Posttraumatic stress disorder, complex PTSD and subtypes of loneliness among older adults

Loneliness and posttraumatic stress in U.S. adolescents: A longitudinal study

BACKGROUND

Loneliness and posttraumatic stress (PTS) are common in adolescence. However, there has been little longitudinal research on their association. To address this deficit, this study examined the longitudinal association between these phenomena in a sample of U.S. school students while also exploring if gender was important in this context.

METHODS

Data were analysed from 2807 adolescents (52.1 % female; age at baseline 11-16 years (M = 12.79)) who were followed over a one-year period. Information was obtained on loneliness in year 1 using a single-item question, while PTS was assessed with the self-report Child Post-Traumatic Stress - Reaction Index (CPTS-RI). A full path analysis was performed to assess the across time associations.

RESULTS

Almost one-third of the students reported some degree of loneliness while most students had 'mild' PTS. In the path analysis, when controlling for baseline PTS and other covariates, loneliness in year 1 was significantly associated with PTS in year 2 (β = 0.06, 95%CI: 0.02, 0.09). Similarly, PTS in year 1 was significantly associated with loneliness in year 2 (β = 0.19, 95%CI: 0.15, 0.23). An interaction analysis further showed that loneliness was higher in girls with PTS than in their male counterparts.

LIMITATIONS

The use of a single-item measure to assess loneliness that used the word 'lonely' may have resulted in underreporting.

CONCLUSION

Loneliness and PTS are bidirectionally associated in adolescence. Efforts to reduce loneliness in adolescence may help in combatting PTS, while clinicians should intervene to address loneliness if detected in adolescents with PTS.

Alone on the frontline: The first report of PTSD prevalence and risk in de-occupied Ukrainian villages

IMPORTANCE

The ongoing Russian invasion of Ukraine marks a critical juncture in a series of events posing severe threat to the health of Ukrainian citizens. While recent reports reveal higher rates of PTSD in Ukrainian refugees following Russia's invasion - data for Ukrainians remaining at the warfront is inherently difficult to access. A primarily elderly demographic, Ukrainians in previously Russian-occupied areas near the front (UPROANF) are at particular risk.

DESIGN

Data was sourced from screening questionnaires administered between March 2022 and July 2023 by mobile health clinics providing services to UPROANF.

SETTING

Previously occupied villages in Eastern and Southern Ukraine.

PARTICIPANTS

UPROANF attending clinics completed voluntary self-report surveys reporting demographics, prior health diagnoses, and PTSD symptom severity (n = 450; Meanage = 53.66; 72.0% female).

EXPOSURE

Participants were exposed to Russian occupation of Ukrainian villages.

MAIN OUTCOME AND MEASURES

The PTSD Checklist for the DSM-V (PCL-5) with recommended diagnostic threshold (i.e. 31) was utilized to assess PTSD prevalence and symptom severity. ANCOVA was used to examine hypothesized positive associations between (1) HTN and (2) loneliness and PTSD symptoms (cumulative and by symptom cluster).

RESULTS

Between 47.8% and 51.33% screened positive for PTSD. Though cumulative PTSD symptoms did not differ based on HTN diagnostic status, those with HTN reported significantly higher PTSD re-experiencing symptoms (b = 1.25, SE = 0.60, p = .046). Loneliness was significantly associated with more severe cumulative PTSD symptoms (b = 1.29, SE = 0.31, p < .001), re-experiencing (b = 0.47, SE = 0.12, p < .001), avoidance (b = .18, SE = 0.08, p = .038), and hypervigilance (b = 0.29, SE = 0.13, p = .036).

CONCLUSIONS AND RELEVANCE

PTSD prevalence was higher than other war-exposed populations. Findings highlight the urgent mental health burden among UPROANF, emphasizing the need for integrated care models addressing both trauma and physical health. Given the significance of loneliness as a risk factor, findings suggest the potential for group-based, mind-body interventions to holistically address the physical, mental, and social needs of this highly traumatized, underserved population.

The Impact of Complex PTSD on Suicide Risk in Patients with Bipolar Disorder: A Cross-Sectional Study

BACKGROUND

Patients with bipolar disorder (BD) are more likely than the general population to experience traumatic events, particularly during childhood, and these may predict and be a risk factor for the development of complex PTSD (cPTSD). The presence of multiple traumas plays a relevant role from a psychopathological point of view, but little is known about the effect this may have on suicide attempts in patients with BD.

METHODS

A cross-sectional study was conducted comparing socio-demographic and clinical characteristics, recruiting 344 patients diagnosed with BD I and II, screened for the presence (or absence) of cPTSD using the International Trauma Questionnaire (ITQ). Suicide attempts were assessed directly during the clinical interview and from the patient's medical record.

RESULTS

The results emerging from the study indicate that cPTSD can be considered a risk factor for suicide attempts in patients with BD. Furthermore, evidence is provided to support the idea that cPTSD is highly prevalent in patients with BD and is related to a higher psychopathological burden.

CONCLUSIONS

The results recommend an urgent and comprehensive assessment of suicidal risk in patients with comorbidity of both bipolar disorder and cPTSD. There is a crucial demand for early intervention initiatives and proactive prevention strategies to address the intricate intersection of these mental health challenges.

Characteristics and Correlates of Ten-Year Trajectories of Posttraumatic Stress Symptoms in Older U.S. Military Veterans

OBJECTIVES

To examine the nature and correlates of 10-year trajectories of posttraumatic stress disorder (PTSD) symptoms in older U.S. military Veterans.

DESIGN AND SETTING

A nationally representative web-based survey of older U.S. Veterans who participated in the National Health and Resilience in Veterans Study over 5 waves between 2011 and 2021.

PARTICIPANTS

A total of 1,843 U.S. Veterans aged 50 and older (mean age = 67).

MEASUREMENTS

PTSD symptoms were assessed using the PTSD Checklist. Self-report measures at baseline assessed sociodemographic characteristics; trauma exposures; psychiatric and substance use disorders; mental, cognitive, and physical functioning; and psychosocial factors including expectations of aging. Latent growth mixture modeling identified the nature and correlates of 10-year PTSD symptom trajectories.

RESULTS

Most of the sample had no/low PTSD symptoms (88.7%), while 6.0% had consistently subthreshold symptoms, 2.7% consistently high symptoms, and 2.6% increasing symptoms. Relative to the no/low symptom group, the subthreshold and high symptom groups reported more medical conditions and cognitive difficulties, with younger age and more lifetime traumatic events additionally linked to the high symptom trajectory. Relative to the no/low symptom group, Veterans with increasing symptoms were more likely to report functional disability and lifetime nicotine use disorder, cognitive difficulties, negative expectations regarding physical and emotional aging, and traumatic events over the study period.

CONCLUSIONS

Despite high rates of trauma exposure, most older Veterans do not evidence symptomatic PTSD trajectories; however, about 11% do. Results underscore the importance of assessing PTSD symptoms in this population and considering longitudinal trajectories as well as associated risk and protective factors.

Factors associated with ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder among older adults during the COVID-19 pandemic

ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD have been understudied in the older population. The study focused on the associations between traumatic exposure before the pandemic, COVID-19 worries, depression, and loneliness with current PTSD and CPTSD among older adults. A random sample of five hundred and twelve Israeli older adults (Mage = 72.67 ± 3.81, range 68-87) was recruited using a Web-based survey company (Ipanel, Israel). Participants completed questionnaires of demographic details, self-rated health, COVID-19 worries, trauma exposure, depressive symptoms, level of loneliness, PTSD, and CPTSD. Univariate logistic regression revealed that trauma exposure, COVID-19 worries, depression, and loneliness were associated with PTSD. Multinomial regression revealed that only trauma exposure was associated with PTSD among older adults with PTSD compared with those not reaching the PTSD cutoff level. In the comparison between older adults suffering from CPTSD with those not reaching the PTSD cutoff level, being married, higher levels of trauma exposure, COVID-19 worries, depression, and loneliness were associated with a higher risk of CPTSD. Results suggest that specific factors may be significant psychological correlates of CPTSD symptoms among older adults during the COVID-19 pandemic. Identifying these factors could assist practitioners in tailoring more effective interventions.

The mental health impact of the COVID-19 pandemic and exposure to other potentially traumatic events up to old age

We investigated whether the impact of potentially traumatic events (PTEs) on trauma-related symptoms changes across the transitional adult lifespan (i.e., 16-100 years old) and if this association differs for self-reported COVID-19-related PTEs compared to other PTEs. A web-based cross-sectional study was conducted among 7,034 participants from 88 countries between late April and October 2020. Participants completed the Global Psychotrauma Screen (GPS), a self-report questionnaire assessing trauma-related symptoms. Data were analyzed using linear and logistic regression analyses and general linear models. We found that older age was associated with lower GPS total symptom scores, B = -0.02, p < .001; this association remained significant but was substantially weaker for self-reported COVID-19-related PTEs compared to other PTEs, B = 0.02, p = .009. The results suggest an association between older age and lower ratings of trauma-related symptoms on the GPS, indicating a blunted symptom presentation. This age-related trend was smaller for self-reported COVID-19-related PTEs compared to other PTEs, reflecting the relatively higher impact of the COVID-19 pandemic on older adults.

Loneliness in Posttraumatic Stress Disorder: A Neglected Factor in Accelerated Aging?

Prior research suggests that people with Posttraumatic Stress Disorder (PTSD) may experience a form of accelerated biological aging. In other populations, loneliness has been shown to elevate risk for many of the same components of accelerated biological aging, and other deleterious outcomes, as seen in people with PTSD. Although standard diagnostic criteria for PTSD include "feelings of detachment or estrangement from others", the relationship of such feelings to the concept of loneliness remains uncertain, in par potentially due to a failure to distinguish between loneliness versus objective social isolation. In order to catalyze wider research attention to loneliness in PTSD, and the potential contribution to accelerated biological aging, the present paper provides three components: (1) a conceptual overview of the relevant constructs and potential interrelationships, (2) a review of the limited extant empirical literature, and (3) suggested directions for future research. The existing empirical literature is too small to support many definitive conclusions, but there is evidence of an association between loneliness and symptoms of PTSD. The nature of this association may be complex, and the causal direction(s) uncertain. Guided by the conceptual overview and review of existing literature, we also highlight key areas for further research. The ultimate goal of this line of work is to elucidate mechanisms underlying any link between loneliness and accelerated aging in PTSD, and to develop, validate, and refine prevention and treatment efforts.

Post-traumatic Stress Disorder in Older U.S. Military Veterans: Prevalence, Characteristics, and Psychiatric and Functional Burden

OBJECTIVE

To characterize the prevalence, characteristics, and comorbidities of subthreshold and full post-traumatic stress disorder (PTSD) in older U.S. military veterans.

DESIGN AND SETTING

A nationally representative web-based survey of older U.S. military veterans who participated in the National Health and Resilience in Veterans Study (NHRVS) between November 18, 2019 and March 8, 2020.

PARTICIPANTS

U.S. veterans aged 60 and older (n = 3,001; mean age = 73.2, SD: 7.9, range: 60-99).

MEASUREMENTS

PTSD was assessed using the PTSD Checklist for DSM-5. Self-report measures assessed sociodemographic characteristics, trauma exposures, suicidal behaviors, psychiatric and substance use disorders, as well as mental, cognitive, and physical functioning. Multivariable analyses examined correlates of subthreshold and full PTSD.

RESULTS

The vast majority of the sample (n = 2,821; 92.7%) reported exposure to one or more potentially traumatic events. Of those exposed to such events, 262 (9.6%, 95% confidence interval [CI]: 8.4%-10.9%) and 68 (1.9%, 95% CI: 1.3%-2.6%) screened positive for subthreshold and full PTSD, respectively. The prevalence of subthreshold and full PTSD was significantly higher in female veterans and veterans who use VA as their primary healthcare. Subthreshold and full PTSD groups endorsed more adverse childhood experiences and total traumas than the no/minimal PTSD symptom group, the most common traumatic experiences endorsed were combat exposure, physical or sexual assault, and life-threatening illness or injury. Veterans with subthreshold and full PTSD were also more likely to screen positive for depression, substance use disorders, suicide attempts, nonsuicidal self-injury, and suicidal ideation, and reported lower mental, cognitive, and physical functioning.

CONCLUSION

Subthreshold PTSD and full PTSD are prevalent and associated with substantial clinical burden in older U.S. veterans. Results underscore the importance of assessing both subthreshold and full PTSD in this population.

The boundaries between complex posttraumatic stress disorder symptom clusters and post-migration living difficulties in traumatised Afghan refugees: a network analysis

BACKGROUND

Psychological distress due to the ongoing war, violence, and persecution is particularly common among Afghan asylum seekers and refugees. In addition, individuals face a variety of post-migration living difficulties (PMLDs). Complex posttraumatic stress symptoms are among the most common mental health problems in this population, and were associated with the overall burden of PMLDs. The complex interplay of posttraumatic symptoms has been investigated from a network perspective in previous studies. However, individuals are embedded in and constantly react to the environment, which makes it important to include external factors in network models to better understand the etiology and maintaining factors of posttraumatic mental health problems. PMLDs are a major risk factor for posttraumatic distress and considering their impact in interventions might improve response rates. However, the interaction of these external factors with posttraumatic psychopathological distress is not yet fully understood. Thus, we aimed to illuminate the complex interaction between PMLDs and CPTSD symptom clusters.

OBJECTIVE

The main objective is the exploration of the network structure and the complex interplay of ICD-11 CPTSD symptom clusters and distinct forms of PMLDs.

METHOD

The symptom clusters of CPTSD and PMLDs were collected within a randomised controlled trial among 93 treatment-seeking Afghan asylum seekers and refugees via a fully structured face-to-face and interpreter assisted interview. Using a network analytical approach, we explored the complex associations and network centrality of the CPTSD symptom clusters and the PMLD factors: discrimination & socio-economical living conditions, language acquisition & barriers, family concerns, and residence insecurity.

RESULTS

The results suggest direct links within and between the constructs (CPTSD, PMLD). Almost all PMLD factors were interrelated and associated to CPTSD, family concerns was the only isolated variable. The CPTSD symptom cluster re-experiencing and the PMLD factor language acquisition & barriers connected the two constructs. Affective dysregulation had the highest and avoidance the lowest centrality.

CONCLUSIONS

Re-experiencing and affective dysregulation have the strongest ties to PMLDs. Thus, these domains might explain the strong association of posttraumatic psychopathology with PLMDs and, consequently, prioritization of these domains in treatment approaches might both facilitate treatment response and reduce burden caused by PMLDs.