final definition was: "A traumatic childbirth experience refers to a woman's experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/ or long-term negative impacts on a woman's health and wellbeing." CONCLUSIONS This definition of a traumatic childbirth experience was developed through consultations with experts and consumer groups. The definition acknowledges that low-quality provider interactions and obstetric violence can traumatize individuals during childbirth. The women-centered and inclusive focus could help women to identify and validate their experiences of traumatic birth, offering benefits for practice, education, and research, as well as for policymaking and activism in the fields of perinatal mental health and respectful maternity care.
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Affiliation(s)
- Julia Leinweber
- Institut of Midwifery, Charité-University Medicine Berlin, Berlin, Germany
| | - Yvonne Fontein-Kuipers
- School of Midwifery, Health and Social Work, University College Antwerp, Antwerp, Belgium.,Edinburgh Napier University, School of Health and Social Care, Edinburgh, Scotland
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit, School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
| | | | - Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University in Borås, Borås, Sweden
| | | | - Ibone Olza
- European Institute of Perinatal Mental Health, Madrid, Spain
| | - Eleni Hadjigeorgiou
- Nursing Department, Faculty of Health Science, Cyprus University of Technology, Limassol, Cyprus
| | - Claire Stramrood
- Department of Obstetrics and Gynaecology, OLVG Hospital, Amsterdam, The Netherlands
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23
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Han J, Choi KM, Yang C, Kim HS, Park SS, Lee SH. Treatment efficacy of tDCS and predictors of treatment response in patients with post-traumatic stress disorder. J Affect Disord 2022; 318:357-363. [PMID: 36055537 DOI: 10.1016/j.jad.2022.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/31/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although transcranial direct stimulation (tDCS) has been proposed as an alternative treatment option for various psychiatric disorders, there is inconsistent information regarding the treatment effects of tDCS for patients with post-traumatic stress disorder (PTSD). This study aimed to investigate the tDCS efficacy and identify predictors of treatment response to tDCS in patients with PTSD. METHOD Fifty-one patients received 10 sessions of tDCS involving the position of the anode over the F3 area and cathode over the F4 as a condition of 2.0 mA and 20 min duration. Digit span test and 10 questionnaires (Clinician-Administered PTSD Scale (CAPS), Cognitive Emotion Regulation Questionnaire (CERQ), Multidimensional Experiential Avoidance Questionnaire (MEAQ), etc.) were used to measure tDCS effects on PTSD symptoms and identify predictors of response to tDCS. RESULTS 1) 50.9 % of patients had a significant reduction in the frequency and severity of PTSD symptoms, 2) PTSD-related symptoms such as depression, anxiety, rumination, and quality of life were significantly improved, 3) baseline scores on rumination and digit span test significantly predicted treatment response to tDCS. LIMITATIONS This study was open design without a sham control group. Also, the patients' medications were not controlled. CONCLUSION This study highlighted the efficacy of frontal tDCS for the treatment of patients with PTSD and identified rumination and digit span as favorable predictive factors for the outcomes of tDCS.
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Affiliation(s)
- Jungwon Han
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychology, Sogang University, Seoul, Republic of Korea
| | - Kang-Min Choi
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; School of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
| | - Chaeyeon Yang
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychology, Sogang University, Seoul, Republic of Korea
| | - Hyang Sook Kim
- Department of Psychology, Sogang University, Seoul, Republic of Korea
| | | | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, Republic of Korea; Bwave Inc., Juhwa-ro, Goyang 10380, Republic of Korea..
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24
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Curiel-Regueros A, Fernández-Lucas J, Clemente-Suárez VJ. Psychophysiological Stress Status of Soldiers Prior to an Operative Deployment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013637. [PMID: 36294217 PMCID: PMC9603038 DOI: 10.3390/ijerph192013637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 05/27/2023]
Abstract
An anticipatory stress response develops before an internal or external stimulus, which initiates a homeostasis process through a chain of responses that enable human organisms to face different threats, thus allowing them to adapt to a continuous and eliciting environment. In the current research, we analyzed the psychophysiological anticipatory anxiety response of professional soldiers prior to a real mission in an actual theater of operation. Autonomic modulation through the heart rate variability values, muscular strength manifestation, and psychological stress of 53 military personnel of Army Airmobile Forces (age: M = 35.4 years, SD = 5.88 years; height: M = 1.75 m, SD = 6.87 cm; body mass: M = 77.33 kg, SD = 11.95 kg; military duty = 14.44 years, SD = 6.43; military operation experience = 4 months, SD = 4.25 months) and a control group of 33 civil participants were analyzed. The military personnel presented significant differences in some HRV values related to the activation of sympathetic systems. We found that the military personnel presented an anticipatory anxiety response only at an autonomic level, showing an increased sympathetic modulation, but not at a psychological level, since their anxiety levels were not significantly different than those of the control civilians. In addition, this anticipatory anxiety response did not affect muscular strength manifestation, as it presented no significant differences between the military personnel and the control group.
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Affiliation(s)
- Agustín Curiel-Regueros
- Faculty of Sport Science, Universidad Europea de Madrid, Tajo, s/n, 28670 Villaviciosa de Odón, Spain
| | - Jesús Fernández-Lucas
- Applied Biotechnology Group, Universidad Europea de Madrid, Urbanización El Bosque, Calle Tajo, s/n, 28670 Villaviciosa de Odón, Spain
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25
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Moral injury among U.S. combat veterans with and without PTSD and depression. J Psychiatr Res 2022; 154:190-197. [PMID: 35947898 DOI: 10.1016/j.jpsychires.2022.07.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/01/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Questions persist about how often potentially morally injurious events (PMIEs) are associated with posttraumatic stress disorder (PTSD) and depression. METHODS This study examined the overlap of morally injurious events with probable PTSD and depression in a nationally representative sample of U.S. combat veterans (n = 1,321, mean age 59.1, 93.7% male). RESULTS Most veterans with probable PTSD (72.2%), probable depression (72.4%), and probable PTSD and/or depression (68.4%), endorsed experiencing PMIEs; 31.1-35.3% of these participants endorsed perpetration, 45.1-50.4% endorsed witnessing others, and 52.6-55.7% endorsed betrayal. The prevalence of PMIEs among veterans without current probable PTSD and/or depression was 33.7%, 32.3%, and 31.5%, respectively; 7.9-9.1% of these participants endorsed perpetration-based PMIEs, 19.2-20.3% witnessing, and 19.8-21.8% endorsed betrayal. PMIEs were more prevalent among veterans with probable PTSD or depression relative to those without (ORs ranging 2.14-3.32; p's < 0.001). CONCLUSIONS This is the first nationally representative study to examine the prevalence of PMIEs among veterans with and without probable PTSD or depression. Results highlight the importance of understanding distress and functional impairment in these veterans to evaluate whether they may benefit from intervention. PMIEs were strikingly more prevalent among veterans with probable PTSD and depression, suggesting that veterans without PMIEs are the minority among combat veterans with these disorders.
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26
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Jongedijk RA, van Vreeswijk MF, Knipscheer JW, Kleber RJ, Boelen PA. The Relevance of Trauma and Re-experiencing in PTSD, Mood, and Anxiety Disorders. JOURNAL OF LOSS & TRAUMA 2022. [DOI: 10.1080/15325024.2022.2116782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Ruud A. Jongedijk
- ARQ Centrum '45, Oegstgeest, Netherlands
- ARQ National Psychotrauma Centre, Diemen, Netherlands
| | | | - Jeroen W. Knipscheer
- ARQ Centrum '45, Oegstgeest, Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | - Rolf J. Kleber
- ARQ National Psychotrauma Centre, Diemen, Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | - Paul A. Boelen
- ARQ Centrum '45, Oegstgeest, Netherlands
- ARQ National Psychotrauma Centre, Diemen, Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
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27
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Insomnia and Post-traumatic Stress Disorder: A Meta-analysis on Interrelated Association (n=57,618) and Prevalence (n=573,665). Neurosci Biobehav Rev 2022; 141:104850. [DOI: 10.1016/j.neubiorev.2022.104850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/27/2022] [Accepted: 08/27/2022] [Indexed: 12/14/2022]
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28
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Kim WH, Jung YE, Roh D, Kim D, Chae JH, Park JE. Development of Korean Version of PTSD Checklist for DSM-5 (K-PCL-5) and the Short Form (K-PCL-5-S). Psychiatry Investig 2022; 19:661-667. [PMID: 36059055 PMCID: PMC9441456 DOI: 10.30773/pi.2022.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study presents the reliability and validity of the Korean version of the post-traumatic stress disorder (PTSD) checklist for the Diagnostic and Statistical Manual for Mental Disorders-fifth edition (DSM-5) (K-PCL-5) and the short form (K-PCL-5-S). METHODS Seventy-one subjects with PTSD, 74 subjects with mood or anxiety disorders, and 99 healthy controls were enrolled. The Korean version of the Structured Clinical Interview for DSM-5-research version was used to confirm the presence of PTSD. The Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Impact of Event Scale-Revised (IES-R), and Spielberger State Trait Anxiety Inventory (STAI) were used to evaluate the concurrent validity of the K-PCL-5 and K-PCL-5-S. RESULTS It presented good internal consistency (Cronbach's α=0.93) and test-retest reliability (r=0.90). The K-PCL-5 and K-PCL-5-S were highly correlated with the BDI-II, BAI, IES-R, STAI-S, and STAI-T. The suggested cutoff score for PTSD was 33 for the K-PCL-5 with a sensitivity of 88.51 and specificity of 89.09, and 6 for the K-PCL-5-S with a sensitivity of 91.95 and specificity of 89.09. The data were best explained with a one-factor model. CONCLUSION These results demonstrated the good reliability and validity of the K-PCL-5 and K-PCL-5-S, and their suitability as simple tools for PTSD assessment.
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Affiliation(s)
- Won-Hyoung Kim
- Department of Psychiatry, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Young-Eun Jung
- Department of Psychiatry, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Daeyoung Roh
- Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Daeho Kim
- Department of Psychiatry, Hanyang University Guri Hospital, Hanyang University Medical School, Guri, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo Eon Park
- Department of Psychiatry, Keyo Hospital, Uiwang, Republic of Korea
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29
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Wang N, Chung MC, Zhang J, Fang S. Network analysis on the relationship between posttraumatic stress disorder, psychiatric co-morbidity and posttraumatic growth among Chinese adolescents. J Affect Disord 2022; 309:461-470. [PMID: 35513114 DOI: 10.1016/j.jad.2022.04.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/14/2021] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study investigated the association between posttraumatic stress disorder (PTSD), psychiatric co-morbidity and posttraumatic growth (PTG) among Chinese adolescents using network analysis. METHODS 867 Chinese adolescents (male = 424, female = 443) were recruited from three secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Posttraumatic Growth Inventory, and the General Health Questionnaire-28. RESULTS Domains of each construct mainly clustered within their respective communities with several bridging edges identified. The prominent roles of bridging nodes and edges (positive and negative) were highlighted. Key bridging nodes were negative alterations in cognitions and mood for PTSD, anxiety and insomnia for psychiatric co-morbidity and appreciation of life for PTG. LIMITATIONS The cross-sectional nature of the present study may preclude the identification of real causal relationships between nodes. CONCLUSIONS Following a trauma, adolescents displayed posttraumatic stress along with general psychological disorder symptoms. These distress reactions could affect the way they appreciated life and their motivation to seek future life possibilities. Findings from the current study may provide some clue for the facilitation of posttraumatic growth among clinical patients.
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Affiliation(s)
- Na Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong
| | - Man Cheung Chung
- Department of Psychology, Zayed University, Dubai, United Arab Emirates
| | - Jieting Zhang
- College of Psychology, Shenzhen University, Shenzhen, China
| | - Siqi Fang
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong.
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30
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Velez‐Cruz RJ, Holstun VP. Pandemic impact on higher education faculty self‐care, burnout, and compassion satisfaction. THE JOURNAL OF HUMANISTIC COUNSELING 2022. [PMCID: PMC9348051 DOI: 10.1002/johc.12174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This correlational study examined the relationship between self‐care, burnout, compassion satisfaction, and secondary traumatic stress among higher education faculty members during the COVID‐19 pandemic. The results inform higher education faculty members about the effects of self‐care and suggest strategies to reduce burnout, compassion satisfaction and secondary traumatic stress.
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Affiliation(s)
| | - Vasti P. Holstun
- Department of Counselor Education and Family Studies Liberty University Lynchburg Virginia USA
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31
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Using Quantitative and Qualitative Rorschach Data within a Multi-Method, Forensic Assessment of Dissociative Posttraumatic Stress Disorder. PSYCHOLOGICAL INJURY & LAW 2022. [DOI: 10.1007/s12207-022-09453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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32
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Bryant RA. Post-traumatic stress disorder as moderator of other mental health conditions. World Psychiatry 2022; 21:310-311. [PMID: 35524624 PMCID: PMC9077625 DOI: 10.1002/wps.20975] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Richard A. Bryant
- School of Psychology, University of New South WalesSydneyNSWAustralia
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Rajkumar RP. The Contributions of Pandemic Severity, Government Stringency, Cultural Values and Internet Usage to Post-traumatic Stress Disorder During the COVID-19 Pandemic: An Analysis of Data From 35 Countries. FRONTIERS IN SOCIOLOGY 2022; 7:881928. [PMID: 35620119 PMCID: PMC9127200 DOI: 10.3389/fsoc.2022.881928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
Emergent symptoms of post-traumatic stress disorder (PTSD) have been frequently reported in the context of the COVID-19 pandemic, and may affect up to 17-18% of individuals. There is preliminary evidence that pandemic severity, cultural values, restrictions imposed by governments, and Internet usage may all influence the emergence of PTSD symptomatology. In this study, possible linear- and non-linear associations between these factors and the prevalence of PTSD symptoms across 35 countries were examined based on data from existing research. Evidence was found for a positive logarithmic relationship between the COVID-19 case-fatality ratio and PTSD (p = 0.046), a positive logarithmic relationship between power distance and PTSD (p = 0.047), and a trend toward a negative quadratic association with Internet usage (p = 0.051). No significant cross-national effect was observed for government restrictiveness. These findings suggest that strategies aimed at minimizing COVID-19 deaths, and at ensuring equitable access to essential resources, may be of use in reducing the emergence of PTSD symptoms at a population level during this pandemic.
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Brunet A, Rivest-Beauregard M, Lonergan M, Cipolletta S, Rasmussen A, Meng X, Jaafari N, Romero S, Superka J, Brown AD, Sapkota RP. PTSD is not the emblematic disorder of the COVID-19 pandemic; adjustment disorder is. BMC Psychiatry 2022; 22:300. [PMID: 35484539 PMCID: PMC9047380 DOI: 10.1186/s12888-022-03903-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/29/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) has been hailed by some as the emblematic mental disorder of the COVID-19 pandemic, assuming that PTSD's life-threat criterion was met de facto. More plausible outcomes like adjustment disorder (AD) have been overlooked. METHODS An online cross-sectional survey was launched in the initial stage of the pandemic using a convenience sample of 5 913 adults to compare the prevalence of COVID-related probable PTSD versus probable AD. The abridged Impact of Event Scale - Revised (IES-6) assessed the severity of trauma- and stressor-related symptoms over the previous week. Demographic and pandemic-related data (e.g., receiving a formal diagnosis of COVID-19, job loss, loss of loved one, confinement, material hardship) were collected. A Classification and Regression Tree analysis was conducted to uncover the pandemic experiences leading to clinical 'caseness'. Caseness was defined by a score > 9 on the IES-6 symptom measure and further characterized as PTSD or AD depending on whether the Peritraumatic Distress Inventory's life-threat item was endorsed or not. RESULTS The participants were predominantly Caucasian (72.8%), women (79.2%), with a university degree (85%), and a mean age of 42.22 (SD = 15.24) years; 3 647 participants (61.7%; 95%CI [60.4, 63.0]) met the threshold for caseness. However, when perceived life-threat was accounted for, only 6.7% (95%CI [6.1, 7.4]) were classified as PTSD cases, and 55% (95%CI [53.7, 56.2]) as AD cases. Among the AD cases, three distinct profiles emerged marked by the following: (i) a worst personal pandemic experience eliciting intense fear, helplessness or horror (in the absence, however, of any life-threat), (ii) a pandemic experience eliciting sadness/grief, and (iii) worrying intensely about the safety of significant others. CONCLUSIONS Studies considering the life-threat criterion as met de facto during the pandemic are confusing PTSD for AD on most counts. This misconception is obscuring the various AD-related idioms of distress that have emerged during the pandemic and the actual treatment needs.
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Affiliation(s)
- Alain Brunet
- Research Center of the Douglas Mental Health University Institute (CIUSSS-ODIM), 6875 boulevard LaSalle, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Marjolaine Rivest-Beauregard
- grid.412078.80000 0001 2353 5268Research Center of the Douglas Mental Health University Institute (CIUSSS-ODIM), 6875 boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, QC Canada
| | - Michelle Lonergan
- grid.412078.80000 0001 2353 5268Research Center of the Douglas Mental Health University Institute (CIUSSS-ODIM), 6875 boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.28046.380000 0001 2182 2255School of Psychology, Ottawa University, Ottawa, ON Canada
| | - Sabrina Cipolletta
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Padua, Italy
| | - Andrew Rasmussen
- grid.256023.0000000008755302XDepartment of Psychology, Fordham University, New York, NY USA
| | - Xiangfei Meng
- grid.412078.80000 0001 2353 5268Research Center of the Douglas Mental Health University Institute (CIUSSS-ODIM), 6875 boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, QC Canada
| | - Nematollah Jaafari
- grid.11166.310000 0001 2160 6368Department of Psychiatry, Université de Poitiers, Poitiers, France
| | - Sara Romero
- grid.38142.3c000000041936754XDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Julia Superka
- grid.264933.90000 0004 0523 9547Department of Psychology, The New School for Social Research, New York, NY USA
| | - Adam D. Brown
- grid.264933.90000 0004 0523 9547Department of Psychology, The New School for Social Research, New York, NY USA
| | - Ram P. Sapkota
- grid.412078.80000 0001 2353 5268Research Center of the Douglas Mental Health University Institute (CIUSSS-ODIM), 6875 boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.57926.3f0000 0004 1936 9131Online Therapy Unit, Department of Psychology, University of Regina, Regina, SK Canada
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Shim M, Im CH, Lee SH, Hwang HJ. Enhanced Performance by Interpretable Low-Frequency Electroencephalogram Oscillations in the Machine Learning-Based Diagnosis of Post-traumatic Stress Disorder. Front Neuroinform 2022; 16:811756. [PMID: 35571868 PMCID: PMC9094422 DOI: 10.3389/fninf.2022.811756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Electroencephalography (EEG)-based diagnosis of psychiatric diseases using machine-learning approaches has made possible the objective diagnosis of various psychiatric diseases. The objective of this study was to improve the performance of a resting-state EEG-based computer-aided diagnosis (CAD) system to diagnose post-traumatic stress disorder (PTSD), by optimizing the frequency bands used to extract EEG features. We used eyes-closed resting-state EEG data recorded from 77 PTSD patients and 58 healthy controls (HC). Source-level power spectrum densities (PSDs) of the resting-state EEG data were extracted from 6 frequency bands (delta, theta, alpha, low-beta, high-beta, and gamma), and the PSD features of each frequency band and their combinations were independently used to discriminate PTSD and HC. The classification performance was evaluated using support vector machine with leave-one-out cross validation. The PSD features extracted from slower-frequency bands (delta and theta) showed significantly higher classification performance than those of relatively higher-frequency bands. The best classification performance was achieved when using delta PSD features (86.61%), which was significantly higher than that reported in a recent study by about 13%. The PSD features selected to obtain better classification performances could be explained from a neurophysiological point of view, demonstrating the promising potential to develop a clinically reliable EEG-based CAD system for PTSD diagnosis.
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Affiliation(s)
- Miseon Shim
- Department of Electronics and Information, Korea University, Sejong, South Korea
- Industry Development Institute, Korea University, Sejong, South Korea
| | - Chang-Hwan Im
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Ilsan Paik Hospital, Inje University, Goyang, South Korea
- Clinical Emotion and Cognition Research Laboratory, Goyang, South Korea
| | - Han-Jeong Hwang
- Department of Electronics and Information, Korea University, Sejong, South Korea
- Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, South Korea
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Di Tella M, Romeo A, Zara G, Castelli L, Settanni M. The Post-Traumatic Stress Disorder Checklist for DSM-5: Psychometric Properties of the Italian Version. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095282. [PMID: 35564677 PMCID: PMC9105570 DOI: 10.3390/ijerph19095282] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022]
Abstract
Background: The present study aimed to investigate the psychometric properties of the Italian version of the PTSD Checklist for the DSM-V (PCL-5) in a group of adults who had experienced heterogenous traumatic events. Methods: Six hundred and one participants met the inclusion criteria and completed a set of questionnaires through an online survey. Before administering the survey, the PCL-5 was translated into Italian according to the back-translation method. The factorial structure of the PCL-5 was assessed through multiple confirmatory factor analyses. Gender measurement invariance and concurrent and criterion validity were also evaluated. Results: The instrument had a seven-factor structure and it worked in a similar manner for males and females. With regard to the concurrent validity, results showed that higher PCL-5 scores were associated with higher levels of depression and rumination and lower levels of life satisfaction. Regarding criterion validity, results revealed that PCL-5 scores were, on average, higher for females than for males, and the temporal distance from the traumatic event was negatively correlated with the total PCL-5 score. Conclusions: The findings indicated that the Italian version of the PCL-5 was able to provide valid and reliable scores for the assessment of PTSD symptoms in the Italian population.
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Sezer I, Pizzagalli DA, Sacchet MD. Resting-state fMRI functional connectivity and mindfulness in clinical and non-clinical contexts: A review and synthesis. Neurosci Biobehav Rev 2022; 135:104583. [PMID: 35202647 PMCID: PMC9083081 DOI: 10.1016/j.neubiorev.2022.104583] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/07/2022] [Accepted: 02/12/2022] [Indexed: 12/12/2022]
Abstract
This review synthesizes relations between mindfulness and resting-state fMRI functional connectivity of brain networks. Mindfulness is characterized by present-moment awareness and experiential acceptance, and relies on attention control, self-awareness, and emotion regulation. We integrate studies of functional connectivity and (1) trait mindfulness and (2) mindfulness meditation interventions. Mindfulness is related to functional connectivity in the default mode (DMN), frontoparietal (FPN), and salience (SN) networks. Specifically, mindfulness-mediated functional connectivity changes include (1) increased connectivity between posterior cingulate cortex (DMN) and dorsolateral prefrontal cortex (FPN), which may relate to attention control; (2) decreased connectivity between cuneus and SN, which may relate to self-awareness; (3) increased connectivity between rostral anterior cingulate cortex region and dorsomedial prefrontal cortex (DMN) and decreased connectivity between rostral anterior cingulate cortex region and amygdala region, both of which may relate to emotion regulation; and lastly, (4) increased connectivity between dorsal anterior cingulate cortex (SN) and anterior insula (SN) which may relate to pain relief. While further study of mindfulness is needed, neural signatures of mindfulness are emerging.
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Affiliation(s)
- Idil Sezer
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Harvard Medical School, Belmont, MA, USA; Paris Brain Institute, Sorbonne University/CNRS/INSERM, Paris, France.
| | - Diego A Pizzagalli
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Harvard Medical School, Belmont, MA, USA; McLean Imaging Center, McLean Hospital, Belmont, MA, USA.
| | - Matthew D Sacchet
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Harvard Medical School, Belmont, MA, USA.
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38
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Lumley MA, Yamin JB, Pester BD, Krohner S, Urbanik CP. Trauma matters: psychological interventions for comorbid psychosocial trauma and chronic pain. Pain 2022; 163:599-603. [PMID: 34338244 PMCID: PMC8799778 DOI: 10.1097/j.pain.0000000000002425] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, United States
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39
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Mekawi Y, Silverstein MW, Walker A, Ishiekwene M, Carter S, Michopoulos V, Stevens JS, Powers A. Examining the psychometric properties of the PCL-5 in a black community sample using item response theory. J Anxiety Disord 2022; 87:102555. [PMID: 35338915 PMCID: PMC9275184 DOI: 10.1016/j.janxdis.2022.102555] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 02/03/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
Black Americans are more likely to be exposed to certain types of traumatic events and experience posttraumatic stress disorder (PTSD) compared to other racial groups. Consequently, sound assessment of PTSD in this underserved and understudied population is necessary to develop and accurately answer research questions about etiology and intervention efficacy. However, the item-level psychometric properties of one of the most commonly used assessment tools, the PTSD Checklist for DSM-5 (PCL-5), has yet to be examined among Black Americans. To address this gap, we used item response theory (IRT) to assess item difficulty and discrimination in a sample of Black American adults (n = 307). We employed a graded response model with all 20 items of the PCL-5 loading on to a latent PTSD factor. At clinically significant levels of PTSD, the most discriminating items were flashbacks, inability to experience positive emotions, and nightmares and the least discriminating items were cued emotional distress, diminished interest, and hypervigilance. These results emphasize the importance of flashbacks, inability to experience positive emotions, and nightmares and deemphasize the importance of hypervigilance and sleep difficulties when assessing for clinically significant symptoms of PTSD in Black Americans. Treatment implications include a nuanced approach towards hypervigilance.
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Affiliation(s)
- Yara Mekawi
- University of Louisville, Department of Psychological and Brain Sciences, USA.
| | | | - Aisha Walker
- Georgia State University, Department of Psychology, USA
| | | | - Sierra Carter
- Georgia State University, Department of Psychology, USA
| | | | - Jennifer S Stevens
- Emory School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Abigail Powers
- Emory School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
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40
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Norman SB, Capone C, Panza KE, Haller M, Davis BC, Schnurr PP, Shea MT, Browne K, Norman GJ, Lang AJ, Kline AC, Golshan S, Allard CB, Angkaw A. A clinical trial comparing trauma-informed guilt reduction therapy (TrIGR), a brief intervention for trauma-related guilt, to supportive care therapy. Depress Anxiety 2022; 39:262-273. [PMID: 35075738 DOI: 10.1002/da.23244] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Trauma-related guilt is common, associated with posttraumatic mental health problems, and can persist after posttraumatic stress disorder (PTSD) treatment. We compared the efficacy of two six-session psychotherapies, Trauma-Informed Guilt Reduction (TrIGR) and Supportive Care Therapy (SCT), for reducing trauma-related guilt. TrIGR helps patients accurately appraise their role in the trauma and re-engage in values. In SCT, patients guide session content. METHODS A total of 184 veterans seeking VA mental health services were enrolled across two sites; 145 veterans (mean age: 39.2 [8.1]; 92.4% male; 84.8% with PTSD) who endorsed guilt related to a traumatic event that occurred during a post 9/11 Iraq or Afghanistan deployment were randomized and assessed at baseline, posttreatment, 3- and 6-month follow-up. RESULTS Linear mixed models using intent-to-treat analyses showed guilt decreased in both conditions with a greater decrease for TrIGR (treatment × time, -0.22; F 1, 455.2 = 18.49, p = .001; d = 0.92) than supportive therapy. PTSD and depressive symptoms showed the same pattern. TrIGR had significantly higher likelihood of PTSD treatment response (67% vs. 40%), loss of PTSD diagnosis (50% vs. 14%), and meaningful change in depression (54% vs. 27%) than supportive therapy. Psychological distress and trait shame improved in both conditions. Quality of life did not change. CONCLUSIONS Targeting guilt appears to be an effective means for reducing posttraumatic symptoms and distress.
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Affiliation(s)
- Sonya B Norman
- Executive Division, National Center for PTSD, Hartford, Vermont, USA.,Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Clinical Research Division, VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Christy Capone
- Department of Mental Health, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Kaitlyn E Panza
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Moira Haller
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Brittany C Davis
- Department of Mental Health, James A. Haley Veterans Hospital, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
| | - Paula P Schnurr
- Executive Division, National Center for PTSD, Hartford, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - M Tracie Shea
- Department of Mental Health, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Kendall Browne
- Department of Research, Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Gregory J Norman
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ariel J Lang
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Clinical Research Division, VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Alexander C Kline
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Shahrokh Golshan
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Carolyn B Allard
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Clinical Psychology, California School of Professional Psychology at Alliant International University, San Diego, California, USA
| | - Abigail Angkaw
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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Drugs age-of-onset as a signal of later post-traumatic stress disorder: Bayesian analysis of a census protocol. Addict Behav 2022; 125:107131. [PMID: 34763301 DOI: 10.1016/j.addbeh.2021.107131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/24/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022]
Abstract
Individuals with PTSD have an increased risk of drug use disorders. Conversely, we aim to evaluate how early onset of alcohol, tobacco and psychoactive drugs use are associated with PTSD later in life. 2,193 brazilian young adults completed modularized assessments: The Trauma History Questionnaire, Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C, transformed to PCL-5 through a crosswalk procedure), the Barratt Impulsivity Scale; and a survey on drug use with self-report questions about first use, current use, frequency, quantity, and interpersonal consequences. Bayesian inference and multivariate regression models were used to examine the effects on the risk of PTSD, considering different assumptions of information flow. Raw and unbiased (multivariate) estimates consistently revealed that earlier age of onset of alcohol and tobacco use increased risk for PTSD (Odds-ratios between 2.39 and 3.19 (Alcohol) and 1.82 to 2.05 (Tobacco). Among those who had PTSD (310), 10.3% (32) were very precocious at the onset age (12 to 18 years) of alcohol consumption (No-PTSD: 89 out 1883, 4.7%). Data supports a model in which age of onset effects are partially mediated by the number of trauma exposures. Early intoxication might suggest vulnerability for qualifying trauma events, or it may increase chances of exposure. Also, PTSD may be more likely to occur among trauma-exposed individuals with early intoxicating experiences due to alcohol or drug self-administration. The last possibility resonates with the idea that early intoxication might disrupt adolescent brain development, with a subsequent reduction in resilience when qualifying trauma events occur.
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Bonde JPE, Jensen JH, Smid GE, Flachs EM, Elklit A, Mors O, Videbech P. Time course of symptoms in posttraumatic stress disorder with delayed expression: A systematic review. Acta Psychiatr Scand 2022; 145:116-131. [PMID: 34523121 PMCID: PMC9293462 DOI: 10.1111/acps.13372] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the hypothesis that PTSD with delayed expression in some cases occurs without subthreshold PTSD symptoms above background levels bridging the gap between the traumatic exposure(s) and the clinical diagnosis. METHODS We performed systematic searches of peer-reviewed papers in English referenced in Pubmed, Embase, or PsycINFO and ascertained 34 prospective studies of PTSD symptom trajectories identified by latent class growth statistical modeling. Studies with delayed and low-stable trajectories provided appropriate data for this study. We computed the difference between the delayed trajectory PTSD symptom sumscore and the low-stable PTSD sumscore at the observed points in time after the traumatic event(s). RESULTS In 29 study populations, the latent class growth analyses displayed delayed trajectories, and in these, we identified 110 data points (% PTSD sumscore difference/months since traumatic exposure). The median PTSD symptom sumscore was 25% higher during the initial 6 months among individuals in the delayed trajectory compared to those in low-stable trajectory. From this level, the difference widened and reached a plateau of 40-50% higher. The variation was large, and the baseline participation rate and loss to follow-up were exceeding 25% in the majority of the studies. Heterogeneity of populations, measures, and analyses precluded formal meta-analysis. CONCLUSION Delayed PTSD is preceded by PTSD symptoms during the first year in most cases. Still, few individuals may experience an asymptomatic delay. The results underpin the rationale for monitoring PTSD symptoms and may inform forensic assessments in that delayed PTSD without symptoms bridging the traumatic event is rare.
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Affiliation(s)
- Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental MedicineBispebjerg and Frederiksberg HospitalCopenhagenDenmark,Institute of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Johan Høy Jensen
- Department of Occupational and Environmental MedicineBispebjerg and Frederiksberg HospitalCopenhagenDenmark,Copenhagen Stress Research CenterCopenhagenDenmark
| | - Geert E. Smid
- Department of Humanist Chaplaincy StudiesUniversity of Humanistic StudiesUtrechtthe Netherlands,ARQ National Psychotrauma CenterDiementhe Netherlands
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental MedicineBispebjerg and Frederiksberg HospitalCopenhagenDenmark
| | - Ask Elklit
- Danish National Centre for PsychotraumatologyUniversity of Southern DenmarkOdenseDenmark
| | - Ole Mors
- Psychosis Research UnitAarhus University Hospital – PsychiatryAarhusDenmark
| | - Poul Videbech
- Centre for Neuropsychiatric Depression ResearchMental Health Centre Glostrup and Clinical InstituteUniversity of CopenhagenCopenhagenDenmark
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Bharti V, Bhardwaj A, Elias DA, Metcalfe AWS, Kim JS. A Systematic Review and Meta-Analysis of Lipid Signatures in Post-traumatic Stress Disorder. Front Psychiatry 2022; 13:847310. [PMID: 35599759 PMCID: PMC9120430 DOI: 10.3389/fpsyt.2022.847310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/12/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Research assessing lipid levels in individuals diagnosed with post-traumatic stress disorder (PTSD) has yielded mixed results. This study aimed to employ meta-analytic techniques to characterize the relationship between the levels of lipid profiles and PTSD. METHODS We performed meta-analyses of studies comparing profiles and levels of lipids between PTSD patients and healthy individuals by searching Embase, Ovid Medline, Scopus, PsycINFO, and Cochrane databases for the studies until March 2021. Meta-analyses were performed using random-effects models with the restricted maximum-likelihood estimator to synthesize the effect size assessed by standardized mean difference (SMD) across studies. FINDINGS A total of 8,657 abstracts were identified, and 17 studies were included. Levels of total cholesterol (TC) (SMD = 0.57 95% CI, 0.27-0.87, p = 0.003), low-density lipoprotein (LDL) (SMD = 0.48, 95% CI, 0.19-0.76, p = 0.004), and triglyceride (TG) (SMD = 0.46, 95% CI, 0.22-0.70, p = 0.001) were found to be higher, while levels of high-density lipoprotein (HDL) (SMD = -0.47, -0.88 to -0.07, p = 0.026) were found to be lower in PTSD patients compared to healthy controls. Subgroup analysis showed that TG levels were higher in PTSD patients who were on or off of psychotropic medications, both < 40 and ≥ 40 years of age, and having body mass index of < 30 and ≥ 30 compared to healthy controls. INTERPRETATION This work suggested dysregulation of lipids in PTSD that may serve as biomarker to predict the risk. The study will be useful for physicians considering lipid profiles in PTSD patients to reduce cardiovascular morbidity and mortality.
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Affiliation(s)
- Veni Bharti
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Aseem Bhardwaj
- Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - David A Elias
- Canadian Health Solutions Inc., Saint John, NB, Canada.,Dalhousie Medicine New Brunswick, Dalhousie University, Halifax, NS, Canada
| | - Arron W S Metcalfe
- Canadian Health Solutions Inc., Saint John, NB, Canada.,Canadian Imaging Research Centre, Saint John, NB, Canada
| | - Jong Sung Kim
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Pinciotti CM, Horvath G, Wetterneck CT, Riemann BC. Does a unique co-occurring OCD and PTSD factor structure exist?: Examination of overlapping OCD and PTSD symptom clusters. J Anxiety Disord 2022; 85:102511. [PMID: 34923293 DOI: 10.1016/j.janxdis.2021.102511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022]
Abstract
OCD and PTSD share many commonalities, including phenotypic and functional overlap in symptoms. Specifically, both disorders are characterized by unwanted, intrusive, anxiety/distress-eliciting intrusive thoughts and evoking behaviors intended to control, neutralize, suppress, or outright avoid intrusive thoughts and associated anxiety/distress. Extant factor analytic research supports a model of PTSD at odds with current DSM-5 criteria, and no examination of the factor structure of comorbid OCD+PTSD currently exists despite the noted overlap in symptomatology and high rates of comorbidity. Using a sample of 4073 patients diagnosed with OCD and/or PTSD enrolled in intensive treatment programs for OCD or PTSD, multigroup confirmatory factor analysis (MGCFA) and measurement invariance tests were run to determine the best fitting model of OCD and PTSD symptoms in patients with OCD+PTSD. Four models were compared across patients with OCD, PTSD, and OCD+PTSD: DSM-5 and 7-factor hybrid PTSD models with OCD symptoms structured as either combined or comorbid constructs. The comorbid hybrid model proved the best fit, and both hybrid models evidenced better fit than DSM-5 models. The current study lends additional support for the hybrid model of PTSD and suggests that there is no existence of a unique factor structure of OCD and PTSD symptoms in individuals with the comorbid conditions.
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Affiliation(s)
- Caitlin M Pinciotti
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA.
| | - Gregor Horvath
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA
| | - Chad T Wetterneck
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA
| | - Bradley C Riemann
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA
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Zhao M, Zhu Z, Li H, Wang W, Cheng S, Qin X, Wu H, Liu D, Pan F. Effects of traumatic stress in adolescence on PTSD-like behaviors, dendrite development, and H3K9me2/BDNF expression in the amygdala of male rats. J Affect Disord 2022; 296:388-399. [PMID: 34619155 DOI: 10.1016/j.jad.2021.09.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/04/2021] [Accepted: 09/26/2021] [Indexed: 12/22/2022]
Abstract
Early detrimental experiences increase the risk of psychiatric disorders, including posttraumatic stress disorder (PTSD). In a previous experiment, we demonstrated that traumatic stress in adolescence triggers changes in the expression of the epigenetic marker H3K9me2 in the hippocampus and prefrontal cortex of adolescent and adult rats, which suppresses transcription of the brain-derived neurotrophic factor (Bdnf) gene that promotes dendrite development and synaptic growth. However, corresponding changes in the amygdala in response to traumatic stress in early life have not yet been fully elucidated. In the current study, we used the inescapable foot shock (IFS) procedure to establish a PTSD model. Half an hour after the end of electric shocks, intraperitoneal injection of the G9a enzyme inhibitor Unc0642, a small molecule inhibitor of EHMT2 that can decrease H3K9me2 expression, was applied to reverse the corresponding epigenetic changes. Exploratory behaviors, anxiety-like behavior, social communication ability, spatial exploration and memory were determined using the open field test (OFT), elevated plus maze (EPM) test, three-chamber sociability test (SIT), Morris water maze (MWM) test, and Y maze test (YMZ), respectively. Additionally, the levels of H3K9me2 and BDNF were measured by quantitative reverse transcription-polymerase chain reaction (qPCR) and Western blotting. Furthermore, neuronal development was examined using Golgi staining. The results showed that the IFS procedure induced anxiety-like and depression-like behaviors, social skills dysfunction, and spatial exploration and memory disorders. It also decreased the mRNA expression of BDNF and BDNF and increased the expression of H3K9me2 in the amygdala. More importantly, compared to unstressed animals, traumatic stress during adolescence induced dendrite maldevelopment in adolescent and adult rats. In summary, the present study indicates that early-life stress alters the epigenetic marker expression of H3K9me2 and decreases levels of BDNF in the amygdala, resulting in dendrite maldevelopment and a higher risk of mental disorders.
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Affiliation(s)
- Mingyue Zhao
- Department of Medical Psychology and Ethics, School of Basic Medical Medicine Sciences, Cheeloo College of Medicine, Shandong University, 44#, Wenhua Xi Road, Jinan, Shandong 250012, PR China
| | - Zemeng Zhu
- Department of Medical Psychology and Ethics, School of Basic Medical Medicine Sciences, Cheeloo College of Medicine, Shandong University, 44#, Wenhua Xi Road, Jinan, Shandong 250012, PR China
| | - Haonan Li
- Department of Medical Psychology and Ethics, School of Basic Medical Medicine Sciences, Cheeloo College of Medicine, Shandong University, 44#, Wenhua Xi Road, Jinan, Shandong 250012, PR China
| | - Wei Wang
- Department of Medical Psychology and Ethics, School of Basic Medical Medicine Sciences, Cheeloo College of Medicine, Shandong University, 44#, Wenhua Xi Road, Jinan, Shandong 250012, PR China
| | - Shuyue Cheng
- Department of Medical Psychology and Ethics, School of Basic Medical Medicine Sciences, Cheeloo College of Medicine, Shandong University, 44#, Wenhua Xi Road, Jinan, Shandong 250012, PR China
| | - Xiaqing Qin
- Department of Medical Psychology and Ethics, School of Basic Medical Medicine Sciences, Cheeloo College of Medicine, Shandong University, 44#, Wenhua Xi Road, Jinan, Shandong 250012, PR China
| | - Huiran Wu
- Department of Medical Psychology and Ethics, School of Basic Medical Medicine Sciences, Cheeloo College of Medicine, Shandong University, 44#, Wenhua Xi Road, Jinan, Shandong 250012, PR China
| | - Dexiang Liu
- Department of Medical Psychology and Ethics, School of Basic Medical Medicine Sciences, Cheeloo College of Medicine, Shandong University, 44#, Wenhua Xi Road, Jinan, Shandong 250012, PR China
| | - Fang Pan
- Department of Medical Psychology and Ethics, School of Basic Medical Medicine Sciences, Cheeloo College of Medicine, Shandong University, 44#, Wenhua Xi Road, Jinan, Shandong 250012, PR China.
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Ghosh S, Mohammed Z, Singh I. Bruton's tyrosine kinase drives neuroinflammation and anxiogenic behavior in mouse models of stress. J Neuroinflammation 2021; 18:289. [PMID: 34895246 PMCID: PMC8665324 DOI: 10.1186/s12974-021-02322-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/12/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Current therapies targeting several neurotransmitter systems are only able to partially mitigate the symptoms of stress- and trauma-related disorder. Stress and trauma-related disorders lead to a prominent inflammatory response in humans, and in pre-clinical models. However, mechanisms underlying the induction of neuroinflammatory response in PTSD and anxiety disorders are not clearly understood. The present study investigated the mechanism underlying the activation of proinflammatory NLRP3 inflammasome and IL1β in mouse models of stress. METHODS We used two mouse models of stress, i.e., mice subjected to physical restraint stress with brief underwater submersion, and predator odor stress. Mice were injected with MCC950, a small molecule specific inhibitor of NLRP3 activation. To pharmacologically inhibit BTK, a specific inhibitor ibrutinib was used. To validate the observation from ibrutinib studies, a separate group of mice was injected with another BTK-specific inhibitor LFM-A13. Seven days after the induction of stress, mice were examined for anxious behavior using open field test (OFT), light-dark test (LDT), and elevated plus maze test (EPM). Following the behavior tests, hippocampus and amygdale were extracted and analyzed for various components of NLRP3-caspase 1-IL1β pathway. Plasma and peripheral blood mononuclear cells were also used to assess the induction of NLRP3-Caspase 1-IL-1β pathway in stressed mice. RESULTS Using two different pre-clinical models of stress, we demonstrate heightened anxious behavior in female mice as compared to their male counterparts. Stressed animals exhibited upregulation of proinflammatory IL1β, IL-6, Caspase 1 activity and NLRP3 inflammasome activation in brain, which were significantly higher in female mice. Pharmacological inhibition of NLRP3 inflammasome activation led to anxiolysis as well as attenuated neuroinflammatory response. Further, we observed induction of activated Bruton's tyrosine kinase (BTK), an upstream positive-regulator of NLRP3 inflammasome activation, in hippocampus and amygdala of stressed mice. Next, we conducted proof-of-concept pharmacological BTK inhibitor studies with ibrutinib and LFM-A13. In both sets of experiments, we found BTK inhibition led to anxiolysis and attenuated neuroinflammation, as indicated by significant reduction of NLRP3 inflammasome and proinflammatory IL-1β in hippocampus and amygdala. Analysis of plasma and peripheral blood mononuclear cells indicated peripheral induction of NLRP3-caspase 1-IL1β pathway in stressed mice. CONCLUSION Our study identified BTK as a key upstream regulator of neuroinflammation, which drives anxiogenic behavior in mouse model of stress. Further, we demonstrated the sexually divergent activation of BTK, providing a clue to heightened neuroinflammation and anxiogenic response to stress in females as compared to their male counterparts. Our data from the pharmacological inhibition studies suggest BTK as a novel target for the development of potential clinical treatment of PTSD and anxiety disorders. Induction of pBTK and NLRP3 in peripheral blood mononuclear cells of stressed mice suggest the potential effect of stress on systemic inflammation.
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Affiliation(s)
- Simantini Ghosh
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
- Department of Psychology, Ashoka University, Rai, India.
| | | | - Itender Singh
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Ambedkar Center for Biomedical Research, Delhi University, New Delhi, India
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Carter JS, Kearns AM, Reichel CM. Complex Interactions Between Sex and Stress on Heroin Seeking. Front Neurosci 2021; 15:784365. [PMID: 34955731 PMCID: PMC8702641 DOI: 10.3389/fnins.2021.784365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Rationale: Stress plays a dual role in substance use disorders as a precursor to drug intake and a relapse precipitant. With heroin use at epidemic proportions in the United States, understanding interactions between stress disorders and opioid use disorder is vital and will aid in treatment of these frequently comorbid conditions. Objectives: Here, we combine assays of stress and contingent heroin self-administration (SA) to study behavioral adaptations in response to stress and heroin associated cues in male and female rats. Methods: Rats underwent acute restraint stress paired with an odor stimulus and heroin SA for subsequent analysis of stress and heroin cue reactivity. Lofexidine was administered during heroin SA and reinstatement testing to evaluate its therapeutic potential. Rats also underwent tests on the elevated plus maze, locomotor activity in a novel environment, and object recognition memory following stress and/or heroin. Results: A history of stress and heroin resulted in disrupted behavior on multiple levels. Stress rats avoided the stress conditioned stimulus and reinstated heroin seeking in response to it, with males reinstating to a greater extent than females. Lofexidine decreased heroin intake, reinstatement, and motor activity. Previous heroin exposure increased time spent in the closed arms of an elevated plus maze, activity in a round novel field, and resulted in object recognition memory deficits. Discussion: These studies report that a history of stress and heroin results in maladaptive coping strategies and suggests a need for future studies seeking to understand circuits recruited in this pathology and eventually help develop therapeutic approaches.
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Affiliation(s)
| | | | - Carmela M. Reichel
- Reichel Laboratory, Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
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Kaysen D, Rhew IC, Bittinger J, Bedard-Gilligan M, Garberson LA, Hodge KA, Nguyen AJ, Logan DE, Dworkin ER, Lindgren K. Prevalence and Factor Structure of PTSD in DSM-5 Versus DSM-IV in a National Sample of Sexual Minority Women. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP12388-NP12410. [PMID: 31833796 PMCID: PMC7292760 DOI: 10.1177/0886260519892960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The impact of changes to posttraumatic stress disorder (PTSD) diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) within diverse communities is unclear. Young adult sexual minority women are at high risk for interpersonal violence and other forms of trauma exposure compared with heterosexual populations and sexual minority men. They are also at heightened risk of PTSD. As a result, young adult sexual minority women are a key population of interest when examining the impact of diagnostic criteria changes. The goal of the current study was to evaluate the impact of changes to PTSD diagnostic criteria in sexual minority women. Using an online survey, we administered both the original PTSD Symptom Checklist-S (based on DSM-IV criteria) and a version adapted to assess DSM-5 criteria to a national, nonclinical sample of young adult sexual minority women (N = 767). The DSM-5 symptom criteria fit the data well in confirmatory factor analysis. Current PTSD prevalence was higher under the DSM-5 diagnostic algorithm compared with DSM-IV (18.6% vs. 22.9%; d = 0.15). Compared with DSM-IV, associations between PTSD and depression were stronger using DSM-5 criteria, whereas associations between PTSD and high-risk drinking were reduced. Findings suggest that changes to PTSD diagnostic criteria do not have a major impact on prevalence of PTSD among sexual minority women but may have some impact on observed comorbidities.
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Shah NN, Schwandt ML, Hobden B, Baldwin DS, Sinclair J, Agabio R, Leggio L. The validity of the state-trait anxiety inventory and the brief scale for anxiety in an inpatient sample with alcohol use disorder. Addiction 2021; 116:3055-3068. [PMID: 33861887 DOI: 10.1111/add.15516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/11/2021] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The Brief Scale for Anxiety (BSA) and the State-Trait Anxiety Inventory Form Y-2 (STAI-Y-2) are self-report scales used to gauge anxiety symptoms in clinical settings. Co-occuring anxiety is common in alcohol use disorder (AUD); however, no studies have assessed the validity of the BSA and STAI-Y-2 compared with a clinical diagnostic tool of anxiety in alcohol treatment programs. We aimed to examine the validity of the BSA and STAI-Y-2 to predict a clinical diagnosis of an anxiety disorder (via the Structured Clinical Interview for DSM [SCID]) in AUD patients. DESIGN Participants were administered the BSA (n = 1005) on day 2 and the STAI-Y-2 (n = 483) between days 2 and 10 of the detoxification program. SCID-based clinical diagnoses of AUD and anxiety were made approximately on day 10. SETTING AND PARTICIPANTS Individuals seeking treatment for AUD admitted to an inpatient unit at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD, USA (n = 1010). MEASUREMENTS Inclusion criteria included a current diagnosis of alcohol dependence (AD) according to DSM-IV-TR or moderate to severe AUD according to DSM-5-RV, as well as available baseline BSA and/or STAI Y-2 data. Empirical receiver operating characteristic (ROC) curves were generated using estimates of sensitivity, 1-specificity and positive and negative predictive values for each cut-point to determine the accuracy of scale outcomes in relation to SCID diagnoses. FINDINGS The BSA demonstrated low accuracy relative to a clinical diagnosis of anxiety with an area under the curve (AUC) of 0.67 at the optimal cut-point of ≥ 10. The STAI-Y-2 had moderate accuracy relative to a clinical diagnosis of anxiety with an AUC of 0.70 at the optimal cut-point of ≥ 51. The accuracy of the STAI-Y-2 increased (AUC = 0.74) when excluding post-traumatic stress disorder and obsessive-compulsive disorder from anxiety disorder classification. CONCLUSIONS Use of the Brief Scale for Anxiety (BSA) and/or State-Trait Anxiety Inventory Form Y-2 (STAI-Y-2) does not appear to be a reliable substitute for clinical diagnoses of anxiety disorder among inpatients with alcohol use disorder. The BSA and STAI-Y-2 could serve as a screening tool to reject the presence of anxiety disorders rather than for detecting an anxiety disorder.
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Affiliation(s)
- Navan N Shah
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD, USA
| | - Melanie L Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Bethesda, MD, USA
| | - Breanne Hobden
- Health Behaviour Research Group, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre in Health Behaviour and Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,University Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Julia Sinclair
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD, USA.,Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA.,Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA.,Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Neuroscience, Georgetown University Medical Center, Washington, DC, USA
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50
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Clemente-Suárez VJ, Martínez-González MB, Benitez-Agudelo JC, Navarro-Jiménez E, Beltran-Velasco AI, Ruisoto P, Diaz Arroyo E, Laborde-Cárdenas CC, Tornero-Aguilera JF. The Impact of the COVID-19 Pandemic on Mental Disorders. A Critical Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10041. [PMID: 34639341 PMCID: PMC8507604 DOI: 10.3390/ijerph181910041] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has impacted the lives of the worldwide population. Citizens suffer the social, economic, physiological, and psychological effects of this pandemic. Primary sources, scientific articles, and secondary bibliographic indexes, databases, and web pages were used for a consensus critical review. The method was a narrative review of the available literature to summarize the existing literature addressing mental health concerns and stressors related to the COVID-19 pandemic. The main search engines used in the present research were PubMed, SciELO, and Google Scholar. We found the pandemic has had a direct impact on psychopathologies such as anxiety, increasing its ratios, and depression. Other syndromes such as burnout and post-traumatic stress disorder have increased with the pandemic, showing a larger incidence among medical personnel. Moreover, eating disorders and violence have also increased. Public authorities must prepare healthcare systems for increasing incidences of mental pathologies. Mental health apps are one of the tools that can be used to reach the general population.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
- Studies Centre in Applied Combat (CESCA), 45007 Toledo, Spain
| | - Marina Begoña Martínez-González
- Departamento de Ciencias Sociales, Facultad de Ciencias Sociales y Humanas, Universidad de la Costa, Barranquilla 080002, Colombia; (M.B.M.-G.); (J.C.B.-A.)
| | - Juan Camilo Benitez-Agudelo
- Departamento de Ciencias Sociales, Facultad de Ciencias Sociales y Humanas, Universidad de la Costa, Barranquilla 080002, Colombia; (M.B.M.-G.); (J.C.B.-A.)
| | | | | | - Pablo Ruisoto
- Department of Health Sciences, Public University of Navarre, 31006 Pamplona, Spain;
| | | | | | - Jose Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Studies Centre in Applied Combat (CESCA), 45007 Toledo, Spain
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