1
|
Hadjistavropoulos HD, McCall HC, Dear BF, Beahm JD, Carleton RN, Titov N. Outcomes of transdiagnostic internet-delivered cognitive behavioural therapy tailored to public safety personnel: A longitudinal observational study. J Anxiety Disord 2024; 104:102861. [PMID: 38640867 DOI: 10.1016/j.janxdis.2024.102861] [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: 05/17/2023] [Revised: 01/07/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
First responders and other public safety personnel (PSP) experience high rates of mental health problems and face barriers to accessing mental healthcare. Internet-delivered cognitive behavioural therapy (ICBT) is an effective and accessible treatment for various mental health concerns. Canadian PSP report favorable attitudes toward ICBT, and preliminary outcomes demonstrate that they benefit from it. Expanding on this research, the current study consisted of a longitudinal observational study of 560 Canadian PSP who participated in ICBT. It was designed to assess the longer term effectiveness of ICBT and moderators of outcomes by gender, linguistic and occupational group, and years of occupational experience. We evaluated symptom change at 8, 26, and 52 weeks post-enrollment, and results among PSP who had elevated clinical scores, showed large reductions (Hedges' g) in symptoms of depression (g = 1.3), anxiety (g =1.48), posttraumatic stress (g =1.24), panic (g =1.19), and anger (g =1.07) and moderate reductions in symptoms of social anxiety (g =.48-.56). Moderator analyses revealed modest differences in pre-treatment symptoms among certain groups but no group differences in symptom change over time. Clients showed good completion of treatment materials and reported high treatment satisfaction. The results suggest further study of ICBT tailored to PSP is warranted, including evaluating ICBT tailored for PSP in other countries.
Collapse
Affiliation(s)
- Heather D Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada.
| | - Hugh C McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia; eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
| | - Janine D Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Nickolai Titov
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia; eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
| |
Collapse
|
2
|
Shields RE, Teckchandani TA, Andrews KL, Ahlgrim B, Caissie DM, Hembroff CC, Nisbet J, Asmundson GJG, Krätzig GP, Carleton RN. Prevalence of current chronic pain in Royal Canadian Mounted Police cadets. Can J Pain 2024; 8:2354394. [PMID: 38915304 PMCID: PMC11195451 DOI: 10.1080/24740527.2024.2354394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/08/2024] [Indexed: 06/26/2024]
Abstract
Background Nearly half of active duty Royal Canadian Mounted Police (RCMP) officers report experiencing current chronic pain (43%; i.e. pain lasting longer than 3 months). Most RCMP officers who report chronic pain indicate that the pain started after working as RCMP officers (91%). Baseline data on chronic pain prevalence among RCMP cadets has not been available. Aims The current study was designed to provide cross-sectional estimates of chronic pain prevalence among RCMP cadets starting the Cadet Training Program and to assess for sociodemographic differences among participants. Methods The RCMP Study uses a longitudinal prospective sequential experimental cohort design to create a clustered randomized trial that engages individual participants for 5.5 years. The current article provides cross-sectional associations between chronic pain prevalence and sociodemographic characteristics. Participants were RCMP cadets starting the Cadet Training Program (n = 770). Location, intensity (on a 0-10 scale and days per week experienced), and duration (number of months) of chronic pain were reported. Differences across sociodemographic characteristics were examined. Results Few RCMP cadets reported experiencing chronic pain (10%); lower back pain was rated as the most severe in terms of intensity and duration and second most frequently reported in number of days experienced per week. Prevalence of chronic pain was lower among RCMP cadets than among RCMP officers. Conclusions Chronic pain prevalence among active duty RCMP officers may result from or be moderated by operational duties, as well as routine aging. Future researchers could examine ways to mitigate chronic pain development during RCMP officer careers.
Collapse
Affiliation(s)
- Robyn E. Shields
- Canadian Institute for Public Safety Research and Treatment–Institut Canadien de recherché et de traitement en sécurité publique (CIPSRT-ICRTSP), Regina, Saskatchewan, Canada
- Anxiety and Illness Behaviours Lab, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Taylor A. Teckchandani
- Canadian Institute for Public Safety Research and Treatment–Institut Canadien de recherché et de traitement en sécurité publique (CIPSRT-ICRTSP), Regina, Saskatchewan, Canada
| | - Katie L. Andrews
- Canadian Institute for Public Safety Research and Treatment–Institut Canadien de recherché et de traitement en sécurité publique (CIPSRT-ICRTSP), Regina, Saskatchewan, Canada
| | - Billea Ahlgrim
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Danielle M. Caissie
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Chet C. Hembroff
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Jolan Nisbet
- Canadian Institute for Public Safety Research and Treatment–Institut Canadien de recherché et de traitement en sécurité publique (CIPSRT-ICRTSP), Regina, Saskatchewan, Canada
| | - Gordon J. G. Asmundson
- Anxiety and Illness Behaviours Lab, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Gregory P. Krätzig
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - R. Nicholas Carleton
- Canadian Institute for Public Safety Research and Treatment–Institut Canadien de recherché et de traitement en sécurité publique (CIPSRT-ICRTSP), Regina, Saskatchewan, Canada
- Anxiety and Illness Behaviours Lab, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| |
Collapse
|
3
|
Saar-Ashkenazy R, Bergman YS, Ashkenazy O, Guez J. Traumatic stress, active engagement and resilience in first responders and civilians in the outbreak of war. Eur J Psychotraumatol 2024; 15:2328506. [PMID: 38516952 PMCID: PMC10962308 DOI: 10.1080/20008066.2024.2328506] [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: 12/19/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
Background: The outbreak of war in Israel on 7 October and the unique events of that day have presented unprecedented challenges to first responders (FRs), who are professionally trained to engage in providing assistance in such circumstances. Moreover, while research demonstrates the long-term psychological consequences of FRs, little is known regarding how FR's engagement in providing assistance relates to stress and resilience levels as events continue to unfold.Objective: The current study examined the relationship between traumatic stress symptoms (TSS) and resilience levels among FRs and controls during the first weeks of the Iron Swords war, while focusing on the moderating role of active engagement in providing assistance.Method: Data were collected during the first month of the Iron Swords war from 374 participants living in Southern Israel, of whom 77 (20.6%) were FRs. All participants filled out scales assessing TSS and resilience and provided relevant background information.Results: High TSS levels were associated with reduced resilience in FRs and non-FRs. Moreover, both the study group and active engagement were significant moderators for the TSS-resilience link, which was insignificant among FRs who provided assistance and for civilians who did not provide assistance. However, the TSS-resilience association remained significant for FRs who did not engage in providing assistance and for civilians who did.Conclusions: Our findings highlight the importance of examining the extent to which FRs act in line with their duties during times of adverse stress. Clinical interventions aimed towards FRs who did not engage in providing assistance are needed and should focus on the extent to which their moral values, beliefs and expectations are met, as these appear critical parameters in preserving resilience.
Collapse
Affiliation(s)
| | - Yoav S. Bergman
- Faculty of Social-Work, Ashkelon Academic College, Ashkelon, Israel
| | - Omer Ashkenazy
- Department of Criminology, Ashkelon Academic College, Ashkelon, Israel
| | - Jonathan Guez
- Department of Psychology, Achva Academic College, Arugot, Israel
| |
Collapse
|
4
|
Khoury JMB, Jamshidi L, Shields RE, Nisbet J, Afifi TO, Fletcher AJ, Stewart SH, Asmundson GJG, Sauer-Zavala S, Krätzig GP, Carleton RN. Putative risk and resiliency factors among Royal Canadian Mounted Police cadets. Front Psychol 2023; 14:1048573. [PMID: 37008880 PMCID: PMC10053504 DOI: 10.3389/fpsyg.2023.1048573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectiveMental health disorders are prevalent among active-duty Royal Canadian Mounted Police (RCMP) officers. The current study was designed to assess whether RCMP cadets commencing the Cadet Training Program are inherently at greater risk of developing mental health challenges by statistically comparing cadet putative risk and resiliency scores to scores from young adult populations. The study was also designed to assess for sociodemographic differences in putative risk and resiliency variables among RCMP cadets in order to facilitate future comparisons.MethodsCadets (n = 772; 72.2% men) completed self-report measures of several putative risk variables (i.e., anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, and state anger) and resiliency. Scores were statistically compared to samples from Canadian, American, Australian, and European young adult populations.ResultsCadets had statistically significantly lower scores on all putative risk variables and statistically significantly higher resiliency scores compared to the young adult populations. In the cadet sample, there were statistically significant differences in putative risk and resiliency variables across gender and sex.ConclusionCadets’ significantly lower scores on putative risk variables and higher scores on resiliency suggest that they may be psychologically strong; as such, it may be that the nature of police work, as opposed to inherent individual differences in risk and resiliency, accounts for active-duty RCMP officers’ comparatively higher prevalence of mental health disorders over time.Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT05527509.
Collapse
Affiliation(s)
- Juliana M. B. Khoury
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Laleh Jamshidi
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
| | - Robyn E. Shields
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jolan Nisbet
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
| | - Tracie O. Afifi
- Department of Sociology and Social Studies, University of Regina, Regina, SK, Canada
| | - Amber J. Fletcher
- Mood, Anxiety, and Addiction Comorbidity (MAAC) Lab, Departments of Psychiatry and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Sherry H. Stewart
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK, Canada
| | | | - Shannon Sauer-Zavala
- Treatment Innovation for Psychological Services Research Program, Department of Psychology, University of Kentucky, Lexington, KY, United States
| | | | - R. Nicholas Carleton
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: R. Nicholas Carleton,
| |
Collapse
|
5
|
Fleuren BPI, Nübold A, Uitdewilligen S, Verduyn P, Hülsheger UR. Troubles on troubled minds: an intensive longitudinal diary study on the role of burnout in the resilience process following acute stressor exposure. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2023. [DOI: 10.1080/1359432x.2022.2161369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Bram P. I. Fleuren
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Annika Nübold
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sjir Uitdewilligen
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Philippe Verduyn
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ute R. Hülsheger
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
6
|
Ricciardelli R, Tamara T, Mitchell MM, Groll D, Afifi T, Nicholas Carleton R. Exposures to Potentially Psychologically Traumatic Events Among Provincial Correctional Workers in Ontario, Canada. VIOLENCE AND VICTIMS 2022; 37:77-100. [PMID: 35165161 DOI: 10.1891/vv-d-21-00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We know little about potentially psychologically traumatic events (PPTE) exposures among provincial correctional workers in diverse occupational positions and even less regarding how exposure to events are associated with mental health disorders. We designed the current study to unpack and quantify estimates of the frequencies that correctional workers, across occupational roles, experience exposure to diverse incidents. We categorized 1,338 of our 1,487 participants into six occupational categories and our measures included established self-report items measuring PPTE exposure and mental disorder symptoms. Almost all correctional workers reported exposures to most PPTE types. Correctional workers collectively report exposures to physical assault (90.2%) and sudden violent death (81.8%), with many (3.1%-46%) reporting 11+ exposures (M = 10.01, SD = 4.29). We found significant differences in exposure patterns across correctional worker categories; specifically, we found a higher prevalence of exposure to toxic substances, physical assault, assault with a weapon, severe human suffering, sudden accidental or sudden violent death, among those working in institutional correctional services (e.g., governance, correctional officers). PPTE exposure and all assessed mental health disorder symptom profiles were closely related, as correctional workers report high exposure to PPTE. Population attributable fractions indicated that the burden of mental disorders among provincial correction workers might be reduced by between 38%-70% if PPTE exposures were eliminated from the population. We conclude with recommendations for mental health related policies, such as investing in peer and psychologically support, as well as interventions for exposure to PPTE and readiness to inform strategies for employee mental health and well-being.
Collapse
|
7
|
Abstract
BACKGROUND Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD. OBJECTIVE This study compared the PTSD symptom profiles of first responder and civilians seeking treatment for PTSD. METHOD Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years (SD = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger. RESULTS First responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger. CONCLUSIONS These findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders.
Collapse
Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Kensington, Australia
| |
Collapse
|
8
|
van Zuiden M, Engel S, Karchoud JF, Wise TJ, Sijbrandij M, Mouthaan J, Olff M, van de Schoot R. Sex-differential PTSD symptom trajectories across one year following suspected serious injury. Eur J Psychotraumatol 2022; 13:2031593. [PMID: 35186216 PMCID: PMC8856115 DOI: 10.1080/20008198.2022.2031593] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Recent years have shown an increased application of prospective trajectory-oriented approaches to posttraumatic stress disorder (PTSD). Although women are generally considered at increased PTSD risk, sex and gender differences in PTSD symptom trajectories have not yet been extensively studied. OBJECTIVE To perform an in-depth investigation of differences in PTSD symptom trajectories across one-year post-trauma between men and women, by interpreting the general trends of trajectories observed in sex-disaggregated samples, and comparing within-trajectory symptom course and prevalence rates. METHOD We included N = 554 participants (62.5% men, 37.5% women) from a multi-centre prospective cohort of emergency department patients with suspected severe injury. PTSD symptom severity was assessed at 1, 3, 6, and 12 months post-trauma, using the Clinician-Administered PTSD Scale for DSM-IV. Latent growth mixture modelling on longitudinal PTSD symptoms was performed within the sex-disaggregated whole samples. Bayesian modelling with informative priors was applied for reliable model estimation, considering the imbalanced prevalence of the expected latent trajectories. RESULTS In terms of general trends, the same trajectories were observed for men and women, i.e. resilient, recovery, chronic symptoms and delayed onset. Within-trajectory symptom courses were largely comparable, but resilient women had higher symptoms than resilient men. Sex differences in prevalence rates were observed for the recovery (higher in women) and delayed onset (higher in men) trajectories. Model fit for the sex-disaggregated samples was better than for the whole sample, indicating preferred application of sex-disaggregation. Analyses within the whole sample led to biased estimates of overall and sex-specific trajectory prevalence rates. CONCLUSIONS Sex-disaggregated trajectory analyses revealed limited sex differences in PTSD symptom trajectories within one-year post-trauma in terms of general trends, courses and prevalence rates. The observed biased trajectory prevalence rates in the whole sample emphasize the necessity to apply appropriate statistical techniques when conducting sex-sensitive research.
Collapse
Affiliation(s)
- Mirjam van Zuiden
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Jeanet F Karchoud
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Thomas J Wise
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Vrije Universiteit, Department of Clinical, Neuro- and Developmental Psychology; Amsterdam Public Health Research Institute, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, The Netherlands
| | - Joanne Mouthaan
- Department of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, AK Leiden, Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands & Arq National Psychotrauma Centre, Amsterdam, The Netherlands
| | - Rens van de Schoot
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
9
|
Diamond RM, Colaianni A. The impact of perinatal healthcare changes on birth trauma during COVID-19. Women Birth 2021; 35:503-510. [PMID: 34924337 PMCID: PMC8678623 DOI: 10.1016/j.wombi.2021.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022]
Abstract
Background Since the onset of COVID-19, giving birth has involved navigating unprecedented healthcare changes that could significantly impact the psychological birth experience. Aim Research has demonstrated increasing rates of birth trauma and birth plan alterations during the COVID-19 pandemic. This study specifically examined these intersecting experiences to understand how COVID-related healthcare changes have impacted birth trauma during the pandemic. Methods 269 people who gave birth in the U.S. during COVID-19 completed an online survey between November, 2020-May, 2021 which included questions about COVID-related perinatal healthcare changes and birth-related posttraumatic stress disorder (PTSD; The City Birth Trauma Scale). T-tests were run on birth demographics to assess for significant indicators of PTSD; variables having significant effects were used to build a hierarchical regression model to predict PTSD symptoms. Findings 5.9% of the sample met criteria for PTSD and 72.3% met partial criteria. The overall regression model predicted approximately 19% of variance in total PTSD symptoms. Labor and birth demographics were entered in Step 1 and predicted approximately 11% of variance: limited length of stay for support person, being allowed 1 support person who had to be the same, and mask requirements were significant predictors of PTSD. Variables related to birth plan changes were entered in Step 2 and predicted approximately 8% of variance: changes to support person(s) for labor and birth, breastfeeding plans, and birth location were significant predictors of PTSD. Conclusion The present study demonstrates the importance of COVID-related perinatal healthcare changes to the development of trauma symptoms following childbirth.
Collapse
Affiliation(s)
- Rachel M Diamond
- Couple and Family Therapy Department, Adler University, Chicago, IL, USA.
| | - Allison Colaianni
- Couple and Family Therapy Department, Adler University, Chicago, IL, USA
| |
Collapse
|
10
|
Adler DA, Tseng VWS, Qi G, Scarpa J, Sen S, Choudhury T. Identifying Mobile Sensing Indicators of Stress-Resilience. PROCEEDINGS OF THE ACM ON INTERACTIVE, MOBILE, WEARABLE AND UBIQUITOUS TECHNOLOGIES 2021; 5. [PMID: 35445162 PMCID: PMC9017954 DOI: 10.1145/3463528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Resident physicians (residents) experiencing prolonged workplace stress are at risk of developing mental health symptoms. Creating novel, unobtrusive measures of resilience would provide an accessible approach to evaluate symptom susceptibility without the perceived stigma of formal mental health assessments. In this work, we created a system to find indicators of resilience using passive wearable sensors and smartphone-delivered ecological momentary assessment (EMA). This system identified indicators of resilience during a medical internship, the high stress first-year of a residency program. We then created density estimation approaches to predict these indicators before mental health changes occurred, and validated whether the predicted indicators were also associated with resilience. Our system identified resilience indicators associated with physical activity (step count), sleeping behavior, reduced heart rate, increased mood, and reduced mood variability. Density estimation models were able to replicate a subset of the associations between sleeping behavior, heart rate, and resilience. To the best of our knowledge, this work provides the first methodology to identify and predict indicators of resilience using passive sensing and EMA. Researchers studying resident mental health can apply this approach to design resilience-building interventions and prevent mental health symptom development.
Collapse
Affiliation(s)
| | | | - Gengmo Qi
- Computer Science, Cornell University
| | | | | | | |
Collapse
|
11
|
Hadjistavropoulos HD, McCall HC, Thiessen DL, Huang Z, Carleton RN, Dear BF, Titov N. Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study. J Med Internet Res 2021; 23:e27610. [PMID: 33949959 PMCID: PMC8135031 DOI: 10.2196/27610] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/01/2021] [Accepted: 04/11/2021] [Indexed: 01/20/2023] Open
Abstract
Background Canadian public safety personnel (PSP) experience high rates of mental health disorders and face many barriers to treatment. Internet-delivered cognitive behavioral therapy (ICBT) overcomes many such barriers, and is effective for treating depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms. Objective This study was designed to fill a gap in the literature regarding the use of ICBT tailored specifically for PSP. We examined the effectiveness of a tailored ICBT program for treating depression, anxiety, and PTSD symptoms among PSP in the province of Saskatchewan. Methods We employed a longitudinal single-group open-trial design (N=83) with outcome measures administered at screening and at 8 weeks posttreatment. Data were collected between December 5, 2019 and September 11, 2020. Primary outcomes included changes in depression, anxiety, and PTSD symptoms. Secondary outcomes included changes in functional impairment; symptoms of panic, social anxiety, and anger; as well as treatment satisfaction, working alliance, and program usage patterns. Results Clients reported large symptom reductions on measures of depression and anxiety, as well as moderate reductions on measures of PTSD and secondary symptoms, except for social anxiety. Most clients who reported symptoms above clinical cut-offs on measures of depression, anxiety, and PTSD during screening experienced clinically significant symptom reductions. Results suggested good engagement, treatment satisfaction, and working alliance. Conclusions Tailored, transdiagnostic ICBT demonstrated promising outcomes as a treatment for depression, anxiety, and PTSD among Saskatchewan PSP and warrants further investigation. Trial Registration Clinicaltrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032
Collapse
Affiliation(s)
| | - Hugh C McCall
- Department of Psychology, University of Regina, Regina, SK, Canada
| | - David L Thiessen
- Department of Mathematics and Statistics, University of Regina, Regina, SK, Canada
| | - Ziyin Huang
- PSPNET, University of Regina, Regina, SK, Canada
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, Regina, SK, Canada.,PSPNET, University of Regina, Regina, SK, Canada
| | - Blake F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| |
Collapse
|
12
|
Nobakht HN, Ojagh FS, Dale KY. Validity, Reliability and Internal Consistency of Persian Versions of the Childhood Trauma Questionnaire, the Traumatic Exposure Severity Scale and the Peritraumatic Dissociative Experiences Questionnaire. J Trauma Dissociation 2021; 22:332-348. [PMID: 33416029 DOI: 10.1080/15299732.2020.1869640] [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] [Indexed: 10/22/2022]
Abstract
The Childhood Trauma Questionnaire (CTQ), the Traumatic Exposure Severity Scale (TESS) and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) are questionnaires widely used in studies of trauma and dissociation. This study aimed to examine the validity of the Persian versions of these questionnaires among a total of 230 individuals from the cities of Kermanshah and Sarpol-e Zahab that had experienced 2017 Iran earthquake. Results from a confirmatory factor analysis did not support the original five-factor solution for the TESS. Two principal component analyses resulted in a four-component solution for a revised version of the scale. PDEQ scores, TESS scores, and its sub-scales, were found to significantly correlate with a PTSD measure with their effect sizes ranging from medium to large according to Cohen's guidelines. Furthermore, significant correlations between two sub-scales of the CTQ and a dissociation measure were found with medium effect sizes. Consequently, reliability and validity measures obtained from the sample of this study were supportive of the use of the Persian versions of the TESS, the PDEQ, and the CTQ among Persian-speaking populations. Further research on psychological responses to earthquakes and other natural disasters can provide the opportunity for cross-cultural comparisons in terms of specific resilience factors and vulnerabilities following mass trauma.
Collapse
Affiliation(s)
- Habib Niyaraq Nobakht
- International Centre for Research in Human Development, Tomsk State University, Tomsk, Russia
| | - Faeze Sadat Ojagh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Karl Yngvar Dale
- Department of Health and Social Sciences, Molde University College, Molde, Norway
| |
Collapse
|
13
|
Kyron MJ, Rees CS, Lawrence D, Carleton RN, McEvoy PM. Prospective risk and protective factors for psychopathology and wellbeing in civilian emergency services personnel: a systematic review. J Affect Disord 2021; 281:517-532. [PMID: 33388463 DOI: 10.1016/j.jad.2020.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/12/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
Emergency services personnel have an elevated risk of developing mental health conditions. Most research in this area is cross-sectional, which precludes inferences about temporal and potentially causal relationships between risk and protective factors and mental health outcomes. The current study systematically reviewed prospective studies of risk and protective factors for mental health outcomes in civilian emergency services personnel (firefighters, paramedics, police) assessed at pre-operational and operational stages. Out of 66 eligible prospective studies identified, several core groups of risk and protective factors emerged: (1) cognitive abilities; (2) coping tendencies; (3) personality factors; (4) peritraumatic reactions and post-trauma symptoms; (5) workplace factors; (6) interpersonal factors; (7) events away from work. Although there was insufficient evidence for many associations, social support was consistently found to protect against the development of mental health conditions, and peritraumatic dissociation, prior mental health issues, and prior trauma exposure were risk factors for future mental health conditions. Among operational studies, neuroticism was significantly associated with future PTSD symptoms, burnout, and general poor mental health, and avoidance and intrusion symptoms of PTSD were associated with future PTSD and depression symptoms. The current review results provide important targets for future research and interventions designed to improve the mental health of emergency services personnel.
Collapse
Affiliation(s)
- Michael J Kyron
- School of Psychology, Curtin University, Perth, Western Australia
| | - Clare S Rees
- School of Psychology, Curtin University, Perth, Western Australia
| | - Donna Lawrence
- Wellbeing and Support Services, St John Ambulance, Perth, Western Australia
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Peter M McEvoy
- School of Psychology, Curtin University, Perth, Western Australia; Centre for Clinical Interventions, Perth, Western Australia.
| |
Collapse
|
14
|
Ricciardelli R, Czarnuch S, Afifi TO, Taillieu T, Carleton RN. Public Safety Personnel's interpretations of potentially traumatic events. Occup Med (Lond) 2021; 70:155-161. [PMID: 32040152 PMCID: PMC7252499 DOI: 10.1093/occmed/kqaa007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Many public safety personnel (PSP) experience trauma directly or indirectly in their occupational role, yet there remain barriers to accessing care or seeking help. Aims To understand how PSP interpret different potentially traumatic events and how perceived eligibility for being traumatized is determined among PSP. Methods We analysed open-ended comments provided by over 800 PSP in a survey designed to assess the prevalence of post-traumatic stress injuries and other mental disorders. Results We found evidence that a trauma hierarchy may exist among PSP. Certain experiences may be interpreted as more traumatic, based on both the event and the PSP role in the actual event. For example, involvement in a shooting may be interpreted as more traumatic than arriving on the scene later. Similarly, a single event may be deemed more traumatic than an accumulation of events. The role of the individual and social context in shaping experiences and interpretations of trauma may be largely ignored in line with confirmation biases. Conclusions The role that individuals and social contexts play in shaping experiences and interpretations of trauma appear suppressed by perceptions of a trauma hierarchy, facilitating systematic discrediting or valuation of some experiences, therein evidencing that trauma is subjective and reinforcing barriers to care seeking. A trauma hierarchy may also propagate stigma and legitimize discrimination regarding mental health. We argue that recognizing, engaging with, and dismantling the perception of a trauma hierarchy may help create a respectful and open occupational culture supportive of mental health needs.
Collapse
Affiliation(s)
- R Ricciardelli
- Department of Sociology, Memorial University of Newfoundland, St. John's, Newfoundland A1C 5S7, Canada
| | - S Czarnuch
- Department of Electrical and Computer Engineering and Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, Newfoundland A1C 5S7, Canada
| | - T O Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 0W3, Canada
| | - T Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 0W3, Canada
| | - R N Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| |
Collapse
|
15
|
Herzog S, Fogle BM, Harpaz-Rotem I, Tsai J, DePierro J, Pietrzak RH. Dissociative symptoms predict risk for the development of PTSD: Results from the National Health and Resilience in Veterans Study (NHRVS). J Psychiatr Res 2020; 131:215-219. [PMID: 32998083 DOI: 10.1016/j.jpsychires.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Dissociative symptoms following trauma exposure, such as derealization (i.e., feeling that one's experience is strange and unreal) and depersonalization (i.e., feeling detached from oneself) have been implicated in the development and maintenance of posttraumatic stress disorder (PTSD). In the current study, we analyzed data from a 3-year prospective cohort study of a nationally representative sample of U.S. veterans to examine whether trait dissociative symptoms, which may impair adaptive emotion regulation following trauma exposure, predict risk for the development of PTSD in trauma-exposed veterans. Results revealed that derealization symptoms predicted a nearly 5-fold increase in relative risk of incident PTSD (relative risk ratio = 4.57, 95% confidence interval = 1.55-13.52), even after adjusting for relevant sociodemographic and trauma-related factors, and severity of PTSD symptoms at baseline. To our knowledge, this study is the first to suggest that trait dissociative symptoms-specifically derealization-may be an important population-based risk factor for the development of PTSD in trauma-exposed U.S. military veterans. These findings add to a body of literature on the prediction of PTSD that largely focuses on stable or immutable risk factors such as sociodemographic and trauma characteristics, or peritraumatic emotional reactions, and underscores the potential clinical utility of assessing, monitoring, and treating derealization symptoms in trauma-exposed U.S. military veterans at risk for PTSD.
Collapse
Affiliation(s)
- Sarah Herzog
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Brienna M Fogle
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA
| | - Jack Tsai
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA; U.S. Department of Veterans Affairs National Center on Homelessness Among Veterans, 13000 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Jonathan DePierro
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA
| |
Collapse
|
16
|
Castro-Vale I, Carvalho D. The Pathways between Cortisol-Related Regulation Genes and PTSD Psychotherapy. Healthcare (Basel) 2020; 8:healthcare8040376. [PMID: 33019527 PMCID: PMC7712185 DOI: 10.3390/healthcare8040376] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 01/30/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) only develops after exposure to a traumatic event in some individuals. PTSD can be chronic and debilitating, and is associated with co-morbidities such as depression, substance use, and cardiometabolic disorders. One of the most important pathophysiological mechanisms underlying the development of PTSD and its subsequent maintenance is a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis. The corticotrophin-releasing hormone, cortisol, glucocorticoid receptor (GR), and their respective genes are some of the mediators of PTSD's pathophysiology. Several treatments are available, including medication and psychotherapies, although their success rate is limited. Some pharmacological therapies based on the HPA axis are currently being tested in clinical trials and changes in HPA axis biomarkers have been found to occur in response not only to pharmacological treatments, but also to psychotherapy-including the epigenetic modification of the GR gene. Psychotherapies are considered to be the first line treatments for PTSD in some guidelines, even though they are effective for some, but not for all patients with PTSD. This review aims to address how knowledge of the HPA axis-related genetic makeup can inform and predict the outcomes of psychotherapeutic treatments.
Collapse
Affiliation(s)
- Ivone Castro-Vale
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- i3S-Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
- Correspondence:
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, São João Hospital University Centre, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;
| |
Collapse
|
17
|
Carlson-Johnson O, Grant H, Lavery CF. Caring for the Guardians-Exploring Needed Directions and Best Practices for Police Resilience Practice and Research. Front Psychol 2020; 11:1874. [PMID: 32973601 PMCID: PMC7472828 DOI: 10.3389/fpsyg.2020.01874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 07/07/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Heath Grant
- John Jay College of Criminal Justice, New York, NY, United States
| | | |
Collapse
|
18
|
Syed S, Ashwick R, Schlosser M, Jones R, Rowe S, Billings J. Global prevalence and risk factors for mental health problems in police personnel: a systematic review and meta-analysis. Occup Environ Med 2020; 77:737-747. [PMID: 32439827 DOI: 10.1136/oemed-2020-106498] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023]
Abstract
Police face an increased risk of developing mental health problems, yet reliable estimates of their psychological difficulties remain unknown. This systematic review and meta-analysis estimate the pooled prevalence and risk factors for mental health problems among police personnel worldwide. Three independent reviewers searched 16 databases and screened 11 506 articles published between January 1980 and October 2019. Eligible studies involved at least 100 active police professionals and used validated instruments to ascertain specific mental health problems. Estimates were pooled using random-effects meta-analyses. In total, 60 cross-sectional and seven longitudinal studies, involving 272 463 police personnel from 24 countries met criteria for inclusion. The overall pooled point prevalence was 14.6% for depression (95% CI 10.9% to 18.6%), 14.2% for post-traumatic stress disorder (PTSD; 95% CI 10.3% to 18.7%), 9.6% for a generalised anxiety disorder (95% CI 6.7% to 12.9%), 8.5% for suicidal ideation (95% CI 6.1% to 11.2%), 5.0% for alcohol dependence (95% CI 3.5% to 6.7%) and 25.7% for hazardous drinking (95% CI 19.6% to 32.4%). The strongest risk factor for depression and suicidal ideation was higher occupational stress, and the strongest risk factors for PTSD were higher occupational stress and avoidant coping strategies. Higher levels of peer-support were associated with significantly lower PTSD symptoms. Our findings suggest that the prevalence of mental health problems among police exceeds twice that previously reported in mixed samples of first responders, and is associated with poor social support, occupational stress and maladaptive coping strategies. Without effective intervention, psychological difficulties will remain a substantial health concern among police.
Collapse
Affiliation(s)
- Shabeer Syed
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford & Oxford Health NHS Foundation Trust, Oxford, UK .,Division of Psychiatry, University College London, London, UK
| | - Rachel Ashwick
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford & Oxford Health NHS Foundation Trust, Oxford, UK
| | - Marco Schlosser
- Division of Psychiatry, University College London, London, UK
| | - Rebecca Jones
- Division of Psychiatry, University College London, London, UK
| | - Sarah Rowe
- Division of Psychiatry, University College London, London, UK
| | - Jo Billings
- Division of Psychiatry, University College London, London, UK
| |
Collapse
|
19
|
Carleton RN, Afifi TO, Taillieu T, Turner S, Mason JE, Ricciardelli R, McCreary DR, Vaughan AD, Anderson GS, Krakauer RL, Donnelly EA, Camp RD, Groll D, Cramm HA, MacPhee RS, Griffiths CT. Assessing the Relative Impact of Diverse Stressors among Public Safety Personnel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1234. [PMID: 32075062 PMCID: PMC7068554 DOI: 10.3390/ijerph17041234] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 12/29/2022]
Abstract
Public Safety Personnel (PSP; e.g., correctional workers and officers, firefighters, paramedics, police officers, and public safety communications officials (e.g., call center operators/dispatchers)) are regularly exposed to potentially psychologically traumatic events (PPTEs). PSP also experience other occupational stressors, including organizational (e.g., staff shortages, inconsistent leadership styles) and operational elements (e.g., shift work, public scrutiny). The current research quantified occupational stressors across PSP categories and assessed for relationships with PPTEs and mental health disorders (e.g., anxiety, depression). The participants were 4820 PSP (31.7% women) responding to established self-report measures for PPTEs, occupational stressors, and mental disorder symptoms. PPTEs and occupational stressors were associated with mental health disorder symptoms (ps < 0.001). PSP reported substantial difficulties with occupational stressors associated with mental health disorder symptoms, even after accounting for diverse PPTE exposures. PPTEs may be inevitable for PSP and are related to mental health; however, leadership style, organizational engagement, stigma, sleep, and social environment are modifiable variables that appear significantly related to mental health.
Collapse
Affiliation(s)
- R. Nicholas Carleton
- Department of Psychology, Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, SK S4S 0A2, Canada (R.L.K.)
| | - Tracie O. Afifi
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada; (T.O.A.); (T.T.); (S.T.)
| | - Tamara Taillieu
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada; (T.O.A.); (T.T.); (S.T.)
| | - Sarah Turner
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada; (T.O.A.); (T.T.); (S.T.)
| | - Julia E. Mason
- Department of Psychology, Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, SK S4S 0A2, Canada (R.L.K.)
| | - Rosemary Ricciardelli
- Department of Sociology, Memorial University of Newfoundland, Saint John’s, NL A1C 5S7, Canada;
| | - Donald R. McCreary
- Donald McCreary Scientific Consulting, Vancouver Island, BC V9K 2R8, Canada;
| | - Adam D. Vaughan
- Office of Applied Research and Graduate Studies, Justice Institute of British Columbia, New Westminster, BC V3L 5T4, Canada; (A.D.V.); (G.S.A.)
| | - Gregory S. Anderson
- Office of Applied Research and Graduate Studies, Justice Institute of British Columbia, New Westminster, BC V3L 5T4, Canada; (A.D.V.); (G.S.A.)
| | - Rachel L. Krakauer
- Department of Psychology, Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, SK S4S 0A2, Canada (R.L.K.)
| | | | - Ronald D. Camp
- Hill-Levene Schools of Business, University of Regina, Regina, SK S4S 0A2, Canada;
| | - Dianne Groll
- Departments of Psychiatry and Psychology, Queen’s University, Kingston, ON K7L 3N6, Canada; (D.G.); (H.A.C.)
| | - Heidi A. Cramm
- Departments of Psychiatry and Psychology, Queen’s University, Kingston, ON K7L 3N6, Canada; (D.G.); (H.A.C.)
| | - Renée S. MacPhee
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada;
| | - Curt T. Griffiths
- School of Criminology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada;
| |
Collapse
|
20
|
Duagani Masika Y, Leys C, Matonda-Ma-Nzuzi T, Blanchette I, Mampunza Ma Miezi S, Kornreich C. Peritraumatic dissociation and post-traumatic stress disorder in individuals exposed to armed conflict in the Democratic Republic of Congo. J Trauma Dissociation 2019; 20:582-593. [PMID: 30958225 DOI: 10.1080/15299732.2019.1597814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to verify the hypothesis that there is an association between peritraumatic dissociation (PD) and post-traumatic stress disorder (PTSD) in individuals exposed to recurrent armed conflict. More specifically, we sought to evaluate whether PD differentially predicts PTSD according to the degree of exposure to the potentially traumatic event (PTE), the level of education, and gender. A total of 120 individuals between 17 and 75 years of age, including 51 women, completed the Traumatic Events List, the Peritraumatic Dissociative Experiences Questionnaire, and the French version of the Posttraumatic Stress Disorder Checklist Scale, as well as a questionnaire providing information regarding sociodemographic details. The group of participants with high scores for PD had significantly more PTSD. PD differentially predicts PTSD depending on the level of education and gender of the individual. Those who had been physically assaulted and raped, as well as the less educated, were more likely to be dissociated during PTE· exposure compared to witnesses and those with a higher level of education. The primary target population for prevention and early management should comprise individuals with high levels of PD, low levels of education, and women.
Collapse
Affiliation(s)
- Yvonne Duagani Masika
- Laboratoire de Psychologie Médicale et d'Addictologie, Université Libre de Bruxelles , Brussels , Belgium.,Faculté de Psychologie et des Sciences de l'Education, Université de Kinshasa , Kinshasa , République Démocratique du Congo (RDC).,Faculty of Psychology, Université Libre de Bruxelles , Brussels , Belgium
| | - Christophe Leys
- Faculty of Psychology, Université Libre de Bruxelles , Brussels , Belgium
| | - Thierry Matonda-Ma-Nzuzi
- Département de Psychiatrie, Université de Kinshasa , Kinshasa , RDC.,Neurophysiology Unit, GIGA Neurosciences, University of Liège , Liège , Belgium
| | - Isabelle Blanchette
- Département de Psychologie, Université du Québec à Trois-Rivières , Trois-Rivières , Canada
| | | | - Charles Kornreich
- Laboratoire de Psychologie Médicale et d'Addictologie, Université Libre de Bruxelles , Brussels , Belgium.,Service de psychiatrie, CHU Brugman, Université Libre de Bruxelles , Brussels , Belgium
| |
Collapse
|
21
|
Bryant RA, Kenny L, Rawson N, Cahill C, Joscelyne A, Garber B, Tockar J, Dawson K, Nickerson A. Efficacy of exposure-based cognitive behaviour therapy for post-traumatic stress disorder in emergency service personnel: a randomised clinical trial. Psychol Med 2019; 49:1565-1573. [PMID: 30149825 DOI: 10.1017/s0033291718002234] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although emergency service personnel experience markedly elevated the rates of post-traumatic stress disorder (PTSD), there are no rigorously conducted trials for PTSD in this population. This study assessed the efficacy of cognitive behaviour therapy (CBT) for PTSD in emergency service personnel, and examined if brief exposure (CBT-B) to trauma memories is no less efficacious as prolonged exposure (CBT-L). METHOD One hundred emergency service personnel with PTSD were randomised to either immediate CBT-L, CBT-B or wait-list (WL). Following post-treatment assessment, WL participants were randomised to an active treatment. Participants randomised to CBT-L or CBT-B were assessed at baseline, post-treatment and at 6-month follow-up. Both CBT conditions involved 12 weekly individual sessions comprising education, CBT skills building, imaginal exposure, in vivo exposure, cognitive restructuring and relapse prevention. Imaginal exposure occurred for 40 min per session in CBT-L and for 10 min in CBT-B. RESULTS At post-treatment, participants in WL had smaller reductions in PTSD severity (Clinician Administered PTSD Scale), depression, maladaptive appraisals about oneself and the world, and smaller improvements on psychological and social quality of life than CBT-L and CBT-B. There were no differences between CBT-L and CBT-B at follow-up on primary or secondary outcome measures but both CBT-L and CBT-B had large baseline to follow-up effect sizes for reduction of PTSD symptoms. CONCLUSIONS This study highlights that CBT, which can include either long or brief imaginal exposure, is efficacious in reducing PTSD in emergency service personnel.
Collapse
Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales,Sydney NSW 2052,Australia
| | - Lucy Kenny
- School of Psychology, University of New South Wales,Sydney NSW 2052,Australia
| | - Natasha Rawson
- School of Psychology, University of New South Wales,Sydney NSW 2052,Australia
| | - Catherine Cahill
- School of Psychology, University of New South Wales,Sydney NSW 2052,Australia
| | - Amy Joscelyne
- School of Psychology, University of New South Wales,Sydney NSW 2052,Australia
| | - Benjamin Garber
- School of Psychology, University of New South Wales,Sydney NSW 2052,Australia
| | - Julia Tockar
- School of Psychology, University of New South Wales,Sydney NSW 2052,Australia
| | - Katie Dawson
- School of Psychology, University of New South Wales,Sydney NSW 2052,Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales,Sydney NSW 2052,Australia
| |
Collapse
|
22
|
Stevens JS, Jovanovic T. Role of social cognition in post-traumatic stress disorder: A review and meta-analysis. GENES BRAIN AND BEHAVIOR 2018; 18:e12518. [PMID: 30221467 DOI: 10.1111/gbb.12518] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/11/2018] [Indexed: 12/31/2022]
Abstract
Social functioning is a key component of recovery after a potentially traumatic experience, and the buffering role of the social support in trauma resilience and recovery has been very well documented. Factors contributing to resilience and recovery are notable because although most people will experience a traumatic event during their lifetimes, only 6% to 10% are diagnosed with post-traumatic stress disorder (PTSD). The relationship between an individual and their social environment is determined both by the quality of the social environment itself, and by the individual's perception and understanding of information conveyed by the other people around them. However, little research has considered the contribution of these internal social cognitive processes to PTSD risk or resilience. The current review draws on the existing literature on social cognitive functioning in trauma exposure and PTSD, identifying key questions and themes for future research. We utilized a meta-analytic approach to assess the evidence for alterations in social cognition in PTSD, finding a consistent large deficit in social cognitive performance in PTSD groups relative to trauma-exposed and healthy controls. We then reviewed the literature on the interaction of genes and the social environment, supporting the hypothesis that social cognitive deficits are a preexisting risk factor for PTSD. Finally, we reviewed relevant neuroimaging findings, which suggest that alterations in social cognition affect the perception of threat cues in PTSD. Overall, research on social cognition and PTSD is still emerging, but existing findings suggest this is an important and understudied area for the understanding of PTSD.
Collapse
Affiliation(s)
- Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
23
|
Ricciardelli R, Carleton RN, Mooney T, Cramm H. "Playing the system": Structural factors potentiating mental health stigma, challenging awareness, and creating barriers to care for Canadian public safety personnel. Health (London) 2018; 24:259-278. [PMID: 32283964 DOI: 10.1177/1363459318800167] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are growing concerns about the impact of public safety work on the mental health of public safety personnel; as such, we explored systemic and individual factors that might dissuade public safety personnel from seeking care. Public safety personnel barriers to care-seeking include the stigma associated with mental disorders and frequent reports of insufficient access to care. To better understand barriers to care-seeking, we thematically analyzed the optional open-ended final comments provided by over 828 Canadian public safety personnel as part of a larger online survey designed to assess the prevalence of mental disorders among public safety personnel. Our results indicated that systematic processes may have (1) shaped public safety personnel decisions for care-seeking, (2) influenced how care-seekers were viewed by their colleagues, and (3) encouraged under-awareness of personal mental health needs. We described how public safety personnel who do seek care may be viewed by others; in particular, we identified widespread participant suspicion that coworkers who took the time to address their mental health needs were "abusing the system." We explored what constitutes "abusing the system" and how organizational structures-systematic processes within different public safety organizations-might facilitate such notions of abuse. We found that understaffing may increase scrutiny of injured public safety personnel by those left to manage the additional burden; in addition, cynicism and unacknowledged structural stigma may emerge, preventing the other public safety personnel from identifying their mental health needs and seeking help. Finally, we discuss how system-level stigma can be potentiated by fiscal constraints when public safety personnel take any leave of absence, inadvertently contributing to an organizational culture wherein help-seeking for employment-related mental health concerns becomes unacceptable. Implications for public safety personnel training and future research needs are discussed.
Collapse
|
24
|
Galatzer-Levy IR, Huang SH, Bonanno GA. Trajectories of resilience and dysfunction following potential trauma: A review and statistical evaluation. Clin Psychol Rev 2018; 63:41-55. [PMID: 29902711 DOI: 10.1016/j.cpr.2018.05.008] [Citation(s) in RCA: 368] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 02/08/2023]
Abstract
Given the rapid proliferation of trajectory-based approaches to study clinical consequences to stress and potentially traumatic events (PTEs), there is a need to evaluate emerging findings. This review examined convergence/divergences across 54 studies in the nature and prevalence of response trajectories, and determined potential sources of bias to improve future research. Of the 67 cases that emerged from the 54 studies, the most consistently observed trajectories following PTEs were resilience (observed in: n = 63 cases), recovery (n = 49), chronic (n = 47), and delayed onset (n = 22). The resilience trajectory was the modal response across studies (average of 65.7% across populations, 95% CI [0.616, 0.698]), followed in prevalence by recovery (20.8% [0.162, 0.258]), chronicity (10.6%, [0.086, 0.127]), and delayed onset (8.9% [0.053, 0.133]). Sources of heterogeneity in estimates primarily resulted from substantive population differences rather than bias, which was observed when prospective data is lacking. Overall, prototypical trajectories have been identified across independent studies in relatively consistent proportions, with resilience being the modal response to adversity. Thus, trajectory models robustly identify clinically relevant patterns of response to potential trauma, and are important for studying determinants, consequences, and modifiers of course following potential trauma.
Collapse
|
25
|
Greene T. Do acute dissociation reactions predict subsequent posttraumatic stress and growth? A prospective experience sampling method study. J Anxiety Disord 2018; 57:1-6. [PMID: 29886305 DOI: 10.1016/j.janxdis.2018.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/17/2018] [Accepted: 05/26/2018] [Indexed: 01/04/2023]
Abstract
While peritraumatic dissociation has been identified as a predictor of posttraumatic stress disorder, it may also have some protective aspect. The study uses experience sampling methods to assess acute dissociation reactions during conflict, and to investigate these reactions as predictors of subsequent posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG). During the 2014 Israel-Gaza conflict, Israeli civilians (n = 96) exposed to rocket fire gave twice-daily experience sampling method (ESM) reports of dissociation symptoms for 30 days via mobile phone. PTSS and PTG were assessed two months later. A mixed effects random intercepts and slopes model estimated acute dissociation reactions. Individual slope coefficients for acute dissociative reactivity were entered as predictors of subsequent PTSS and PTG in regression analyses investigating linear and curvilinear associations. Exposure to sirens elicited acute dissociation reactions. Dissociative reactivity gradually reduced over the conflict. Higher acute dissociative reactivity during conflict predicted PTSS in a curvilinear manner (inverted U) and PTG in a positive linear manner two months later. The current study provides an important and novel contribution to the field by using ESM methods to assess peritraumatic dissociation, and in demonstrating that peritraumatic dissociation may be both adaptive and maladaptive, which has implications for risk assessment and clinical practice.
Collapse
Affiliation(s)
- Talya Greene
- Department of Community Mental Health, University of Haifa, 199 Aba Houshy Ave, Haifa, 3498838, Israel.
| |
Collapse
|
26
|
Boyd JE, Protopopescu A, O’Connor C, Neufeld RWJ, Jetly R, Hood HK, Lanius RA, McKinnon MC. Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD. Eur J Psychotraumatol 2018; 9:1463794. [PMID: 29805778 PMCID: PMC5965037 DOI: 10.1080/20008198.2018.1463794] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/20/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Posttraumatic Stress Disorder (PTSD) is associated with significant functional impairment in important areas, including interpersonal relationships and occupational or educational roles. Preliminary evidence suggests that the dissociative subtype of PTSD (PTSD+DS), characterized by marked symptoms of depersonalization and derealization, is associated with increased functional impairment and disease severity, including among military members and veterans diagnosed with PTSD. Similarly, first responders (e.g. police, fire, paramedics) have also been found to experience dissociative symptoms. Despite these findings, little work has investigated whether dissociative symptoms are related to heightened functional impairment among these populations. Objective: We examined the relation between functional impairment and symptom level variables, including dissociative symptoms of depersonalization and derealization among military members, veterans, and first responders with probable PTSD. We further investigated the hypothesis that dissociative symptoms mediate the relation between PTSD symptomatology and functional impairment. Method: Eighty-one medical charts of inpatients at a residential PTSD treatment programme were accessed via retrospective review. Sixty-two were included in the present analyses. Comparison of means on symptom measures between first responders and military members/veterans were conducted, followed by correlational and mediation analyses. Results: Compared with first responders, military members and veterans showed higher levels of derealization, functional impairment, alexithymia, anxiety, and depression. Within the total sample, dissociative symptoms emerged as the strongest correlate of functional impairment and, among the dissociative symptom clusters, derealization symptoms demonstrated the strongest relation with impairment. Mediation analyses revealed that total dissociative symptoms and derealization symptoms significantly mediated the relation between PTSD symptoms and functional impairment. Conclusions: These findings highlight the importance of assessing and treating dissociative symptoms, consistent with the dissociative subtype of PTSD, among military members, veterans, and first responders with PTSD. Successful recovery on a functional and symptomatic level may necessitate treatment of dissociative symptoms, particularly derealization.
Collapse
Affiliation(s)
- Jenna E. Boyd
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
| | - Alina Protopopescu
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
| | - Charlene O’Connor
- Homewood Research Institute, Guelph, Canada
- Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, Canada
| | - Richard W. J. Neufeld
- Department of Neuroscience, Western University, London, Canada
- Department of Psychiatry, Western University, London, Canada
- Department of Psychology, Western University, London, Canada
| | - Rakesh Jetly
- Defence Research and Development Canada, Toronto, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Heather K. Hood
- Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Ruth A. Lanius
- Homewood Research Institute, Guelph, Canada
- Department of Neuroscience, Western University, London, Canada
- Department of Psychiatry, Western University, London, Canada
- Imaging Division, Lawson Health Research Institute, London, Canada
| | - Margaret C. McKinnon
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| |
Collapse
|
27
|
Anxiety-related psychopathology and chronic pain comorbidity among public safety personnel. J Anxiety Disord 2018; 55:48-55. [PMID: 29566981 DOI: 10.1016/j.janxdis.2018.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 01/06/2023]
Abstract
Canadian Public Safety Personnel (PSP; e.g., correctional service officers, dispatchers, firefighters, paramedics, police officers) regularly experience potentially traumatic, painful, and injurious events. Such exposures increase risk for developing mental disorders and chronic pain, which both involve substantial personal and social costs. The interrelationship between mental disorders and chronic pain is well-established, and both can be mutually maintaining; accordingly, understanding the relationship between mental health and chronic pain among PSP is important for improving health care. Unfortunately, the available research on such comorbidity for PSP is sparse. The current study was designed to provide initial estimates of comorbidities between mental disorders and chronic pain across diverse PSP. Participants included 5093 PSP (32% women) in six categories (i.e., Call Center Operators/Dispatchers, Correctional Workers, Firefighters, Municipal/Provincial Police, Paramedics, Royal Canadian Mounted Police) who participated in a large PSP mental health survey. The survey included established self-report measures for mental disorders and chronic pain. In the total sample, 23.1% of respondents self-reported clinically significant comorbid concerns with both mental disorders and chronic pain. The results indicated PSP who reported chronic pain were significantly more likely to screen positive for posttraumatic stress disorder (PTSD), major depressive disorder, generalized anxiety disorder, social anxiety disorder, and alcohol use disorder. There were differences between PSP categories; but, the most consistent indications of comorbidity were for chronic pain, PTSD, and major depressive disorder. Comorbidity between chronic pain and mental disorders among PSP is prevalent. Health care providers should regularly assess PSP for both symptom domains.
Collapse
|
28
|
van de Schoot R, Sijbrandij M, Depaoli S, Winter SD, Olff M, van Loey NE. Bayesian PTSD-Trajectory Analysis with Informed Priors Based on a Systematic Literature Search and Expert Elicitation. MULTIVARIATE BEHAVIORAL RESEARCH 2018; 53:267-291. [PMID: 29324055 DOI: 10.1080/00273171.2017.1412293] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There is a recent increase in interest of Bayesian analysis. However, little effort has been made thus far to directly incorporate background knowledge via the prior distribution into the analyses. This process might be especially useful in the context of latent growth mixture modeling when one or more of the latent groups are expected to be relatively small due to what we refer to as limited data. We argue that the use of Bayesian statistics has great advantages in limited data situations, but only if background knowledge can be incorporated into the analysis via prior distributions. We highlight these advantages through a data set including patients with burn injuries and analyze trajectories of posttraumatic stress symptoms using the Bayesian framework following the steps of the WAMBS-checklist. In the included example, we illustrate how to obtain background information using previous literature based on a systematic literature search and by using expert knowledge. Finally, we show how to translate this knowledge into prior distributions and we illustrate the importance of conducting a prior sensitivity analysis. Although our example is from the trauma field, the techniques we illustrate can be applied to any field.
Collapse
Affiliation(s)
- Rens van de Schoot
- a Department of Methods and Statistics , Utrecht University
- b Optentia Research Program, Faculty of Humanities , North-West University
| | - Marit Sijbrandij
- c Clinical, Neuro- en Developmental Psychology , VU University Amsterdam
| | | | - Sonja D Winter
- a Department of Methods and Statistics , Utrecht University
| | - Miranda Olff
- e Department of Psychiatry, Academic Medical Center , University of Amsterdam
- f Arq Psychotrauma Expert Group , Diemen the Netherlands
| | - Nancy E van Loey
- g Department of Clinical Psychology , Utrecht University
- h Association of Dutch Burns Centers , Department of Behavioral Research
| |
Collapse
|
29
|
Carleton RN, Afifi TO, Turner S, Taillieu T, Duranceau S, LeBouthillier DM, Sareen J, Ricciardelli R, MacPhee RS, Groll D, Hozempa K, Brunet A, Weekes JR, Griffiths CT, Abrams KJ, Jones NA, Beshai S, Cramm HA, Dobson KS, Hatcher S, Keane TM, Stewart SH, Asmundson GJG. Mental Disorder Symptoms among Public Safety Personnel in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:54-64. [PMID: 28845686 PMCID: PMC5788123 DOI: 10.1177/0706743717723825] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP. METHODS An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures. RESULTS There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure. INTERPRETATION The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.
Collapse
Affiliation(s)
- R Nicholas Carleton
- 1 Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | | | - Sarah Turner
- 2 University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | | | - Rose Ricciardelli
- 4 Memorial University of Newfoundland, Saint John's, Newfoundland and Labrador, Canada
| | | | | | - Kadie Hozempa
- 3 University of Regina, Regina, Saskatchewan, Canada
| | | | - John R Weekes
- 8 Correctional Service of Canada, Ottawa, Ontario, Canada
| | | | - Kelly J Abrams
- 10 Canadian Health Information Management Association, Regina, Canada
| | | | - Shadi Beshai
- 3 University of Regina, Regina, Saskatchewan, Canada
| | | | | | | | - Terence M Keane
- 13 National Center for Post Traumatic Stress Disorder, White River Junction, Vermont, USA
| | | | | |
Collapse
|
30
|
Carleton RN, Afifi TO, Turner S, Taillieu T, El-Gabalawy R, Sareen J, Asmundson GJG. Chronic pain among public safety personnel in Canada. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2017; 1:237-246. [PMID: 35005358 PMCID: PMC8730622 DOI: 10.1080/24740527.2017.1410431] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Chronic pain is highly prevalent in the general population and may be even higher among public safety personnel (PSP; e.g., correctional officers, dispatchers, firefighters, paramedics, police). Comprehensive data on chronic pain among diverse Canadian PSP are relatively sparse. Aims: The current study was designed to provide initial estimates of chronic pain frequency and severity among Canadian PSP. Methods: Estimates of chronic pain frequency and severity (i.e., intensity and duration) at different bodily locations were derived from self-reported data collected through an online survey. Participants included 5093 PSP (32.5% women) grouped into six categories (i.e., call center operators/dispatchers, correctional officers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police [RCMP]). Results: Substantial proportions of participants reported chronic pain, with estimates ranging from 35.3% to 45.4% across the diverse PSP categories. Across PSP categories, chronic lower back pain was the most prevalent. For some pain locations, firefighters and municipal/provincial police reported lower prevalence, but paramedics reported lower intensity, and duration, than some other PSP groups. Over 50% of RCMP and paramedics reporting chronic pain indicated that the pain was associated with an injury related to active duty. Conclusions: Discrepancies emerged across PSP members with respect to prevalence, location, and severity. The current data suggest that additional resources and research are necessary to mitigate the development and maintenance of distressing or disabling chronic pain for Canadian PSP.
Collapse
Affiliation(s)
- R. N. Carleton
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - T. O. Afifi
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S. Turner
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - T. Taillieu
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - R. El-Gabalawy
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J. Sareen
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - G. J. G. Asmundson
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| |
Collapse
|
31
|
Abstract
Although kidnapping is common in war-torn countries, there is little research examining its psychological effects. Iraqi refugees (N = 298) were assessed upon arrival to the U.S. and 1 year later. At arrival, refugees were asked about prior trauma exposure, including kidnapping. One year later refugees were assessed for posttraumatic stress disorder (PTSD) and major depression disorder (MDD) using the SCID-I. Individual resilience and narratives of the kidnapping were also assessed. Twenty-six refugees (9 %) reported being kidnapped. Compared to those not kidnapped, those who were had a higher prevalence of PTSD, but not MDD, diagnoses. Analyses examining kidnapping victims revealed that higher resilience was associated with lower rates of PTSD. Narratives of the kidnapping were also discussed. This study suggests kidnapping is associated with PTSD, but not MDD. Additionally, kidnapping victims without PTSD reported higher individual resilience. Future studies should further elucidate risk and resilience mechanisms.
Collapse
|
32
|
Greene T, Gelkopf M, Grinapol S, Werbeloff N, Carlson E, Lapid L. Trajectories of traumatic stress symptoms during conflict: A latent class growth analysis. J Affect Disord 2017; 220:24-30. [PMID: 28577426 DOI: 10.1016/j.jad.2017.05.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/24/2017] [Accepted: 05/23/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The ways in which traumatic stress symptoms unfold under situations of ongoing threat and trauma exposure are poorly understood. The current study aims to identify traumatic stress symptom trajectories during conflict, as well as potential risk factors. METHODS Experience sampling methods were used to study traumatic stress symptoms during the 2014 Israel-Gaza conflict in 100 Israeli civilians exposed to rocket fire. Summary reports of traumatic symptoms were made twice-daily for 30 days via mobile phone. RESULTS Latent class growth analysis revealed four distinct classes (low, reducing, moderate, and high) characterised by their trajectory of traumatic stress symptoms during the conflict. Female gender, not being in a relationship, and higher prior trauma exposure were identified as potential risk factors. LIMITATIONS Data were not collected in the early phase of the conflict, the sample was relatively small, and only traumatic stress symptoms were investigated as outcomes. CONCLUSIONS This study identified heterogeneous traumatic stress symptom trajectories among civilians during a conflict, with different subgroups showing distinct response patterns over time, associated with various risk factors. Investigating responses to ongoing trauma, and identifying predictors of different stress symptom trajectories has clinical implications for the targeted delivery of interventions. Further exploration of heterogeneous trajectories could potentially elucidate mechanisms that drive resilience and recovery, including in situations of ongoing exposure such as during conflict.
Collapse
Affiliation(s)
- T Greene
- The Department of Community Mental Health, University of Haifa, 199 Aba Houshy Ave, Haifa, Israel.
| | - M Gelkopf
- The Department of Community Mental Health, University of Haifa, 199 Aba Houshy Ave, Haifa, Israel; NATAL, Israel Trauma Center for Victims of Terror and War, Tel Aviv, Israel
| | - S Grinapol
- The Department of Community Mental Health, University of Haifa, 199 Aba Houshy Ave, Haifa, Israel
| | - N Werbeloff
- Division of Psychiatry, University College London, UK
| | - E Carlson
- National Center for PTSD and VA Palo Alto Health Care System, Dept. of Veterans Affairs, USA
| | - L Lapid
- The Department of Community Mental Health, University of Haifa, 199 Aba Houshy Ave, Haifa, Israel; NATAL, Israel Trauma Center for Victims of Terror and War, Tel Aviv, Israel
| |
Collapse
|
33
|
Utilization of machine learning for prediction of post-traumatic stress: a re-examination of cortisol in the prediction and pathways to non-remitting PTSD. Transl Psychiatry 2017; 7:e0. [PMID: 28323285 PMCID: PMC5416681 DOI: 10.1038/tp.2017.38] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/01/2016] [Accepted: 12/15/2016] [Indexed: 01/24/2023] Open
Abstract
To date, studies of biological risk factors have revealed inconsistent relationships with subsequent post-traumatic stress disorder (PTSD). The inconsistent signal may reflect the use of data analytic tools that are ill equipped for modeling the complex interactions between biological and environmental factors that underlay post-traumatic psychopathology. Further, using symptom-based diagnostic status as the group outcome overlooks the inherent heterogeneity of PTSD, potentially contributing to failures to replicate. To examine the potential yield of novel analytic tools, we reanalyzed data from a large longitudinal study of individuals identified following trauma in the general emergency room (ER) that failed to find a linear association between cortisol response to traumatic events and subsequent PTSD. First, latent growth mixture modeling empirically identified trajectories of post-traumatic symptoms, which then were used as the study outcome. Next, support vector machines with feature selection identified sets of features with stable predictive accuracy and built robust classifiers of trajectory membership (area under the receiver operator characteristic curve (AUC)=0.82 (95% confidence interval (CI)=0.80-0.85)) that combined clinical, neuroendocrine, psychophysiological and demographic information. Finally, graph induction algorithms revealed a unique path from childhood trauma via lower cortisol during ER admission, to non-remitting PTSD. Traditional general linear modeling methods then confirmed the newly revealed association, thereby delineating a specific target population for early endocrine interventions. Advanced computational approaches offer innovative ways for uncovering clinically significant, non-shared biological signals in heterogeneous samples.
Collapse
|
34
|
Dorahy MJ, McKendry H, Scott A, Yogeeswaran K, Martens A, Hanna D. Reactive dissociative experiences in response to acute increases in shame feelings. Behav Res Ther 2017; 89:75-85. [DOI: 10.1016/j.brat.2016.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 10/30/2016] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
|
35
|
Posttraumatic stress symptoms across the deployment cycle: A latent transition analysis. J Psychiatr Res 2016; 83:54-60. [PMID: 27566139 DOI: 10.1016/j.jpsychires.2016.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/27/2016] [Accepted: 08/04/2016] [Indexed: 11/20/2022]
Abstract
Our objective was to examine symptom-level changes in the course in posttraumatic stress disorder (PTSD) across the deployment cycle among combat-exposed Marines, and to determine the degree to which combat exposure and post-deployment stressor exposure predicted PTSD symptom profile transitions. We examined PTSD symptoms in a cohort of U.S. Marines (N = 892) recruited for the Marine Resiliency Study (MRS). Marines deployed as one battalion infantry unit to Afghanistan in 2010 and were assessed pre-deployment and one, five, and eight months post-deployment. We employed latent transition analysis (LTA) to examine Marines' movement across PTSD symptom profiles, determined by latent class analysis (LCA). LCAs revealed a 3-class solution one month pre-deployment, a 4-class solution at five months post-deployment, and a 3-class solution at eight months post-deployment. LTA revealed notable movement between classes over time, which depended chiefly on pre-deployment symptom presentation. Marines who reported few pre-deployment symptoms either maintained these low levels or returned to low levels by eight months. Marines who reported a moderate number of symptoms at pre-deployment had variable outcomes; 50% had reductions by eight months, and those who reported numbing symptoms at five months post-deployment tended to report more symptoms at eight months. Marines who reported more PTSD symptoms prior to deployment retained more symptoms eight months post-deployment. Combat exposure and post-deployment stressor exposure predicted profile transitions. Examining transitions between latent class membership over time revealed prognostic information about Marines' eight-month PTSD outcomes. The extent of pre-deployment PTSD symptoms was particularly informative of likely PTSD outcomes.
Collapse
|
36
|
How Much Do We Really Know About Employee Resilience? INDUSTRIAL AND ORGANIZATIONAL PSYCHOLOGY-PERSPECTIVES ON SCIENCE AND PRACTICE 2016. [DOI: 10.1017/iop.2015.107] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Past research purporting to study employee resilience suffers from a lack of conceptual clarity about both the resilience construct and the methodological designs that examine resilience without ensuring the occurrence of significant adversity. The overall goal of this article is to address our contemporary understanding of employee resilience and identify pathways for the future advancement of resilience research in the workplace. We first address conceptual definitions of resilience both inside and outside of industrial and organizational psychology and make the case that researchers have generally failed to document the experience of significant adversity when studying resilience in working populations. Next, we discuss methods used to examine resilience, with an emphasis on distinguishing thecapacity forresilience and thedemonstration ofresilience. Representative research is then reviewed by examining self-reports of resilience or resilience-related traits along with research on resilient and nonresilient trajectories following significant adversity. We then briefly address the issues involved in selecting resilient employees and building resilience in employees. The article concludes with recommendations for future research studying resilience in the workplace, including documenting significant adversity among employees, assessing multiple outcomes, using longitudinal designs with theoretically supported time lags, broadening the study of resilience to people in occupations outside the military who may face significant adversity, and addressing the potential dark side of an emphasis on resilience.
Collapse
|
37
|
Schwarzer R, Cone JE, Li J, Bowler RM. A PTSD symptoms trajectory mediates between exposure levels and emotional support in police responders to 9/11: a growth curve analysis. BMC Psychiatry 2016; 16:201. [PMID: 27373581 PMCID: PMC4931706 DOI: 10.1186/s12888-016-0907-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 06/16/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Exposure to the terrorist attack on the World Trade Center (WTC) on 9/11/2001 resulted in continuing stress experience manifested as Posttraumatic Stress Disorder (PTSD) Symptoms in a minority of the police responders. The WTC Health Registry has followed up a large number of individuals, including police officers, at three waves of data collection from 2003 to 2011. This analysis examines the relationship between initial exposure levels, long-term PTSD symptoms, and subsequent emotional support among police responders. METHODS The study population included police responders who had reported their 9/11 exposure levels at Wave 1 (2003/4), provided three waves of data on PTSD symptoms using the 17-item PCL scale, and rated their received emotional support at Wave 3 (N = 2,204, 1,908 men, 296 women, mean age: 38 years at exposure). A second-order growth curve reflected a PTSD symptom trajectory which was embedded in a structural equation model, with exposure level specified as an exogenous predictor, and emotional support specified as an endogenous outcome. RESULTS Exposure had a main effect on mean symptom levels (intercept) across three waves but it made no difference in changes in symptoms (slope), and no difference in emotional support. The symptom trajectory, on the other hand, had an effect on emotional support. Its intercept and slope were both related to support, indicating that changes in symptoms affected later emotional support. CONCLUSIONS Initial trauma exposure levels can have a long-term effect on mean symptom levels. Emotional support is lower in police responders when PTSD symptoms persist over seven years, but becomes higher when reduction in symptoms occurs.
Collapse
Affiliation(s)
- Ralf Schwarzer
- />Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia
- />SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - James E. Cone
- />World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY USA
| | - Jiehui Li
- />World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY USA
| | - Rosemarie M. Bowler
- />Department of Psychology, San Francisco State University, San Francisco, CA USA
| |
Collapse
|
38
|
Fleming CJE, Resick PA. Predicting three types of dissociation in female survivors of intimate partner violence. J Trauma Dissociation 2016; 17:267-85. [PMID: 26274868 DOI: 10.1080/15299732.2015.1079807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Previous research suggests that studying the effect of dissociation is particularly important in survivors of intimate partner violence because of the risk of revictimization. The current study investigated demographic variables, child and current abuse characteristics, coping style, and cognitive distortions as predictors of peritraumatic, trait, and posttraumatic stress disorder (PTSD)-related dissociation in a sample of female intimate partner violence survivors. The sample consisted of 372 women, the majority African American, with an average age of 34.41 years (SD = 8.09). Peritraumatic dissociation was significantly predicted by child physical abuse, current abuse injury, cognitive distortions about safety, and problem disengagement coping. Trait dissociation was significantly predicted by minority race, personal income, and cognitive distortions about safety and self-worth. PTSD-related dissociation was significantly predicted by cognitive distortions about self-worth, problem and emotion disengagement coping, and peritraumatic dissociation. In the models predicting both trait and PTSD-related dissociation, abuse characteristics significantly predicted dissociation until the entry of cognitive variables into the model. The analysis indicated a significant indirect effect of cognitive distortions on the relationship between current sexual aggression and trait dissociation. Results also suggested that there were indirect effects of both cognitive distortions and peritraumatic dissociation on the relationships between current psychological abuse/injury and PTSD-related dissociation. Findings point to the importance of cognitions in the development and maintenance of dissociation and suggest that treatments designed to help clients accept and process traumatic events may help reduce dissociation and in turn prevent future revictimization.
Collapse
Affiliation(s)
- C J Eubanks Fleming
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , North Carolina , USA
| | - Patricia A Resick
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , North Carolina , USA
| |
Collapse
|
39
|
Castro-Vale I, van Rossum EF, Machado JC, Mota-Cardoso R, Carvalho D. Genetics of glucocorticoid regulation and posttraumatic stress disorder—What do we know? Neurosci Biobehav Rev 2016; 63:143-57. [DOI: 10.1016/j.neubiorev.2016.02.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 11/30/2015] [Accepted: 02/05/2016] [Indexed: 02/05/2023]
|
40
|
Mental Health Functioning in the Human Rights Field: Findings from an International Internet-Based Survey. PLoS One 2015; 10:e0145188. [PMID: 26700305 PMCID: PMC4689393 DOI: 10.1371/journal.pone.0145188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 12/01/2015] [Indexed: 11/19/2022] Open
Abstract
Human rights advocates play a critical role in promoting respect for human rights world-wide, and engage in a broad range of strategies, including documentation of rights violations, monitoring, press work and report-writing, advocacy, and litigation. However, little is known about the impact of human rights work on the mental health of human rights advocates. This study examined the mental health profile of human rights advocates and risk factors associated with their psychological functioning. 346 individuals currently or previously working in the field of human rights completed an internet-based survey regarding trauma exposure, depression, posttraumatic stress disorder (PTSD), resilience and occupational burnout. PTSD was measured with the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C) and depression was measured with the Patient History Questionnaire-9 (PHQ-9). These findings revealed that among human rights advocates that completed the survey, 19.4% met criteria for PTSD, 18.8% met criteria for subthreshold PTSD, and 14.7% met criteria for depression. Multiple linear regressions revealed that after controlling for symptoms of depression, PTSD symptom severity was predicted by human rights-related trauma exposure, perfectionism and negative self-appraisals about human rights work. In addition, after controlling for symptoms of PTSD, depressive symptoms were predicted by perfectionism and lower levels of self-efficacy. Survey responses also suggested high levels of resilience: 43% of responders reported minimal symptoms of PTSD. Although survey responses suggest that many human rights workers are resilient, they also suggest that human rights work is associated with elevated rates of PTSD and depression. The field of human rights would benefit from further empirical research, as well as additional education and training programs in the workplace about enhancing resilience in the context of human rights work.
Collapse
|
41
|
Lilly MM, London MJ, Mercer MC. Predictors of Obesity and Physical Health Complaints Among 911 Telecommunicators. Saf Health Work 2015; 7:55-62. [PMID: 27014492 PMCID: PMC4792921 DOI: 10.1016/j.shaw.2015.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 08/21/2015] [Accepted: 09/01/2015] [Indexed: 11/29/2022] Open
Abstract
Background This study aims to: (1) examine rates of obesity and physical health complaints among 911 telecommunicators; and (2) document the role of emotion dysregulation, psychological inflexibility, duty-related distress and dissociation, and psychopathology in predicting obesity and physical health complaints in this population. Methods The sample consisted of 911 telecommunicators from across the country (N = 758). Participants completed an online survey assessing their mental and physical health functioning. Results A total of 82.5% of the sample reported a body mass index that fell within the overweight or obese category and an average of 17 physical health complaints within the past month. Peritraumatic reactions (distress and dissociation), emotion dysregulation, and psychological inflexibility had effects on physical health largely through psychopathology (alcohol abuse, post-traumatic stress disorder, and depression). Conclusion Development of adapted prevention and intervention efforts with this population is needed.
Collapse
Affiliation(s)
- Michelle M Lilly
- Northern Illinois University, Department of Psychology, DeKalb, IL, USA
| | - Melissa J London
- Northern Illinois University, Department of Psychology, DeKalb, IL, USA
| | - Mary C Mercer
- Northern Illinois University, Department of Psychology, DeKalb, IL, USA
| |
Collapse
|
42
|
Ozdemir O, Boysan M, Guzel Ozdemir P, Yilmaz E. Relationships between posttraumatic stress disorder (PTSD), dissociation, quality of life, hopelessness, and suicidal ideation among earthquake survivors. Psychiatry Res 2015; 228:598-605. [PMID: 26106056 DOI: 10.1016/j.psychres.2015.05.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/10/2015] [Accepted: 05/03/2015] [Indexed: 12/25/2022]
Abstract
Researches have demonstrated that Posttraumatic stress disorder (PTSD) is one of the most common stress reactions in the face of disasters and significantly associated with a broad range of trauma-induced sequelaes including anxiety, depression, suicidality as well as functional impairments. To date, though many aspects of risk factors with respect to the development and maintenance of PTSD have been addressed, mediating role of dissociation has received relatively less attention. In the present study, we examined relations of PTSD with quality of life, hopelessness, suicidal ideation, and mediational effect of pathological dissociation in these connections. 583 subjects most of whom experienced a severe earthquake participated in the study after two years of the disaster. We found that being female, being single, earthquake exposure, and having greater suicidal ideation were significant predictors of PTSD symptom severity. Role-Physical, Bodily-Pain, General Health and Role-Emotional subscales of the SF-36 were inversely associated with PTSD symptom severity. Pathological dissociation significantly mediated the substantial associations between predictors and PTSD symptom clusters. Chronic dissociation appears to put trauma exposed individuals in jeopardy of prolonged posttraumatic reactions by mediating the negative influences of risk factors in the face of experienced earthquake.
Collapse
Affiliation(s)
- Osman Ozdemir
- Yüzüncü Yıl University, Department of Psychiatry, Dursun Odabas Medical Center, Van, Turkey
| | - Murat Boysan
- Yüzüncü Yıl University, Department of Psychology, Faculty of Arts, Van, Turkey
| | - Pinar Guzel Ozdemir
- Yüzüncü Yıl University, Department of Psychiatry, Dursun Odabas Medical Center, Van, Turkey.
| | - Ekrem Yilmaz
- Yüzüncü Yıl University, Department of Psychiatry, Dursun Odabas Medical Center, Van, Turkey
| |
Collapse
|
43
|
Hart R, Lancaster SL. Initial validation of self-reported trajectories in military veterans. JOURNAL OF LOSS & TRAUMA 2015. [DOI: 10.1080/15325024.2015.1067104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
44
|
Bonanno GA, Romero SA, Klein SI. The Temporal Elements of Psychological Resilience: An Integrative Framework for the Study of Individuals, Families, and Communities. PSYCHOLOGICAL INQUIRY 2015. [DOI: 10.1080/1047840x.2015.992677] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
45
|
Lilly MM, Allen CE. Psychological Inflexibility and Psychopathology in 9-1-1 Telecommunicators. J Trauma Stress 2015; 28:262-6. [PMID: 25964163 DOI: 10.1002/jts.22004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Mental health in 9-1-1 telecommunicators has been understudied in comparison to other emergency responders. This study enrolled a sample of telecommunicators from across the United States (N = 808). As measured by self-report, the prevalence of current probable posttraumatic stress disorder (PTSD) was 17.6% to 24.6%; it was 23.9% for probable major depression. Structural equation modeling revealed a significant direct effect of psychological inflexibility on psychopathology (path coefficient = .32) when considered among duty-related distress and dissociation, neuroticism, anger, and emotion dysregulation. The results provided further evidence of the adverse psychological effects of duty-related trauma exposure, including exposure that is vicarious in nature. The results indicate a need for prevention and intervention in this population, with psychological inflexibility as a potential target in these efforts.
Collapse
Affiliation(s)
- Michelle M Lilly
- Department of Psychology, Northern Illinois University, DeKalb, Illinois, USA
| | - Christy E Allen
- Department of Psychology, Northern Illinois University, DeKalb, Illinois, USA
| |
Collapse
|
46
|
Andersen JP, Papazoglou K, Koskelainen M, Nyman M, Gustafsberg H, Arnetz BB. Applying Resilience Promotion Training Among Special Forces Police Officers. SAGE OPEN 2015; 5:10.1177/2158244015590446. [PMID: 26137394 PMCID: PMC4484868 DOI: 10.1177/2158244015590446] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Police Special Forces (a.k.a. special weapons and tactics [SWAT]) officers are tasked with responding to the most critical situations, including incidents that require specialized skills and equipment beyond typical policing activities. In this study, we tested the feasibility of applying Arnetz and colleagues' resilience promotion training that was developed for patrol officers to SWAT team officers (n = 18). The resilience promotion training program included psychoeducation focused on police stress and resilience, and the practice of resilience promotion techniques (controlled breathing and imagery) while listening to audio-recorded critical incident scenarios. The aims of this study were to (a) examine if a resilience training program was relevant and accepted by SWAT team officers and (b) assess participants' physiological stress responses (heart rate, respiration) during the resilience training sessions to note if there were improvements in stress responding over time. Our findings revealed that participants were able to significantly reduce their average heart rate and improve their ability to engage in controlled respiration (i.e., breathing) during simulated critical incidents over the course of the 5-day training. Improvements in stress responding were observed even when the critical incident scenarios became more graphic. Results suggest that an intervention to reduce stress responses of SWAT officers to critical incident scenarios works in a simulated training setting. Translation of these findings to real-world occupational hazards is a recommended next step.
Collapse
|
47
|
Galatzer-Levy IR, Moscarello J, Blessing EM, Klein J, Cain CK, LeDoux JE. Heterogeneity in signaled active avoidance learning: substantive and methodological relevance of diversity in instrumental defensive responses to threat cues. Front Syst Neurosci 2014; 8:179. [PMID: 25309354 PMCID: PMC4173321 DOI: 10.3389/fnsys.2014.00179] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/05/2014] [Indexed: 11/13/2022] Open
Abstract
Individuals exposed to traumatic stressors follow divergent patterns including resilience and chronic stress. However, researchers utilizing animal models that examine learned or instrumental threat responses thought to have translational relevance for Posttraumatic Stress Disorder (PTSD) and resilience typically use central tendency statistics that assume population homogeneity. This approach potentially overlooks fundamental differences that can explain human diversity in response to traumatic stressors. The current study tests this assumption by identifying and replicating common heterogeneous patterns of response to signaled active avoidance (AA) training. In this paradigm, rats are trained to prevent an aversive outcome (shock) by performing a learned instrumental behavior (shuttling between chambers) during the presentation of a conditioned threat cue (tone). We test the hypothesis that heterogeneous trajectories of threat avoidance provide more accurate model fit compared to a single mean trajectory in two separate studies. Study 1 conducted 3 days of signaled AA training (n = 81 animals) and study 2 conducted 5 days of training (n = 186 animals). We found that four trajectories in both samples provided the strongest model fit. Identified populations included animals that acquired and retained avoidance behavior on the first day (Rapid Avoiders: 22 and 25%); those who never successfully acquired avoidance (Non-Avoiders; 20 and 16%); a modal class who acquired avoidance over 3 days (Modal Avoiders; 37 and 50%); and a population who demonstrated a slow pattern of avoidance, failed to fully acquire avoidance in study 1 and did acquire avoidance on days 4 and 5 in study 2 (Slow Avoiders; 22.0 and 9%). With the exception of the Slow Avoiders in Study 1, populations that acquired demonstrated rapid step-like increases leading to asymptotic levels of avoidance. These findings indicate that avoidance responses are heterogeneous in a way that may be informative for understanding both resilience and PTSD as well as the nature of instrumental behavior acquisition. Characterizing heterogeneous populations based on their response to threat cues would increase the accuracy and translatability of such models and potentially lead to new discoveries that explain diversity in instrumental defensive responses.
Collapse
Affiliation(s)
| | - Justin Moscarello
- Department of Arts and Sciences, Center for Neural Science, New York University New York, NY, USA
| | - Esther M Blessing
- Department of Psychiatry, New York University School of Medicine New York, NY, USA
| | - JoAnna Klein
- Department of Arts and Sciences, Center for Neural Science, New York University New York, NY, USA
| | - Christopher K Cain
- Department of Psychiatry, New York University School of Medicine New York, NY, USA ; Department of Arts and Sciences, Center for Neural Science, New York University New York, NY, USA ; Nathan Klein Institute Orangeburg, SC, USA
| | - Joseph E LeDoux
- Department of Arts and Sciences, Center for Neural Science, New York University New York, NY, USA ; Nathan Klein Institute Orangeburg, SC, USA
| |
Collapse
|
48
|
Galatzer-Levy IR, Steenkamp MM, Qian M, Inslicht S, Henn-Haase C, Otte C, Yehuda R, Neylan TC, Marmar CR, Marmar CR. Cortisol response to an experimental stress paradigm prospectively predicts long-term distress and resilience trajectories in response to active police service. J Psychiatr Res 2014; 56:36-42. [PMID: 24952936 PMCID: PMC5759781 DOI: 10.1016/j.jpsychires.2014.04.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/25/2014] [Accepted: 04/24/2014] [Indexed: 11/24/2022]
Abstract
Heterogeneity in glucocorticoid response to experimental stress conditions has shown to differentiate individuals with healthy from maladaptive real-life stress responses in a number of distinct domains. However, it is not known if this heterogeneity influences the risk for developing stress related disorders or if it is a biological consequence of the stress response itself. Determining if glucocorticoid response to stress induction prospectively predicts psychological vulnerability to significant real life stressors can adjudicate this issue. To test this relationship, salivary cortisol as well as catecholamine responses to a laboratory stressor during academy training were examined as predictors of empirically identified distress trajectories through the subsequent 4 years of active duty among urban police officers routinely exposed to potentially traumatic events and routine life stressors (N = 234). During training, officers were exposed to a video vignette of police officers exposed to real-life trauma. Changes in salivary 3-methoxy-4-hydroxyphenylglycol (MHPG) and cortisol in response to this video challenge were examined as predictors of trajectory membership while controlling for age, gender, and baseline neuroendocrine levels. Officers who followed trajectories of resilience and recovery over 4 years mounted significant increases in cortisol in response to the experimental stressor, while those following a trajectory of chronic increasing distress had no significant cortisol change in response to the challenge. MHPG responses were not associated with distress trajectories. Cortisol response prospectively differentiated trajectories of distress response suggesting that a blunted cortisol response to a laboratory stressor is a risk factor for later vulnerability to distress following significant life stressors.
Collapse
Affiliation(s)
- Isaac R. Galatzer-Levy
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury,New York University School of Medicine,Corresponding Author: Isaac R. Galatzer-Levy, Ph.D., NYU School of Medicine, 1 Park Ave. New York, NY, 10028, 847-420-2527,
| | - Maria M. Steenkamp
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury,New York University School of Medicine
| | - Meng Qian
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury
| | - Sabra Inslicht
- San Francisco Veterans Affairs,University of California San Francisco
| | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury,New York University School of Medicine
| | | | | | - Thomas C. Neylan
- San Francisco Veterans Affairs,University of California San Francisco
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury,New York University School of Medicine
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, United States; New York University School of Medicine, United States
| |
Collapse
|
49
|
Orcutt HK, Bonanno GA, Hannan SM, Miron LR. Prospective trajectories of posttraumatic stress in college women following a campus mass shooting. J Trauma Stress 2014; 27:249-56. [PMID: 24819209 PMCID: PMC4218731 DOI: 10.1002/jts.21914] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In a sample with known levels of preshooting posttraumatic stress (PTS) symptoms, we examined the impact of a campus mass shooting on trajectories of PTS in the 31 months following the shooting using latent growth mixture modeling. Female students completed 7 waves of a longitudinal study (sample sizes ranged from 812 to 559). We identified 4 distinct trajectories (n = 660): (a) minimal impact-resilience (60.9%), (b) high impact-recovery (29.1%), (c) moderate impact-moderate symptoms (8.2%), and (d) chronic dysfunction (1.8%). Individuals in each trajectory class remained at or returned to preshooting levels of PTS approximately 6 months postshooting. The minimal impact-resilience class reported less prior trauma exposure (η(2) = .13), less shooting exposure (η(2) = .07), and greater emotion regulation skills than all other classes (η(2) > .30). The chronic dysfunction class endorsed higher rates of experiential avoidance prior to the shooting than the minimal-impact resilient and high impact-recovery classes (η(2) = .15), as well as greater shooting exposure than the high impact-recovery class (η(2) = .07). Findings suggest that preshooting functioning and emotion regulation distinguish between those who experience prolonged distress following mass violence and those who gradually recover.
Collapse
Affiliation(s)
- Holly K. Orcutt
- Northern Illinois University, Department of Psychology, DeKalb, Illinois, USA
| | - George A. Bonanno
- Teachers College, Department of Counseling and Clinical Psychology, Columbia University, New York, New York, USA
| | - Susan M. Hannan
- Northern Illinois University, Department of Psychology, DeKalb, Illinois, USA
| | - Lynsey R. Miron
- Northern Illinois University, Department of Psychology, DeKalb, Illinois, USA
| |
Collapse
|
50
|
Sánchez-Teruel D, Auxiliadora Robles-Bello M. Personalidad y resiliencia en un cuerpo especial de la Policía Nacional de España. JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2014. [DOI: 10.1016/j.rpto.2014.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|