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Roze M, Melchior M, Vuillermoz C, Rezzoug D, Baubet T, Vandentorren S. Post-Traumatic Stress Disorder in Homeless Migrant Mothers of the Paris Region Shelters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134908. [PMID: 32646029 PMCID: PMC7370032 DOI: 10.3390/ijerph17134908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022]
Abstract
Migrant women are disproportionately more likely to experience traumatic events in their country of origin, during migration and after arriving in the host country. Homeless women are more likely to be exposed to multiple victimizations in childhood (emotional or physical maltreatment) and in adulthood (sexual abuse, street victimization). This study’s objective was to describe the factors associated with the likelihood of post-traumatic stress disorder (PTSD) among homeless migrant mothers in the Paris region. Face-to-face interviews were conducted by bilingual psychologists and interviewers in a representative sample of homeless families in the Paris region. PTSD was ascertained using the Mini International Neuropsychiatric Interview (MINI) (n = 691 mothers). We studied PTSD in mothers using weighted Poisson regression. Homeless migrant mothers had high levels of PTSD (18.9%) in the 12 months preceding the study. In multivariate analysis, PTSD was associated with departure from the country of origin because of violence (PR = 1.45 95% CI 1.03; 2.04), depression in the preceding 12 months (PR = 1.82 95% CI 1.20; 2.76), and residential instability (PR = 1.93 95% CI 1.27; 2.93). Homeless migrant mothers have high levels of traumatic events and PTSD. Improvements in screening for depression and PTSD and access to appropriate medical care are essential for this vulnerable group.
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Affiliation(s)
- Mathilde Roze
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; (M.R.); (M.M.); (C.V.)
| | - Maria Melchior
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; (M.R.); (M.M.); (C.V.)
| | - Cécile Vuillermoz
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; (M.R.); (M.M.); (C.V.)
| | - Dalila Rezzoug
- CESP Inserm 1178, Université Paris 13, APHP Hôpital Avicenne, 93000 Bobigny, France; (D.R.); (T.B.)
- Centre National de Ressources et Résilience, 59800 Lille, France
| | - Thierry Baubet
- CESP Inserm 1178, Université Paris 13, APHP Hôpital Avicenne, 93000 Bobigny, France; (D.R.); (T.B.)
- Centre National de Ressources et Résilience, 59800 Lille, France
| | - Stéphanie Vandentorren
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; (M.R.); (M.M.); (C.V.)
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
- Correspondence:
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Hosseininejad SM, Jahanian F, Elyasi F, Mokhtari H, Koulaei ME, Pashaei SM. The prevalence of post-traumatic stress disorder among emergency nurses: a cross sectional study in northern Iran. Biomedicine (Taipei) 2019; 9:19. [PMID: 31453800 PMCID: PMC6711322 DOI: 10.1051/bmdcn/2019090319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/26/2019] [Indexed: 12/27/2022] Open
Abstract
Background and objective: Posttraumatic stress disorder (PTSD) is one of the anxiety disorders which occurs in response to facing events and accidents accompanied by fear, frustration, and terror. Nurses who worked in the emergency departments witness unpleasant accidents and are exposed to stress and violence more than others. The aim of this study was to investigate the prevalence of PTSD among Iranian nurses working in the emergency department. Materials and Methods: In this cross-sectional study, all nurses working in the emergency department of educational hospitals affiliated with Mazandaran University of Medical Sciences were included through census method (n = 131). Each of the participants in this study responded to the questionnaires individually. The first part of the questionnaire captured demographics, while the second part was the Civilian Mississippi Scale for PTSD, which was used to investigate the extent of PTSD in this study. Data were analyzed using SPSS version 22. Results: In this study, 131 respondents were included. In the classification of age, nurses with 20-30-year- old had the maximum frequency (41.2 %,). Most nurses in the study (93.1%, n = 122) had a bachelor’s degree in nursing and 84 were married. The prevalence of PTSD in emergency nurses was 82.96%, which was higher in nurses with shorter working background and nurses with lower levels of education. Further, the average score of PTSD was higher in married nurses. Conclusion: The results of this study revealed the high prevalence of PTSD among nurses who worked in emergency department. Therefore, it seems that designing and providing supportive and educational services to emergency nurses can be effective for preventing and managing this disorder, which probably can improve their performance.
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Affiliation(s)
- Seyed Mohammad Hosseininejad
- Department of Emergency Medicine, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Jahanian
- Department of Emergency Medicine, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Faculty of Medicine, Mazandaran University of Medical Science, Sari, Iran
| | - Hossein Mokhtari
- Head Nurse of Emergency Department, Sari Imam Khomeini Hospital, Mazandaran University of Medical Science, Sari, Iran
| | - Mohammad Eslami Koulaei
- Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyedeh Masoumeh Pashaei
- Department of Emergency Medicine, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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The Impact of Psychological Interventions on Posttraumatic Stress Disorder and Pain Symptoms: A Systematic Review and Meta-Analysis. Clin J Pain 2019; 35:703-712. [PMID: 31145146 DOI: 10.1097/ajp.0000000000000730] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) and pain often co-occur, introducing clinical challenges and economic burden. Psychological treatments are considered effective for each condition, yet it is not known which therapies have the potential to concurrently address PTSD and pain-related symptoms. MATERIALS AND METHODS To conduct a systematic review and meta-analysis, databases were searched for articles published between January 2007 and December 2017 describing results from clinical trials of interventions addressing PTSD and pain-related symptoms in adults. Two independent reviewers finalized data extraction and risk of bias assessments. A random-effects model was used for meta-analysis and to calculate pooled and subgroup effect sizes (ESs) of psychological-only (single modality) and multimodal interventions. RESULTS Eighteen trials (7 uncontrolled, 11 randomized controlled trials, RCTs), totaling 1583 participants, were included in the systematic review. RCT intervention types included exposure-based, cognitive-behavioral, and mindfulness-based therapies. Data from 10 RCTs (N=1, 35) were available for meta-analysis, which demonstrated moderate effect for reduced PTSD severity (ES=-0.55, confidence interval [CI]: -0.83, -0.26) and nonsignificant effect for pain intensity (ES=-0.14, CI: -0.43, 0.15) and pain interference (ES=-0.07, CI: -0.35, 0.20) outcomes. Findings from uncontrolled trials supported meta-analytic results from RCTs. Using GRADE assessment, the quality of evidence was deemed as moderate for RCTs and low for non-RCTs. DISCUSSION Findings indicated that the majority of the interventions appeared to have a greater impact on reducing PTSD rather than pain-related symptoms. There remains a need to further develop interventions that consistently impact PTSD and pain-related outcomes when these 2 conditions co-occur.
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Risbrough VB, Glynn LM, Davis EP, Sandman CA, Obenaus A, Stern HS, Keator DB, Yassa MA, Baram TZ, Baker DG. Does Anhedonia Presage Increased Risk of Posttraumatic Stress Disorder? : Adolescent Anhedonia and Posttraumatic Disorders. Curr Top Behav Neurosci 2019; 38:249-265. [PMID: 29796839 PMCID: PMC9167566 DOI: 10.1007/7854_2018_51] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anhedonia, the reduced ability to experience pleasure, is a dimensional entity linked to multiple neuropsychiatric disorders, where it is associated with diminished treatment response, reduced global function, and increased suicidality. It has been suggested that anhedonia and the related disruption in reward processing may be critical precursors to development of psychiatric symptoms later in life. Here, we examine cross-species evidence supporting the hypothesis that early life experiences modulate development of reward processing, which if disrupted, result in anhedonia. Importantly, we find that anhedonia may confer risk for later neuropsychiatric disorders, especially posttraumatic stress disorder (PTSD). Whereas childhood trauma has long been associated with increased anhedonia and increased subsequent risk for trauma-related disorders in adulthood, here we focus on an additional novel, emerging direct contributor to anhedonia in rodents and humans: fragmented, chaotic environmental signals ("FRAG") during critical periods of development. In rodents, recent data suggest that adolescent anhedonia may derive from aberrant pleasure/reward circuit maturation. In humans, recent longitudinal studies support that FRAG is associated with increased anhedonia in adolescence. Both human and rodent FRAG exposure also leads to aberrant hippocampal function. Prospective studies are underway to examine if anhedonia is also a marker of PTSD risk. These preliminary cross-species studies provide a critical construct for future examination of the etiology of trauma-related symptoms in adults and for and development of prophylactic and therapeutic interventions. In addition, longitudinal studies of reward circuit development with and without FRAG will be critical to test the mechanistic hypothesis that early life FRAG modifies reward circuitry with subsequent consequences for adolescent-emergent anhedonia and contributes to risk and resilience to trauma and stress in adulthood.
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Affiliation(s)
- Victoria B Risbrough
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Center of Excellence for Stress and Mental Health, San Diego Veterans Administration, La Jolla, CA, USA.
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Elysia P Davis
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Andre Obenaus
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Hal S Stern
- Department of Statistics, University of California, Irvine, CA, USA
| | - David B Keator
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Department of Computer Science, University of California, Irvine, CA, USA
- Department of Neurology, University of California, Irvine, CA, USA
| | - Michael A Yassa
- Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA
| | - Tallie Z Baram
- Department of Pediatrics, University of California, Irvine, CA, USA
- Department of Neurology, University of California, Irvine, CA, USA
- Department of Anatomy/Neurobiology, University of California, Irvine, CA, USA
| | - Dewleen G Baker
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, San Diego Veterans Administration, La Jolla, CA, USA
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Asmundson GJG, Thorisdottir AS, Roden-Foreman JW, Baird SO, Witcraft SM, Stein AT, Smits JAJ, Powers MB. A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder. Cogn Behav Ther 2018; 48:1-14. [PMID: 30332919 DOI: 10.1080/16506073.2018.1522371] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Numerous studies have demonstrated the efficacy of cognitive processing therapy (CPT) for treating posttraumatic stress disorder (PTSD). Two prior meta-analyses of studies are available but used approaches that limit conclusions that can be drawn regarding the impact of CPT on PTSD outcomes. The current meta-analysis reviewed outcomes of trials that tested the efficacy of CPT for PTSD in adults and evaluated potential moderators of outcomes. All published trials comparing CPT against an inactive control condition (i.e. psychological placebo or wait-list) or other active treatment for PTSD in adults were included, resulting in 11 studies with a total of 1130 participants. CPT outperformed inactive control conditions on PTSD outcome measures at posttreatment (mean Hedges' g = 1.24) and follow-up (mean Hedges' g = 0.90). The average CPT-treated participant fared better than 89% of those in inactive control conditions at posttreatment and 82% at follow-up. Results also showed that CPT outperformed inactive control conditions on non-PTSD outcome measures at posttreatment and follow-up and that CPT outperformed other active treatments at posttreatment but not at follow-up. Effect sizes of CPT on PTSD symptoms were not significantly moderated by participant age, number of treatment sessions, total sample size, length of follow-up, or group versus individual treatment; but, older studies had larger effect sizes and percent female sex moderated the effect of CPT on non-PTSD outcomes. These meta-analytic findings indicate that CPT is an effective PTSD treatment with lasting benefits across a range of outcomes.
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Affiliation(s)
- Gordon J G Asmundson
- a Department of Psychology , University of Regina , Regina , Saskatchewan , Canada
| | - Audur S Thorisdottir
- a Department of Psychology , University of Regina , Regina , Saskatchewan , Canada
| | - Jacob W Roden-Foreman
- b Division of Trauma, Critical Care, Acute Care Surgery , Baylor University Medical Center at Dallas , Dallas , TX , USA
| | - Scarlett O Baird
- c Department of Psychology , University of Texas at Austin , Austin , TX , USA
| | - Sara M Witcraft
- d Department of Psychology , The University of Mississippi , University , MS , USA
| | - Aliza T Stein
- c Department of Psychology , University of Texas at Austin , Austin , TX , USA
| | - Jasper A J Smits
- c Department of Psychology , University of Texas at Austin , Austin , TX , USA
| | - Mark B Powers
- b Division of Trauma, Critical Care, Acute Care Surgery , Baylor University Medical Center at Dallas , Dallas , TX , USA.,c Department of Psychology , University of Texas at Austin , Austin , TX , USA
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Vandentorren S, Le Méner E, Oppenchaim N, Arnaud A, Jangal C, Caum C, Vuillermoz C, Martin-Fernandez J, Lioret S, Roze M, Le Strat Y, Guyavarch E. Characteristics and health of homeless families: the ENFAMS survey in the Paris region, France 2013. Eur J Public Health 2015; 26:71-6. [DOI: 10.1093/eurpub/ckv187] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Peritraumatic distress but not dissociation predicts posttraumatic stress disorder in the elderly. Int Psychogeriatr 2013; 25:1007-12. [PMID: 23433477 DOI: 10.1017/s1041610213000069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a severe anxiety disorder whose symptoms include re-experiencing, avoidance, and hyperarousal after a particularly intense event. In view of the aging of the population, increased clinical knowledge is required for better understanding of PTSD in the elderly. Extending previous research in this field in adults and children, the aim of our study was to assess the utility of peri-traumatic dissociation and distress as a predictor of PTSD in the elderly. METHODS A prospective longitudinal study was conducted in a consecutive cohort of subjects aged 65 years and over admitted to emergency departments after a physical assault or a road traffic accident. Peri-traumatic responses of distress and of dissociation were measured. One, 6, and 12 months after trauma exposure, PTSD symptoms and diagnosis were assessed using both a dimensional and a semistructured interview. RESULTS Thirty-nine male and female participants with an average age of 72.4 years were recruited. Mixed model regression analyses did not detect a significant effect of age, sex, nor time. Significant associations were detected between peri-traumatic distress and the self-report PTSD Checklist (p = 0.008), as well as the Clinician-administered PTSD scale (p = 0.03). No association was detected between peri-traumatic dissociation and PTSD. CONCLUSIONS Peri-traumatic distress predicts PTSD symptoms and diagnosis in the elderly, thereby suggesting its systematic evaluation at the emergency department would be a worthwhile thing to do.
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Panagioti M, Gooding P, Tarrier N. Post-traumatic stress disorder and suicidal behavior: A narrative review. Clin Psychol Rev 2009; 29:471-82. [DOI: 10.1016/j.cpr.2009.05.001] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 05/29/2009] [Accepted: 05/30/2009] [Indexed: 01/07/2023]
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Gamble J, Creedy DK. A counselling model for postpartum women after distressing birth experiences. Midwifery 2009; 25:e21-30. [PMID: 17673341 DOI: 10.1016/j.midw.2007.04.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Revised: 04/01/2007] [Accepted: 04/04/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE to describe the development and application of a brief counselling intervention for women who have experienced a traumatic birth. INTERVENTION the birthing trauma counselling model reflecting women's need to establish a therapeutic connection with a midwife, talk about their birth experience and have their feelings validated. Gaps in understanding of events need explanation and explicit connections made between the event and subsequent emotions and behaviours. Developing a rational understanding of birthing events and how labour may have been managed differently assists women to revise their assumptions about maternity care and gain a sense of control. Fostering social support, reinforcing positive approaches to coping and exploring solutions to restoring self-confidence and reducing anxiety may help re-establish psychological equilibrium. DISCUSSION AND CONCLUSION the counselling intervention is consistent with trauma theory and draws on cognitive behavioural therapy principles. Midwives are well placed to provide counselling support to women experiencing birth-related distress. Further testing of the intervention in the clinical setting with a large sample is required.
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Affiliation(s)
- Jenny Gamble
- Research Centre for Clinical Practice Innovation, Griffith University, Logan Campus Meadowbrook, Queensland 4131, Australia.
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Asmundson GJ, Katz J. Understanding pain and posttraumatic stress disorder comorbidity: Do pathological responses to trauma alter the perception of pain? Pain 2008; 138:247-249. [DOI: 10.1016/j.pain.2008.06.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 06/24/2008] [Indexed: 11/16/2022]
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Asmundson GJG, Stapleton JA. Associations between dimensions of anxiety sensitivity and PTSD symptom clusters in active-duty police officers. Cogn Behav Ther 2008; 37:66-75. [PMID: 18470738 DOI: 10.1080/16506070801969005] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Prior studies have shown that anxiety sensitivity (AS) plays an important role in posttraumatic stress disorder (PTSD) symptom severity. The purpose of this study was to evaluate associations between empirically supported PTSD symptom clusters (i.e. reexperiencing, avoidance, numbing, hyperarousal) and AS dimensions (i.e. psychological concerns, social concerns, somatic concerns). Participants were 138 active-duty police officers (70.7% female; mean age = 38.9 years; mean time policing = 173.8 months) who, as a part of a larger study, completed measures of trauma exposure, PTSD symptoms, AS, and depressive symptoms. All participants reported experiencing at least one event that they perceived as traumatic, and 44 (31.9%) screened positive for PTSD. Officers with probable PTSD scored significantly higher on AS total as well as the somatic and psychological concerns dimensional scores than did those without PTSD. As well, a higher percentage of officers with probable PTSD scored positively on the AS-derived Brief Screen for Panic Disorder (Apfeldorf et al., 1994) compared with those without PTSD. A series of regression analyses revealed that depressive symptoms, number of reported traumas, and AS somatic concerns were significant predictors of PTSD total symptom severity as well as severity of reexperiencing. Avoidance was predicted by depressive symptoms and AS somatic concerns. Only depressive symptoms were significantly predictive of numbing and hyperarousal cluster scores. These findings contribute to understanding the nature of association between AS and PTSD symptom clusters. Implications for the treatment of individuals having PTSD with and without panic-related symptomatology are discussed.
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Affiliation(s)
- Gordon J G Asmundson
- Anxiety and Illness Behaviours Laboratory and The Traumatic Stress Group, University of Regina, Regina, Saskatchewan, Canada.
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Sareen J, Cox BJ, Stein MB, Afifi TO, Fleet C, Asmundson GJG. Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosom Med 2007; 69:242-8. [PMID: 17401056 DOI: 10.1097/psy.0b013e31803146d8] [Citation(s) in RCA: 379] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess if posttraumatic stress disorder (PTSD), recognized as a common mental disorder in the general population and veteran samples, has a unique impact on comorbidity, disability, and suicidal behavior (after adjusting for other mental disorders, especially depression). METHODS Data came from the Canadian Community Health Survey Cycle 1.2 (n = 36,984; age > or = 15 years; response rate 77%). All respondents were asked if they had been given a diagnosis of PTSD by a healthcare professional. A select number of mental disorders were assessed by the Composite International Diagnostic Interview. Chronic physical health conditions, measures of quality of life, disability, and suicidal behavior were also assessed. RESULTS The prevalence of PTSD as diagnosed by health professionals was 1.0% (95% CI = 0.90-1.15). After adjusting for sociodemographic factors and other mental disorders, PTSD remained significantly associated with several physical health problems including cardiovascular diseases, respiratory diseases, chronic pain conditions, gastrointestinal illnesses, and cancer. After adjusting for sociodemographic factors, mental disorders, and severity of physical disorders, PTSD was associated with suicide attempts, poor quality of life, and short- and long-term disability. CONCLUSIONS PTSD was uniquely associated with several physical disorders, disability, and suicidal behavior. Increased early recognition and treatment of PTSD are warranted.
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Affiliation(s)
- Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
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Abstract
Although the term "compassion fatigue" is often used interchangeably with the term "burnout", they are two different concepts. Compassion fatigue stems from an overcommitment to work that involves caring for others and is considered by some to be a kind of secondary posttraumatic stress disorder. Because they often invest themselves deeply in the animals they care for, veterinarians, technicians, and other members of an animal health team may be particularly vulnerable to compassion fatigue. This article summarizes the current state of knowledge about compassion fatigue, describes its symptoms, and suggests ways to prevent or overcome it.
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de Leeuw R, Schmidt JE, Carlson CR. Traumatic stressors and post-traumatic stress disorder symptoms in headache patients. Headache 2006; 45:1365-74. [PMID: 16324169 DOI: 10.1111/j.1526-4610.2005.00269.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to assess the prevalence of significant traumatic stressors and post-traumatic stress disorder (PTSD) symptoms in a headache population. BACKGROUND Several recent publications have emphasized the relationship between life stressors and/or daily hassles and recurrent headaches. However, little is known about the prevalence and impact of major traumatic stressors in patients with recurrent headaches. METHODS Eighty patients with either migraine or tension-type headache completed a PTSD checklist. Data were compared with those from patients with chronic masticatory muscle pain of similar intensity and duration. RESULTS Almost 64% of the headache patients reported one or more major traumatic stressors. This percentage was not significantly different from that of the comparison group, and fell within the broad range reported for exposure to traumatic stressors in epidemiologic studies with nonpatient populations. One out of 6 patients in the total headache sample, and 1 out of 4 of those reporting a traumatic stressor, reported symptoms suggestive of current PTSD. The prevalence of current PTSD-like symptomatology reported by the headache patients was comparable to that of the comparison group of the present study, but higher than that reported for the general population in the available literature printed in English. Traumatic stressors most often reported were not related to direct physical trauma, but rather associated with loss or serious illness of a loved one. CONCLUSION Exposure to traumatic events in patients with a primary diagnosis of recurrent headaches is similar to that reported for chronic masticatory muscle pain patients or nonpatient populations. However, symptoms consistent with a diagnosis of current PTSD appear to be more frequent in patients with recurrent headaches than reported in the scientific literature printed in English for nonpatient populations. Screening for PTSD symptomatology is recommended as part of the routine clinical evaluation of headache.
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Affiliation(s)
- Reny de Leeuw
- Orofacial Pain Center, University of Kentucky, Lexington 40536-0297, USA
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McWilliams LA, Cox BJ, Asmundson GJG. Symptom structure of posttraumatic stress disorder in a nationally representative sample. J Anxiety Disord 2005; 19:626-41. [PMID: 15927777 DOI: 10.1016/j.janxdis.2004.06.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Revised: 06/01/2004] [Accepted: 06/17/2004] [Indexed: 11/27/2022]
Abstract
Diagnostic criteria (e.g., Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) for posttraumatic stress disorder (PTSD) posit three symptom clusters including reexperiencing, avoidance/numbing, and hyperarousal. Factor analytic studies have suggested several alternative models of PTSD symptomatology. It is uncertain whether these new models are widely generalizable as most studies have relied on relatively select treatment seeking samples (e.g., combat veterans). To address this limitation, confirmatory factor analysis was applied to symptom data from National Comorbidity Survey respondents with a lifetime history of PTSD (n = 429). Several models were tested. The model comprised of four intercorrelated factors (reexperiencing, avoidance, numbing, and hyperarousal) received the strongest support, but did not meet all the goodness-of-fit criteria. A follow-up principal-components analysis yielded a four-factor solution, with factors representing dysphoria, cued reexperiencing and avoidance, uncued reexperiencing and hyperarousal, and trauma-related rumination. The theoretical and clinical implications of these findings are discussed.
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Affiliation(s)
- Lachlan A McWilliams
- Department of Psychology, University of Manitoba, PZ-430 PsycHealth Centre, 771 Bannatyne Ave., Winnipeg, Manitoba, Canada R3E 3N4.
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Caspi Y, Gil S, Ben-Ari IZ, Koren D, Aaron-Peretz J, Klein E. Memory of the Traumatic Event is Associated With Increased Risk for PTSD: A Retrospective Study of Patients With Traumatic Brain Injury. JOURNAL OF LOSS & TRAUMA 2005. [DOI: 10.1080/15325020590956756] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Greiffenstein MF, Baker WJ, Axelrod B, Peck EA, Gervais R. The Fake Bad Scale and MMPI-2 F-family in detection of implausible psychological trauma claims. Clin Neuropsychol 2005; 18:573-90. [PMID: 15841958 DOI: 10.1080/13854040490888512] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We tested the validity of the Lees-Haley Fake Bad Scale (FBS) and the family of MMPI-2 F scales (F-family; F, F(p), and F-K scales) in predicting improbable psychological trauma claims in an applied setting. Litigants reporting implausible symptoms long after minor scares and nonlitigants clinically referred following severe stressors completed the MMPI-2. Both groups were naturally matched on social class. The FBS demonstrated sensitivity, specificity, and positive predictive power in the detection of atypical problems but the F-family showed poor utility. FBS cutting scores derived from logistic regression were applied to a third group made up of litigants with histories of undeniably severe traumas. A substantial number of this third group scored above cutoffs for exaggeration, but this finding is ambiguous. Reasons for the F-family's insensitivity to real-world exaggeration may include using student simulators for validation and content reflective of psychotic simulation. The superiority of the FBS in applied forensic settings could derive from its development in actual litigants and content reflective of nonpsychotic exaggerations. The FBS appears acceptable for use in applied forensic settings where persons seek compensation for nonpsychotic syndromes.
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De Leeuw R, Bertoli E, Schmidt JE, Carlson CR. Prevalence of post-traumatic stress disorder symptoms in orofacial pain patients. ACTA ACUST UNITED AC 2005; 99:558-68. [PMID: 15829878 DOI: 10.1016/j.tripleo.2004.05.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is a high comorbidity between symptoms of post-traumatic stress disorder (PTSD) and chronic pain incidence. The objective of this investigation was to determine the prevalence of PTSD symptoms in chronic orofacial pain patients. STUDY DESIGN The study included 1478 adult patients (mean age 36.4 +/- 12.7 years) with primary diagnoses of masticatory/cervical muscle pain or temporomandibular joint pain. Patients completed a battery of psychometric questionnaires including a screening for PTSD symptoms. The sample was divided into a PTSD-positive group (n=218, 15%) a PTSD-negative group (n=551, 37%), and a no-stressor group (n=709, 48%) according to stressor incidence and symptom severity. RESULTS The current prevalence of PTSD symptomatology was considerably higher than that reported in surveys from the general population. Patients in the PTSD-positive symptom group reported significantly higher psychological distress, sleep dysfunction, and pain severity compared to patients in the other groups. Psychological distress as measured by the SCL-90-R reached clinically significant levels only in those patients with PTSD symptomatology. CONCLUSIONS The results of this study performed at a tertiary care center suggest that TMD patients without PTSD symptomatology show low levels of psychological distress, if any. Clinically significant levels of psychological distress are likely indicators for PTSD. PTSD screening should be included as part of a routine psychometric test battery in TMD patients.
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Affiliation(s)
- Reny De Leeuw
- Orofacial Pain Center, University of Kentucky, Lexington, KY 40536, USA.
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Affiliation(s)
- Jenny Gamble
- Convenor master of midwifery program, Research Centre for Clinical Innovation Griffith University
| | - Debra Creedy
- Dean, Griffith Health Research Centre for Clinical Innovation Griffith University
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Shea A, Walsh C, Macmillan H, Steiner M. Child maltreatment and HPA axis dysregulation: relationship to major depressive disorder and post traumatic stress disorder in females. Psychoneuroendocrinology 2005; 30:162-78. [PMID: 15471614 DOI: 10.1016/j.psyneuen.2004.07.001] [Citation(s) in RCA: 260] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Revised: 05/18/2004] [Accepted: 07/02/2004] [Indexed: 11/16/2022]
Abstract
A history of child maltreatment increases the vulnerability to the development of Major Depressive Disorder (MDD) and/or Posttraumatic Stress Disorder (PTSD), especially in females. Both MDD and PTSD are associated with a dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. Dysregulation of the HPA axis may be an important etiological link between child maltreatment and subsequent psychiatric disorder, yet little is known about the relationship between exposure and outcome. The aim of this review is to explore the role of HPA axis dysregulation in the link between child maltreatment and MDD/PTSD among women. Studies of females with MDD frequently indicate a hyperactivity of the HPA axis, and contribute to our understanding of the underlying mechanisms involved in mood dysregulation. Evidence for HPA axis dysregulation in PTSD is less convincing and suggests that timing of the stressful experience as well as the type of the trauma may influence the outcome. The strongest evidence to date suggesting that the development of the HPA axis may be affected by early life stressful experiences comes from pre-clinical animal studies. Together these studies add to our understanding of the role of the HPA axis in psychiatric disorders in relation to stress. The literature on HPA axis function in both children and adults following child maltreatment further highlights the potential relevance of early stress to later onset of major psychiatric disorders. Such knowledge may also contribute to the development of early interventions targeted at primary prevention.
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Affiliation(s)
- Alison Shea
- Women's Health Concerns Clinic, St Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, Ont., Canada
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21
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Post-traumatic Stress Disorder; Or How to Make Yourself a Traumatized Body Without Organs. SOCIAL THEORY & HEALTH 2005. [DOI: 10.1057/palgrave.sth.8700041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
We present the conceptual basis and empirical evidence for considering avoidance and numbing as distinct posttraumatic stress disorder (PTSD) symptom clusters. The majority of data from factor analytic studies supports the position that avoidance and numbing are distinct symptom clusters. As well, the available data suggest that (a) different treatment modalities have differential effects on reducing avoidance but not numbing, (b) patients with more severe pretreatment numbing have poorer treatment outcomes, (c) avoidance and numbing have different patterns of correlation with depression, and (d) they have different correlations with physiological indices of attention. We conclude that avoidance and numbing are distinct PTSD symptom clusters. This distinction has implications for revising current diagnostic criteria. The recognition of this distinction may lead to advances in understanding and treating PTSD.
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Affiliation(s)
- Gordon J G Asmundson
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada.
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Sommer I, Ehlert U. Adjustment to trauma exposure: prevalence and predictors of posttraumatic stress disorder symptoms in mountain guides. J Psychosom Res 2004; 57:329-35. [PMID: 15518666 DOI: 10.1016/j.jpsychores.2004.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2003] [Accepted: 01/05/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The present study was designed to assess the frequency of trauma exposure, the prevalence rates of posttraumatic stress disorder, comorbid symptoms, and sense of coherence (SOC) in Swiss mountain guides. METHOD All mountain guides (n=1347) were surveyed using of the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire (GHQ-28), and the Sense of Coherence Self-Rating Scale (SOC-29). RESULTS Although Swiss mountain guides are exposed to many traumatic situations, the prevalence rate of PTSD is very low (2.7%), and their SOC total scores are high (157.9+/-18.4). Subgroups differentiated by the extent of traumatic stress symptoms differ significantly in SOC and GHQ total scores. Regression analysis showed SOC total score to be a significant predictor, although it only accounted for 1% of the variance in the number of PTSD symptoms endorsed. CONCLUSION The low prevalence rate of PTSD is not in line with findings in other high-risk populations for PTSD. SOC seems to be a marker for psychological health rather than a protective factor against PTSD.
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Affiliation(s)
- Isabelle Sommer
- Department of Clinical Psychology, University of Zurich, Zürichbergstrasse 43, CH-8044 Zurich, Switzerland
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Williams DR, Herman A, Kessler RC, Sonnega J, Seedat S, Stein DJ, Moomal H, Wilson CM. The South Africa Stress and Health Study: rationale and design. Metab Brain Dis 2004; 19:135-47. [PMID: 15214513 DOI: 10.1023/b:mebr.0000027424.86587.74] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The South Africa Stress and Health Study (SASH) is a large psychiatric epidemiological survey that is currently underway in South Africa. It is a part of the World Health Organization's World Mental Health (WMH) 2000 initiative and seeks to complete interviews with a nationally representative sample of 5000 adults. The WMH initiative is obtaining population-based data on the prevalence and severity of specific psychiatric disorders, demographic and psychosocial correlates of these diagnoses, and the levels and adequacy of mental health service utilization. SASH is using the fully structured pencil and paper version of the WHO Composite International Diagnostic Interview (CIDI) to assess lifetime and 12-month rates of mental disorders using both the DSM-IV and the ICD-10 diagnostic systems. In addition, the SASH seeks to collect information on the prevalence of exposure to physical and psychological torture in South Africa and to assess the association between such traumas and specific psychiatric disorders. It will also assess a broad range of risk factors and resources that may modify the association between exposure to human rights violations and mental health.
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Affiliation(s)
- David R Williams
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan 48106-1248, USA.
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Asmundson GJG, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2002; 47:930-7. [PMID: 12553128 DOI: 10.1177/070674370204701004] [Citation(s) in RCA: 400] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
It is common for individuals with symptoms of posttraumatic stress disorder (PTSD) to present with co-occurring pain problems, and vice versa. However, the relation between these conditions often goes unrecognized in clinical settings. In this paper, we describe potential relations between PTSD and chronic pain and their implications for assessment and treatment. To accomplish this, we discuss phenomenological similarities of these conditions, the prevalence of chronic pain in patients with PTSD, and the prevalence of PTSD in patients with chronic pain. We also present several possible explanations for the co-occurrence of these disorders, based primarily on the notions of shared vulnerability and mutual maintenance. The paper concludes with an overview of future research directions, as well as practical recommendations for assessing and treating patients who present with co-occurring PTSD or chronic pain symptoms.
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Affiliation(s)
- Gordon J G Asmundson
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S 0A2.
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